16-17 - Why pharma needs to understand population health

One of the more enigmatic elements of NHS reform is the shift from disease management to population health. As a concept, this is something that’s been talked about a lot in the past: seasoned policy-watchers will remember both the Five Year Forward View and the NHS Long Term Plan both describing a future built around greater investment in preventative health.

Now though, the agenda looks and feels more grounded, with a clear structure, focus and statutory intent around it. Baked into the foundations of integrated care systems (ICSs) is the idea that a more enlightened and joined-up approach to planning services can help reduce health inequalities and prevent ill health through earlier ‘upstream’ intervention.

Particularly relevant is the role of place-based partnerships within the ICS governance structure. Consisting of NHS and local authority leaders, they will be responsible – according to latest guidance – for “facilitating joint action to improve health and care outcomes and experiences across their populations.” They will do this by generating “an integrated care strategy to improve health and care outcomes and experiences for their populations”.

Supporting this, there will be a big change in the way health services are incentivised: the shift away from paying for episodes of (acute) activity via the national tariff in a way that encourages competition between providers, towards a ‘blended’ contract that draws on a shared pot of money at system level to encourage all organisations to take collective responsibility for improving the health of local populations.

So far, so good. Yet swirling around these changes is a lingering suspicion that this presents a strategic risk for pharma; that a greater emphasis placed on preventative services and a long-term shift away from hospital-based activity ultimately means cash diverted away from medicines and treatments.

These concerns are largely unfounded, though that isn’t to say population health doesn’t pose some significant challenges for pharma, as we will see. The truth is that it will require commercial organisations to forge a different relationship with the NHS, but it also gives pharma companies an opportunity to embed itself as an integral part of a more holistic, outcomes-led approach to healthcare.

However, succeeding in this new environment will require industry to be aware of the changing context – and ready to insert itself confidently into these population health discussions. In this article, I will look at three critical steps you can take to develop your organisation’s ability to engage with this fast-developing agenda.

Data is the fundamental building block of population health management. Indeed, its whole philosophy is built around using data analysis to understand the fundamental needs of a given population, hence enabling resources to be directed into areas where they can have the biggest effect.

This channelling and interpretation of data to improve population-wide outcomes will inform how integrated care systems operate and what they prioritise. Data will be used to model current trends and predict future needs and their likely impact. Analysis should also help to identify local or national ‘at risk’ cohorts requiring more proactive support.

At all three levels – system (via ICSs), place (via provider collaboratives) and neighbourhood (via primary care networks) – this means that there will be a keen hunger for data, analysis and insights that helps to predict, model and shape how healthcare services and other interventions should be developed to meet population needs.

Pharmaceutical companies can offer a range of things that NHS decision makers will find useful in this context, from expertise in understanding conditions and patient needs, through to modelling and the segmentation of data to help systems understand and identify cohorts of patients who may benefit most from a particular intervention.

Crucially, commercial suppliers will need to be able to use data to build a strong case for their proposition within a wider frame. They will need to be able to demonstrate its value relative to other types of intervention, in terms of making a sustainable, long-term contribution to patient or population outcomes.

Armed with the data, the next step is to develop your value proposition and identify who is ready to listen. Population health, though not entirely novel, is still new for many people in the NHS so not all ICSs or localities will necessarily be on the same level in terms of embracing it as a shaping principle. You may need to develop a way of segmenting your customers around their appetite for population health solutions.

The majority of areas at least will have a population health “champion” who is leading this agenda – often identifiable from board reports relating to population health management. These are typically a transformation lead or partnerships director, or the medical or clinical director.

Yet while ICSs hold the single budget, remember that most of the activity and delivery happens at place-based provider (PBP) level. This is where you will need to direct most of your conversations, as well as with clinical pharmacists, pharmacy technicians, nurse associates, social prescribers and others within primary or community care.

There are a few critical questions to ask yourself when making an approach. Where does your value proposition or proposal fit within a service’s ambitions? How can you integrate your position as an appropriate level of intervention within the service? How might you align and scale your intervention to an integrated provider environment? And finally, how do you connect your proposition to local, regional or national targets or objectives?

The embryonic nature of population health as a defining concept within the NHS can also serve as an opportunity. You could consider positioning yourself as a ‘starter’ project for an NHS customer – part of a shared learning journey to understand the potential benefits that population health techniques can bring to a given pathway or disease area.

The final step is designing and embedding your solution within a population health context. This means thinking ‘beyond the pill’ and taking a more holistic approach to how you can work with the NHS to secure better outcomes for their patients and populations.

A lot will depend on what you’ve derived from steps 1 and 2 in terms of the priority cohorts and their needs, but typical ‘added value’ interventions might include: funding and delivering training programmes to build staff knowledge and skills; co-developing public education programmes to help patients manage their own condition more effectively in terms of lifestyle and behaviours; or supporting measures to improve adherence to a treatment protocol, or reduce unplanned episodes of care, so that resources are used more effectively.

Equally, population health management doesn’t mean the end of discussions about your product range – but it does demand that the product’s benefits are framed in a wider context. Pharmaceutical companies will need to demonstrate how its offers can support patients, clinicians, services and whole systems to achieve better outcomes in return for the investment provided.

Expect some challenge too: a single budget means that systems will be under pressure to bear down on any inefficiencies, making sure interventions are delivered earlier and in the least costly way. You will therefore need to be able to demonstrate that your proposition is not only an effective intervention but also the most appropriate within the pathway. That’s potentially a very different conversation from what has gone before and will mean making a much sharper economic case for investment.

The much-heralded shift from a ‘scoop-up-and-mend’ NHS to a ‘prevent-and-keep-well’ service built around population health principles is radical in theory. Yet even with these reforms, it will take time to become an orthodoxy in practice. Be aware the pace is likely to quicken as areas begin working on their integrated care strategies next year.

Pharma therefore has a critical window to adapt to the new environment. It must marshal its data and evidence base to build the economic case for its products; refine and update its value propositions so that they align with a system or locality’s strategic objectives; and, most importantly develop the organisational savvy, from product development through to sales and marketing, to answer the new challenges posed by population health management.