The future of work in health – preliminary observations for pharma/life-sciences

The mega trends affecting the healthcare sector are well-documented: ageing populations; longevity increasing the prevalence of chronic disease; more knowledgeable and assertive patients; public policy challenges in funding and resource-allocation against a background of seemingly inexorable increasing demand and scientific opportunities.

Technological developments of many kinds offer opportunities for transforming the way healthcare is delivered, bearing particularly on the relationships between professionals and patients. Virtual consultations; home-based monitoring; implant drug-delivery – all tend to obviate the need for the time-consuming surgery visits. It puts the patient at the centre of the healthcare system; traditionally, the system has been largely designed around the professional service suppliers. This is predicated on patients being willing and able to take the primary interest in their own health and health outcomes. While much evidence confirm such trends, it remains unclear whether individuals will seek to practise a healthier lifestyle; or, alternatively to look to pharmaceutical intervention to nullify the effects of an unhealthier hedonistic lifestyle. There are policy – and cost – implications from such human choices.

Much of the transformative drive in the healthcare sector will come – as in so many sectors – from enhanced data and analytics. Big data analytics applied dynamically to patient records can be harnessed to assess, monitor and, through artificial intelligence protocols, intervene to effect outcomes. It can equally be applied to another revolutionary development in the area of genetics, where understanding of which population sub-types respond to which therapies can transform the nature of diagnosis and therapy. This will also tend to put the focus more on the individual patient; and while it is unrealistic to conceive of an individualised medicine, it is feasible for patients to be grouped into a number of sub-types for which effective therapies can be identified and administered.

For such visions to be realised requires a range of hurdles to be overcome, not all of which relate strictly to the pace of scientific development. They also include the concerns of the public in relation to the sharing of individual medical and genetic data, which could have profound implications for individuals and families. There are also wider issues involving population-wide genetics and the need for ‘bio-banks’ to analyse and determine the sub-types predisposed to specific diseases.

The consequences of a more patient-focussed system on financing are yet to be resolved.in relation to whether future funding of healthcare will be more-or-less public, or more-or-less private. For the pharma/life-sciences industry, it will be highly important to understand the nature of which type of demand it will need to meet: a consumer market or an industrial market: the key success factors will be distinctly different, especially in relation to the types of products demanded and the willingness to pay. One feature that will be common to both, nevertheless, will be the emphasis on evidence-based value propositions relating to health outcomes of alternative therapies – a field relying heavily on data analytics.

In a world where public funding predominates, pharma/life-science organisations would negotiate contracts with payers based on ex-post treatment outcomes, rather than the flawed system of ex-ante outcomes from limited clinical trial data. Research would have a new impetus – more selective and less serendipitous – but the industry would also be more conscious of the need to ensure an end-market for the product through close liaison with payers. It is also possible that the nature of product design and development would change from one where companies offer products of their own conception to more of a defence-type procurement system, in which payers set out what products they want and are prepared to pay for. The traditional mind set among public funders to see therapeutic breakthroughs as a cost threat rather than a benefit opportunity might well still prevail. Hence the pharma/life-science industry would need deeper skills to link up with patient groups, who would wish to take advantage of the new therapeutic opportunities and act as a joint lobbying force on public funders.

Alternatively, in a world where private funding predominates, with private sector being encouraged, most likely through a thriving private insurance sector. Individuals would take responsibility for managing their risk profiles through lifestyle and behaviour. There would be a strong focus on the development and supply of medicinal therapies for specific population genotypes. Such developments might well blur the difference between different types of healthcare, such as prevention, genetic screening, genetic counselling, lifestyle management, diagnostics and therapeutic options. The pharma/life-science sector can either be a marginal provider or a big orchestrator of a whole well-being programme in partnership with other specialist functions. This distinction might be a big differentiator.

In any event, the future is likely to encompass a sea-change in the operating model of the pharma/life-science industry and in its relationships with its key constituents – payers, healthcare professionals and patients. A very different range of skills will be required for the industry.

Written by Mike Owen, SAMI Fellow and Chairman.

The views expressed are those of the author and not necessarily of SAMI Consulting.

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