Articles and news
Reimbursement
≠ patient access
‘It’s said that the greatest danger in times of turbulence is not the turbulence, it is to act with yesterday’s logic’
By Toby Gunner, CEO, nzyme
For many years now, our approach to market access has focused too heavily on budget impact rather than value.
In our experience, creating future-proof reimbursement strategies now relies heavily on achieving two critical components. Firstly, that the way to transform healthcare is to realign competition within the healthcare system and instead focus on value for patients. (Value in the healthcare system = health outcome per pound/euro/dollar of cost expended.) The second component is optimal patient pathways that deliver value for patients through improved outcomes.
It is only through a focus on value across the whole system that high quality, sustainable healthcare systems are achieved. This is a fundamental approach in future reimbursement. It has also been brought into sharp relief recently as drug reimbursement has become easier to achieve, while patient access has become further away from our reach.
Healthcare organisations have long talked about adopting a value approach. Across Europe and the US, value-based procurement is being debated, trialled and implemented. The healthcare sector is clearly moving away from traditional lowest price procurement strategies and product buying, and this has been seen with the new routes to reimbursement available in the UK today.
Increasingly we see companies gaining reimbursement for innovative therapies through the various reimbursement routes and accelerated access channels, only to see limited patient access. In extreme cases we are seeing charities provide bursaries to hospitals to ensure patients receive new therapies. This clearly limits patient access and prohibits equity of access.
Why is this? The simple answer is COVID-19. As an accelerant to the capacity crisis in the NHS, it is unprecedented. The reality is, however, the NHS has been prioritising restructuring to a value-based healthcare system for some time, as the current system became increasingly unsustainable.
The news regularly features the capacity crisis in the NHS. All services are struggling, trying to fulfil unprecedented demand with reduced capacity and additional backlogs. Winter is coming, and the NHS is redeploying finite resources to cope with another wave of unprecedented demand. Already the latest figures are showing the busiest summer ever for the NHS emergency departments. July saw the highest number of category 1 ambulance call-outs since records began. Against this backdrop, normal service delivery is struggling. The net result is both established therapies and new therapies are facing significant barriers to patient access.
Therefore, we believe capacity within the healthcare system is the biggest barrier to market access for our clients. No longer can reimbursement be the primary focus of market access activities. Increasingly, we are discovering that drug reimbursement within specialised commissioning has been decoupled from the commissioning of the necessary service to facilitate treating patients with new therapies. Introducing expensive new therapies into a stretched service or within existing tariffs means it’s not viable for providers to deliver the treatment within traditional models.
It’s said that the greatest danger in times of turbulence is not the turbulence, it is to act with yesterday’s logic. It is certainly a time of turbulence within our healthcare system. It is also an opportunity to further develop the partnership approach and value that pharmaceutical companies demonstrated to healthcare systems during COVID-19. How do we do this? The simple answer is to demonstrate our commitment to value-based healthcare.
To achieve reimbursement in the future that is representative of patient outcomes, companies will need to continue to robustly map existing pathways, evidence the current costs and outcomes within the pathway and model the costs and outcome of product entry or service innovation to the future pathway. Importantly, working with the healthcare system to develop and evidence innovative new service delivery models and pathways will be critical in achieving patient access. Launch activities will have to include data capture on a product’s performance and patient outcomes to satisfy future reimbursement models that are linked to value in real time.
Thankfully the NHS’ focus on integrated care systems is designed to deliver value-based healthcare. They are, by definition, partnerships of organisations that come together to plan and deliver joined-up health and care services, and to improve the lives of people who live and work in their area.
The road map for market access moving forward is clear. Access in the UK requires a national and sub-national focus. A deep understanding of a therapy’s value within existing or new pathways. This needs to be generated through deep insights into problems within the system and a compelling narrative that positions therapies against the backdrop of value-based healthcare. The healthcare system is clear in how it expects pharmaceuticals to demonstrate value. Pharmaceutical companies are inherently innovative. Supporting innovative new pathways and delivery models within the healthcare system is a key practice of our market access activities.
Pharma chameleon
Positive change in industry can be the catalyst for success on the journey to optimal patient access.
By Dom Knights, Director of Customer Engagement, nzyme
The nzyme proposition to optimise patient access was developed with deep, forensic research and co-created with key NHS stakeholders, on the understanding that in a post-COVID world the need for traditional pharma models to change and at pace, is not an aspiration but an imperative.
Our Mind the Gap white paper was an output of the questions we posed to our NHS contacts and while there is a lot that pharma is doing right, there is still a lot of disconnect between what HCPs desire and what the industry is delivering.
The ability to delve quickly into the minds of NHS leaders and gather insights in almost real time around any number of prescient challenges became such an attractive and powerful proposition that it necessitated the formation of the nzyme Brains Trust.
Our Brains Trust is an expert panel comprising over twenty KOLs and senior NHS stakeholders across a range of disease areas and specialties.
Not as proscribed as a traditional Advisory Board, more a collective intelligence and anathema to the echo chambers that have informed conventional thinking for too long.
They work closely with the nzyme group because of a shared belief system that pharma still has a huge role to play in NHS and industry engagement, but on the understanding that without value underpinning every HCP interaction there is only a finite number of opportunities to engage.
They have helped us co-create our own value proposition that we share with clients to help optimise NHS interactions and patient access, and key to this is our success catalysts – five embedded principles that are the lifeblood of our organisation.
High five
Outside-in thinking – a new approach to customer and partner engagement that focuses on designing business models, processes, and services according to the customer’s wants and needs. In this approach, the customer’s perspective and context comes first
Value-led narratives – Research shows people are more likely to remember a story than a statistic. We put stories at the heart of all our programmes and develop them with the needs of patients and clinicians at the centre
Digitally enabled and powered by AI – We create resilience and agility through applying learning. We design with metrics to understand, learn and optimise and use technology to make it easier
Innovative hybrid engagement – Designed to deliver the right message at the right time in the right channel: On demand, remote, in –person or hybrid
Test, Learn & Iterate – We hack the usual programme approach and implement programmes step by step so build in ways to learn as you go, iterate and optimise.
In this disrupted, uncertain post-COVID era, organisations live and die by their ability to adapt, embrace and manage change
nzyme believes that there is an imperative for change and that the future of healthcare will be fundamentally different. Our company mantra is that we are customer-centric, insight driven, digitally resilient and value-obsessed.
Distilled down, we are the perfect partner and collaborator to help pharma navigate the potentially treacherous waters ahead.
“The greatest danger in times of turbulence is not the turbulence – it is to act with yesterday’s logic”
Peter Drucker
