Healthcare system reform

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Scenario wherein the healthcare system is more integrated, shorter lines between pharma, medicine, insurance companies, which gives pharma incentive to focus more on market pull than technology push

Developments in time

2010-2015

At the beginning of 2009, the global economic environment was still in a major state of flux. The ever increasing cost of healthcare became one of the major issues in developed countries as well as developing world. In the United States, the actions of the Obama administration and Congress were committed to addressing healthcare issues as part of economic reform. The global economic slowdown sparked acceleration of reform in other countries as well, whether in the form of increasing government demands for price cuts, as in Germany and the U.K., or encouraged use of generics, as in Japan. Next to the governments, insurance companies started to take more significant role as the primary payer of the healthcare expenditure.

On the regulatory side, a major milestone opened the way to integration in the healthcare system. Sentinel system, initiated by the FDA’s at early 2005, was opened to pharmaceutical companies in 2011 to provide access to existing electronic health information, including claims data, emerging electronic health records, and diagnostic databases. The primary aim of the FDA was using these databases to monitor the safety of drugs and devices, and the Sentinel database was also likely to support Phase IV post-marketing studies and surveillance. In Europe a similar initiative was taken in a number of countries, like the Netherlands passed legislation in 2008 for a system called Aorta (Electronic Patient File, EPD) see [[1]] (in Dutch), Sweden and Belgium [[2]]. After those individual country initiatives, European Union passed Europe-wide legislation and allowed controlled sharing of electronic health care information by 2013.

2015-2020

As one of the most innovative industry, ICT industry saw those developments as an opportunity and moved quickly to capitalize this new market opportunity. Two of the biggest ICT giants Microsoft and Google has both launched their respective services where health and fitness information of the individuals can be stored online. While those services were targeting private individuals to manage and control their personal health, they also formed potential secondary information source for pharmaceutical industry next to the Sentinel (US) and Aorta (NL) government databases. While government systems were providing information related to health incidents, hospitalization, treatments, claims etc, those public ICT services focused beyond hospital and insurance records and collected broader data about daily life of the people in which Pharmaceutical companies later found vast valuable information for potential new drug development. Due to the sensitivity of the information, ICT and Pharmaceutical industry had to wait till end of 2018 where new legislation allowed controlled sharing of the information collected by those private services.

2020-2025

By 2020, development in the past decade created the suitable environment for the pharmaceuticals companies to overcome major challenges of their industry, namely, financial pressure both from insurance companies for the cost reduction and drying R&D pipelines. In 2021, Pfizer, Microsoft, UnitedHealth , WellPoint (two of the top health insurance providers in US) came together to form a joint venture firm in order to gain “first mover” advantage in what they by then perceived was “the way forward” for the health bio-economy. The new business model enabled integration of the commercial and development sides of the pharma business to ensure the commercial relevance of scientific and clinical innovation. In the first joint venture, UnitedHealth and Wellpoint reviewed R&D pipeline of Pfizer and prioritized the projects based on their potential value to the total healthcare system. In return, Pfizer enjoyed support of insurance companies in the marketing of the products to the market. The data from Sentinel system combined with Microsoft Vault system gave Pfizer the opportunity to increase success ratio of clinical trials and to decrease drug development lifecycle from 10-15 years to as low as 5 years.

This commercial initiative set the success model for the new coordinated mode of operation which became known as Networked Health Care (NHC). By 2025, 6 of 10 biggest pharmaceutical companies in US formed similar joint operations. The pharmaceutical industry mainly moved from the heavy “push model” to market pull model where their primary customer definition is extended from only physicians to include also non-physician customers such as insurance companies, pharmacies, and patients..