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Does the Rise of Payer Power Mean the End of Patient Empowerment?

March 18, 2015 by Wendy Blackburn

At a recent pharmaceutical marketing conference in New York, speakers and attendees were focused on – and visibly concerned about – a massive sea change happening in healthcare. The concern went well beyond “the best way to implement wearables into pharma programs,” or “how pharma can get involved in social media.” This wasn’t about shiny objects. This was about business. The theme? The impact of the Affordable Care Act is here. And increasing scrutiny on costs and outcomes is having an unprecedented impact on our industry.

The conference-opening panel, titled “How Will Marketing Innovation Help Pharma Adapt to the Massive Changes in Healthcare?” highlighted this conundrum well. Monique Levy, Vice President of Research, Manhattan Research, may have sent a bit of a panic throughout the room with her provocative point that “it’s time to face the music: treatment decisions are not happening the way they used to be.” Levy cited Manhattan Research findings that the real treatment decisions are happening elsewhere, and, in her opinion, “the glory days of patient empowerment are over.”

It’s no secret that, thanks to the Affordable Care Act and a variety of other factors, more and more treatment decisions are being made by payers – not providers, and – to Levy’s point – not patients. Levy maintained that patients may have preferred choices – they may even ask their doctors about them – but the payers are in control. For an industry that, for decades, has viewed its primary audiences and critical decision-makers as physicians and consumers, this represents a fundamental shift. Craig Kemp of Merck Vaccines, who also spoke on the panel, agreed. “There are fewer options now to promote pharmaceutical brands, and there will be even less in the future … Things are changing fast.”

So does the rise of payer power mean the end of patient empowerment? A recent study published in Health Affairs provides an alternative viewpoint. In the two-year study, researchers analyzed patient “activation” levels for more than 32,000 adult patients at Fairview Health Services in Minnesota. For the study, activation was defined as a “metric used to quantify a person’s knowledge, skills and confidence in managing one’s own health and healthcare.” (Some might call that empowerment.) To summarize the findings, patients with higher levels of activation demonstrated more improved healthcare outcomes and lower healthcare costs. In contrast, those with lower activation levels experienced significantly reduced chances of positive outcomes and their healthcare costs were higher. Researchers saw costs increase or decrease as patients’ activation levels changed. In other words, empowered patients had healthier outcomes and cost the healthcare system less than their less-empowered counterparts.

This study proves ending patient empowerment may not be the best option after all. In fact, it provides an important link from patient empowerment to the two things that matter most to payers: costs and outcomes.

While there’s no doubt we are experiencing a massive shift in the way healthcare is “consumed” and decisions are made, it’s important to not lose sight of the big picture. Imagine a world, for example, where pharmaceutical companies adopted a model of only “selling to” and speaking with payers, leaving the HCP and consumer completely out of the discussion. Of all of the stakeholders in this decision-making mix, isn’t it the patient who has the most at stake?

Yes, there are more challenges and barriers than ever before. Yes, there are many unknowns about the future. But that doesn’t mean the industry must choose one audience over the other, or shift its focus completely from one realm to the next.

Think about the outcomes that matter to payers and how you can measure and report your products’ impact on those outcomes. Encourage ties between empowerment, education, outcomes, and cost. Prove the worth of your products. And if those products work better with adjunct services and tools, prove the worth of those, too, and they will be reimbursed.

And yes – still – think about what patients want and need, and serve that up. Empower them with knowledge, skills, confidence, and choices. Because it’s the patient – the true “end user” – that is the greatest reminder of why we are in this business to begin with.

Wendy Blackburn