Paradigms change when questions emerge that the old paradigm can no longer answer. Market access has become a buzz word, as access to markets is as significant a hurdle to product uptake as registration itself. Initially a topic for pharmaceutical companies concerned about sales volume, it now affects all aspects of healthcare. The current understanding of market access will undergo a fundamental shift in perspective, away from a company-centered toward a patient-centric view of the problem. This column identifies several forces that challenge the current understanding of market access and lobbies for a comprehensive approach that aims to address the needs of all stakeholders, with a primary focus on what creates value for patients.
What killed market access?
There are four reasons why the current approach to market access is doomed to fail:
The term "market access" itself says a lot about the self-centered mindset, which is one of the reasons for the paradigm change. Healthcare companies want access to markets, revenues, and profits, and market access aims to persuade those that control access to let them in. But the market access framework often does not address the needs and goals of all the parties involved. Market access looks at the world from the perspective of healthcare companies with the ultimate goal of gaining access to markets for their products and most of their attention is focused on convincing a few payers of the value of their products.
Market access is considered a remedy to address the pricing pressures the healthcare industry is facing—a result of a marketing model that basically ignored the fourth P every marketer learns about in business school: Price. As policy-makers and payers search for ways to control cost without compromising care, the failure to communicate a convincing value proposition to these stakeholders results in our being forced to compete on price. The increased use of tenders as a means of cost containment should be interpreted as a failure to communicate the value of a medication.
Market access is based on a one-size-fits-all, product-driven marketing model. However, while patients have similar needs, the healthcare systems they live in go about pursuing the same common goal—improving public health—differently. A one-size-fits-all approach is not effective at addressing the different needs in each market, yet to manage market-by-market is not realistic. A practical approach is to define market archetypes and address the needs of each archetype effectively while leveraging limited resources efficiently.
Traditional marketers tend to focus on lagging metrics such as number of patients diagnosed and number of patients receiving treatment (often illustrated as a waterfall chart), but they fail to understand and appreciate the patient and payer journey: Why does the market look the way it does? What are the incentives and success metrics? Marketers need to focus on understanding the why instead of the what.
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It is all about the patients
We suggest focusing on patient access as a remedy for a marketing model that was for a long time geared towards addressing the needs of a single stakeholder—the professional writing the prescription. Patient access is a mindset that focuses on providing patients with access to the medicines they need at acceptable prices. Providing patients with access is the one common goal all stakeholders can agree on. While each healthcare system differs in how its patients, providers, professionals, payers, and policymakers go about improving public health, a patient access mindset helps to develop a compelling value proposition aimed at addressing the needs of the various stakeholder groups, tailored to the needs of the local market, yet based on a well-understood positioning. Most importantly, patient access provides a unified focus for healthcare systems and companies.
What are the changes a healthcare company has to make as it moves from a market access to a patient access mindset?
» Drop 'market access.' Words matter. It requires organizations be aligned on researching, developing, and delivering the products that improves people's lives. A company has to recognize that its goal is to demonstrate the value proposition.
» It is a uniting focus of all stakeholders in a healthcare system, since it is everyone's goal to achieve improved patient outcomes.
» Patient access focuses on actual product usage. Market access is oftentimes tasked with obtaining strong pricing and favorable reimbursement status, but this mindset ignores real product uptake.
» Breaking the traditional development paradigm: Registration is all that matters. Market access today is often just paid lip service to as a commercial function, as opposed to patient access—aligning internal stakeholders from research to representatives toward a new principle: A product only matters when a patient uses it. The journey from R&D to sales becomes smoother as all the internal stakeholders are aligning towards a common goal.
» Patient access re-orients marketing analysis from looking beyond patient flows from diagnosis to treatment adherence toward a comprehensive understanding of the payer flow: Where actually the costs incurred? Who stands to gain or lose financially? A patient access mindset aims to understand the patient and provider pathways, with the ultimate objective to ensure access for those patients who can optimally benefit from a product.
Six steps to reset the clock
Instead of a win/lose mindset at the core of market access, patient access tries to create win/win/win solutions that lead to value for patients, companies, and the healthcare system at large.
The first step is a change of mindset. What is the objective? Get products to those patients who can benefit from it. Educating the internal and external stakeholders is a key. Beyond that, here are some suggestions to consider:
» Embed patient access as a guiding principle across all functions. Clarify how each function impacts patient access.
» Develop a deep understanding of the goals and key performance indicators of all stakeholders. Map the complete patient journey. Understand the payer flow. Ask yourself: What is the healthcare system trying to achieve? How is the healthcare system funded? How does this intervention help? Could this intervention create concerns? Make sure your plans address these issues.
» Develop a clear and compelling value proposition for each stakeholder group.
» Create a formal framework for understanding the impact of decisions on patient access. Get payer input and advice early on.
Look for metrics that matter to all stakeholders, for example: percentage of people using the product for the designed use or percentage of physicians freely choosing the product for a certain therapy.
Putting it all together
"The future has already happened, it's just unequally distributed," the famous quote from the acclaimed science fiction author William Gibson, helps to explain the various pathways healthcare companies are exploring as they struggle to come to terms with the end of the blockbuster era. Almost every healthcare company has created a market access function. Many have started to look at the competencies required to communicate the value of their products in a language payers and policy-makers understand. But to be truly successful, healthcare companies are well advised to consider patient access as the overall objective and adopt a multi-stakeholder approach that aims to meet the needs of all the critical decision-makers. It is not about "we used to look at physicians, now we look at payers." Patient access uses a system view with the patient at the center.
John Glasspool is Global Head of Emerging Therapies and Market Development at Baxter Healthcare Corporation. He is based in Chicago and can be reached at [email protected]