Is the pharmaceutical industry missing a huge opportunity?
As digital technologies have generated the ability for brands to build even closer relationships with their customers by creating service offerings, many industries have grabbed the opportunity by the horns. Some of the world’s biggest brands today are product-as-a-service (PaaS) companies.
The value of services
Where other industries have been revolutionised by moves to PaaS, the pharmaceutical industry does not seem to have revolutionised experiences for customers in the same way as the entertainment, automotive and fitness industries.
So what is a product-as-a-service? Well, PaaS companies often combine a one-time sale of a core product with subscription-based services to create a more holistic and long-term customer experience, fostering loyalty and sustained engagement. Rather than just selling someone a product and the relationship ending there, product-as-a-service companies focus on selling outcomes.
Take Peloton, a fitness company valued at just under $2 billion - alongside sales of its home exercise bikes, Peloton also sells subscriptions to virtual fitness classes and promises that you will “Reach your goals with Peloton”. They’re not selling bicycles, they’re selling fitness. For the pharmaceutical industry, this would mean selling health, rather than selling a pill.
So far though, this potential has not been realised.
You could argue that medicines are already a subscription product. But subscription without the service cannot unlock the potential benefits of PaaS. Netflix started out as a DVD subscription but quickly moved to an online platform service. This move rocketed them from obscurity to being one of the leading entertainment companies in the world. It improved the user experience, created huge efficiencies and, crucially, allowed Netflix to gather data insights. These insights allow them to not only personalise each individual’s experience, in real-time, but also to use those data to inform the development of their own shows and movies. And every company in the entertainment industry followed suit. One of the most recent being Disney+, which has now overtaken even Netflix in revenue.
But patient support programmes do exist. They offer a service that is provided in conjunction with a pharmaceutical product. So why has it not become pharma+?
Why does every drug not come with a service?
Not all PSPs are made the same
There are some excellent examples of PSPs but excellence is not universal. A truly successful PSP should offer a triple win experience for patients, healthcare and the manufacturer. But doing this is difficult: it requires a deep understanding of the clinical pathway the programme aims to complement, as well as the needs of and challenges faced by patients and their healthcare teams. To achieve this, a substantial investment of both time and money needs to be made during the design phase of a programme. When not achieved, the outcome is, invariably, a poor service that at best does not achieve its desired outcomes and, at worst, actually just creates additional administration and inefficiencies.
PSPs are point solutions not platforms
Imagine if each of Peloton’s fitness instructors had to create their own website to deliver their coaching. This is how PSPs are currently commissioned: each new drug launch requiring a PSP results in a request for proposals (RFP) going out to suppliers, pitches being made and a new programme being designed. Whilst it is crucial for each PSP to be highly specific to the care pathway, there are many learnings that, if retained and built upon in each programme, could result in better outcomes and higher efficiencies. A platform approach could also start to address how support is delivered to patients living with multiple long-term conditions who currently may be offered entirely separate, and sometimes conflicting, care experiences for each of their conditions.
PSPs lack a home in pharmaceutical companies
According to an Accenture report that surveyed over 200+ patient support executives at leading pharmaceutical companies, patient services are, on average, spread over 2.5 different functions. This lack of ownership for patient services more broadly, as well as PSPs specifically, hinders growth, innovation and the realisation of potential efficiencies.
Moving fully to a PaaS model would require radical organisational restructuring, elevating patient services to the very core of the business.
Inefficiencies prevent scale
Most PSPs involve healthcare professionals interacting with patients, either via phone or video calls, face-to-face meetings or through messaging. These human interactions offer a huge amount of value for patients, and in terms of driving the programme’s objectives, but one-to-one interactions are not always scaleable; to maximise their impact, they need to be deployed intelligently.
Programme design in PSPs is generally static and uniform across all patients: for instance, all patients might receive a call from a nurse during weeks one, three, 26 and 40. The programme design is not only inflexible but also lacks the required data to generate a dynamic, personalised approach to person-led interactions. By providing a static approach to person-led support, the potential impact of this valuable resource is diluted and inefficient. Intelligent, data-informed deployment would mean that person-led services could be precisely targeted and the programme could support more users overall.
To achieve this, there are two factors to consider:
For patients, health is a journey and throughout that journey health needs will rise and fall.
Each individual patient will have a preference on how they wish to receive support, this will likely fluctuate throughout their journey with periods where they would really like to have a chat with a nurse and times when they simply want to enjoy their lives, forget about their conditions and would perhaps prefer to receive information they require via an email.
The best way to monitor patients who are currently in the top right hand side of the grid is by interacting with them frequently and gathering insights. These insights can then inform a dynamic, responsive approach to the deployment of PSP nurses.
Data is not meaningfully collected and utilised
All of the PaaS examples I have given have one thing in common - data. They are generating insights from the data their services collect and using these to fuel their products. Pharma are missing three key opportunities when it comes to data generated by PSPs:
Personalisation and engagement
As part of my work at Nye Health, I have carried out dozens of interviews with patients living with long-term conditions and one of the themes that comes up most frequently is personalisation. Every health condition is different and every person who lives with a health condition is different. People have different goals, different needs and when it comes to side effects, everyone has different deal breakers.
Patients are savvy and, increasingly, have expectations of personalisation, expectations that the pharmaceutical industry is not currently meeting. We live in a society where most of the products around us, from entertainment, to shopping, to fitness are personalised to provide us with an optimal experience and keep us coming back to them time and time again. But when it comes to patient support and healthcare, often what patients receive is a generic leaflet. It’s hardly surprising then that engagement with PSPs is low - as little as 3% in some cases.
One of the core aims of a PSP is to drive the best possible patient outcomes by supporting users to follow correctly their medication regimen and persist for the full course prescribed. But if patients are not adhering to the programme, how can the programme help them adhere to their medication?
PaaS companies are only able to create highly personalised, engaging user experiences because they are using Big Data analytics and predictive algorithms. They collect huge amounts of data about their users’ preferences and behaviours, analyse this using machine learning to identify trends and patterns and then use predictive modelling to tailor the experience each individual will receive to make it as relevant and engaging as possible. Research and development
As mentioned above, part of the success of Netflix lies in how it uses data, not just to decide which of the shows on its platform should be recommended to individuals, but also which shows it should add to the platform, either through commissioning or via its own studio. It’s alleged that House of Cards was approved without Netflix decision-makers ever watching a pilot - they didn’t need to because the show matched the characteristics that they knew, from their data-generated insights, would resonate with audiences.
In the past decade, AI has increasingly been woven into how companies are approaching the discovery of new pharmaceutical products. It was announced recently that GSK is hiring 100 people to form a new team dedicated to just that. But artificial intelligence and machine learning need data from which to learn - the better the quality of the data and the higher the volume of data, the better equipped these algorithms can be to identify successful candidate molecules.
PSPs represent a unique time at which the distance between patients and drug manufacturers is at its shortest: a time when, if done correctly, high-quality, clinically validated, longitudinal data could be collected. But it’s not being collected. Why? Some ideas:
The aforementioned lack of a centrally organised, platform approach to PSP commissioning is one reason.
The associated overheads of compliance, if this were to be set up for each new PSP, is overly burdensome.
Siloed thinking also contributes as brand managers, who generally hold budget for PSPs, don’t usually have R&D in their remit so don’t make data collection a priority when designing programmes.
Measurement of impact
A review by Sacristán et al on the impact of PSPs in Europe found a high level of heterogeneity in the measures and methods by which PSPs are evaluated. They found a total of 20 suitable studies, each measuring different outcomes and none of which included any measure of healthcare provider satisfaction. Even though the programmes’ objectives were achieved in most studies, the sample size and lack of standardisation makes drawing conclusions about the general impact of PSPs difficult and means the specific characteristics that result in maximal impact from PSPs, cannot be pinpointed.
Designing and running high-quality PSPs comes at a cost. As demonstrated by Sacristán et al, many PSPs do achieve their outcomes, but there are many areas where that can’t be said with certainty because there are no standards to compare against. That makes PSP evaluation and ROI difficult to determine and the budget for future projects more difficult to justify.
The author’s final remark is, “In order to reach their full potential, the development of guidelines and recommendations to harmonize the definition of PSPs, standardize methods, systematically measure their impact, and develop and use new digital technologies should be a priority for the different stakeholders involved in their design and implementation.”
Wise words indeed.
The Solution?
An intelligent data platform that can deliver meaningful patient engagement whilst also being able to scale efficiently across multiple therapy areas.
Well, at least that’s what I think the answer is and why myself and the team at Nye Health have built just that.
The Nye Platform
Nye PSPs combine data-powered participant engagement with high-quality, patient-centred programme design. They also generate valuable patient insights for our life sciences industry customers.
If you would like to find out more, come say hi at nye.health/PSPs.
Clare Woods, Product Manager at Nye