The HealthXL Sprint 2-part meeting series connects senior leaders across our community to solve the latest health challenges. In our most recent sprint we discussed payment models for delivering virtual care to cardiovascular patients. In this blog we’ve pulled out the top takeaways from this series.
5 Key Recommendations:
#1 What does and doesn’t work in a digital health and pharma partnership. Pharma is unlikely to support the design, operation, or everyday workflow of a digital health business. A company that is interested in partnering with pharma will need to approach pharma with a fully baked proposal and a complete solution offering. Pharma companies are less likely to ideate with a digital health company and co-develop a model. Though the pharma / digital health relationship often includes things like data sharing, patient access or strategic benefit, when approaching pharma the proposal and solution should first be thought through by the digital health company.
#2 The business model follows the use case. Oftentimes companies need to explore or use multiple business models. Some possible approaches include direct to provider with or without reimbursement, direct to consumer, among others. A few examples are described below:
- Direct to Consumer (D2C): This ensures access for everyone, but there’s typically a cap to what someone is willing to pay for out of pocket. Outside of weight loss, this is likely about $20 per month. With D2C it’s possible to surpass customer acquisition costs, but it is challenging.
- Full virtual care provider: This approach involves providing a digital care solution inclusive of the medical provider. For example, a digital cardiac rehabilitation program may include physician or nurse providers through the application to work directly with patients as part of the service. This approach has the benefit of offering a complete health solution, but it comes with the added cost of building a network of providers and it needs to fit well within existing healthcare systems without causing conflict among physicians who may refer patients to the solution.
- Contract Research Organizations (CROs): CROs provide support to pharma companies on a contractual basis to help alleviate some of the workload often associated with research services for drugs and medical devices. By integrating with CROs rather than going directly to a pharma company, a digital health solution can show that they are already part of the package of services offered by an organization that may already be a reliable and trusted partner of a pharma company. Through CRO integration, a digital health company becomes a plug and play solution that can reduce the amount of in-house work required of the pharma company and this can solve many problems.
#3 Payers and employers typically have short timeframes for seeing results. Payers typically expect to see savings within 1-2 years, potentially up to 4 years. Savings over a long term 10+ year period are less interesting to payers. For employers, the expectation is that results will be seen in as early as 3 months to a year. Some cardiology outcomes are often seen after long term patient engagement, presenting a challenge for solutions looking to embark on payer or employer partnerships. Thoughtfully designed studies showing clinical utility and economic benefit in a meaningful time frame are essential to obtaining reimbursement and payment. Shorter-term KPIs, like atrial fibrillation control and normal sinus rhythm can be important milestones for these types of collaborators while working towards long term results.
#4 Pharma is hoping for a new sales approach when it comes to digital health. It is a big lift to sell directly to hospitals or providers. Alternatively, partnerships with virtual care companies create the opportunity to integrate monitoring into their platforms and become almost a competitor to the traditional brick-and-mortar system. The platform can create a D2C market opportunity and acts as an aggregator that allows multiple solutions to plug and play. However, major proof of scale is still needed. While with a telehealth first approach, physicians are still part of the business model, these may not be the same physicians a patient sees in a brick-and-mortar setting and physicians may not be willing to give up patient ownership to a third party. A hybrid model will be needed to link brick-and-mortar in-person visits with virtual care in between appointments. It may be some time before cardiologists get on board with this model and we may be more likely to see this type of model grow first in primary care.
#5 There needs to be a service within virtual care to sift through the data. Physicians are concerned about the burden of reviewing additional data and the liability that comes with it. Rather than a cardiologist reviewing large quantities of digital health data, a triage team, specialized nurse, virtual care provider, or potentially artificial intelligence (AI) should take the onus away from the cardiologist and summarize or escalate the most crucial information to the physician. The physician’s role can then focus on how to inform patient management and treatment with actionable insights vs. reviewing endless quantities of raw data.
Experts included: Aman Bhatti (SVP & Global Head, AliveCor), Ankita Deshpande (Head of Innovation Accelerator, Alexion), Ashutosh Malhotra (Digital Business Development & Innovation Scouting Manager Europe, Daiichi Sankyo Europe), Logan Smith (CEO, Hula), Mathieu Chaffard (Project Coordinator Digital Health Innovation, Roche Diagnostics), Patrick Keenan (Associate Director - Business & Commercial Development, Rx+ Commercial Group, Astellas Pharma), Stephen Egan (Director, Redicare), Tim Fonte (SVP Upstream Marketing, HeartFlow) and Meaghan Schedel (Senior Digital Health Consultant, HealthXL).
*All opinions are the participants’ own and do not necessarily reflect the stance of their respective employers.
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