The ways in which HCPs consume information, make prescribing decisions, and run their practices has radically changed. For example, is a doctor using ChatGPT to summarize a clinical study a good thing because more of her fellow clinicians will likely read about the study, or is it bad because the summary itself will lack the nuances of the trial design and may mistakenly bury the key findings? Have pharma marketers kept up with these changes by using new approaches to their age-old challenges of getting attention, changing perceptions, and driving new behaviors?
Yet while industry pundits are making predictions every day about the massive impact of AI on clinical development and the practice of medicine, let’s review some other trends from the recent past that have quietly but profoundly changed how HCPs manage patients and their practices, make prescribing decisions, and respond to pharma marketing.
The Cost Conversation
There has been a fair amount written about this trend, but a pediatrician on stage at Publicis Health Media’s (PHM) 2024 HealthFront event brought this concept to life for me. Dr. Preeti Parikh said, “I’ve been practicing for over 15 years. When I started, cost conversations weren’t always top of mind. But now, in every patient encounter I have, we talk about cost. It has also become a bigger factor in my decisions about treatment plans. And I’ve seen a dramatic increase in the amount of time and energy my staff puts into prior authorization, pharmacy calls, calls between my colleagues and patients about other medications when they can’t afford them.”
Like many tasks already added to their workloads over the past decade, HCPs don’t really get paid to counsel patients on paying for their care, including prescription medications. Yet part of the reason they do it is to provide options for their patients beyond insurance like manufacturer copay programs or pharmacy discount cards that reduce out-of-pocket (OOP) costs and increase the chances that patients will actually pick up the drug at the pharmacy, take it as prescribed, and get their refills as needed.
HCP-as-Employee
The trend of ‘corporate medicine’ in which healthcare providers leave private practice to become employees continues to grow steadily. “As of 2012, fewer than 26% of physicians worked for hospitals or health systems.” In 2024, according to the Physicians Advocacy Institute, “nearly 78% of physicians are now employed by hospitals, health systems or other corporate entities” such as private equity firms and health insurers.
Corporate ownership can reduce autonomy for individual physicians, even experienced ones, by centrally deciding which tests to order, which treatment protocols to follow, and which treatments to prescribe. HCPs may be less willing to go out on a limb to advocate for a patient whose illness does not neatly fit into approved protocols, or whose insurance is inadequate for the required treatment.
Health IT: The Enforcer
Linked with the HCP-as-Employee trend are health IT platforms and software like electronic health records (EHR), e-prescribing, clinical decision support (CDS), and population health management tools. On the plus side, corporate ownership may mean that more HCPs have access to sophisticated, evidence-based tools that educate them about best practices and guide care decisions for a range of medical conditions, including some conditions they may not see very often.
Yet in addition to doing what they advertise, these tools often perform another important function for hospitals and large healthcare system administrators that employ physicians: they keep prescribers in line. These systems and their algorithms are the electronic enforcers of formularies and clinical protocols that help hospitals and health systems standardize evidence-based treatment, maximize contractual value with pharma companies, increase care coordination, and reduce their costs of care.
No amount of detailing, emails, or journal ads can change the fact that at the point of prescribing, your brand may be invisible.
For pharma marketers, this means that if your drug is not on the institutional formulary, it may be prevented from appearing as an e-prescribing option. No amount of detailing, emails, or journal ads can change the fact that at the point of prescribing, your brand may be invisible.
The Private Equity Effect
According to the Lown Institute, “private equity (PE) acquisitions in healthcare have exploded in the past decade. The number of private equity buyouts of physician practices increased six-fold from 2012-2021.” In addition to potentially large payouts, physicians who sell their practices to PE firms may also do it to offload their large administrative burden (staffing, insurance, debt collection, prior authorization, etc.) to the new owners.
And “at least 386 hospitals are now owned by private equity firms, comprising 30% of for-profit hospitals in the U.S.” Subsequently, the rate of “adverse events at PE-acquired hospitals compared to control hospitals increased by 25%,” possibly suggesting that PE firms may prioritize financial performance over the ‘quainter’ healthcare measures of success like patient safety, utilization, quality scores, and health outcomes.
Of course AI will continue to disrupt healthcare and pharma marketing in ways we cannot imagine. However, we mustn’t let that distract us from responding to other important trends that have already disrupted the way HCPs learn, think, act, care for patients, and earn a living.