Innovating Outside the Boundary of the Profitable Patient

The border between the profitable patient and the healthy human

We often talk about the customer trifecta in life sciences: the provider, the payer, and the patient. At the core, all three want the patient to be a healthy person with a decent quality of life. But friction does inevitably arise; a healthy person is not necessarily a profitable patient. For example, in theory, pharma companies care about the well-being of people, but by design they want the appropriate person who is ill to be diagnosed and treated with their products. It is how they make money. Thus, a healthy person is not necessarily a profitable patient for a pharma company.

This statement is not intended to make pharma companies the “bad guy” within the healthcare ecosystem. On the contrary, they offer protective, restorative, and lifesaving treatments which indeed lead to healthier people and a healthier society. The intent, instead, is to identify innovative approaches to reduce friction between profitable patients and healthy humans. If pharma companies want to prioritize true human-centric innovation around prospective patients, then leaders in this space must think about the human health journey more holistically.  

Being out of bounds – and why pharma companies should care

 After a routine annual examination and review of blood work, a person is causally left a voice message from their doctor’s office: “Your blood work came back fine overall, and your FBS is 100.” This person is now on the cusp of prediabetes. But the provider does not necessarily want to see them again, as they need to focus on more pressing patients. The payer certainly does not want to pay for more visits or tests at this stage and branded medication from a pharma company is not typically used to help in this situation. In other words, it is not profitable to help this human being be healthier at this stage. This person is out-of-bounds. They should absolutely take personal accountability by making healthier lifestyle choices – taking the doctor's advice to eat healthier, leveraging discounts offered by the payer on gym membership to become more active, etc. If the person does improve their health without progressing to need medical treatment for diabetes, this healthy human is not a profitable patient for a pharma company.

So, why should a pharma company care? Because in this example there are more than 350 million individuals who are in the same position and could represent a new revenue stream, as well as improve human health, helping remove the friction between profit and people.

Innovating with allies to complete the jobs-to-be-done

 Pharma companies have more data than ever and have been leveraging design thinking techniques like patient journey mapping for some time. Often those journeys and that data look at how someone moves from pre-diagnosis to diagnosis to treatment. But that approach does not consider what the person is really trying to do: avoid needing treatment. Leveraging a “jobs-to-be-done” innovation approach can help a pharma company shift focus and solve for the person, even if they never become a patient. What if pharma companies could partner differently with payers who are more profitable when people do not progress through the journey to illness and treatment? What if pharma companies could leverage the scale of big tech instead of competing against it? What if pharma companies could support doctors better by helping ensure their patients apply the healthy lifestyle advice they provide? And what if they could still generate revenue whether or not a person needs to use medication as a treatment?

Digital health can helps transform the ecosystem

Leveraging “jobs-to-be-done” thinking, here is one thought on how we might reconcile a person’s desire to avoid illness and treatment while creating a new source of revenue for pharma companies at the same time. It starts by addressing the portion of the jobs-to-be-done that is not currently addressed with medication, i.e., the person that is going to do whatever they can to stay healthy and not become a patient. In this example – leveraging pre-pre-diabetes as a trigger at, say, a fasting blood sugar (FBS) of 75 to 100 – pharma companies could provide health subscriptions to doctors to offer patients or even to patients directly with the intent of helping prevent diabetes altogether. The subscription could contain any number of bundled brand-name products and services aligned to maintaining a healthier lifestyle, such as WeightWatchers for diet, a Planet Fitness membership for exercise, Fitbit (now part of Google) for tracking, Calm to help stop smoking, health and wellness programming from Amazon Prime, etc. Leveraging brand names helps reduce the trust barrier which exist between people and the pharma company. Nevertheless, the pharma company behind the subscription service and becomes part of the person’s journey before there’s a problem to treat. Value is realized on both sides for the patient and the pharma company. If the person does still eventually become ill and medication is required for treatment, an increase in the subscription is made to include the cost of medication, along with pharmacy services like those provide by GoodRx and/or direct-to-patient services like hims & hers or RxPass, as well as other connected health services to support adherence and compliance. If a state of health is achieved that no longer requires medication, the subscription cost may return to lower levels and services may stay the same or shift to include items which support quality of life. If desired by the patient, their data (or portions of it) could be monetized or gamified and they could share in personal revenue generation, essentially being paid to be healthy, similar to services like HealthyWage, DietBet, Achievement, or stickK.

So who is paying for the subscriptions and why?

 Assuming the appropriate health economic proposition exists, payers should be willing to pay for the subscriptions as they profit the most from people remaining healthy. Furthermore, if personal data for the subscriptions is shared to support underwriting activities like in the automotive industry (think Progressive Insurance’s Snapshot), payers may be able to calibrate profitability even more effectively. They already provide some services such as gym membership discounts and bear the cost of promoting them to their members. The cost of this promotion could shift to pharma and providers to some degree. In addition, individual companies that are part of the subscription service bundle may also be willing to offset the cost associated with their services for the benefit of bringing in new customers or expanding their own business lines. Such might be the case for Amazon which could expand use of Amazon Prime Video to sell other services or quickly expand the use of RxPass beyond generics. Employers may also be a reasonable source of funding. Finally, the patient themselves might be willing to buy in to the service at some level.

The concept of jobs-to-be-done remains a valuable tool for life-sciences companies and can be leveraged to help them rethink the paradigm of selling treatments vs. developing a healthier society.

Life-sciences companies can take advantage of an opportunity to bring together several players in the healthcare ecosystem to look beyond the patient journey of pre-diagnosis to treatment. If they don’t, other will continue to significantly disrupt their business and patients will look for help from others who see them as people.