Engaging with IDNs & ACOs - cbinet.com · Engaging with IDNs & ACOs Life Sciences and Financial Services Consulting February 2017 Version 1.0. Copyright © 2017 The Exequor Group,

Copyright © 2017 The Exequor Group, LLC All rights reserved.

E X P E R T I S E • C R E AT I V I T Y • A C T I O N • I M PA C T

Engaging with IDNs & ACOs

Life Sciences and Financial Services Consulting

February 2017

Version 1.0


Table of Contents

1. Introductions

2. IDN Market Overview

3. Capabilities for Effective Engagement

4. Pharma / IDN Collaboration

5. Discussion and Wrap-up

2


We Have Our Ears to the Ground

Health Systems

Health Plans

3

Over 210 Customer Interviews Conducted:

• 10 CEOs

• 60 C-Suite/VPs

• 35 Medical Directors

• 35 Mid Level

• 10 IT Directors

• 30 Panel Providers

• 30 Case Managers

http://www.pmgphysician.com/index.html

http://www.pmgphysician.com/index.html

http://www.nyhq.org/

http://www.nyhq.org/

http://www.novanthealth.org/

http://www.novanthealth.org/

http://www.harbinclinic.com/

http://www.harbinclinic.com/


Table of Contents

1. Introductions





4


CMS

Moody’s Reacts

Recognition of emerging trend

towards value

Pilot bundled-payment program

What’s the common thread?

Shared

Risk

AAAHC

First PCMH

Accreditation

Program

HITECH Act

Push for

Meaningful Use

Private Sector

Begin Using

Bundled Payment

CMS Center for

Innovation established

Medicare and Medicaid Reform

• Medicaid demonstration models created

around bundled payments, global capitated

payments, and ACOs

• Medicare payments to hospitals for

preventable readmissions reduced

Historical

IOM Report

Crossing the

Quality Chasm

Medicare

Modernization Act

Crossing the

Quality Chasm

Use of Fee for

Service (FFS) for

all reimbursements

Full CMS

Finalized Domains

and Measures/

Dimensions

Implemented

• Efficiency

• Outcomes

• Clinical Process

• Patient

Experience

of Care

Next Generation

ACO Model

Medicare CCM Billing

Greater financial risk,

more shared savings

rewards

New reimbursement

for chronic care management

providers

Pioneer ACO Model

• Align payment model with value

• Implement: performance measurement,

internally distributing shared savings

payments, and clinical leadership

• Invest in population health and care

management system, and integrate with

EHR

Patient Protection and Affordable Care Act

Transition of Healthcare to Triple Aim

Development of Physicians

to Group Practices

Patient-Centered Outcomes

Research Institute (PCORI)

Established

Health Market Place Exchange

• Coverage begins in state-based

insurance exchanges

• Established Independent Payment

Advisory Board on Medicare

Spending

Comparative

Effectiveness

Research (CER):

CMS grant to PCORI

2000 – 2008 2009 2010 2011 2012 2013 2014 2016 – BEYOND

MACRA QPP - MIPS

BUNDLED

PAYMENTS-APMs

The Changing Healthcare Landscape:

An Ecosystem Focused on Risk…IDNs are the Delivery Vehicle

He who manages the risk, calls the shots

– Craig Samitt, EVP, Chief Clinical Officer, Anthem

5


• Regional market

dynamics dictate the

speed of the transition

The Dynamic of Shared Risk Aligns IDN and Payer Customers

Shift towardsvalue-based market

continues to accelerate

Provider risk-shifting will move beyond current ACO model

Customersfacing various

disruptive forces

Customers heavilyfocusing on chronicdisease management

• ACOs often serve as

an initial step to help

Health Systems begin

the transition

• Consolidating market,

potential further

reconfiguration

• Growing consumerism

and emergence of

narrow networks

• Changing care models

with expanding retail

sector

• Evolving structural

models dominated by

large integrated and

non-traditional players

• Across chronic

conditions, key

challenges include

preventable

hospitalizations, low

medication adherence,

and suboptimal patient

engagement

• Although population

health management is

considered to be a

critical competency, it is

still in its infancy

Plans and health systems are looking to achieve the same

goal of making the right thing the easy thing.

– David Carmouche , Chief Medical Officer, BCBSLA (regarding Humana Gold program)

6


• Quality Improvement

• HIT Adoption and

Rollout

IDNs/Organized Customers Areas of Focus:

The Quadruple AIM

IMPROVE HEALTH OF

POPULATIONS

REDUCE PER CAPITA COST OF

HEALTHCARE

IMPROVE INDIVIDUAL EXPERIENCE

OF CARE

IMPROVE CAREGIVEREXPERIENCE

• Real-world data

• Increase Revenue

• Improve efficiencies and

reduce costs

• Standardized Care

• Patient/Provider

Relationships

• Patient Engagement/

Adherence

• Enhance HCP

Development &

Leadership Skills

The focus of health systems today goes beyond

quality and encompasses value and efficiency

– Corporate Care Management, UPMC

7


Lack of understanding amongst manufacturers on how to address reduced prescription of branded drugs

The IDN landscape has resulted in several challenges for

Pharma companies; Pharma is responding

Restriction

of Access

Major hospitals and health systems are

restricting samples, gifts, meeting the

residents, and pharmaceutical

representatives access

• Creation of new IDN facing roles: Create new positions

beyond sales representative and medical liaison roles

• Use of non-traditional venues: Utilize new innovative venues

such as e-detailing, video conferencing, etc.

Reduced

Prescription

Of Branded

Drugs

Three-tiered prescription coverage in major

IDNs, upheaval of Comparative Effectiveness

Research (CER) and patent expirations will

reduce prescription of branded drugs with

little therapeutic efficacy compared to

generics

• Provision of evidence based data beyond trials: Collect Real

World Data (RWD) and additional Phase 3P trials data

• Alliances for clinical trials: Collaborate on trial design, site and

protocol

• Alliances with PBMs: Partner with PBMs observed to have

some success in educating prescribers

Meet

Changing

Sales

Dynamics

Pharma has been faced with the changing

healthcare customer segments, and

emerging new key decision makers in those

segments

• Identification of key stakeholders: Identify and target

stakeholders within IDN (CMOs and Service line directors)

• Adoption of newer sales force mix: Create separate IDN-

focused sales force within hospital sales force; use hybrid and

account executive models for targeting IDNs

Provision of

Drug/Service

Across

Continuum

of Care

Difference in IDN priorities over independent

hospitals are requiring Pharma to improve

their relationship with IDN through expansion

of their products and services

• Changing marketing focus: Portfolio approach in comparison to

product/brand focus for independent hospital

• Expansion of product portfolio and services: Expand into

diagnostics and devices, generics, nutraceuticals and health

management, and value added services—for overall wellness to

meet the basic IDN priorities

The Pharma Approach to Address IDN Challenges

Pharma Approach to IDN Customer

8

Copyright © 2017 The Exequor Group, LLC All rights reserved. 9

• Networks of health care providers, hospitals and organizations which through ownership or formal agreements, align health care facilities to deliver integrated healthcare services by improving quality and reducing costs

• Cater to healthcare needs of a population in a specific geographic area; and could cater to single or multiple TAs

• Involve multiple entities in the healthcare value chain which enable them to provide services across the continuum of care

Definition

Integrated Healthcare Networks ('Account') –Definition and Structure:

Integrated Healthcare Networks are associations of multiple entities that

aim to provide a continuum of care in a defined geography

Pa

tien

ts

Need for IDN Goals of 'Account'

I

D

N

Producer

Payers

Government

Employers

Individuals

Insurers

HMOs 1

PBMs 2

Hospitals

Physicians

Pharmacies

Wholesalers

Mail-order

distributors

GPOs 3

Pharma

Device Mfg

Companies

Increase buying power

Provide better health to

more population

Reduce cost

Facilitate patient

satisfaction

Better time utilization

Increased market

Larger customer base

Accessible network

Access to large

customer base

Integrated service

Fiscal

Intermediaries

Providers

Purchasers

Cost

Inflation

Staff

Shortage

Health

Quality

Stakeholders Motivations to adopt an IDN IDN Attributes

Care Across

Continuum

Patient Focus

Geographical

Coverage

Clinical Care

Integration

Quality

Improvement

Financial

management

Governance

Note: 1. HMO – Health Maintenance Organization

2. PBM – Pharmacy Benefit Managers

3. GPO – Group Purchasing Organizations

Increase

competitive

edge

Improve quality

of care

Share financial

risks

Improve cost

savings

Eliminate

cost-shifting

Copyright © 2017 The Exequor Group, LLC All rights reserved. 10

Integrated Healthcare Networks – Decision Making Models

IDNs exist with varying levels of decision making in drug selection and

treatment guideline policies

Notes: 1. Based on sample case studies

2. Policy Making – Guidelines set by the organization for treatment and care protocol

3. Drug Selection – Policy surrounding contracts and agreements with pharma for specific drugs

4. Prescription – Final prescribing decision that the HCP undertakes

Centralized

Model

Association of entities that are financially and clinically

integrated across regions

Single, centrally integrated formulary

Leading practices shared across regions - system wide

Clinical Practice Advisory Group reconciles protocols

from entity-based clinical committees

Sample and access restrictions exist at certain level

Decentralized

Model

Associations of financially independent entities which

are not integrated clinically as well

Multiple formularies across the 'Account' with one

formulary within an enrolled facility/region

Sharing of leading practices across regions may exist

Sample and access restrictions may exist

Hybrid Model

Association of smaller 'Account', grouping financially

independent entities, along with some clinical integration

Multiple formularies (inpatient and out-of-'Account' health

plan)

Sharing of leading practices with guidelines set by

system-wide Clinical Practice Advisory Group

Sample and access restrictions exist at certain level

Policy making

fully

centralized

Mayo Clinic

Health Care Entities (Hospitals, Med.

Groups, LTCs, etc.)

Treatment Guidelines

Drug selectionDrug selection

highly

integrated

Kaiser PermanentePolicy making

partially

centralized

Drug

selection

in each regionRegion A Region B Region C

Policy making

highly

centralized

North Shore Health System

Medical Groups

Drug selection

not integrated

Hospitals

Greater

collaboration

Consistent

care

Increased

economies of

scale

Hostility

issues from

physicians

Centralized

policy may

ignore facility

specific

issues

Greater policy

flexibility

Effective

formularies

based on

facility needs

Financial

independence

fail to capture

economies of

scale

Inconsistenci

es in care

delivery

Potential for

greater co-

ordination

Clinical

practice

consistency

across

system

Financial

independence

fail to capture

economies of

scale

Model Type Indicative Representation2,3,4Highlights of the Model1 Pros Cons


Table of Contents

1. Introductions





11


Why engage? • Give voice to unmet need

• Produce evidence of value (e.g. time to complete

regimen; higher CAHPS scores)

Opportunity • Transform the HEC patient experience

• Differentiate on patients

Which ones to engage? • Buy and Bill %

• Skews low on SoC for HEC patients (claims)

• New option for delayed

onset CINV

• Misunderstood prevalence

• Well-established standard

of care

• Yet…large unmet patient

need

Why IDNs Matter: Value of Engaging at Launch

IDNs as Value Proposition Generator

12


Decision-Maker Access

Account Prioritization

Value-Focused Channel Strategy

Account Patient Experience

Joint Sales & Account Operations

Evolved KPIs & Reporting

Account Collaboration

Beyond profiling; identifying high-response

segments

Seeing patients / therapy area thru eyes of

the account

Beyond getting meetings: ensuring right

topic with right stakeholder

Right resources to offer account segments

Field & KAM deployment / pull-through

Metrics & incentives alignment

How to partner and implement for value

1

2

3

4

5

6

7

Evolving commercial capabilities for successful engagement

Evolving capability: What’s different:

13


Beyond Profiling: segmenting / mapping IDNs to understand

their operations and engagement opportunities

ABD Healthcare (INS00000091)

Medical Dir.: William Clay Dunagan, MD

15 Home Health

sites

Physician/Hospital Org.

76 Group Practice

sites

2 Outpatient

Clinics

2 Dialysis Centers

1 Distributor

sites

9 Pharmacies 4 Imaging

Centers

5 Work Place

Wellness sites

3

Neurosciences

sites

11 Long Term Care

sites

3 Surgery

Centers

17 Acute Care

Hospitals

1 Rehab Hospital

Novation

VHA GPO

Managed

Care

A Business Ecosystem Servicing Group Practices:

- McKesson (e.g., Electronic Health Record System Companies)

- Cerner (e.g., Practice Management System Companies)

- Sage Software, Inc. (e.g., Patient Flow Companies)

- Call-A-Nurse (e.g., Patient Service and Health Information Companies)

…..creates opportunity space

for “strategic partner” value to Barnes Jewish

understanding related business ecosystems …..

Formulary: Closed

14


Beyond Profiling: Prioritizing High-Impact Engagements

15

UPMC Infectious Disease Division created

an at-home IV clinic in 2013:

• Model enables completion of antibiotic

treatment at home, shortening stays

• Resulted in 1/3 drop in readmission rates,

from 32% to 20-24%

• 3 hospitals; looking to expand

What enabled the program:

• Monitoring protocols created for antibiotics

and infection types

• Deployed nurse visits at least once a week

• Integrated payer-provider focus

• Patient education / support: patients

instructed prior to discharge on use of PICC /

refilling the medication pack

UPMC and Pitt Medical School Launched

National Microbiome Institute*

Potential Areas of Engagement:

• Patient instruction / support materials

• At home copays / affordability

• Consumer technologies for home

monitoring

• Outcomes measurement in greater

detail

• Nurse education / support for

deployed nurses

• Physician engagement to drive

program support / utilization

• Payer support: risk stratification /

patient profile development for the

program

• http://www.upmc.com/media/NewsReleases/2016/Pages

/center-for-medicine-and-microbiome.aspx

http://www.upmc.com/media/NewsReleases/2016/Pages/center-for-medicine-and-microbiome.aspx


Account Patient Experience – Therapy Utilization

16

Met /

Sulf

Basal -

SA

Basal -

LATZD DPP4 SGLT2 GLP1

IDN All

HCPsAligned Underuse Aligned Overuse

Moderate

OveruseUnderuse Underuse

Endos

PCPs

NPs/PAs

NPs/PAs

Other

Non Afil

Region-Based Clinical Informatics:

IDN patient-factored drug utilization vs. system-issued patient guidelines

Why / how to align

to guidelines?


Account Patient Experience – SPP Performance

Care Opportunities:

• IDN patients vs. regional / nation

• Build norms / benchmarks to offer information

• Use to create contract incentives

• Help with IDN owned SPP

Example SP KPIs:

• Fill rate

• Days from referral to

onboarding

• Starter kit utilization

• Patient days of therapy

• Copay / voucher utilization

• Brand specific metrics

IDNs

IndependentsMulti-Specialty Practices

Assessing SPP-based care opportunities, based on referring sphere

Account

17


Value-focused Channel Strategy

18

Analytics Influence &

Risk-Bearer Control

Multi-stakeholder

Influence & Control

Clinician Influence &

Payer Control

Clinician

Control

Differentiating on Product

Differentiating on Portfolio

Differentiating on Patients

Differentiating on Partnerships

• Real World Evidence Engagements

• Population Health and DM Initiatives

• Patient Outcomes and Satisfaction

• Therapy Adherence and Compliance

Need to Mutually Align

Objectives with Key Accounts

• Collaborative engagements creating impact for accounts and Brands

• Metrics to support / drive collaboration and impact


IDN & ACO Solution Framework

Attention / Awareness Fit

Size Timing Ops Design Work flow

Support for Scaling

MeasureProgram

OfficeEmbed Report

• Significant care need

• Ability to operationalize in

a defined time period

• Solution that fits

the organization

• Post pilot commitment &

effectiveness

Value-focused Channel Strategy – What’s Needed

Health

Systems

Marketing

KAMsMedical

Brands HEOR

Cross-functional

involvement…

…executing an IDN solutions

process:

19


Joint Account & Sales Operations

20

IDN

Regional Deployment

• Team roles aligned to IDN / local market

• Actions driven by account plan

• Marketing support for aligned offerings

KAM

Medical

HEOR

Rep

RAM

Standard tools / approach:

• IDN stakeholder maps

• Relationship progress reporting tool

• Resources / materials aligned to IDN

• Top partnership concepts pre-vetted

• CRM-based reporting

• KPI dashboards – account vs. national

Resources / offerings for:

• Formulary decision-makers

• Pathways / protocol decision-makers

• KOLs

• Patient satisfaction / experience

• Quality and process improvement

Clinicians

& Pharm.

Managed

Medicaid Patient

Advocacy

Employers

KOLSPayers &

CMS

State

Medicaid

Team

Engagement

IDN Stakeholders


Joint Deployment – KAM Skills

21

• Transactional

• Highly structured

engagement

practices

• Short / frequent

interactions

• Measured on

activity and

prescribing

• Product and

patient-centric

• Complex navigation

• Listening for

addressable needs

• Analytics recognition;

RWE opportunities

• Aligning /

coordinating cross-

functional team

• Triple aim

understanding

• Value strategies

• Account planning

Traditional Skills Evolved Skills

SKILLSETS ADAPTED FOR COORDINATION AND PLANNING

Recent study: 75+% of

KAMs come from 3

commercial functions:

• Payer account

management

(NAEs, NAMs, RAMs)

• Field sales

management

(RMs, DMs, RDs)

• Hospital and field

territories


Evolving KPIs, Aligning Metrics, Account Reporting

22

• Increase in access – formulary, protocol, CPOE

• Expansion with C / D levels

• Collaborations in play

• Involvement in care process planning / innovation

• Adoption of content / services

• Team coordination, account planning, customer communications, other factors tied to the engagement model

• HCRU savings attributable to brand

• Time from Dx to 1st fill / adherence

• Defined outcomes performance

• Patient satisfaction improvement

• Net sales growth

• IDN growth vs. community

• % HCPs prescribing / penetration

Patient Access Customer Relationship

Organization Effectiveness Triple Aim Improvement

Portfolio Value

EXAMPLE


Capability assessments – diagnostic

23

New Value

Propositions

Strategies for

IDNs

Target Patient

Experience

Ecosystem

Access

Diagnostic as

first step

Need: Develop non-

product

differentiators / full

solutions to

engage non-

traditional

decision-makers

Need: Enable brand

teams to develop

and manage IDN

strategies,

aligning with

Managed Markets

on execution

Need: Set regional /

ecosystem

priorities for

contract

innovation, new

roles, and

resources to drive

access

How to start:All four project

capabilities

evaluated to

determine areas

of improvement

focus

Need:End in mind:

Design the ideal

experience using

patient & disease

KPIs to better

manage the

optimal

experience

4 areas to initially evaluate to improve your engagement strategy:


Table of Contents

1. Introductions





24


In a survey of 52 IDNs, Over 92% of health systems are willing to collaborate with the

industry to address care gaps and improve the process of care delivery.

Source: Health System – Pharma Survey, The Kinetix Group (2015) n=40

IDNs / Organized Customers Are Interested in Partnering

with Industry

“Our goal is to work with industry within

different arms of health economic

research to pull real-world data and

evidence to demonstrate efficacy and

cost benefits”

“We look to collaborate with manufacturers of our

preferred products”

“Presentation of an unbranded disease

management program would definitely

take our interest”

“We regard this type of research

[pragmatic trials] as very

valuable”

“Diabetes is our main

focus for collaboration

with industry”

25


Copyright©2016TheExequorGroup,LLCAllrightsreserved.

Technology

Strategy

People Processes

Provide Institutional

Approach

• Process

• Tools

Ensure Alliance

Management

Skills

• Expert

• Practitioner

• Aware

Manage Knowledge Capital

• Capture

• Refine

• Provide

Link to Strategy

• Portfolio

• Capabilities

and priorities

Effective alliance management is an integrated organizational capability.


Alliance

Manager

Organizational Design Key Responsibilities:

• Design organizational structure for managing the Alliance

• Establish governance processes

• Interpret contract and charter

• Identify and prepare appropriate team members

Skills / Attributes required:

• Organizational and governance planning

• Contingency planning

• Team development

Conflict Resolution Key Responsibilities:

• Perform alliance diagnostic (reading the environment)

• Manage conflicts and escalation


• Strong interpersonal and organizational skills

• Meeting planning, facilitation, and management

• Coaching and morale building

• Self-control

Portfolio Management Key Responsibilities:

• Participate in Therapeutic Class strategic planning

• Advise senior management of alliance's strategic

role


• Sound scientific skills and understanding

• Quantitative risk management

• Senior management perspective

• Organizational astuteness

• Efficiency

Reporting and Monitoring Key Responsibilities:

• Support alliance leader’s project

management

• Prepare alliance status reports

• Monitor team workflow


• Financial analysis

• Database and software skills

• Personnel assessment

• Adaptability

• Attention to detail

Alliance Strategy Key Responsibilities:

• Maintain understanding of BI, BIPI, and

Therapeutic Class strategies

• Provide up-to-date industry and market

knowledge

• Participate in specific alliance strategic plan

development


• Strategic planning--alliance and portfolio

• Competitive analysis

• Tactical planning

• Written and oral communication

• Big-picture thinking

• Self-confidence

Consultation Key Responsibilities:

• Provide counsel and perspective to Alliance

Leader

• Manage culture development


• Political astuteness

• Active listening

• Change management

• Relationship building

• Initiative

• Honesty and Integrity

Alliance Manager: Defining the Role (Key Responsibilities, Skills and Attributes)

1

2

3

4

5

6


As we optimize the OCC capabilities, key Questions relating to

each of the High-Level Process steps will need to be addressed

1.0

Develop OCC

Road Map

3.0

Evaluate

Opportunities

4.0

Escalate &

Evaluate Deals

2.0

Search for

Opportunities

5.0

Close Deals

6.0

Realize Value

Key Questions:

§ How should BIPI

decide which

markets / segments

are attractive?

§ What are the

criteria by which

BIPI should target

and prioritize

markets /

segments?

§ What are the

criteria by which

BIPI should assess

each Project?

§ How should the

criteria be weighted

in reaching a

priority for each

Project?

- Are these the

same for different

Markets /

Segments?

Key Questions:

§ What does the

search engine

consist of?

§ What resource,

tools databases,

etc. ought BIPI

leverage?

§ How will searching

be organized /

coordinated (geo /

TA, etc..)?

§ Who owns key

relationships and

how are these

managed?

§ How will opportunity

responsibility be

determined?

§ How should

opportunities be

tracked against the

criteria set forth in

the OCC

Roadmap?

Key Questions:

§ How should we

sequence the

various types of

analyses to ensure

efficient use of

resources?

§ Who should

“champion” given

opportunities?

§ How will the

learnings from

opportunities be

logged for future

reference?

§ What is the

threshold for

opportunities to

advance to the next

stage?

§ Who needs to be

involved in these

decisions?

Key Questions:

§ How and when will

the due diligence

process be

initiated?

§ How will BIPI

determine “deal

breakers”?

§ Can we assemble a

standard set of

questions to be

answered through

the DD effort?

§ How will efforts to

structure the deal

link into the due

diligence process?

§ At what point will

BIPI involve Sr.

Management?

§ Will the decision criteria at this stage

differ significantly

from those at earlier

stages?

Key Questions:

§ How will BIPI stay

familiar with trends

in deal shaping?

§ Who is involved

with deal design?

§ Is there a

somewhat standard

approach to

negotiation, or is it

more of an art?

§ At what point do we

need to introduce

those with

responsibility for

implementation to

the process

§ Who needs to be

updated when deal

terms change?

§ How is the final go/no-go decision

made?

Key Questions:

§ Who will be

responsible for

maintaining

relationships with

the partner?

§ How deeply do we

need to involve the

partner in BIPI’ planning and

implementation?

§ How should this

change over time,

and as we

approach key

Project or

Development

milestones?

- Illustrative -

Exequor has experience supporting clients in their journey to Design,

Build and Run their IDN Collaboration Capabilities.


Alliance Lifecycle

FIND the

Right Alliance

GET the

Deal Closed

RUN the

Alliance Well

Identify alliances to

fit corporate strategy

Craft clear strategy that

identifies role of

alliances.

Prioritize portfolio to link

strategy and targets.

Maximize day-to-day

alliance performance

Ensure appropriate skills

and tool to manage

alliances.

Share experiences

across alliances.

Ensure clear internal

communication of strategy.

Acquire best alliance partners

Provide easy access to

competitive and alliance

intelligence.

Maximize value of partner relationships

Leverage existing

relationships to develop

new opportunities.

Improve communication

with alliance partners.

Maintain continuous

contacts with partners.

Optimize alliance portfolio

Create broad view of

alliance possibilities from

current portfolio.

Maintain robust and timely

alliance portfolio status

reporting.

Make faster, better-

informed decisions.

Capitalize on assets

created through alliances

Capture and

institutionalize best

practices.

Build on knowledge

gained in alliances and

make information easily

available.

Increase access to

partners’ developments

Monitor existing partners’

portfolios for emerging

opportunities.

Negotiate to build an

effective working

environment.

Create broader potential

for future deals.

These levers highlight different priorities across the alliance lifecycle


Moving to the Next Level

n Deals are created and

negotiated quickly

n Alliance measures exist but

are primarily focused on

financials

n Sharp division between

deal-makers and managers

n Perception that alliances are

formed reactively

n Limited leverage of alliances

Emerging

n Alliances are grouped and

prioritized relative to the

business model

n Excellence in creating 1

or 2 types of alliances

n Best practices are

documented

n Informal knowledge

transfer exists

n Alliance champions are

self-appointed

n Performance measures

are defined

Evolving

n Best practices actively

spread across the

organization

n Alliances integral to

business strategies

n Hierarchy of partners,

corporate policies, toolkits

n Partner-partner

communication mechanisms

exist

n Alliance training program in

place

n Top talent attracted to

alliance management

n Measurement is a core

process

n Perceived as "partner of

choice“

Excelling

Companies must objectively assess their alliance-management level


Optimize alliance portfolio

Do the alliances right

Identify alliances to fit corporate strategy

Acquire best alliance partners

Do the right alliances

Maximize value of partner relationships

Maximize day-to-day alliance performance

Capitalize on assets created through alliances

Alliance Management Value Tree

Increase value created through

alliance

Deriving value from alliances requires a focus on key value levers


Aligned leadership

• Understand sources of

value

• View the organization as a

network

• Act as alliance champions

• Actively manage portfolios

Effective human resource

management

• Recruit, develop, and

reward based on ability to

manage alliances

Partner-friendly culture

• Demonstrate mutual

respect

• Share vision and values

across alliance

• Maintain collaborative

environment

Institutional process to form

and manage alliances

• Focus on value creation first

• Evaluate alliance options and

targets

• Assess fit of potential partner

• Agree aligned objectives and

shared vision

• Define core capabilities

• Create operations integration

plan

• Create a collaborative culture

• Provide leadership to the

alliance

Firm-wide portfolio

management process

• Evaluate current portfolio and

needs

• Define future capability

requirements

• Plan for capability

development using alliances

• Revisit portfolio choices as

conditions change

Alliance-focused structure

• Organize to create and

sustain alliance

management capability

• Design to complement

parent organization

Clear governance model

• Craft decision criteria and

process to particular

situations

• Create portfolio

management process

linked to company planning

cycle

Supporting technology

interface (Applications &

tools)

• Provide easy-to-use tools to

support local decision

making

Supporting technology

infrastructure

• Support cross-functional,

cross-geographic, and

cross-alliance partner

communication and

information exchange

Process Skills & Behaviors Organization Technology

Critical Partnering Characteristics

Building needed capabilities necessitates a broad perspective.

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Collaboration Center of Excellence (COE):

Supporting Customer Collaborations

“Collaboration COE”

Facilitated Activities

“Collaboration COE”

Driven Activities

Projects Owned and

Executed by the Business

Early

Product

Development

Real World

Evidence

Generation

Joint Care

Interventions

Dis-

engagement

Selection /

Initiation

Alliance

Management

Innovation Catalyst (Process and Content)

Organizational Learning and Communication

Collaboration (Alliance) Portfolio Management

Pharma Companies are finding the need to create a COE to effectively select, negotiate, manage,

engage internal participants and realize the benefits of multi-year collaboration initiatives with customers

27


Partnership

DomainPartnership Description Objectives

Engagement

During Research

& Pre-Market

Development

• Understand unmet needs and evidence

requirements for products in development,

beginning as early as phase 1 or phase 2

• Example: Tri-I TDI (Memorial Sloan Kettering

Cancer Center, The Rockefeller University and

Weill Cornell Medical College ) and Takeda for

early stage drug discovery

• Inform portfolio decisions and shape

development programs based on customer

experiences of critical unmet medical needs,

evidence requirements and market access

considerations

Pre-Market &

Post-Market Real

World Evidence

Generation

• Jointly-designed and conducted research

addressing topics across the product lifecycle

such as: unmet medical needs, current

standards of care, treatment patterns, safety

and efficacy, clinical and economic costs, and

budget impact

• Example: Humana – Lilly in evidence and

outcomes for T2DM

• Inform development programs, demonstrate

clinical, humanistic and economic value of

products and identify expanded product

opportunities

Joint Care

Interventions for

Patient/Provider

Engagement

• Identification, development and implementation

of care models and interventions to address

gaps in care, population health management,

and educational needs

• Example: Sutter Health – Boehringer-

Ingelheim in patient care for COPD

• Develop enhanced patient-focused care

interventions (based on insight into provider and

patient challenges) that can be scaled and

delivered to customers, enhancing cost and

quality outcomes

Illustrative Pharma – Customer Collaboration Areas

28


Overview of Product Development Partnership Framework

Product Development

Product Development Framework

• Objective: To understand unmet needs and evidence requirements for products in development

• Advice and perspectives on key decisions about portfolio and development programs including clinical differentiation requirements, clinical program design, pricing and reimbursement strategies cost impact and outcomes management

“What”Iterative Dialogue

• From Phase I through Phase III

• Long-term process and meeting sequence agreed to upfront

• Triggered by specific events

– Key development or commercial strategy decisions, e.g., clinical program design, pricing and reimbursement strategy, patient / physician support strategies

– ‘New news’ (e.g., competitive information or BI trial release, diagnostic developments, etc.)

“When”Engagement

Timing and Triggers

• Selection criteria for qualifying customer opportunities

• Participants depend on advice and expertise being sought (e.g., medical, scientific, commercial)

• Customer roles and responsibilities

• Pharma: CDMA, Pipeline Marketing, HEOR, Pricing and Reimbursement, Contracting

• Customer: Plan Medical, Pharmacy, Pharmacy Contracting

“Who” Participants

“How”Nature of

Engagement

• Iterative engagement

– Well planned/structured meetings (2 per yr) with a core set of people from Pharma and customer

– Cross-stakeholder meetings at key junctures to create alignment and momentum within a disease area

– Follow up on how input / perspectives were used (or not)

• Based on transparent use of data, while including linkages with other data sources

29


Customer Real World Evidence Generation (RWEG)

Partnership Framework

Real World Evidence Generation

Real World Evidence Generation Framework

“What”Jointly-Designed

Real World Studies

“When”Timing and Triggers

“Who”Study Development and Execution Team

“How”Study Mobilization

• Objective: Inform development, demonstrate clinical, humanistic and economic value, identify

opportunities for expanded indications, targeted populations, etc. based on real world research with

organized customers

• Jointly designed and executed research with an organized customer to evaluate unmet medical needs, current standards of care, treatment patterns, safety and efficacy, clinical and economic costs, and budget impact using

– Medical and pharmacy claims, clinical data, patient reported outcomes, patient/ provider surveys

– Pragmatic clinical trials and prospective and retrospective non-interventional studies


• Pharma – HEOR, CDMA, Clinical Ops, Biometrics and Data Management, Pharmacovigilance, Epidemiology and Brand Marketing

• Customer – Pharmacy, Medical, Informatics / Analytics, IT

• 3rd Party – Research / Analytics Vendors, Data Services Vendors, Medical Societies, Advocacy Groups, AMCs

• Study execution – hypotheses and research objectives, study protocol and synopsis, implementation

of RWEG study and evaluation of study results, examination of real world implications

• Governance structure including decision rights (such as ownership of data/results) and scope of

activities

• Metrics to monitor study progress/results and identification of linkages across other partnership types

and internal functions

• Throughout the product lifecycle to understand unmet clinical needs, gaps in care, drug effectiveness, etc.- built into development and / or brand plans

• Triggers: Questions in product development, value proposition development for Pharma product, evolving disease guidelines, new competitive market entrants, need for confirmation of Pharma value proposition, etc.

30


Customer Joint Care Interventions Partnership

Framework

Joint Care Interventions

Joint Care Interventions Framework

• Objective: Develop patient-focused care interventions that help improve patient outcomes

• Aligned to customer priority areas and manufacturers products and services

• Addresses needs and gaps in care beyond safety and effectiveness

• Types of intervention programs: Adherence, population health management, quality support, value based benefit design and pay for performance, and transitions in care

“What”Collaborative

Care Intervention Program

• Account and / or brand plan driven• Opportunistic events (e.g., account team opportunity identification, customer request and / or market

event)

“When”Engagement

Timing and Triggers


• Participating Functions:

– Pharma – Managed Care Marketing, HEOR, CDMA, Account Manager

– IDN/Payer – Medical, Pharmacy, Care Management, IT

– 3rd Party - Disease Management Vendors, Data Analytics/Informatics, Academic Medical Centers, etc

“Who”Participants

“How”Nature of

Engagement

• Jointly designed and executed care intervention

• Identification of unmet needs and pain points

• Generation of intervention objectives

• Selection of patient cohort and intervention components

• Implementation of care intervention

• Evaluation of patient outcomes and examination of implications for future programs

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Documents

Engaging with IDNs & ACOs - cbinet.com · Engaging with IDNs & ACOs Life Sciences and Financial Services Consulting February 2017 Version 1.0. Copyright © 2017 The Exequor Group,