Health systems support patient journeys but we’re now seeing how patient journeys are revolutionising innovation in health, attacking inefficiencies and generating untapped value
When FIXING US started, we began by simply creating authentic patient journey content to inspire patients and caregivers via TV shows for millions of viewers. Soon thereafter, we started to find ways to help parts of the NHS in the UK to inspire more patients to engage with their health and then started using patient journeys to help healthcare organisations to more effectively engage with healthcare professionals (HCPs) and other healthcare system stakeholders. But then something interesting happened.
One of our clients, a pharmaceutical company. decided to not deploy some content as planned due to a change in circumstances. And yet they fed back to us that the content had been successful. At first, we did not understand how this could be but we later learned that this patient journey content had led to an increase in engagement between various parts of the client’s organisation – serving as an effective catalyst for greater collaboration and momentum.
This was a revelation for us and initiated what is now one of the most powerful drivers of our business. Over the following years, as our understanding of different parts of global and local health innovation systems grew, we began to see how the authentic patient journey and other patient-centric content are able to revolutionise pharmaceutical and other healthcare organisations’ innovation systems in ways that attack inefficiencies, speed up adoption and deployment of medicines and tools, and increase morale by emboldening workforces.
Effectively, the very patient journeys that health innovations serve are themselves being utilised to expedite progression between each stage, generating immense and untapped incremental value, impacting health outcomes and financial returns.
Taking A Closer Look At The Health Innovation System
The health innovation system is complex to say the least. It is rarely the same for different organisations, depending upon the history and nature of key players, pharma or digital focus, tacit knowledge, intellectual property, disease arenas, geographical focus, marketplaces and access to talent and financial power. However, for the purposes of this article, we will segment an example health innovation system, with estimated timelines associated with those segments, as follows:
There is no set timeline associated with how long it takes for a solution to traverse through different stages nor is there, of course, any guarantee that one will move from one segment to another or any assured return on the considerable investment required for it. According to the OECD Health Policy Pharmaceutical Innovation and Access to Medicines report, “successful development of a new medicine takes an average of 10 to 15 years [and] the probability of obtaining marketing approval for a drug entering Phase I clinical trials ranges from 7% to 45%...”
If we then look at the time it takes for deployment of medicines, we can potentially double that timeline and, even then, deployment to local health systems might be ineffective or otherwise limited due to varying engagement and adoption of medicines by a range of internal and external stakeholders that include, among others, local market teams, policymakers, HCPs, patient groups, charities, supply chains and of course patients themselves.
The benefit to health systems and financial benefits for providers of a faster and more engaged process is considerable. If we look at just one part of the New Drug Application (NDA) Submission and Regulatory Review stage, the Food & Drug Administration (FDA) Priority Review Vouchers (PRV) can give us one insight. PRVs can be used to shorten the FDA review time for a new drug down to 6 months from 10 months (although this does fluctuate) with secondary market values of these alleged to be around $100 million. The shortened review time can be very valuable and opportunities to shorten other stages of the health innovation process and increase engagement of stakeholders across it can be transformative for both health outcomes and financial returns.
Each segment of that health innovation system includes a range of different stages and functions that can benefit from better engagement in the form of greater collaboration, stronger support and faster progression.
Reducing The Timeline & Increasing Stakeholder Engagement
Whilst we do envisage there being significant value from advocacy supported from authentic patient journeys at initial stages to help companies to look beyond just specific symptoms and at the fuller patient experience, we have not encountered any first-hand experience in expediting the initial Pre-Clinical Research/Investigational NDA and NDA Submission and Regulatory Review processes.
However, we have seen evidence of how authentic patient journeys and their content has supported increased engagement within the other stages of the health innovation system with clear outcomes relating to patient experiences, stakeholder-engagement and commercialisation.
Clinical trials are fraught with challenges and can take many years to progress through the different phases (and the proportion that do fully progress is relatively small). From Phase 1 studies to extended trials in Phase 2 and larger-scale trials in Phase 3 as greater attention is made over a number of years towards efficacy and any adverse reactions, we are increasingly seeing ways that patient journeys content is accelerating and increasing engagement and effectiveness.
Clinical trials had never been a priority for us but, we have now discovered benefits being leveraged that improve recruitment, education, stakeholder support and reporting. Initially, this was an unintended benefit enjoyed by clients’ wider diffusion of patient journey content but, over time, we began to seee a more proactive approach that increasingly recognises the need to frame clinical trials within the overall patient’s journey - recognising other factors including the role of caregivers, any special circumstances and diversity parameters – to support recruitment, education and internal and external reporting.
- Diffusion of content is driving recruitment of patients and activation of caregivers, offering greater conversion and inbound acquisition.
- Supporting more productive engagement with patient advocacy groups and charities to foster a partnership culture and accelerate participant recruitment, enrolment and retention.
- Providing a repository of relatable content that helps with education of HCPs and key stakeholders to streamline trial protocols and enhance participant recruitment and retention.
- Adding a new dimension to the reporting of results, bringing to life trials and highlighting impacts that go beyond just data for internal and external stakeholders.
- Deployment of patient journeys content to help broaden diversity and inclusion, avoiding overreliance on a smaller groups of less-representative patients.
Approval & Global Deployment:
Upon approval by an initial regulatory authority, treatments can be launched in the global market to support making the solutions available in different countries to support local regulatory submissions, negotiations, financing and engagement with various agencies. Timelines for global deployment can vary significantly and range from months to years.
There are obviously a huge number of combinations and permutations of scenarios in light of the different types of organisations. On one side of the spectrum are the big pharmaceutical organisations with highly complex innovation systems and portfolios of expertise that operate internally across multiple markets and disease areas with symbiotic relationships with hundreds of other organisations’ innovation systems and intellectual property. On the other side of the spectrum are organisations with focused expertise in specific parts of the system, disease areas and markets. For the purpose of this paper, we focus on the larger organisations across whom we have seen the most notable impact.
Firstly, it is worth noting another revelation to us. Whilst global organisations have immense influence, resource and far-reaching health innovation systems, it is interesting to see that rather than them being masters over the local markets, from our vantage point, their relationship can in practice be akin to them being more like a service provider and the local markets being more like the internal clients.
This creates an extensive need for effective engagement at multiple levels that include the need for global teams to “sell” strategies, shape solutions to local market challenges and health system priorities, respect different patient pathways, adapt to local stakeholders, align to medical and commercial priorities, and communicate information that is both consistent and at the same time able to accommodate local market dynamics. The difference between high engagement and less optimal engagement (and adoption) can have immense implications, especially when looking at different windows of opportunity and different trajectories over time.
The power of an authentic patient journey and its capacity for content, advocacy - and as a vessel for collaboration - is considerable. For example, when a global team is deploying a new solution or perhaps an existing solution for a new use, the market or markets “selected” by them is as much about the local market being able to understand or agree to the strategy or being sufficiently resourced to prioritise it or to have enough confidence to be able to deliver a plan. A wide range of factors will determine their level of engagement, including existing relationships, market penetration, supply chain infrastructure, tacit knowledge and local awareness (to name a few).
As part of this process of resourcing, communication, education and empowerment, there is a sophisticated system that includes reviews, meetings, events, presentations, forums, campaigns, submissions, strategic and financial planning, as well as extensive efforts to engage with local health systems, regulators and policymakers. We have seen how patient journeys have enhanced engagement across almost every facet of this process from helping to inspire and embolden various stakeholders, bringing to life patient pathways in a way that reduces the time needed for adoption, supporting prioritisation, and increasing the quality and effectiveness of local support as well as providing greater impetus and emboldening teams from medical affairs, local brands, marketing and sales.
This increased stakeholder engagement, which spans internal and external parties, can not only result in more markets executing plans earlier in the cycle but also improves the quality of that execution. This helps to centre thinking towards the patient with a host of positive ancillary benefits towards culture, morale and collaboration – all of which contribute towards greater momentum, greater trajectories and a higher likelihood of success.
Health systems can sometimes (understandably) put the disease at the centre, especially as most parts of the process have little physical proximity to patients in their daily work, and so the ability to also place the patient journey at the centre can be particularly valuable.
- Brings the patient pathway to life, enhancing the impact and excitement around global launches amongst both global teams and recipients of communications.
- Increases adoption of strategies by key stakeholders, especially international groups whose focus aligns with patient pathways.
- Empowers more effective engagement with key groups and key opinion leaders (KOLs) and provides vessels for collaboration within proven regulatory and compliance rules and frameworks.
- Provides a more emotionally engaging platform for communicating with internal and external stakeholders, groups and policymakers.
- Creates a repository of authentic patient journeys and related patient-centric content that can be localised to support later local deployments, reducing lead times and increasing early adoption.
Local Market Deployment:
Local market deployment involves obtaining regulatory approvals, ensuring compliance with local laws and regulations, negotiating pricing and reimbursement agreements, and establishing distribution networks. The timeline for this can vary considerably, and market priorities can change as a result.
Having identified in the previous section a tendency for local markets to be considered to be akin to internal clients, once a treatment is available, deployment to and by local markets will be tailored on a country-by-country basis. However, it is important to note that many markets may not be as turn-key or in a position to move the baton forward so readily.
Although there is a huge amount of resource, expertise, tacit knowledge and systems in place to support effective local deployment, many people may need to be moved from brand teams that relate to other disease areas or different organisations and some of their external relationships will be focused towards other arenas. This means that new knowledge and new relationships and frameworks need to be devised and activated within a complex matrix organisation that requires a high degree of credibility and engagement.
The patient journey is a valuable tool, even if just deployed internally. Where there is a strong degree of confidence and relevant resource in place, it can provide an emotionally engaging way to rise above other communications. Where local markets are less associated with a specific disease arena, the patient journey is an effective tool for demonstrating an understanding of and commitment to the needs of patients, emboldening workforces, and serving as a catalyst for local collaborations that might support or inform local markets in their tasks.
First and foremost, professionals across different health innovation systems are human beings and the ability to enhance their emotional engagement and resonance is inspiring and powerful. And inspiration can be contagious.
- Support collaboration with local legal and compliance experts to ensure adherence to requirements, and help demonstrate value propositions and address concerns with greater patient-centricity.
- Maintains impactful, resonating and continuous engagement with HCPs through conferences, webinars, and peer-to-peer interactions.
- Equip local markets with content and traction/support as they balance different demands for resource – tapping into momentum and providing them with faster activations.
- Engage with local distributors and develop efficient supply chain networks.
- Develop robust pharmacovigilance systems and engage with HCPs and patients using video devices for recording authentic patient experiences and efficient reporting.
HCP Engagement & Patient Access:
The scope and breadth of activities that are possible for local markets to support HCP Engagement & Patient Access varies considerably across different markets and conditions. Whether in a market that permits direct communications with patients or highly regulated markets that limit communications to predominantly unbranded and highly restricted messaging for limited audiences, the common challenge is stakeholder engagement.
There are countries like the USA, where FIXING US via its extensive partnership with NBC Universal and parts of the health system reaches tens of millions of Americans to inspire them to engage with their health (and the health of their loved ones) in partnership with brands giving the ability to integrate specific disease arenas and solutions. There are also regions like the Middle-East and China, where communications and narratives are restricted by different regulatory frameworks, conventions and cultures, and Western Europe where dominant health systems feature monopolistic sellers and markets where communications strategies for HCPs and patients differ but where pharma communications strategies can be particularly conservative and risk-averse regardless of what might be possible.
However, the one thing that is consistent – albeit for different reasons in different markets – is the challenge relating to stakeholder engagement. For example, some brands wish to collaborate with patient groups and charities to understand specific patient pain-points and how particular solutions are addressing unmet needs or to inform HCPs to be aware of and consider a specific treatment for patients at particular parts of a patient’s discovery process, or perhaps when certain symptoms lead to specific indications. However, engagement with stakeholders can be diminished, not possible or otherwise compromised due to suspicion, misunderstanding, a tendency to treat all collaborations as transactional relationships, or due to compliance constraints that either prohibit or greatly discourage direct or contractual relationships.
It is here that authentic patient journey content is proving to be particularly powerful. By creating and managing a patient journey centrally, the journey also becomes an especially effective vessel for collaboration where a healthcare provider’s or brand’s involvement or funding for an authentic patient journey is transparently declared without diminishing the appeal for involvement by almost all potential stakeholders.
We can then enlist stakeholder support or involvement of patient groups, charities and HCPs to be part of that journey from an early stage with their focus being on the patient journey. The journey can draw attention to real-life experiences with a view to inspire, educate and engage patients and caregivers - in multiple ways, whether that is in patient recruitment, endorsement and association, integration and/or in the diffusion of content.
Often, depending upon the local market, patient journeys can be efficiently brought to life in different branded and unbranded forms and delivered to a variety of audiences with different perspectives (e.g. from multiple perspectives of patients, caregivers, HCPs, specialists, policymakers and specific members of an organisation). Frequently, the patient journey itself or the content of the patient [or HCP] experience can effectively feature policymakers, KOLs, hospitals, payors, procurement executives, or other stakeholders. This ensures the wide diffusion of the content relating to the patient journey(s) which is able to resonate with multiple parts of a health system and serve as a tool for stakeholder engagement with them all.
More effective stakeholder engagement comes from taking a closer look at authentic patient journeys from multiple perspectives instead of relying on an unrealistic one size fits all approach (or singular brand perspective) that many agencies creating content for brands often rely on.
This more effective approach will enable a patient journey to act as a vessel for non-transactional collaboration between almost any part of a health system in accordance with even the most conservative compliance and communications frameworks. We have now established this approach as a genuine and proven stakeholder engagement tool that improves engagement, speeds up processes and which elicits considerable value and efficiencies that could otherwise be – and indeed, often are - missed.
The organisation effectively learns to use the patient journey it seeks to support to power itself and generate extra value from improved engagement, outcomes and commercialisation - which also benefits a large number of complementary assets across its matrixed organisation at both local and global levels.
- Helping to increase engagement with, and collaboration, between providers and HCPs.
- Highly resonating education tool for patients, caregivers, HCPs and as part of training programs, but also increasingly deployed by HCPs, patient advocacy groups, charities and health systems to patients.
- Provides a vessel for non-transactional collaboration that enables engagement to flourish using compliance-friendly mechanisms.
- Content can be made available in multiple branded and unbranded forms and from different perspectives, supporting diffusion of content to all participants in the patient journey.
- Authentic content reduces reliance upon paid-placement, with 67% of patient journeys generating extensive free media coverage on TV, in the Press and at major events.
Measuring The Transformative Impact Of Better Engagement
As time goes by and utilisation of patient journeys increases across new parts of health innovation systems, layered with continued diffusion with greater competency in existing parts of those systems, we are beginning to see anecdotal observations relating to effectiveness as it evolves into data-supported evidence and, in due course, return-on-investment measurements.
This is important because engagement can be difficult to measure and, if it is difficult to measure, it can be difficult to include within strategic and communications planning and budgeting processes even if it feels right instinctively. Moreover, due to the complexity of health innovation processes, its long timeline and plethora of constituent parts, it is likely to be a number of years before financial models can accurately predict its impact with a clear and accurate attribution for certain stages of processes, parts of the organisation and specific stakeholder engagements.
Furthermore, most such measures are likely to be valuable and kept close to the client’s chest (as is the case currently, and which is why we exclude that data from this piece) until such a time when the approach is so widely practised to the extent that we will be able to talk about industry averages or other key performance indications (KPIs) that will be shared publicly. Until then, the measurable impact of patient journeys is likely to be piecemeal and limited to specific parts of the health innovation system where attribution is more clearly identified and treated confidentially by organisations that are already embracing it as an essential component and comparative advantage.
Today, we have evidence that we can share, we also have evidence that we have been privy to but which we cannot share, we are informed that clients have evidence that they cannot or will not share, we have clients that are benefitting from evidence that they see qualitatively or anecdotally but which is not being measured using data and we also have clients who embrace the practice culturally because they regard it to be the right approach for them and something that is vital to their organisation even without any expectation of measurement.
Additionally, we are now working with universities to help introduce new frameworks, measures and studies as academics recognise how little attention has been put towards engagement until now and how academic research has a strong role to play in helping to measure its impact across health systems to draw greater attention towards this vital area with policymakers.
We know that patient journey tools for one project helped improve e-Health patient retention rates to 84% after 180 days and we learned that meetings between sales teams and physicians improved by about 600% following the deployment of patient journey content in another initiative. We have also seen 67% of all patent journeys generate extensive free media coverage on TV, in the Press and at major events, and we saw how the creation of authentic patient journey content - even before its deployment - was successfully utilised as a stakeholder engagement mechanism that secured support from policymakers, charities and patient groups, which sped up one deployment cycle by an entire fiscal period.
There are at least a hundred other engagements that we need to measure over the coming years, and which we need to measure a sufficiently robust number of times to further increase confidence. The total number of touchpoints that provide opportunities for greater engagement in later stages of the process are huge (compared to early in the process) and so perhaps it is the earlier stages that provide the easier opportunity to create measurable and aggregated effectiveness data.
In the arena of Clinical Trials before the health innovation system enters those later stages of significantly higher diffusion and touchpoints, we can measure the impact of increased stakeholder engagement with HCPs and key groups to support education and recruitment, the deployment of content utilised to help acquire and retain effective enrolment and the effects both internally and externally for conventional reporting and reporting that utilises content from patient journeys for trials. This is something that is already being embraced amongst a sea of data.
So how long do we think it will be before we can create a quantitative measure which accurately reflects both the increased engagement and the reduction in effective progression across health innovation systems from authentic patient journeys and their content?
By looking at the visual representation of the enhanced engagement and speed of progression through the various health innovation stages, we can see the considerable impact and value but we also see that it could be a few decades before a confirmed timeline saving measure and incremental financial value of this increased engagement based upon actual events can be delivered.
The good news is that there is already evidence of how this quickening, widening and increasing quality of engagement and measures are supporting this. Moreover, the benefits from it can be enjoyed by organisations and patients now whilst measures are put in place – providing an opportunity to support the patient journey and power the health innovation it serves with increased confidence and accountability.