Should Industry Be Looking “Beyond The Pill”?
Baby boomers are less healthy than their parents. While this may be hard to grasp given the medical innovations over the past 20 years, this was exactly the conclusion in a recent study titled, “The Status of Baby Boomers’ Health in the United States. The Healthiest Generation?” Briefly, when investigators compared National Health and Nutrition Examination Survey (NHANES) results for adults aged 46 to 64 between the timeframes of 1988-1994 and 2007-2010 (i.e., baby boomers) the latter group was more likely to experience chronic diseases such as hypertension, diabetes and hypercholesterolemia. Additionally, they tended to have higher levels of disability. While baby boomers are predicted to live longer, they are not living healthier.
Delving into this further, we took a look at medical innovations that have taken place between those two time periods. We saw a number of medical breakthroughs that came about including the intracoronary stent and the first “super aspirin”, Plavix. With respect to dyslipidemia, one of the conditions highlighted in the study, between 1988 and 1994 the only treatments available included the statins Mevacor, Zocor and Pravachol. Other classes consisted of resins, fibrates and niacin (slow-release). Alternatively, the baby boomer generation was exposed to the benefits offered by Lipitor, which in fact was the top-selling drug in the history of pharmaceuticals which was not introduced until 1996. They also had access to Crestor dubbed the “super statin” which followed almost a decade later in 2003 and Zetia introduced in 2002. Niaspan approved in 1999, afforded the effects of niacin without the facial flushing. Furthermore, during the 2007-2010 timeframe, antihypertensive angiotensin receptor blockers (ARBs) were marketed while not available during the earlier period. Overall, more combination products had been made available which would likely enhance compliance.
It is therefore quite perplexing that despite the innovations that have taken place not even an incremental improvement was observed in the health status of the baby boomers compared with the prior generation at the same age. One likely reason for this phenomenon is that achieving outcomes with these interventions requires a more comprehensive approach than the treatment alone. Optimizing outcomes in the management of chronic disease is fraught with considerable challenges including those as basic as medication adherence and lifestyle modification.
This brings us to the concept of a “beyond the pill” strategy, i.e., offering services designed to address the needs of all stakeholders (patients, clinicians, payers, caregivers, etc.) along the patient pathway. This should ultimately result in better health outcomes coupled with a higher value to stakeholders and thus, a competitive advantage for the company. Pharmaceutical companies are in an excellent position to institute this form of strategy. They are experts in the science and disease state and have an astute understanding as well as existing relationships with many of the key stakeholders. They also market the products which form much of the backbone of management for many chronic conditions. This approach is also relevant to devices particularly those which are designed to augment or even replace certain medications in chronic diseases.
The exact types of service-based programs implemented through this strategy would need to be customized to the company based on a number of factors including the product itself, geographic reach, internal capabilities, and cost structure. Still, they could range from those which companies are already doing to some extent such as addressing medication adherence, supportive education and coordinating the “non-therapeutic” aspects of the disease to disease management and care delivery which has not customarily been within the realm of the therapeutics industry. Regardless, a comprehensive analysis including multiple factors is required to discern the most appropriate strategy.
At a recent conference we attended at Wharton, we heard from several CEOs of major healthcare players. One of the central themes of the conference was how progressive companies need to start looking beyond the pill and address ways to improve overall outcomes.
It is not too late to shift the health status curve upward for the baby boomers and generations to follow so that they can reap the benefit from medical innovation. By taking a new focus on chronic disease and moving away from “delivering therapies” and towards “delivering outcomes” the industry will benefit through a loyal stakeholder base and a healthier aging population.