2023 Impact Live proposes a blueprint for pharma reinvention

A confluence of external forces is putting unprecedented pressure on the business model that’s served the pharmaceutical industry so well for so long, forcing companies to reimagine how they discover, develop and commercialize their innovations. At Impact Live, ZS’s exclusive client event, ZS CEO Pratap Khedkar laid out the choice confronting drug manufacturers in the face of these pressures: Adapt and thrive or maintain the status quo and risk extinction.

Why the urgency today?

First, the industry faces mounting challenges to how it makes money. Drugs responsible for more than 40% of pharma’s revenue will face generic competition in the coming years, and nearly half (40%) of the remaining share will face increasing pressure from the Inflation Reduction Act (IRA) and similar efforts across Europe and in China.

“This phenomenon is intensifying, but there’s a new element: The time horizon is constricting for the first time,” Khedkar told his audience of senior pharma leaders in San Francisco, Philadelphia and London. “And this kind of pressure forces a change in the way we do business in a much more fundamental way.”

He’s referring to provisions of the IRA and similar legislation in the EU that shrink the period of exclusivity for new drugs by (in many cases) two years, reducing the amount of time companies have to generate return on their investments. And this is happening against the backdrop of the biggest technological breakthrough of our lifetimes.

While generative AI’s hype currently outstrips its real-world value, Khedkar told his audience that it will change the way we live and work.

“The most frequent question asked of AI in healthcare has been, ‘Will AI replace doctors?’” he said. “The answer is no, but the doctor with AI will replace the doctor without it. So, the dialogue in healthcare is changing from … not the future of the workforce but the future of work.”

Khedkar’s keynote functioned as a provocation to those in the room and a tee up to each day’s sessions, which examined all the ways pharma will have to rethink how it discovers, develops and commercializes its therapies.

In a series of breakout sessions, Maria Whitman, managing partner of global commercialization strategy and solutions at ZS, and Bill Coyle, managing partner of ZS’s global biopharma vertical, led open discussions on how to strengthen pharma-provider relationships. Critical areas included how to:

• Unbundle the sales rep. ZSers and attendees stressed the need for a partnership between pharma sales reps and physicians that goes beyond the transactional, highlighting the significance of trust and the opportunity for collaborative problem-solving. Convenience also is crucial, especially when reps provide real-time information and solutions that digital means cannot.

While reps are well-versed in their company’s mission, vision, value proposition and product specifications, they need to acknowledge, better understand and address the unique challenges physicians care most about. Emotional intelligence, self-awareness and empathy will help sales reps act more like consultants who solve problems than marketers who spout rote messages.

“There are good reps out there doing this a lot, but what percentage of our field force are the good reps—20%, 30%?” Whitman posed. “It’s not 80%, and we need to get it to a place where 80% of our reps are the good reps.”

• Enhance the context stream. By moving beyond one-size-fits-all approaches, pharma can better understand individual doctors as unique entities, including their communication channel preferences, backgrounds, patient interactions, financial situations and practice dynamics. The goal is to inform reps’ decision-making so they can tailor the services they provide and more effectively support healthcare professionals.
• Reimagine marketing. A consensus quickly formed around the collective need for pharma marketing to evolve and deliver new value to prescribers and patients. With respect to reps’ individual relationships with physicians, marketing messages must be more substantial than talking points focused on landing a sale.

Marketing and sales teams need to improve feedback loops that facilitate collaboration, with marketers spending time in the field to gain pragmatic insight into the challenges reps face. Marketers with better defined metrics can align campaigns with organizational goals and bridge gaps between their team and sales reps, especially with resource allocation and strategy execution.

Whitman and Coyle also participated in panel discussions with ZS colleagues on how pharma can drive efficiency by focusing on connectivity among various processes in the ecosystem to reduce isolation; continuity to move from periodic, discrete processes to dynamic processes aided by data connectivity and automation; and context to emphasize situation-specific decision-making and design.

“I think the companies that are really making strides are saying, ‘How do we be patient-centric?’ and stepping back and saying, ‘We have to do it by expanding the aperture of where we’re focused in the patient journey.’ It’s not just a nice-to-have,” Whitman said. “It’s becoming a necessity both for patient outcomes as well as for (pharma’s) business.”

Another critical shift is the sharing of data and knowledge across all pharma domains to better understand patient needs, make more effective decisions and accelerate clinical development. AI and technology will help extract and analyze information from unstructured sources to expand the scope of data-driven insights that help close health equity gaps and respond to evolving healthcare consumer needs.

In a series of TED Talk-style presentations, ZSers led discussions on how pharma can uncover innovative therapies and reduce time to market by:

• Increasing human centricity in clinical trials. ZS’s Sharon Karlsberg made the case for transforming clinical trial design, concentrating on efficiency, cost savings and better patient experiences. Pharma can begin by meeting patients where they are and engaging them across their healthcare journey.

“When it comes to clinical trials, the imbalance of information is significant,” Karlsberg said. “We’re putting a tremendous amount of burden on the patient to make a decision to join.”

Pharma also must recognize patient population diversity and tailor outreach. Different groups bring unique preferences and consult myriad healthcare information sources. Patients in Japan, for example, look to social media influencers, while some Black healthcare consumers in the U.S. rely on search engines. Clinical trials that account for patients’ individual needs, preferences and diverse backgrounds can be more effective and efficient.

• Using AI to boost agility. ZS’s Pranava Goundan defined AI in clinical development as a work in progress. While AI’s promise and transformative role in clinical development are undeniable, hurdles remain. We must perfect data quality, form multidisciplinary teams and build the computing infrastructure, change management processes and trust that will facilitate the journey from hype to realized impact. 

Goundan discussed how classical AI helped advance healthcare in the last decade by solving predefined problems. With the advent of generative AI, we can tackle a broader range of issues with diverse data sets and large language models for tasks beyond prediction, translation and synthesis. AI can enhance trial design and dynamic content creation by generating plain language summaries to personalize patient communication and better serve diverse populations. AI can assist in authoring regulatory and clinical trial documents, reducing timelines. AI-powered answer engines quickly respond to complex questions and assist with creating co-pilots.

• Breaking down organizational silos. Kim Walpole, head of product at ZS’s Trials.ai, and ZS’s Jonathan Lowery identified data and technology as the engines of innovation, with human ingenuity and patient centricity as the GPS to guide the global clinical research and health outcomes we all want to see. They encouraged attendees to think of themselves as champions of scientific progress and advocates for change.

They emphasized the upfront need for data-driven intelligence and data-driven decisions in study design. Efforts to transform clinical trials from static protocols into dynamic blueprints must be guided by AI and predictive models that incorporate an ever-growing wealth of data sources. Real-time decision-making, reducing patient burden and mitigating costly study amendments are critical. Recognizing the need to answer ongoing questions about context, constraints and outcomes in study design will guide our efforts.

Leveraging data and technology, especially generative AI, holds significant promise to drive greater connectivity and patient impact across biopharma’s clinical and commercial operations.

“The role of drug development is to take our science and demonstrate its safety and efficacy, its value to patients and to ultimately create a great platform for commercialization,” said Chris Braithwaite, senior vice president and global head of drug development digital and IT at Novartis. “Everything we do in the context of technology needs to contribute to that value.”

In clinical development, IT leaders expressed the most excitement about two use cases in particular: automating manual processes and optimizing clinical protocol design. Both hold significant potential to speed up the process for bringing therapeutic innovation to patients.

On the commercial side, attendees recognized the potential for bringing together new and existing data sets to enable the sales and marketing “holy grail”: behavior-changing personalization at scale. Attendees agreed that while the technology exists to deliver on this promise, companies’ data and talent strategies lag.

Data is needed to generate insights that inform messaging and trigger next best actions, but attendees expressed that they lack conviction about what’s the right data to feed into the context stream. ZS’s Asheesh Shukla says it’s about shifting from collecting data to connecting it. Data meshes can bring the data together, but how do you classify data sources? The best value will be found by overlaying structured and unstructured data. While structured data offers the size and volume, unstructured data offers the nuance.

On the talent question, attendees agreed that finding people with the right blend of business and technical skills—so-called “boundary spanners”—is a mounting challenge. Upskilling talent to insource IT processes is challenging but worthwhile, as it allows IT teams to rapidly prototype solutions, thereby showing proof of value to the business faster.

To secure buy-in for investments from the business, panelists and attendees recommended a few strategies:

• Make sure value claims are credible. Too big, and either stakeholders won’t believe them or results will fall short of expectations.
• Position technology gains in terms of “old day in the life” versus “new day in the life.”
• Communicate value in terms business stakeholders understand and value. Rather than talk about cost avoidance, talk about things like revenue definition and productivity increases.

Doing these things will go a long way to position IT as a strategic partner to the business, not merely an enabling function.

In San Francisco, Jessica Groopman, director of digital strategy and innovation at Intentional Futures, called for societies to reimagine how they use technology to keep pace with disruptions affecting individuals, businesses and broader ecosystems. She explored three key disruptors: “welltech” and the commercialization of biometrics for emerging therapies, the organizational implications of reimagining how we invent things and the imperative for tying innovation to net-positive outcomes.

“Our relationship to technology is one that characterizes our adaptations and our breakthroughs, as well as many of our big existential and systemic risks,” Groopman said. “We shape the tools that we make, and our tools shape us. This is a story as old as human history.”

In Philadelphia, Kevin Ahmaad Jenkins, a social epidemiologist and leading voice on diversity, equity and inclusion at University of Pennsylvania, spoke about the very real consequences of health disparities and urged organizations to close the gap between our so-called values (what we say we care about) and our norms (what happens in the real world).

“People will tell you, ‘Diversity and stir’ will fix the problem,” Jenkins told the audience. “But we can’t do enough ‘diversity and stir’ to get us out of where we are … We’re saying, ‘Oh, we need to fix the social determinants of health.’ But we keep forgetting that there are determinants of the determinants. There are obstruction points along the way making it harder for us to do that work.”

In London, Soumitra Dutta, dean of the Saïd Business School at the University of Oxford, discussed the growing chasm between our technological capabilities and our ability to harness them—a product both of the exponential growth of frontier technologies and a business culture that’s not designed to support disruptive innovation.

In his keynote, Jenkins shared an interesting piece of hydrological trivia: In fast-moving rivers, the larger the rocks obstructing the flow of water, the greater the speed and force of the rapids. He was talking about the impediments to eliminating health disparities, but he could just as easily have been talking about those impinging on pharma’s business model today.

From the CEO’s opening keynote to the cross-functional panels and tracked breakout sessions, across three days and in three cities, the overarching theme of Impact Live was this: We are in a period of transition. But while the challenges our industry faces today are monumental, they’re creating a correspondingly forceful momentum to fundamentally transform how we serve patients.