Below is a Q&A with Mark Bard, Co-Founder of The DHC Group, who offers his insights on the challenges COVID-19 has brought to pharma, as well as what innovation is taking place due to this full shift to digital and what lies ahead in the future.
What is the most challenging aspect of COVID-19 for the industry?
Mark Bard: I think the most challenging aspect of the current situation is the inability of anyone – patient, physician, payor, or pharma – to truly predict how long it will take for various parts of the system to get to what becomes the steady state – a new way of operating, the new normal. How does the situation impact pharma? Let’s break it down with the two core customer groups: the patients patients and the physicians.
With patients, you had a wave of Rx fills and refills earlier as many with chronic health conditions requiring ongoing Rx therapy stocked up on prescriptions in case they could not leave home – and safely get to a physician or pharmacy. They made it through March, April, and May – and many have yet to get back to normal in terms of ongoing treatment with a physician in the practice for routine disease management and adjustments (if needed) to therapy.
Of course some patients have also been impacted on the economic front. Perhaps they lost health insurance through an employer or those with a high co-pay for therapy may have decided to put off refills – or new fills – due to cost concerns. Pharma has been very proactive the past 6 months with efforts to educate patients about available co-pay and patient assistance programs for those with a financial need or hardship.
Looking beyond the patients, it seems like the challenges and impact on physicians has been widespread, yet with specialty-specific variations. While pulmonologists may be very busy with patients in the hospital, routine office visits may have decreased as some of their patients with chronic respiratory conditions were afraid to venture out – or to visit a physician office. Many primary care physicians suffered a similar situation earlier this year when many patients may have put off routine care, annual physicals, or wellness visits. Given most physicians require volume to run a successful practice, the slowdown during the past 6 months has been a financial hit to their business and their practice. Physicians have also put safeguards in place in the waiting rooms – and office overall – to limit the number of people other than patients scheduled for a visit that day. In other words, no guests, or limited to one guest with each patient.
How does this new system of limiting access to outsiders, reducing the number of people in the waiting room, and eliminating visits from outsiders impact pharma?
Access by pharma sales rep has been significantly reduced across the board. Does that mean they have no access? Of course not. Many of the most successful organizations have been investing in their digital and tech-based engagement platforms and strategies for the past 10-20 years. The pandemic has forced what was a second-line approach to HCP engagement to the forefront – and the first line or only access channel available.
What types of solutions have you seen that are innovative?
Bard: Again, let’s start with the patients as a customer. Clearly telemedicine, telehealth, virtual visits, and any use of technology to connect a patient with their physician has seen rapid growth the past 6 months. Many physicians went from using telemedicine with 10% of their patients – to 80-90% of their patients overnight. While those rates have been coming down, as practices open their doors to in-person office visits, it’s clear that telemedicine is finding a home with many physicians who previously may have viewed the technology as something other than mission critical to the business. When you have to use something to see the majority of your patient volume for a period of time, it becomes mission critical. In addition to the use of virtual care platforms, there have been innovations with how physicians are sharing and providing patient education to their patients. The ability to provide relevant content in a virtual waiting room, while waiting for a physician to show up to the video consult, has been a great way to use down time the patient has online.
On the physician front, the core technology that is powering meetings between a physician and patient is also making engagement between a pharma rep and a physician possible. While the platforms are different, the underlying concept of a secure video chat, conversation, and presentation is very similar. Specific to physicians, offerings from Veeva and others have enabled reps to utilize systems they have already been using to extend their reach virtually to a physician on the terms of the HCP – when they are requesting and demanding information. Similar to the spike in the use of telemedicine between patients and physicians, there has been a spike in virtual detailing between pharma reps and physicians. It is yet to be seen what steady state looks like in 2021 as firms reevaluate their field force and consider what a tech-first field force looks like – skills, size, and of course, the underlying technology and platforms that will become the core of a truly tech-enabled (or tech-first) field force.
What changes will have staying power?
Bard: It’s a big question and tough to answer because we don’t really know how long this market dynamic of limited access by reps and demand for video consults by patients will last. It’s clear we have at least 3 months – or possibly 6 months – of increased (outsized) demand for these technology-first engagements and encounters. It’s not hard to see that telemedicine is finding a home in the practice of most physicians. Will it be 20% of their visits? 40% of their visits? That is still unclear and there will be big differences by specialty. For example, a dermatologist may offer video consults for new patient consults and follow up but there is clearly a limit to how much can be done with a patient requiring a procedure in the office. Oncology is another great example where tech can be very powerful, though, the in-person office visit is critical for many patients requiring complex lab work, infusion therapy, or radiation therapy.
What has happened is that as a society – and as a workforce – we had a shock that made us go digital-first as a requirement. The impact on travel and hospitality is immense with many companies experiencing a drop in sales and volume of 80-90% from last year. Other industries like entertainment and media experienced a shock as theaters remained empty despite attempts to reopen. The reaction from the movie producers was to experiment with on-demand, direct-to-home and digital-first strategies. Of course some have also decided they plan to “wait it out” until they can return to the traditional model of releasing content on their terms, not the customer.
Something similar is playing out in health care. The system was forced to go remote – and digital – fast. While the total economic impact of COVID-19 to the pharma industry remains to be seen, in terms of sales impact this year, the good news is that it’s clear that health care is front and center and will remain so for the foreseeable future. Patients know they need to remain healthy – or get healthy – to avoid possible complications if they happen to be exposed and infected with COVID-19 (or any other seasonal virus).
Pharma is also in a unique position in that innovative therapies to treat and stop the future impact of COVID-19 on a global scale will be created by the pharma and biotech industry. We have already seen the value of older therapies like dexamethasone reducing mortality and we get to see the rapid testing and use of truly innovative products such as those from Regeneron. In a world where therapeutics are the primary way to attack and control COVID-19, pharma is front and center – it is the solution.
In the end, digital-first was already a trend well underway the past decade. COVID-19 just served as a massive catalyst for providers, patients, and pharma to rapidly accelerate their use of digital platforms and to better understand where tech fits, and where it has limitations. Just as people become more capable – and comfortable – in a work from home environment, health care workers and pharma companies are also learning how we can maximize value and outcomes using technology to fill gaps where in-person communication and engagement may not be possible, or desired for reasons of convenience.