Q&A: How pharma can help bridge the gaps between patients and providers in Germany

A major underlying theme of ZS’s 2024 Future of Health Report was that trade-offs exist in every healthcare system that we surveyed. Our survey found that Germans, like consumers in many countries, want more preventive care, faster access to specialists, higher levels of partnerships with their physicians and more convenient and equitable care.

To discuss what’s driving the perceptions and attitudes that adults in Germany have about their healthcare system—and to share ideas for how pharmaceutical companies could help patients and providers bridge some of those gaps—we brought together ZS leaders who work with clients in the EU, including Bill Coyle, global head of biopharma in ZS’s Zurich office, and Associate Principal Eva Struckmeyer and Manager Kevin Santo, both from ZS’s Frankfurt office.

ZS: Like many countries, there’s a disconnect in Germany between how patients feel after a healthcare interaction and how their general practitioners (GPs), or Hausärzte, think they feel. How could pharma help bridge this gap and enhance patient and physician interactions to improve patient centricity?

Eva Struckmeyer: In my mind, it starts with pharma being patient centric in the first place. For organizations, that includes setting up a patient-centric vision, driving a patient-centric mindset internally and making some structural changes away from product-focused silos toward more customer- and patient-centric engagements. It involves capturing the needs of the patients early, for example, during development. Understanding patient needs early on can lead to deeper engagement with healthcare professionals (HCPs) about what the patient needs. You can develop specific patient profiles and educate HCPs about how to engage with different types of patients.

Kevin Santo: To provide some German context, I think patients, historically, have had very strong and long-standing relationships with their GPs—often lifelong relationships. But I think multiple recent events and factors such as COVID-19, ongoing healthcare provider consolidation—both in the hospital and in office-based settings—have had some impact and have disrupted some of these relationships. What Eva outlined is the way to go moving forward.

Bill Coyle: I think it’s important to recognize that German physicians get reimbursed quarterly per patient. So, there’s some pressure on them to see patients once per quarter and only once a quarter. I think that’s important context for some of the gaps we found, such as patients feeling rushed or like they’re not getting what they need from an appointment.

As for pharma’s role, Eva highlighted all the right things. A pharmaceutical company can deploy tools and efforts directly to physicians and others to build disease awareness, to enhance the doctor-patient dialogue. Pharma can give physicians tools to help them think about the best way to talk to a patient suffering with depression, for example. Pharma can also prime the patient so they are bringing the right pieces of information to activate the physician.

To Kevin’s point about long-standing relationships, I think that comes with some biases, like, “I’ve known this patient forever and I have preconceived notions of their life, how they work.” There’s an opportunity for pharmaceutical manufacturers to dig into the biases that disproportionately affect German physicians and the patients they see every day, which might manifest in how they engage around certain diseases.

ZS: How can digital play a role in bridging this gap between patients and physicians?

ES: I think a different way to think about this is: What’s holding HCPs back from being more patient centric? One piece, as Bill said, is the point around how the reimbursement system works. The other one is just the pure time element. And I think that that’s where digital can play the biggest role—bridging the gap in terms of the HCP always being short on time. Digital can help support patient education and create awareness, or it can help with the actual treatment or disease management.

Take, for example, smart physiotherapy apps that provide instructions and track whether you’re doing physiotherapy the right way. This is, practically speaking, an intervention that greatly complements what HCPs do.

KS: There are other examples that aren’t explicitly on the market as a digital health app (DiGA), but more like a companion app that accompanies patients along their whole treatment journey and documents their feelings and symptoms. They can show it to their doctor in a more objective way that avoids the recency bias they might have.

BC: I like where Kevin was going with these companion apps. I think what holds a lot of them back is pharmaceutical companies try to make branded apps versus apps that are disease specific. I think the Migraine Buddy was seen as a success across the industry because it didn’t matter what product the patient was on, Migraine Buddy did exactly what Kevin described. The patient has a diary of when they had migraines, how severe they were, how long they lasted. And so, now when the patient sees their neurologist, they can literally show them a picture of their migraine experience over the past three months. And that goes back to Eva’s original point around enhancing the physician-patient dialogue. The more we have tools like that, the more we can rapidly accelerate the quality of the individual physician-patient interaction. Because, instead of a 10-minute conversation, the doctor can literally, in 30 seconds, see the patient’s migraine experience over the past few months.

ZS: As the Future of Health Survey found in other countries, German respondents with obesity were superusers of digital health, suggesting they’re more open to using this channel as part of their treatment plan. As treatments for obesity like GLP-1s and others increasingly use telehealth and digital platforms, who are potential partners for pharma in this space?

BC: The potential partners for chronic weight management drugs are platforms like Noom—a proven behavioral health app that brings the science of behavioral health to weight management. Other partners may be healthcare systems themselves, the Krankenkasse, or health insurer of record, to create partnerships for their members. It could be other players in the chain, whether it’s wellness or fitness organizations—we’ve seen this with Equinox gyms and WeightWatchers in the U.S.

One thing to highlight is employers. And the reason I’d highlight employers in Germany is because the government doesn’t cover weight loss and the payer system doesn’t cover weight loss medications. I think there is now reimbursement for weight management programs that are behavioral, but they’re not covering the drugs.

If you’re Volkswagen, if you’re Deutsche Bahn, you’ve got tens of thousands of German employees who are with you for decades, and they’re subject to lost time injuries associated with weight on their hips, knees and backs. Is there an incentive for large employers to actually work wellness-plus-drug into their treatment of employees? Would this differentiate them in the talent market or reduce lost time? Of course, they also control the diet of employees in some ways because many tend to eat one or two meals on their premises every day. There are great examples of German companies taking innovative steps to improve employee health in other ways.

ES: For example, VECTOR Informatik, a German electronics company, opened an employee canteen operated by the renowned restaurant group Traube Tonbach where employees and their families can eat fresh three-star level meals at minimal cost. Can you think of a more holistic approach to bring more value to your employees and their families through employer-driven health?

KS: Especially with the concept of the company doctors at large corporations in Germany. That’s a great angle that pharma companies have taken in Germany in the past. This is a prime opportunity to rejuvenate those efforts.

ZS: How do these Future of Health Survey results compare to the findings from our organized customer study in the EU?

KS: Our EU organized customer study saw a meaningful opportunity here, with providers saying they have a significant interest in partnering with pharma, but also outside of pharma, to overcome the challenges they’re having. So that’s basically digitalization, staffing shortages, sustainability cost pressure and so on.

What pharma really needs to do to set up successful partnerships is move from a product orientation to a solution orientation and really understand and address the needs of those provider systems. I think there is a strong interest on the provider side and good momentum.

ES: I think policymakers, including the German government can and should be considered as partners, and in many places they already are. Some of our clients are already working to drive policy changes in areas of noncommunicable diseases.

And when you think about the selling of fast food in public places, or candy in public schools, there’s so much room for improvement in terms of what policymakers or the government can do. If pharma really means it in terms of patient centricity and changing the state of obesity, for example, I think policymakers should be considered another partner.

ZS: Across all markets, consumers said they want but don’t necessarily have partnerships with their providers in which they make treatment and care planning decisions together. Germany had the highest proportion of respondents who currently have this type of relationship. What’s Germany doing well?

BC: I guess, Kevin and Eva, the thing that’s probably different in Germany is the duration of the physician-patient relationship. Kevin, you mentioned disruption to that recently.

KS: I think part of the reason why it has been so good is probably due to the nature of the German healthcare system, which is set up with a large, widespread and established office-based setting. I think Germany is one of the top three countries in Europe regarding HCP density. But to your point, Bill, the disruption is something that became apparent during the COVID-19 crisis. And most recently with a lot of private equity investments in the outpatient sector.

ES: I think it’s, very simply, that the GP, or Hausärzt, is a gatekeeper. It means there’s a stable relationship between the patient and physician before a patient is referred to a specialist, which has an impact there.

BC: One thing that’s different in Germany versus the U.S. is if you change your Krankenkasse, you wouldn’t have a physician say “No, I don’t take that insurance,” right? In the U.S. if you change your insurance company you might have to change your doctor. You would never have that dynamic in Germany, so that probably supports some stability as well.

ES: One final thought on this topic. I think that what’s yet to be seen is whether the rise of the ePA, or the electronic patient record, will change the stable nature of the patient-Hausärzt relationship. Because technically, in the future, any physician will have visibility into a patient’s historical record. Right now, their history sits with the individual physician but in the future, there will be more transparency. So, it’s going to be interesting to see if and how that’s going to change.