Healthcare pathway transformation

Innovation in pharma traditionally meant developing new blockbuster drugs, or in the last decade, digitally-led innovation. Now a new model is emerging, where pharma partners deeply with health systems to identify and treat more patients at lower cost. Jon Stephens, Upstart’s Pathway Transformation Director, explains how this is creating new business models and better outcomes for all stakeholders. 

What is Pathway Transformation?

The traditional business model for the pharmaceutical industry is to invest in research and develop drugs. Profits are maximised by not just having the most effective drugs or the next price points, but also by marketing new products to doctors and health system decision makers ensuring brand names are ‘top of mind’ and being prescribed in accordance with clinical guidelines.

However, health systems are increasingly exploring more value-based partnerships with pharma. The goal is to link reimbursement not just to the volume of drugs sold, but also to patient outcomes and even operational and commercial improvements that can be generated from innovative treatments. Of course, a single drug is only one of many conditions that shape patient outcomes. The efficiency of healthcare pathways in which the drugs are prescribed are often as important as the efficacy of the drugs themselves.

Pharma can no longer focus resources just on the development, testing and marketing of drugs. Instead, they will need to collaborate more closely with healthcare systems in the redesign of clinical pathways, bringing them in line with approved standards of care, as a bare minimum. This can generate a huge impact in terms of earlier patient identification, intensification of treatment and improved adherence.

The good news for pharma is that Pathway Transformation could expand its total addressable market. For example, identifying patients earlier through the use of AI-assisted screening and personalised medicine could lead to more intensive use of a specific drug at an earlier stage of the disease. 

Other suppliers to healthcare can benefit: medical devices, as a key supplier to health systems, can also ensure that the innovations they create are embedded into more effective pathways to produce a triple-win: for industry, the healthcare system, and for patients

Why does it matter now?

Pathway Transformation also has the potential to address many of the challenges facing healthcare systems worldwide. Many of these, including the NHS in the UK, are under extreme pressure to improve efficiency and outcomes. The deployment of more patient-centric, integrated care models as part of Pathway Transformation could be the answer.  

More recently, the Covid-19 pandemic has created backlogs and delays in the diagnosis and treatment of other diseases, especially among more vulnerable demographics who are fearful of attending hospitals because of the risk of catching the virus. This has intensified the search for more digital-first pathways including remote healthcare and diagnostics. 

Pathway Transformation in action

A good example is Imperial College Healthcare NHS Trust in London which has recently redesigned its heart failure pathway, a priority triggered by a worrying drop in patient admissions during lockdown. This included research which showed higher community mortality at the same time that hospital visits were falling. 

The Imperial team worked with patients, GPs, cardiologists, pharmacists and heart failure specialist nurses to transform the treatment of heart failure and create a more integrated pathway across primary and secondary care. They also wanted to minimise unplanned hospital admissions, and reduce the burden on specialists so that they could focus more on the patient experience and outcomes, and less on administration. 

One important component was a remote monitoring pilot for patients starting out on a course of heart failure drugs. Using simple medical equipment, participants take daily blood pressure readings, and upload this onto an app along with other information including weight and heart rate. The app provides them with the information to adjust their medication and dosage until they find the best combination. 

As a result, they no longer need to attend frequent check-ups, freeing up the time of GPs and specialists to concentrate on face-to-face appointments. At the same time, medical staff get daily updates on remote patients and can intervene more quickly when the data indicates a problem such as an increase in blood pressure. 

Overall, Imperial made more than 13 changes to the pathway resulting in a 7% increase in referrals while increasing time available to nurses and cardiologists who saved at least 40 minutes a week. 

The team demonstrated saved hospital admissions and used primary and secondary care data to show the cost savings that can be generated from scaling up these changes. 

What’s next?

The experience of Imperial and others shows that Pathway Transformation, at speed, is possible. But there are still barriers to overcome for healthcare and big pharma organisations wanting to build a sustainable transformation model. These include organisational structures, cultural resistance and lack of resources and skills.

Some large pharma organisations have set up digital innovation teams that are small, nimble and fast-thinking. But these sometimes lack the bandwidth to influence overall strategy and deliver the tools that enable change.  

Pathway Transformation calls for a mix of skills across service design, transformation, change management, health economics and innovation. Not all of these are available internally. As a result, digital teams in healthcare and pharma are supplementing their resources with external experts who can immediately import their skills to a project.  

Selecting the right partner in this space is critical. As well as skills and availability, a good match with working culture is essential. Digital innovation teams typically move at speed, are highly collaborative and learn quickly. When considering Pathway Transformation you need an equally agile partner with experience in big pharma who can help influence the wider organisation and its most senior decision makers. 

To find out more about Pathway Transformation and how it can deliver better outcomes for patients, healthcare systems and the pharmaceutical sector, get in touch with Upstart TODAY.