Health systems will “call the shots” which demands an effective pharma key account management structure
The Kinetix Group recently hosted a health system and plan panel for the pharmaceutical industry focusing upon the future healthcare landscape and its impact on pharma. One panelist, Dr. Jerry Penso (Chief Medical and Quality Officer of AMGA* and President of the AMGA Foundation), identified the Medicare Access and CHIP Reauthorization Act (MACRA) legislation – now known as the Quality Payment Program – as a driver that will fundamentally change healthcare delivery in the CMS patient population. Dr. Penso stated that preparing for this program is the #1 priority of virtually the entire AMGA membership. Together with AMGA, TKG will be conducting a webcast focused on the Quality Payment Program’s impact on the life science industry – details to come.
What is the Quality Payment Program and why all the interest? There are two payment incentive tracks within the Quality Payment Program that will come into effect as of January 2019: APMs (Alternative Payment Models) and MIPS (Merit-Based Incentive Payment System), both oriented towards providers within health systems. As a result, an aggressive round of consolidation is expected over the next two years in preparation for both the upside and downside risk that will come from the Quality Payment Program. Currently, approximately 50% of physicians are employed by a health system. It is anticipated that this number will increase dramatically as consolidation accelerates.
Impact for industry: double down on health systems. A medical director from a large, national health plan stated, “He who owns risk will call the shots, and systems will own the risk.” Population health management will continue to evolve and emerge as the dominant health system care delivery model strategy which includes elements such as formulary management, patient registries, care management pathways and protocols, and patient activation and engagement. The health system governance will lead decision making with the plans providing less direct patient services: a whole new contracting format.
At the conclusion of our panel, questions from the audience centered on the who, how and what:
- Who should pharma be calling on within the health system setting?
- How can we engage leadership within health systems and what should we be discussing?
- What programs do we build around our products, including patient services?
For answers to these and other questions, contact TKG Vice President Merissa Oliver at moliver@thekinetixgroup.com. The Kinetix Group has leading B2B health system marketing leveraging our consulting business that has direct contracts with both payors and systems. We are the health system agency that has been developing and executing strategies and tactics on time and on budget for over 17 years.
*AMGA represents 450 health systems providing care to approximately one third of the US population