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Market Access Strategic Execution Consultant

I’m Difficulty For Difficulty

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I'm Difficulty For Difficulty

Katherine May’s book Wintering: The Power of Rest and Retreat in Difficult Times has become the unofficial Covid book as it has given strength to many who are struggling in the face of the pandemic.

An excerpt from the book:

‘Plants and animals don’t fight the winter; they don’t pretend it’s not happening and attempt to carry on living the same lives that they lived in the summer. They prepare. They adapt. They perform extraordinary acts of metamorphosis to get them through. Winter is a time of withdrawing from the world, maximising scant resources, carrying out acts of brutal efficiency and vanishing from sight; but that’s where the transformation occurs. Winter is not the death of the life cycle, but its crucible.’

There are difficult parts of our job that we sometimes wish didn’t exist: 3 deadlines back-to-back; Client meeting with the team leader unable to attend; work in a new therapeutic area; working with someone whose standard answer is ‘no’ to all requests; working for a difficult Client.

How do we react during those difficult times?

Do we fall flat on our faces and accept defeat? Feel self-pity and dream of escaping to a beach? Or roll up our sleeves and get to work?

Marketing is not just for the account managers or account VPs. EVERY single person on the team plays the critical role of a marketer because EVERY single part of our work (even the meetings and the work itself) is a form of marketing.

Pandurang Shastri Athavale explains that Chapter 2 Verse 40 of the Bhagavad Gita means: ‘there is no such thing as difficulty. Because I’m difficulty for difficulty.’

The Market Is Beginning To Side-Step Payers

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The Market Is Beginning to Side-Step Payers

Adam Fein published an interesting article today about how GoodRx’s discount card business is allowing PBMs to side-step managed care organizations, avoiding having to pay pass through payments.

In short, consumers can use discount cards, such as GoodRx, to save money on prescription drugs at the pharmacy. When they use GoodRx, they’re benefitting from a PBM’s network rate that they’re not even paying premium for. PBMs whose network rates are utilized through GoodRx are not obligated to pass through the manufacturer rebates to plan sponsors and can keep that money for themselves. It is important to note that 70% of GoodRx’s consumers already have commercial or Medicare Part D insurance, which they’re deciding not to use because GoodRx will save them more money.

Is the value of managed care organizations being questioned?

Reading this reminded me of something that I had read earlier this month by Fast Company. Providers (just like patients in the GoodRx example above) are finding ways to side-step insurers. Concierge practices promise more provider-patient time and more comprehensive health care for an annual membership fee in ADDITION to health insurance. Direct primary care goes a step beyond that by requiring monthly fees and with NO regard to insurance coverage.

Is the value of managed care organizations being questioned?

This is just the beginning. Managed care organizations cannot be completely done away with just yet. Just like colleges and universities can’t be done away with—yet. But changes are happening.

A rip has been made and the seam is ready to be opened.

I’m not rooting for or slamming any single party. I am, however, rooting for whoever is actually in the business of benefiting patients. And there ARE gems among manufacturers, payers, and providers who are honestly showing up for patients.

What’s important is: How will I benefit patients with [[heart failure]] today? What did I do this week to give patients with [[Medicaid coverage]] hope? Why did God give me this position? By the way, those who don’t ask why they have this will have no right to ask why it was taken away.

I need to ask myself these questions, as do you. Irrespective of your level in the food chain.

Experiment Like Amazon

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Experiment Like Amazon

Today STAT published a story about Amazon officially starting its ascent to the national telehealth stage — and its nationwide expansion is putting the rest of the telemedicine industry on notice.

AP provides more details.

This topic is interesting and relevant to market access in SO many ways.

Besides the fact that Amazon is disrupting the health care system right before our very own eyes, it’s important to appreciate the company’s willingness to experiment.

Amazon partnered with Berkshire Hathaway and JPMorgan Chase 3 years ago to solve America’s problem of high-cost health care system. This sent shock waves throughout the world of health care.

Then, in January 2021 we learned that this joint venture, called Haven, was disbanding and the stakeholders would individually continue to push forward in their efforts. While some considered this venture a failure, the news today suggests otherwise.

Today, we see what Amazon had been up to. I imagine that this is just the beginning.

Ironically, Fast Company wrote about experimentation today itself. The article asserts that leaders should democratize experimentation because their teams are bursting with untapped ideas. They just need tools and the authority to help drive continuous innovation.

It is no exaggeration to say that the fate of the world hangs on experimentation.

If we open our eyes, we’re surrounded by problems. How can we solve them? How can we measure the effectiveness of our proposed solutions? What would change if we decided to avoid experimentation and live with the status quo? Who would step up if we didn’t vote ourselves for this experiment?

What’s the Worst That Could Happen?

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What's the Worst That Could Happen?

Today I was reminded of an experiment by Professor Carol Dweck of Stanford University. This experiment is also narrated in Douglas Stone and Sheila Heen’s book Thanks for the Feedback.

When we fail, do we go back into the shadow OR assert, ‘I haven’t succeeded YET’?

Dweck brought children to her lab and had them engage with progressively tougher puzzles. As the puzzles got more challenging, about half of the kids grew frustrated, disengaged, and finally gave up.

The other half kept going.

  • Fixed mindset: The ones who gave up quicker did so out of discouragement, impatience, and embarrassment. They enjoyed the puzzles that made them look smart, but decided to quit as the puzzles made them feel dumb.
  • Growth mindset: In contrast, the kids who persisted viewed the tough puzzles as fun games that challenged them to improve. They didn’t even think they were failing—they thought they were learning.

Dweck noticed that the progression through the puzzles had little to do with interest or aptitude, and more to do with the OUTLOOK.

So many times throughout the day, I notice ourselves (including me) shy away because we’re afraid to look bad.

We’re afraid to speak up in meetings, try a new approach, ask for a raise, apply for a new position, or say our names in the Indian accent (still work-in-progress for me). What learning opportunity did we just lose when we did that? What would it look like if we side-stepped our fear of looking dumb and just did it? What’s the worst that could happen?

Intentional Focus

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Intentional Focus

Hold a magnifying glass between the sun and a tinder. You’ll notice a small, bright dot appears on the tinder. Tilt the magnifying glass back and forth to change the dot’s size. This will eventually create enough heat to start a flame.

The magnifying glass was able to focus the dispersed light rays of the sun onto a single spot, creating focused and intense energy that could ignite something.

There is beauty in simplicity. As Nancy Duarte states in her book Slide:ology: ‘Keep it simple. Save the decorations for the holidays.’ The extras actually TAKE AWAY meaning because they become a distraction.

I believe that this design concept can be applied in many contexts: meetings, content development, communicating a project to the team at-large, your day/week/month/year/life, and the list goes on.

What are the 3-5 main points your audience needs to know in order to get the joke?

This is why I always start with an outline. I make sure I get buy-in from all stakeholders on the outline before proceeding to make my art (I call ‘art’ what what others call a ‘deck,’ ‘brochure,’ or ‘dossier’).

How do you ensure that your craft remains focused?

What Business Are We Really In?

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What Business Are We Really In?

Today, Fast Company published an article that absolutely blew my mind. Comunidad Partners, a real estate investment firm that buys apartment communities, renovates them, and manages them, offers its tenants free telehealth services.

Comunidad Partners and its strategic partner, Veritas, has partnered with a Fortune 500 health care provider (they won’t reveal who) for a telehealth contract because they believe that people don’t have to rely on a job to receive health care services. A real estate firm has partnered with a health care provider that otherwise engages with employers only.

At the core of Comunidad Partners is its mission of delivering enhanced multifamily living by providing more than just a home but a LIFESTYLE.

When I read about this, I was reminded of Chipotle who recently launched a makeup collection inspired by ingredients like guacamole and salsa.

We fall in love with what we think we do, instead of what the market wants us to do. Book publishers aren’t in the paper business, any more than Penn Central was in the train business.

What business are we really in? What business does the market want us to be in?

Remember to Get That Marketing Myopia Checked Out​

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Remember to Get That Marketing Myopia Checked Out​

Market access brainstorm sessions typically gyrate around strategic objectives such as:

  • “Our goal is to achieve parity”
  • “The strategic objective for this year is to defend access”

This is the fatal trap of marketing myopia. Market access teams often treat their asset as their own child and customers’ needs as a stepchild. This backfires on the business as the stepchild always turns out to be the Cinderella of the story.

To put it a different way, Harvard Business School Professor Theodore Levitt said “people don’t want to buy a quarter-inch drill. They want a quarter-inch hole!”

If you’re looking to influence payers’ and PBMs’ utilization management strategies, understand why it’s important for THEM. Hint: the cop-out answer would be “they need to save money.”

Today, Harvard Business Review published an interesting article on Profit Segmentation. A sophisticated payer or PBM would categorize its beneficiaries into 3 buckets: Profit Peaks, Profit Drains, and Profit Deserts. Profit Peaks are the high-profit customers (typically about 20% of the customers that generate 150% of their profits). Profit Drains are high-revenue, low-profit/loss customers (typically about 30% of the customers that erode about 50% of these profits). Finally, Profit Deserts are the low-revenue, low-profit customers that produce minimal profit but consume about 50% of the company’s resources.

Benefit designs can be effective tools for payers to solve the problem for Profit Drains. Most of the Profit Drains’ problems are fixable, but they require teams that are expert at changing the cost to serve by managing the relationship with these beneficiaries. Fortunately, in most cases, the beneficiaries receive a parallel reduction in their own cost.

For example, if a patient on a statin visits a clinic for muscle pain, it’s just as costly for him as it is for the payer. Therefore, implementing the right order pattern (i.e. benefit design) is a win-win that often converts Profit Drain customers to Profit Peaks.

What would a reasonable change-in-order pattern look like for this patient? If you were responsible for the payer strategy for a statin competitor, how would you encourage payers and PBMs to convert the target population from Profit Drains to Profit Peaks?

Deloitte pointed out that 70% of launches fail by missing expectations at launch. Could marketing myopia be the culprit?

In the famous words of Seth Godin, “when you shine a light, both of you can see better.”

We Get a Chance to Begin

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We Get a Chance to Begin

Today was my Commencement from Seth Godin’s altMBA workshop. I started it 4 weeks ago in the spirit of professional development. To put it lightly, this workshop transcended professional development and into personal metamorphosis.

In short, the altMBA program is a 4-week workshop that promises the experience of a 2-year MBA program. There are no tests and no lectures. It’s one of those things where you get what you put into it—and it requires tremendous amount of emotional labor.

My biggest revelation from this experience has been that I had, in a way, put a snuffer on my spark by keeping my enthusiasm and passion from my colleagues. For me, passion and purpose for my work comes from spirituality—which I had somehow compartmentalized out of my professional engagements. What I have come to truly understand now is what Einstein stated in 1940: ‘Science without religion is lame.’

Now for a personal story: 3Q2020 was the most successful quarter yet for my consulting business. For 2 months (October and November), I worked 70-80 hours/week, with most work happening after 9pm. Thanks to the pandemic, both of my little ones were at home, so I took care of them during the daytime so that my husband could attend his meetings during business hours. I didn’t know when the schools would re-open or when the work would die down (basically, there was no end in sight). Although I was tired throughout these 2 months, I was stress-free, happy, and left everyone around me delighted: my clients, kids, husband, and myself. What kept me going during this trying time? After all, there is no amount of money you could’ve paid me to create slides on p-values at 2am when everyone else is sound asleep—day after day. To willfully take up struggles beyond all reason requires a higher purpose.

For me, I take my career AS seriously as family and spirituality. The reason is: WHAT I HAVE IS GOD’S GIFT TO ME; WHAT I DO WITH IT IS MY GIFT TO GOD.

The funny thing is…none of this was taught in the altMBA. What it did provide, however, was the space to experiment with my baseline ideas and a supportive network to tell me like it was.

Seth Godin himself showed up at the Commencement to share some insightful thoughts:

  • Change can be done to us or by us. If it’s done by us, then we get to do the work that we’re proud of.
  • Given the injustice, illness, and trauma in our society, we can think our way out of this by WORKING our way out of this.
  • Commencement is not the end, but it’s actually the beginning. Go forward because you can’t step in the same river twice. Now what do we do with it? We get a chance to begin.
  • Go make a ruckus everybody. The work matters.

I would love to hear from you! What keeps you going during trying times in your career? What give you the spark?

Most Outpatient Practices Have Adapted to The New Normal—But Not Pediatrics

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Most Outpatient Practices Have Adapted to The New Normal—But Not Pediatrics

Data from The Commonwealth Fund offers a glimmer of hope as it suggests outpatient care has finally rebounded during the pandemic. As a matter of fact, weekly visits to certain specialists, such as rheumatologists and oncologists, exceeded the pre-pandemic baseline.

Pediatrics seem to be the exception to this—by far. In December 2020, there were 24% fewer pediatric visits (whether telehealth or in-person) compared to December 2019, making it the worst-hit outpatient specialty right now.

The American Academy of Pediatrics is specifically trying to push for more wellness visits.

Why are parents foregoing wellness visits?

I’m interested to know the top 3 reasons why kids aren’t coming in for visits. I’m eagerly waiting to hear back from the researchers of Commonwealth Fund study with the answer.

In the meantime, here are possible reasons:

  • The Institute for Child Success suggests that this declining trend may be due to the overall trend of slow increase in Medicaid patients returning for doctor visits. According to Kaiser Family Foundation, 37.5% of pediatric population was covered by Medicaid in 2019. I imagine that this number is much larger right now. 
  • The Institute for Child Success also points out that there has been a rise in child abuse/trauma during the pandemic.
  • Record number of mothers are leaving the workforce due to burnout.
  • The Primary Care Collaborative suggests that practices that weren’t able to weather the pandemic were shut down.

At the professional level, it’s hard for market access strategists to act on this problem without knowing its largest contributors.

At a human level, however, there is something each of us can do. There’s no question that this pandemic has been hard on all of us. We all could benefit from seeing others and being seen. It’s called Sawubona.

Try to catch someone doing something right–then call them out on it. Do this 3 times everyday for the next 1 month. Notice what happens to your conversations. Notice what happens to you.

Whereas blaming undoes us, the posture of good-finding nourishes us. Try it.

Who Is This Really For?

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Who Is This Really For?

On the same day, both Harvard Business Review and Adam Fein exposed the reality of consolidation within the health care system.

Harvard Business Review predicts that the pandemic will speed up this process. “Given the financial difficulty that many providers have suffered during the pandemic, this trend is likely to continue, reducing competition and increasing prices.”

It seems like the big players are riding the wave (for now, at least).

What I’m wondering is: is this the ultimate truth (big guys get to have all the fun), or is this the perfect opportunity for a new guy (not necessarily little—just new) to creep in and make it reign?

Scott Galloway points out that our health care industry is the industry with the lowest net promoter score (basically, it’s a broken system—as if we needed someone to tell us this). Therefore, the health care industry is ripe for incumbents to be replaced by newcomers.

Generally speaking, smaller companies are more nimble than larger companies. Will the sheer size of a large conglomeration inhibit itself to react/adjust to the borderline-prophetic Great Dispersion as suggested by Scott Galloway? This could very well be the perfect opportunity for a newcomer who wants to eat the pie (not just a slice…but all of it).

To put all of this in a different way, here are 2 questions: (1) Who is this [the vertical and horizontal integrations] for? (2) Who will this be for? Hint: many people have the answer to the first question; the second question cannot be Googled.

To put all of this in a 3rd way: Seth Godin says, ’empathy is at the heart of design.’

Krishna Patel, PharmD
Market Access Strategy and Execution Consultant
info@sojusllc.com
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