The enormous hospital system and The Biosphere 2 Strategy
What we have today is a large number of enormous health systems. Those systems might have been the ‘community chest or charity type organizations,” but are today billions of dollars. Bush cited Methodist or Ascension Health as examples. These systems now include “enormous numbers of previously independent and currently independent-minded physicians.” I like the fact that he is thinking of physician behavior and culture.
What are they up to? Bush says lovingly of his large clients they are up to the Biosphere 2 Strategy. “They are basically saying, I am going to have my own ocean, make my own babies, have my own men and women from my own gene pools and I am going to have all these things and… I am going to go inside…” Bush is referring to the actual Biosphere 2, financed by billionaire Ed Bass, in which a group of male and female scientists were to seal themselves inside for two years without any contact with the outside world. They were to grow their own food, live peacefully together. Although, to my recollection, there were several times in which the outside world had to intervene—for oxygen, to kill off an ant invasion etc., the thing that rocked the cage so to speak was that two of the scientists became involved in an affair and were thrown out for being disruptive. Ed Bass had federal marshals called in, the ocean died, research failed, and that is the end of Biosphere 2. It went through ownership by Columbia University and in 2011, according to my research, the University of Arizona picked it up.
According to Bush, these enormous systems are faced with a similar dilemma. “Hospitals are realizing that they actually can’t produce enough sick people by buying up primary care doctors to do this so they’re sort of struggling with ‘How am I going to expand the number of patients that I touch this hospital with?’
“What they are doing is forming a risk bearing entities…integrated marketing and financing or pricing efforts to equip themselves to profit from savings …to profit to getting more people covered over the fixed cost they carry. You see the actual number of ACOs go up but these are the actual Medicare enrolled ACOs that get 50 % of the savings that they generate…a legal kickback from Medicare. There are also others…in Massachusetts, every single life is now covered under an alternative quality contract and I believe Alabama or Arkansas (should never confuse those two)…but one of those states has now required that every single contract in the state be that way. You have seen an enormous increase in capitation children… various forms of ‘you will profit from reducing the cost intensity of an individual patient.’ You have seen an explosion in marketing efforts by health systems to try and to get to more patients and an explosion in accountable care efforts to get smarter about reducing hospital days. So all of a sudden, after all of these years of being the subject of a fund raiser, the one inviolable good guy in the healthcare system—the hospital day has become the essentially Public Enemy No 1.”
The Jonathan Bush Organizing Principle for Pharma: “Organize every cure ever invented and define it in terms of the number of hospital days it could kill.”
Bush asked the pharma marketers in the room to not only focus on hospital days, but on hospital stay. Here is the three-step process he admonished the community to take:
- Take every drug you have and organize it by disease by the number of hospital days that could go away. “Find the moments that matter financially and clinically.”
- Jump into the moment of care with a cure. “There is more than one definition of the ‘cure’.” At this point, armed with a true understanding of hospital stay, pharma can market directly to the “biospheres”…the same systems that are shutting down the ability to go doctor by doctor, the gatekeepers. Bush says what once was your enemy, will become your friend.
- Follow up on the prescriptions that are written and make sure the patients get those drugs but also ‘don’t end up in the hospital.” “Relentlessly follow up on all conditions for success,” said Bush.
Bush Proposes Sponsoring the Medical Home Outreach Program
According to Bush, athenahealth has a ‘higher percentage of patients connecting to our clients online than anyone else…much higher that Kaiser…which used to be number one at this.” What’s in the secret sauce?
- Pharma can sponsor a medical home program with any doctor that wants it or with any biosphere that wants it. Using Athena’s ability to bring the right pathway to the physician and his/her patient, and to get the patient to do the thing the patient is supposed to do, pharma can activate being at the right time and at the right moment…with a cure. Find help with analyzing the hospital stay, it could be athenahealth, it could be others.
- Jonathan says that pharma’s marketing style to physicians and to consumers is the turn off. The experience of Epocrates is 12 pt. font. Simple. Essential. Relentless. “Think of advertising on NPR…you are extremely constrained on what you can do and say on NPR but the impact it makes when you just get down to the facts and cut all the fluff is higher in some audiences.” To be clear, athenahealth advertises on NPR. Physicians have learned to deconstruct, then reconstruct for a living. “It is deconstruction discipline.”
- Bush believes that pharma can serve the doctor by knowing how the drug works. Pharma can knows this too–not just that it works, but in what population and how it works best. Pharma can know the hospitals days and stay, the deflection point, so to speak.
- athenahealth has the cloud and the technology. They are able to pop up on the doctor’s portal, powered by athenahealth and have the physician message the patient as they pass a Walgreens…even if they filled a prescription at CVS last week. Remember, athenahealth is going to get to that patient no matter what depends on it. That is their business model.
- Lastly, Bush praised pharma for their clinical trials. Too bad they don’t resemble real life. “Of course as soon as your drug is legal, well then of course everything else is in play…the smog, the stress, the location, the fashion…everything is now part of whether your drug works.” Therein is the market opportunity in “working the way in which drugs are fit into real life and so you become a welcome sponsor again.” He said, ‘if this doesn’t work, if you’ve eaten already, if this doesn’t work if you miss a dose, if this works better if you cut down on animal facts, you (pharma) are in play for that.” This is where pharma can excel. “The more you can do to wrap real life around your drug, make your cure actually cure, the more you can point to hospital days that went away, the more those biospheres will actually be your accelerator, not your preventer.”
Pharma marketers are taking a new wave of “beyond the pill” marketing solutions into healthcare. Is this really new? In 1999 when I was one of the first employee’s at CareInsite during pre-acquisition of WebMD for the Marty Wygod team, we were planning many pharma-sponsored interventions on PDAs and PCs for physicians. These ideas have been around awhile, but according to Bush, the cloud is creating new opportunities. I think it’s time we stopped using marketing buzz words to describe what pharma needs most. What pharma needs most, according to Bush, is a sustainable business model that pulls “the good thing through.”
Lois Drapin, MPS-H.S.A. is a digital health correspondent for HIT Consultant and the founder of New York-based The Drapin Group LLC, a boutique advisory and consulting firm with a relentless passion for digital/mobile health technology.