Merck’s Weight Management Business – A Patient Centered Model

The future of healthcare dictates that in order to survive, life science companies need to figure out ways to become more patient centric.  In a prior article, I equated patient centricity not with a patient-oriented digital strategy but with non-drug/device products or services that complement the therapies.  These business lines take into consideration such aspects as lifestyle, culture, accessibility and convenience with the goal of optimizing the therapies’ benefit and adherence.

Many companies in our industry are actively exploring means to redefine offerings and even their corporate identity so that they are viewed as providers of “solutions” rather than treatments.  No matter how much product manufacturers want to believe that a given therapy is the solution, research has kindly reminded us that a multifaceted approach is often required.   

One example of a company that has made the leap beyond therapy is Merck.  In December of 2013, Merck announced that they were launching a weight management business through the acquisition of Health Management Resources Corporation (HMR).   HMR is a 30 year old company which according to its website is backed by research and provides diet and activity counseling through clinic and web-based support.  Looking at Merck’s product portfolio which includes anti-diabetes, anti-hypertensive and lipid lowering agents and with the experimental agents for atherosclerosis and heart disease, this makes perfect sense.  

The direct correlation is well known between weight loss along with the required lifestyle changes, and the various parameters treated by these agents.  Therapies that treat such chronic conditions are more often than not, indicated along with diet and exercise.  However, adherence with diet and exercise is commonly poor which then results in poor control of metabolic parameters thus requiring an increase in medication dose. Patients may experience poor tolerability to the elevated dose and fail to adhere to therapy.   

Once more, this is why this business line makes perfect sense.  In essence, for diabetes and comparable conditions, Merck is offering an integrated plan which incorporates all elements of management.  Products such as Januvia lower blood glucose but effective diet and physical activity help to ensure success.  Even if there is such success that the patient can eventually wean off of the medication (which really should be the goal), Merck may still have a customer as weight maintenance should be a lifetime focus.

As expected with any novel endeavor, some in the industry did not know what to make of it.  The reception to Merck was in fact mixed with some indicating that it is a distraction from true innovation and others essentially dismissing it.  Additionally, as HMR is still considered a subsidiary and not branded as Merck it may not quite be considered an integrated solution.  It is a start though.

Snowfish will continue to follow Merck and others who are moving to a true patient-centered model.  Please check for our next article which features another interesting example of corporate and product redefinition.  

Mid-Level Providers: How Much Do You Know?

In honor of National Nurses Week, we thought it would be appropriate to showcase nurse practitioners (NP) as well as other mid-level providers.  For a growing number of patients, the clinician in the white lab coat taking their history, examining them, ordering tests, and prescribing their treatment will not be a physician, but an NP, physician assistant (PA), clinical nurse specialist (CNS), nurse midwife, or nurse anesthetist, also referred to as “mid-level providers.” In the U.S. NPs and PAs alone are already 150,000 strong. Outside the U.S., countries such as UK and Netherlands also utilize advance practice nurses such as NPs.

 

Yet, despite their growing role and influence, even the most sophisticated life science companies are not completely sure how to work with mid-level providers.  The result is lack of attention or the wrong types of engagement by industry.  Considering that mid-level providers can represent the upwards of 30% to 40% of the Rx volume for a given brand, a solid understanding of this stakeholder group is critical.

Below are some of the misperceptions that we have heard from top industry professionals with a shot of reality based on current information and a survey and interviews with over 400 hundred mid-level providers:

Misperception:  Mid-level providers always take direction from the physician when it comes to making a diagnosis.

Reality:  Of our respondents, 95% noted they make diagnoses independently of their collaborating physicians.

Misperception:  When writing a new prescription, mid-level providers will only prescribe what their collaborating doctor wants anyway.

Reality:  78% percentage of respondents indicated they independently decide which treatment to prescribe for their patients all or most of the time.

Misperception:  Mid-level providers don’t write that many prescriptions.

Reality:  More than 60% report writing at least 41 prescriptions per week with 45% of the sample noting at least 56 per week.  Other sources have cited well over that number.  In certain drug classes they represent billions of dollars in power.  For example, antibiotics, antihypertensives, antidiabetics, and psychiatric drugs are huge categories and they represent a significant overall sales volume.

Misperception:  All mid-level providers work directly with physicians and for NPs, a collaborative practice agreement means direct oversight.

Reality:  In the U.S., 18 states do not require a collaborative practice agreement between an NP and physician for NPs to practice.  Some states require a number of collaborative hours with a physician and then the NP can practice independently.  Connecticut has just passed a bill allowing such independence and a number of other states are on the verge.

In the majority of U.S. states where such an agreement is required, the level of oversight is quite variable.  This may range from working in the same office to NPs working off-site with the physician only reviewing a single chart every three months.  Therefore, even when working “collaboratively”, many mid-level providers are quite independent.

Misperception:  Industry in effectively engaging this key audience.

Reality:  There is little engagement strategy implemented specifically for mid-level providers.  According to our survey many in fact felt ignored by industry sales representative when a physician is available – noting that many representatives “visit with the physicians and not me”. In general, there seems to be a disconnect between their role and their perception of how they are being regarded by industry

Targeting the Mid-Level Practitioner:

Once we’ve demonstrated the importance of the mid-level provider, the basic question we often receive is can they be targeted by disease state and therapeutic area?  The simple answer is yes.  We have built very sophisticated and unique means to identify mid-level providers who are the most important to your disease state.    We have also created unique programs that are targeted to this very important audience.   As one respondent stated, the industry should “provide information, resources for us as equal healthcare providers”.

To learn more about this valuable opportunity, you can request two white papers that Snowfish has written on the topic:   In-Depth Analysis of the U.S. Mid-Level Practitioner Market and the Opportunity it Represents, and Mid-Level Practitioners Myths and Realities.