As the foundation of the healthcare economy is shifting away from episodic care and organizational and informational silos, so too is the way industry analysts provide overviews for the ever-widening ecosystem of involved stakeholders.

"Just a couple years ago, we would do a report and say 'This is a pharma report, this is a provider report, this is a payer report,'" said Ceci Connolly, managing director of the Health Research Institute at PricewaterhouseCoopers. "Now we believe those silos are collapsing in the new health economy. You see it in the industry and in our consulting and hopefully in our thought leadership."

HRI's latest report, 21st Century Pharmaceutical Collaboration: The Value Convergence, outlines several of the new multi-stakeholder collaborations influencing pharmaceutical development and the concomitant drive toward improved outcomes.

Also See: Real World Evidence – 10 Benefits for Providers, Payers and Pharma

"So many of these big pharma companies in the past really had some smashing successes all on their own," Connolly said. "Now the environment has gotten quite challenging and the value pressures are so significant that they have sought these other partners to help fill in some of the data gaps to get closer to patients.

"If we were discussing hospitals or insurance companies I would be saying many of the similar things, because as those silos come down, whether they do it out of warm and fuzzy feelings or hard-nosed business decisions, they absolutely have to find ways to work together to benefit consumers."

The report highlights the new roles of four key stakeholder groups plus that of regulatory and legislative activity in outlining the trends in emerging collaboration. Those groups include:

*Purchaser groups linking administrative claims data with electronic health records to conduct population research – with biopharma collaborators – to better understand important population segments, like patients with more than one chronic disease

*Healthcare providers, pushed by new payment incentives, collaborating with the drug industry to measure the effectiveness of therapies on the patients they treat. Prescribing practices increasingly reflect sophisticated cost/benefit analyses.

*New entrants bringing biosensor technology and digital tools to healthcare to help biopharmaceutical companies better understand the lives of patients, and how they change in response to drug intervention.

*Patient advocacy organizations creating disease-specific registries for research, and consulting with industry players on clinical trial design and protocols.

In addition, proposed legislation such as the 21st Century Cures bill would make it easier for drug companies to promote cost effectiveness data as an additional product attribute.

Connolly and the report's lead author, Benjamin Comer, said the report mentioned several examples of how cross-sector collaboration was influencing drug development, the inclusion of medications on formularies, and deeper involvement of those taking medications in real-world situations to better measure efficacy.

One example of the new model outlined is partnerships announced between HealthCore, an Anthem clinical outcomes research subsidiary, and pharmaceutical firms Eli Lilly and Boehringer Ingelheim. Drug makers spend 7-10 years and $1 billion generating evidence on 7,000 people, on average, Marcus Wilson, president of HealthCore, told PwC. “You can’t extrapolate that out, but you can get 7,000 people using the drug in our population the first month it launches.”

Another is an agreement between insurer Cigna and drug maker AstraZeneca, in which the companies used medical and pharmacy information to create a predictive model that identified patients at a higher risk for atherosclerosis. Patients meeting the high-risk criteria were given access to AstraZeneca's Crestor as a preferred brand-name statin, with a lower co-pay and without a requirement for prior authorization.

"I think Cigna, to their credit, saw that spending more on that medication was probably going to save them other costs on those patients," Connolly said.

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