Taking Stock

Editor's note: Abbey Ahearn is partner at HawkPartners. She can be reached at abigail.ahearn@hawkpartners.com. Jarod Ricci is director strategic insights at GSK. He can be reached at jarod.v.ricci@gsk.com. Steve Yonish is partner at Trinity Partners. He can be reached at syonish@trinitylifesciences.com. The following also contributed to this article: Heather Collins, senior account executive at Momentive.ai; Bj Kirschner, director, business development, Just Worldwide; and Bill Salokar, vice president client solutions, SKIM.

Intellus Worldwide, an organization for health care insights professionals, has partnered with Trinity Life Sciences to track the ever-changing pharmaceutical marketplace and the impact those changes may have for the market research professional through the annual Trends and Futures survey. The Trends and Future survey has been developed by Intellus membership to gain a deeper insight across several categories of exploration from the perspective of manufacturers and agency suppliers. The Wave 1 (Q1 2020) survey focused on identifying broader trends influencing health care researchers, while the most recent Wave 2 (Q1 2021 survey¹) signaled broader insights across the key thematic areas of consumers, clinical trials and technology. Each wave of the survey includes a sample of health care market researchers at biopharmaceutical and health care companies as well as professionals across market research, data, technology and sample providers.

Consumers

Today, U.S. consumers make the decision of where they receive care more than ever. As in all aspects of life, we want to receive goods and services quicker, better and cheaper, so why should health care be different? Over the years, consumers often were directed to where they received care as their insurance plans did the bulk of the paying. However, with people seeing premiums and out-of-pocket (OOP) costs increase year after year, it becomes inevitable that insurers shift more away from strictly controlling site of care as consumers assume more of the cost burden. In fact, the insurer’s network of coverage is expanding to where consumers have much more choice compared to a time when your primary care physician’s (PCP) office might not have had an option for labs covered by one’s insurance. Why might this aspect of health care delivery be shifting?

The Intellus Trends and Futures Survey (Wave 2)1 found that:

• 42% agree patients will increasingly shop around to better manage their out-of-pocket costs for medications and services (-7% vs Wave 1).
• 31% agree consumers’ out-of-pocket expenses for medications will increase significantly (-11% vs Wave 1).
• 24% agree (64% neutral) consumers will seek alternatives to integrated delivery networks that can provide more individualized care (n/a Wave 1).

The survey data would suggest that the current level of OOP costs is perhaps flattening to where the consumer, for example, is agnostic between the assumed lower copay cost to see a network PCP versus the convenience of an assumed higher copay for an out-of-network urgent care. With 64% of survey respondents having a neutral view on consumers looking for more individualized care, there are hypotheses we can monitor in trends moving forward. The most individualized care would have patients longitudinally seeing a single trusted health care provider (HCP) who would have all the information about them to be able to offer the optimal treatment. The observation of consumers shifting away from a single HCP point of care for all symptom origination could indicate a few things. First, consumers have either high trust across HCPs for their care or perhaps don’t discern a lack of care by seeing HCPs with whom they may not have a direct relationship. Second, by nature, consumers want to garner “more” and make decision trade-offs that they believe improve the health care they receive. The question then is, what are the criteria included in these consumer trade-off decisions?

Today, a consumer might have an acute injury, go to urgent care and be treated by an HCP whom they have never met before. A week later they may have a telemedicine visit offered by their employer benefit where they receive an Rx from a different HCP they have never met before, then sometime later see their local pharmacy for an adult vaccination and, finally, visit their PCP for a chronic condition checkup. The site of care and insurer benefit evolution has naturally led to consumers optimizing where and how they manage their health.

Wave 21 found that:

• 51% agree CVS, Walgreens and Walmart minute-clinics will compete to be the first point of primary care (+7% vs Wave 1)
• 43% agree urgent care offices will compete to be the first point of primary care (+3% vs Wave 1)
• 37% agree retail pharmacies will compete to be the first point of primary care (+11% vs Wave 1)

As respondent agreement is trending towards non-traditional sites of care becoming more prominent providers of primary care, what does this consumer convenience mean for us in the pharmaceutical industry and as insights professionals? In more recent years we have seen the big data explosion and now the seemingly shiny AI/machine learning emergence for a way to solve the answers believed to be housed within big data. However, as we become more data-rich, are we not also losing visibility into consumers along the journey? Let us think about how typically claims data is utilized to see the path of patients longitudinally. Within a closed claims system, data sets that most manufacturers or vendors procure provide a good lens of the consumer journey for a given diagnosis, as long as it is included within the claims network. As consumers go to new sites of care for differing types of care, this longitudinal visibility begins to diminish as the claims may or may not be completely represented. As patient sites of care change, there is potential for HCP prescription-writing to shift by some degree that would in turn, perhaps change how and where field representatives or medical representatives should focus their attention. Or perhaps, the pattern becomes a minor shift and because of the fragmentation of the data across so many sites of patient care, we miss an important gap in the patient journey.

Clinical trials

The global COVID-19 pandemic led to unprecedented changes in our lives. It has also showcased resilience that many did not think possible. One of the positive achievements during the pandemic has been the speed of therapeutic development due to the partnership between government and private companies. When resources can be focused accordingly, the speed that a therapy can reach the market compared to what typically had been multi-year endeavors is dramatic. The question now might be, could that speed of therapy development be expected to hold for future pipeline products?

Wave 21 found that:

• 24% agree the fast-track review process for COVID-19 vaccines is a regulatory pathway that will be more broadly applied for pipeline assets (n/a Wave 1).
• 18% agree that public trust in the regulatory review process for new products is waning (n/a Wave 1).

The quarter of respondents who see broad applicability for the COVID-19 regulatory pathway reflects ample skepticism among the majority that this model will become a regulatory standard. Part of this skepticism is likely rooted in the high investment level required to support asset development and the constraints on a firm in moving multiple assets forward at the same rate. As a result, industry hopes for COVID-19-like speed and responsiveness in the regulatory pathway is not likely in the near-term to de-risk portfolio management of assets in development. 

Despite skepticism associated with the COVID-19 regulatory pathway, respondents were not in agreement that public trust in the development process would be diminished. It’s important to point out that the survey preceded the recent controversy associated with the FDA approval of Aduhelm. Moreover, the FDA’s handling of guidelines associated with the COVID-19 booster shot has further contributed to controversy hanging over the “gold standard” institution of regulatory approval. The optics of these recent developments, coupled with public sentiment among those who distrust the speed with which the vaccine was approved, are likely to be additional factors manufacturers must contend with as the efforts to move therapies from development to market continue to accelerate.

Even before COVID-19, manufacturers were in an increasingly challenging position to seek innovation that will drive down clinical development cost and timelines. As manufacturer portfolios include a heavier weight of rare or less-prevalent disease, the investment in trials will not produce the same market return on investment as the days of Lipitor/Crestor/Zocor. To continue long-term viability, the pharmaceutical industry must evolve how new drugs are brought to market.

Wave 21 found that:

• 45% agree that R&D productivity will improve the pace of new therapies brought to market (22% Wave 1).
• 53% agree that predictive analytics will increase drug development efficiency (45% Wave 1).
• 11% agree that drug approvals will be granted where predictive analytics output will be an acceptable means to forego large-scale clinical trials (7% Wave 1).

There is clear respondent agreement that R&D productivity will increase, with one of the key aspects being through the use of predictive analytics to drive the clinical outputs. It is an interesting time where technology advancement is being integrated into the drug development process. As technology is integrated, respondents have lower agreement that it will be used to forego any large-scale trials. This makes sense as the elements that technology is addressing augment existing processes, thereby permitting the efficiency, quality or additional data (e.g., patient-reported outcomes) that might be used in analyzing the study information. How do changes in trials affect the market researcher? One could argue that primary market research should be done earlier in the clinical phases of development and have more significant budget. For example, patient journey work done in Phase I/II rather than when companies typically begin ramping up commercial planning at or near Phase III

Technology

Where patients are treated, who treats them and how treatments make it to market are ever-changing. Behind the scenes, technology (and the data it leverages) plays an essential role by: enabling a shift in salesforce activity to include more virtual visits and non-personal promotion; delivering new channels for reaching consumers; and driving improvements in diagnosis and treatment decisions. Though technology trends in the Intellus Trends and Futures Survey (Wave 2) outputs were somewhat overshadowed by COVID-19-associated repercussions, technology continues to evolve exponentially and is a focus area of survey response agreement. 

Survey1 respondents agree that technology will have an impact for patients as follows:

• 57% agree that technology/analytic algorithms will become more prominent in generating treatment recommendations in clinical practice (-9% Vs. Wave 1).
• 48% agree that technology/analytics will become more prominent in diagnosing patients in the office practice (-19% Vs. Wave 1).

Agreement wave over wave is relatively high, likely driven by the promise of predictive analytics that always seems to be just around the corner. While agreement declined from Wave 1, perceptions of a decline could in part be related to the pandemic. Some recent reports suggest that technology’s potential contribution to the diagnosis and treatment of diseases is growing rather than declining  – like CVS’ Transform Diabetes Care, which uses predictive analytics to identify patients at greater risk for diabetes and helps those with diabetes better manage their care. Similarly, Mass General Brigham has partnered with Nuance Technologies to develop AI tools in an effort to transform radiology. 

As AI and predictive analytics are applied on a more widespread basis at the practice level, how will the insights professional’s role change? In helping educate clinicians on treatments, how can we better understand the influence of digital diagnostic and treatment tools on attitudes and behaviors? In our efforts to understand HCP decision-making, are we doing enough to understand how those decisions are now impacted by technology in addition to other longstanding factors like access?

Per Intellus’ members responding to the survey¹: 

• 54% agree that pharmaceutical companies will acquire technology companies to improve drug diagnostics and delivery (-8% Vs. Wave 1).

This sentiment declined since Wave 1, but regardless of how tech-life sciences deals are approached, manufacturers have not stopped integrating technology throughout the marketing lifecycle. For example, Novartis has stated a strategic priority is to “spark a digital revolution at Novartis, embracing digital technologies, advanced analytics and artificial intelligence to help drive innovation and improve efficiency.” 

The direct impact of technological advances on consumers is less clear. This year’s survey respondents do not seem to have a clear consensus on who will own the data and the degree to which the tools built upon the data will truly empower patients. 

Wave 21 found that:

• 40% agree that consumers will have ownership/control to grant permission rights of any data (digital, electronic medical record/electronic health record) a third party wishes to access (-4% Vs. Wave 1).

As data capture continually grows, consumers are increasingly aware it is occurring, given the personalization of ads and more public acknowledgement of how that data is being utilized. With the advent of blockchain technology, it can be conceived that an individual can control each website click or credit card swipe purchase. With legislation like GDPR in the EU combined with the technological ability to control bits of individual data, the future of data control and ownership could be very different than today. This could change the face of health care patient research and data analytics significantly. On one hand, the data could become more granular in understanding a specific patient. On the other, large data sets could be a thing of the past as a researcher may only have access to opt-in patient data platforms. 

Regardless of who controls the data, there is even lower agreement that patients will be able to leverage it to make their own health care decisions.

Wave 21 found that:

• 35% agree that technology companies are providing patients with the means to make decisions about their health care independent of HCPs (n/a Wave 1).

This speaks to the recognition that technology is unlikely to be a surrogate for the human HCP. In other words, patients may continue to consult Google, Alexa and their smartwatches for insights into their health, but only to a degree. 

Finally, while the pandemic may have paused more traditional in-person engagement, it has had the opposite effect on telemedicine, which was forced to grow up fast during COVID-19. Though telemedicine is not likely to remain the primary channel for HCP consultation, it has since gained long-sought acceptance by consumers, providers, regulators and payers alike to fill a need outside of the office visit. Some HCP practices are now adopting a hybrid model whereby a patient has the option for in-person and virtual visits. 

Hence, survey responses¹ should come as no surprise:

• While only 17% agree that telemedicine will result in overall decrease in quality of patient care, 30% disagree with this statement (n/a vs. Wave 1).

As technology continues to change how health care decisions are made, where and from whom consumers find health care information, where care is delivered and whether/how much of a treatment is paid for, insights professionals will play a critical role in monitoring these trends and adapting how we gather insights to account for them. 

Impact of technology

In summary, Wave 21 gives insights professionals a lot to consider, both in terms of the markets we are charged with understanding and how we go about generating that understanding. 

With respect to HCP engagement, this means being aware of the impact technology (whether more advanced electronic medical record platforms, clinical decision-making tools or digital media sources) has on HCP awareness and treatment decision-making. It also means continuing to listen closely to the voice of the customer to understand ways in which technology and the emergence of new sites of care either help or hinder HCP practice of medicine. 

In the words of Robin Verlinde, head of customer engagement North Europe, Sanofi:

“With sites of care expanding, pharma will be forced to make tougher choices and balance relationships with a broader set of stakeholders, but in doing so they should not forget the health care professionals they have been engaging with for years. Becoming a true partner and offering insights-rich solutions that help HCPs to navigate the changes might create a strong, mutually beneficial relationship.”

For helping patients, we will need to keep channels front and center, e.g., apps, social media support groups or even tried-and-true printed resources through which patients learn about and engage with new treatments. It certainly means understanding where and in what circumstances they seek care. As insights professionals know, clear understanding of patients is what guides the work we do. 

Our search for answers, collaborative spirit and drive to improve will ensure we emerge stronger, smarter and are leading the changes that come next. At Intellus Worldwide, we work together with hundreds of community members to discuss our common challenges and the latest advances in health care insights and analytics that empower us moving forward. To become an Intellus member and be part of the next crucial opportunity to build professional networks and develop collective solutions, visit https://www.intellus.org/.

Look for Wave 3 results in late 2022! 

References

1 Sessions exploring the findings from the Wave 2 survey are available on demand for members. Visit https://www.intellus.org/become-a-member to become a member or to access the Intellus Worldwide’s Video Library https://www.intellus.org/Member-Resources/Virtual-Learning-Center