In the world of modern healthcare The Big Question is ‘How are we going to thrive?’ The key to thriving is to take control rather than simply react to the changing environment, so we have to look ahead to the future of our industry, its direction of travel and its potential destination. 

We are in the middle of a huge upheaval where everything we know is being turned on its head. Welcome to the world of modern healthcare: a state of continuous change. This is a major challenge for all stakeholders involved in healthcare, including the pharmaceutical industry. Competition is increasing and profits are being squeezed, while resources are increasingly expensive. Meanwhile the expectations for what it takes for a product to reach the market and be successful are higher than ever.   

But the question must be not simply ‘Can they survive?’ but ‘How are they going to thrive?’ The key to thriving is to take control rather than simply react to the changing environment, so we have to look ahead to the future of the health care delivery and pharmaceutical market , its direction of travel and its potential destination.   

First some historical context: the delivery of healthcare made huge strides forward in the 20th Century. This was led by major advances in three core areas: 
Health: Access to innovative medicines, surgery and anaesthetics, clean air and water 
Wealth: Minimum wage, employment opportunities, savings and pensions 
Society: Education, welfare and labour   

These developments have saved, extended and improved billions of lives. For example, in the UK average life expectancy rose from 49 years of age in 1900 to 79 in the year 2000. Over the same period, the percentage of GDP spent on health rose from one to nine 9 per cent. These are astonishing statistics and similar trends have been seen globally. However these advances have also brought issues of their own, as 20th century structures struggle to deal with 21st century problems: populations who are living longer, with chronic conditions and they have higher expectations for their health. To add to that challenge the healthcare world is changing faster than ever before. researchers identified 13 drivers of healthcare change grouped into four key categories:   
Appliance of Science Science and technology is fuelling a greater understanding of medical profile of the individual and its impact on their health   
Industry Squeeze The bar is being set higher for the industry on all levels: regulatory approval, demonstration of clinical cost effectiveness and requirements for trust and transparency   
New World Order The growth of populations and income in emerging markets is increasing economic power but also increasing issues of resource sustainability   
Wealth to burden of health The advances of the 20th century are leading to real issues now for care for the elderly and management and prevention of chronic disease   

This future world will emerge from the complex interaction of these thirteen drivers, and others, as yet unknown. What that future world looks like is dependent on which factors rise to the top of the pile and begin to predominate over and influence the others.   

Real-time wellness healthcare systems use new technological advances to maximise resource efficiency, and put much greater emphasis on preventing illness and managing existing conditions, rather than simply treating illness.

Though there are a variety of possibilities in a 50 year time horizon. Its manifestation globally will vary depending on the levels of income and growth in markets around the world but this more integrated, interdependent healthcare world in the future will require significantly more sophisticated marketing skills than have historically been employed in the pharmaceutical industry and greater emphasis on collaborative working with other corporations and healthcare bodies.   
A future model for pharma

There are two core areas that will define the future model for successful pharmaceutical companies. The first is the core competencies of pharma companies themselves. So what are pharmaceutical companies good at? In recent times the industry has been less successful at discovering innovative new molecules. Proof of this are the current pipelines of the top 20 companies, particularly if you consider how many molecules have been in-licensed. This core competency of discovery now lies as much with smaller, more innovative scientific research companies with whom the pharma industry partners successfully.   

Pharmaceutical companies are good at shaping late stage clinical trial programmes to meet regulatory requirements and bringing molecules to market. They also excel in commercialising those molecules and realising their patented lifetime value. They have the resources and infrastructure globally to effectively achieve these goals.   

The second area are the external drivers of change as discussed above; Appliance or Science, Industry Squeeze, New World Order and Wealth to Burden of Health. These drive a two tier world of high growth, low individual income countries and low growth, high individual income countries. Both tiers have a common unifying need for more cost effective healthcare, though for different reasons.   

What does an integrated world look like?

This is a world where pharma companies focus on getting molecules to market and commercialising them, and where new solutions are developed in long-term partnership with smaller, more innovative research organisations. In this world, pharma companies facilitate capture of real time patient data from in home and mobile monitoring systems, and this is used to predict and proactively manage the health outcomes of patients.   

This could allow regulatory organisations to lower market access hurdles because of the ability to continuously monitor in-market, and for the benefits of real time management to increase the efficiency of healthcare. Pharmaceutical companies have partnered with software companies like Microsoft, Google and IBM to make integrated healthcare a reality and to share scientific knowledge openly to improve health for all.   

In this world, patients can purchase service packages to support their treatment regimens based on their personal preferences, thereby creating new revenue streams. They also feel greater affinity for pharmaceutical corporate brands as they receive relevant feedback on their health and advice and support on how to manage their conditions.   

Communications must be integrated

Integrated communications that can be used in real time will play a key role in communications with healthcare professionals and patients. The rise of social media and the use of video as a learning medium mean that communications will need to be more flexible and responsive to anticipate customer preferences. This will also mean that pharma will need to rethink its promotional approval processes to meet these needs. In the future, there will not be the luxury of lengthy multiple person processes.    

Many people will think “that is impossible” or “we can’t do that” and in the context of current regulatory and legal frameworks, they are probably right. For too long the industry has been too passive and accepting of the regulatory, clinical and structural status quo. We must be far more active in creating new approaches. Other industries are far more adept at shaping the future – companies such as Microsoft, Google and IBM are all engaging in the future of healthcare. You can spot the market leaders of tomorrow in an industry by those who are shaping that future today. Where are the voices of global pharmaceutical companies in that future?  Perhaps words like “can’t” and “impossible” should be removed from the pharma lexicon and replaced with “what if we” and ‘how could we..’. That might enable us to shape the future we want to thrive in. 

By 2020 the current role of the pharmaceutical industry’s sales and marketing workforce will be replaced by a new model as the industry shifts from a mass-market to a target-market approach to increase revenue.

This report highlights the fundamental dynamics the industry faces that are reshaping the pharmaceutical marketplace:

• Chronic disease is soaring
• Healthcare policy makers and payers are increasingly mandating what doctors can prescribe
• Pay-for-performance is on the rise
• The boundaries between different forms of healthcare are blurring
• The markets of the developing world, where demand for medicines is likely to grow most rapidly over the next 13 years, are highly varied
• Governments are beginning to focus on prevention rather than treatment
• Regulators are becoming more risk-averse

In order to be successful, companies will need to stop the aggressive marketing focusing only on the product of the current model and:

• Recognise the interdependence of the payer, provider and pharmaceutical value chains
• Invest in developing medicines the market wants to buy
• Adopt a more flexible approach to pricing
• Develop plans for marketing and selling specialist therapies
• Manage multi-country launches and live licensing
• Form a web of alliances to offer supporting services
• Create cultures that are suitable for marketing specialist healthcare packages
• Develop marketing and sales functions that are fit for the future and a knowledge based commercial organisation

Thank you for reading.

Steve Ramsey, PhD- Public Health.

Calgary, Canada.