Paul Ivans

As payors and providers advance toward outcomes-based medicine, that shift is affecting pharmaceutical companies as well. As decisions about prescribing shift away from the doctor, who has been the primary recipient of pharma marketing for the past 20 years, to the C-level of integrated delivery networks (IDNs) and accountable care organizations (ACOs), pharma is going to have to dramatically change how it sells drugs.

"Decision-making is getting stripped out of the point of care," Manhattan Research VP of Research Monique Levy said at the ePharma Summit in New York City. "Now we know that physicians tell us one in two of the scripts they write are not based on their clinical preference. This is a big deal. Fifty percent of everything you’re doing is more or less irrelevant."

But others at the conference had a more optimistic take. Paul Ivans, president and CEO of Evolutionary Road consulting, said that although pharma will gradually see less return from selling to doctors, selling to higher up decision makers allows pharma to market their drugs based on efficacy and plain demonstrations of ROI. 

"Clearly we have to focus on IDNs and ACOs and their broader goals," he said "They care about outcomes, quality, and decreased system costs. They don’t really care that my pill costs $10 more than your pill. But if my pill, plus a beyond-the-pill program helps patients be healthier and maybe reduces hospital readmissions by a couple of percent, we all know those are $15,000 to $20,000-dollar hospitalizations. ... It just changes the game."

Craig Kemp, director of Innovative Partnerships at Merck Vaccines, agreed that these sorts of sales, though a hard shift for pharma to make, could ultimately lead to a better system.

"The optimistic side is the things you can do, if you do them right, are going to be more sustainable, they’re going to be in a partnership fashion, and they’re probably going to be more gratifying and satisfying," he said. "It’s going to take longer, it’s going to be harder, but in the end you’ll be able to look back and say it was  a much richer experience."

Pharma needs to make the shift, as many companies have already begun to do, from selling drugs and therapies, to selling holistic condition management, whether that means apps, wearables, or other forms of patient engagement.

"There’s lots of these examples of individual pharma companies partnering with individual technology providers and [mobile health] and it’s great," said Ivans. "But it’s not enough. It’s not big enough. We have to figure out how to make a dent in healthcare with these dynamics."

Levy added that Manhattan's data shows patients might be surprisingly receptive to pharma stepping in to the role of helping them manage their care through engagement and behavior change.

"We’re shifting more risk to the patient, but patients aren’t trained in any part of their lives about how to manage their care," she said. "So this whole patient engagement thing -- we still don’t know how to floss, we can’t even do that. There’s a big gap in the market about who’s going to teach patients how to take care of themselves. They’re telling us in all different ways that they’re very open to pharma stepping in — they’re even open to Amazon and Google stepping in — to somebody coming in and saying 'This wearable isn't really working for me. What’s the next generation of services that can help a patient truly learn how to change their behavior?'"