Sander Flaum, the grand master of pharmaceutical marketing asks, “If you put the world’s top CEOs together in a room and asked them what challenges kept them up at night, what do you think you’d hear?”
The answer is shocking if not surprising/
According to the Conference Board’s CEO Challenge 2011 Survey – Fueling Business Growth with Innovation and Talent Development, most CEOs in the U.S. and Europe listed Business Growth as their top challenge.
According to Flaum there’s an even bigger concern. “Look down the list of the top challenges. Where did these leaders consistently rank Innovation? #3! And guess what U.S. CEOs collectively viewed as an even more pressing challenge than the need for innovation– Government Regulation!”
Flaum continues, “A CEO who is more worried about being handcuffed by regulations than coming up with the next big idea needs a priority readjustment. Sure, regulations can be a pain. But they can also be simply an excuse for failure. In Pharma, we’re always contending with the FDA in the struggle to bring innovations to market. And it’s not easy. But doesn’t the need for Innovation come first? If we don’t have something new and important to bring to market, then why complain about the regs?
Top 5 Global Challenges by Region
Rank | U.S. | Europe | Asia |
1 | Business Growth | Business Growth | Talent |
2 | Government Regulation | Cost Optimization | Business Growth |
3 | Innovation | Innovation | Innovation |
4 | Talent Cost Optimization (tied) | Customer Relationships | Corporate/Brand Reputation |
5 |
| Government Regulation | Sustainability |
Wither innovation? This crucial question becomes even more problematic when you consider the issue of “disinvestment” -- the processes of (partially or completely) withdrawing health resources from existing healthcare practices, procedures, technologies, or pharmaceuticals that are deemed to deliver little or no health gain for their cost, and thus do not represent efficient health resource allocation. “Disinvestment” is a more honest (and frightening) term for “comparative effectiveness.”
And leading the disinvestment charge (not surprisingly) is NICE.
Over the past 10 years NICE has identified over 800 clinical interventions for potential disinvestment. But, in the July 27th edition of the British Medical Journal, Sarah Garner and Peter Littlejohns (both of NICE) report that although disinvestment will increase the opportunity for cash saving is unlikely to provide ways of controlling costs without cutting quality of care.
The authors write:
There is general agreement that stretched health services budgets should not be used to fund low value services. However international experience has shown that identifying and removing those services can be problematic and controversial.
Are you listening AHRQ?
Many suggestions for total disinvestment are based on a “social judgment” about whether it is appropriate for the NHS to fund the intervention rather than evidence of poor clinical or cost effectiveness. Others relate to “experimental” use of technologies outside their indications and evidence base.
Are you listening Dr. Berwick?
Opponents of a total disinvestment approach highlight the methodological flaws of using average estimates of effect drawn from populations; they argue that an intervention may be beneficial for an individual patient and should be an option, even if a last resort. An alternative strategy is optimal targeting: identifying subgroups in which an intervention is most clinically and cost effective.
Are you listening Dr. Pazdur?
Disinvestment is part of a broader agenda to improve efficiency and quality focusing on public health and prevention and ensuring that patients receive the right care at the right time in the right way.
Are you listening PCORI?
Although this approach releases resources in the long term, it may entail investment in the short term. It is very important to make the distinction between improving the efficiency of care and saving money.
Aha!
Without data, it is also difficult to identify the subgroups necessary to fully understand variation in care and therefore determine realistic potential savings.
Did somebody say “personalized medicine?” Did somebody say, “more and more targeted molecular diagnostics?”
The author’s conclude, “However, current evidence suggests that disinvestment is unlikely to achieve the huge savings required to meet tightened NHS budgets.”
We would be wise to learn from honesty of our transatlantic cousins.
