The new NHS – customer or strategic partner for pharma in 2020 and beyond?
The NHS is going through the biggest change in its history. Pharma needs to accelerate its evolution in how it navigates its new customer architecture but more importantly how it redefines its role in the development of new delivery models.
Where are we today?
In 2019 Visions4Health conducted the first- of-its-kind benchmarking survey between life sciences and NHS front-line leaders. Both life sciences and NHS respondents were closely aligned on the importance of specific attributes of effective partnerships (see figure 1): ‘mutual trust and respect’ and ‘having a shared vision’ were rated as the most key enablers. However, when participants were asked to rate their satisfaction of working in partnerships, NHS respondents were significantly less satisfied in both areas.
When asked for their opinions about the current state of NHS and industry partnerships, most respondents scored below the midpoint, showing that work needs to be done to evolve a more mature relationship (figure 2). Concerningly, the survey also indicated that the NHS was no more likely to look to the life sciences industry for partnerships now than five years ago.
Where is the NHS heading?
The NHS Long Term Plan (LTP) seeks to resolve many of the challenges resulting from a very fragmented system and to establish value-based care and population health management as the foundations of the new operating model. New possibilities are also emerging on personalised medicine as we bring together novel approaches, such as whole genome sequencing, data and informatics, and wearable technology. It is the interconnections between these innovations that makes it possible to move to an era of truly personalised care.
Value-based and personalised care will undoubtedly change the way care is commissioned for common diseases, specialised and rarer conditions. Rather than the traditional annualised contracting and payment by results system, value-based care will integrate quality measures and patient outcomes into the equation over a longer timescale and incentivise providers to work together across pathways to manage care together for defined patient populations. Populations for priority intervention will no longer be determined by their scale but also by the scope for prevention, health improvement and relative economic value and cost reduction.
The establishment of population health management functions in the NHS will require providers to collectively understand and respond to their population’s health and care needs, gathering data and insights across multiple care groupings and service settings, developing new health and care delivery models and more effectively engaging patients and consumers. Providers will need to work together to proactively manage the continuum of care for defined population segments or patient cohorts in a geographical place - from preventive and maintenance care to acute and long-term care.
What does this mean for pharma?
The NHS structural changes will require companies to review how they navigate the new landscape, identifying the decision- makers and the multiple influencers. More importantly the industry will need to assess how it adapts to manage the challenges and realise the opportunities brought about by value-based care and population health business models.
As integrated care systems (ICS) become fully established by 2021, providers will be commissioned to coordinate the delivery of care across pathways and it will impact almost every part of patient care delivery including medicines. This will mean collaboration to redesign care models, improve clinical engagement and alignment, and build the technology infrastructure for sophisticated data analytics and financial modelling to manage new clinical and financial risks.
Payers will not only consider the cost of life sciences products but also how, as a key part of an integrated delivery model, medicines and technology will drive long-term economic value by improving efficiency and productivity, enhancing patient experience and delivering better health outcomes.
Simply offering a product or service at a competitive price and using traditional market access approaches is unlikely to be enough in the new NHS market. Life sciences suppliers will need to go beyond that to really stand out and become a valued provider in the local health system.
Pharma is starting to address this shift in the landscape and is redesigning customer teams, building capabilities, adopting new contracting models for drugs and devices, and investing in wrap-around solutions. But the pace of change is varied amongst companies. Those that can accelerate their development of partnership capabilities together with more sophisticated outcome models will have a competitive advantage and be better placed to be invited ‘to the table’ as an equal partner to support the NHS develop innovative care models.
The opportunity for 2020 – partnering to support development of care
Pharma and the NHS have been working jointly on service redesign initiatives for many years. In September 2019, the ABPI set out a clear ten-step process for how this can work best. However, joint projects have generally been relatively small in scale and impact. Population health analytics is enabling the NHS to risk stratify and segment patient populations and identify their health needs. This enables them to better understand patterns of multimorbidity and its relationship to utilisation, costs and outcomes that better inform priorities for care model redesign and improvement of high value patient cohorts.
A care delivery model outlines best practice care and services for a population group or large patient cohort as they progress through the stages of a condition or event. It aims to ensure people get the right care, at the right time, by the right team and in the right place whether that’s at home, primary care or in-hospital. An example would be an integrated and dedicated service supporting residents with multimorbidities in all the care homes across an ICS footprint.
Establishing a care delivery model is a change management process that requires a wide range of skills, expertise and processes including clinical leadership, communication and stakeholder management, financial, workforce, research, economic and data analysis, evaluation, project and change management.
The change process is comprised of six stages: initiate, define, design, implement, evaluate and sustain. By aligning and combining pharma’s resources and capabilities with the NHS it has the potential to deliver greater impact and become a true population health partnership. Table 1. illustrates an example of the potential skills and expertise that pharma could bring to the development of a care model for a population of multiple sclerosis patients in a typical ICS.
Getting ready to partner now
In June 2019, the ABPI and NHS Confederation published an ambition for cross-sector collaboration with the life sciences industry to support NHS sustainability and transformation. The publication calls for better relationships, leadership and cultural change along with real initiatives that build trust by planning and delivering change together. But partnering is challenging, resource intensive and never easy to achieve.
In order for pharma to accelerate and maximise the benefits of collaboration the right strategies, approach and capabilities will be required in 2020 and beyond. Pharma will need to:
* Ensure an understanding of how NHS partnerships will deliver value for
the organisation and have a clear strategy to inform and prioritise engagement, along with the right leadership to implement it
* Have the right approach and support to identify, facilitate and build relationships with potential NHS partners, gaining their commitment and agreeing to the joint purpose
* Have robust systems and procedures in place to manage partnerships through their life cycle from initial identification through value assessment, due diligence and sign-off, implementation, evaluation
* Have staff with the right mindset and partnership capabilities including, relationship and trust-building skills as well as technical knowledge
* Establish a pro-partnering culture that is outward-looking and seeks to collaborate
As the new NHS changes are implemented, pharma needs to be ready to partner in order to remain competitive and achieve its business goals. The first step will be to determine the organisation’s readiness for partnering and to develop a clear strategy setting out the needs, potential benefits and a plan to deliver them.
Sabina Syed (firstname.lastname@example.org) is managing director and Conor Burke (email@example.com) strategic advisor at Visions4Health