Ozgur Sensoy

Rules of Patient Engagement 2024. What would you add? Follow us at DontBePatient Intelligence to see examples of how we do it.

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This is an important practical recommendation about how to help people recieve peritoneal dialysis. This needs to happen all over the world with tailored models of care.

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In the PBM landscape, pricing often appears similar across the board. However, the real value differentiator lies in how PBMs manage clinical programs. Effective clinical management not only drives cost savings but also ensures optimal patient outcomes. It’s essential to look beyond pricing and focus on the quality of clinical programs when evaluating PBMs. 💊💡 #PBM #TransparentRx #ClinicalManagement #PatientOutcomes #PharmacyBenefits

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Not an uncommon experience with #insurance and #priorauthorization. Think about the steps to a #specialty mail order medication: Day 1: 1. Doctor writes prescription and sends to patient's preferred pharmacy. 2. The insurance rejects the claim and directs the patient to a "specialty" pharmacy. Day 2-3: 3. Patient tries to get prescription transferred (if electronic or verbal) to specialty pharmacy or mails hardcopy. 3b. Patient chooses instead to call doctor and ask for a new prescription to be sent to the specialty pharmacy. Day 3-5: 4. Doctor sends prescription #2 to the specialty pharmacy. 5. Prescription rejects for prior authorization. (It's now at the "right" pharmacy, but the formulary requires a review by the insurance). 6. The pharmacy contacts doctor and informs patient. Day 5-8: 7. After much back and forth, PA forms, missing information, clarifications, follow up calls by the patient to the doctor and insurance, by the doctor to the insurance, and by the patient to the pharmacy, an approval is granted. 8. Because the member has a plan with a deductible that is not met, their cost-share for the approved medication is $1000+. Day 9-10: 9. Patient receives medication in the mail. 10 days is being generous. Many patients get lost in the shuffle, may wait until their next doctor appt, or never get the prescription at all. Little did the patient know they could have just paid $80 cash at their original pharmacy without a prior authorization. The patient would have received the medication on Day 1 at their preferred pharmacy at a fraction of the cost. The numbers used are for representative purposes only and may sound like an egregious variance, but it exists. Seeing many examples throughout my career serve as motivation to do something about it. #getgreenback #greenbackhealth #pricemymeds

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Just like how every software company is being asked what their AI strategy is, I believe every healthcare provider will be asked what their GLP-1 treatment strategy is. Reducing obesity is one of the most impactful things that can be done to improve society's health.

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What is Value Based HealthCare (VBHC) and how can it improve the Healthcare services performance?(Part 3) Value-based healthcare is important for several reasons: 1. Improved Patient Outcomes: VBHC focuses on achieving better patient outcomes and experiences. By emphasizing quality and effectiveness of care, value-based healthcare models aim to optimize patient health and well-being. 2. Cost Efficiency and Sustainability: VBHC aims to deliver high-quality care while optimizing costs. By incentivizing providers to deliver cost-effective and efficient care, value-based models help control healthcare spending and promote sustainability. By identifying and eliminating unnecessary or low-value services, VBHC reduces waste, improves resource allocation, and lowers overall healthcare costs. 3. Patient-Centered Care: VBHC models prioritize patient-centered care, where the patient's needs, preferences, and goals are at the center of decision-making. By aligning care delivery with patient preferences and engaging patients in shared decision-making, value-based healthcare enhances patient satisfaction and promotes care that is personalized, respectful, and responsive to individual needs. 4. Focus on Prevention and Population Health: VBHC encourages a shift from reactive, episodic care to proactive and preventive approaches. By emphasizing preventive services, early interventions, and population health management, value-based models aim to improve overall health outcomes, reduce the burden of chronic diseases, and prevent avoidable hospitalizations. 5. Accountability and Transparency: VBHC promotes accountability and transparency in healthcare delivery. By measuring and publicly reporting performance metrics, outcomes, and costs, value-based models hold providers accountable for the quality and value of care they deliver. This transparency encourages providers to continuously improve their performance, fosters competition based on quality and outcomes, and empowers patients to make informed decisions about their healthcare. 6. Continuous Improvement and Learning: VBHC models encourage continuous improvement and learning in healthcare delivery. By analyzing data, measuring outcomes, and identifying variations in care, providers can identify areas for improvement and implement evidence-based practices. This focus on continuous learning and improvement drives innovation, fosters a culture of quality improvement, and leads to better outcomes and efficiency in healthcare. 7. Alignment of Incentives: VBHC aligns financial incentives with desired outcomes. By shifting from fee-for-service models to payment models that reward value and outcomes, providers are incentivized to focus on delivering high-quality, efficient care. This alignment of incentives drives changes in care delivery processes, promotes care coordination, and encourages providers to adopt evidence-based practices that improve patient outcomes.

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How to blow $230 million/year: - Sell a big market forecast with Standard Model thinking - Confuse said big market forecast (i.e., metrics) for a strategy - Point resources and capabilities in the wrong direction - Change said wrong direction early and as often as possible - Assume expert knowledge of the past is the way to construct a future - Ignore, misread or pretend-away the 'ground truth' from the frontline And when the mathematical gymnastics packaged in the PowerPoint don't manifest NOW in terms of the 'next $1 billion in growth' or, even better, delivering on the true center of the American Way of Healthcare (i.e., more shareholder value), throw in the towel, announce layoffs and revert to the place you're comfortable with conceptually. Says Walmart in a statement to Endpoints News: "What we learned through Walmart Health centers will help us continue to innovate and support the healthcare needs of our communities through our legacy pharmacy and vision." Possible, but not probable. By definition, the only place a "legacy" vision can lead is back to the past. If there's a "learning" here -- the kind of thing Harvard Business School can package in a PowerPoint to sell as a new corporate/executive education program -- is that making big market innovation come to life is hard work. It isn't a solo sport (Walmart can/would have fared better collaborating with a big pharmaceutical company on the roadmap). And it doesn't start with a forecast that everyone knows is bullshit, particularly the people buying and selling it. The upside of a new market is unknowable at the start, just ask the team at Amazon/Amazon Web Services (AWS), who ten years ago invented what is now a $600 billion market for 'cloud infrastructure' services. They had no idea it could be that large. But maybe the biggest learning of all is that making a Big Dent happen, particularly in healthcare, takes time, a more original vision and a completely different starting point. Quoting from the epigraph to War and Peace: "The two most powerful warriors are patience and time." via Shelby Livingston

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GLP-1s continue to be a hot topic. Impressive weight-loss results were seen for both tirzepatide and semaglutide in a recently released real-world study, but comparative analysis shows tirzepatide the clear winner. Tirzepatide demonstrated superior weight reduction while having similar safety & tolerability to semaglutide. These results are surely going to put even more pressure on Lilly to supply market demand fueled by growing evidence of superiority. "Tirzepatide-treated patients were also 76% more likely to achieve at least a 5% weight loss -- the threshold for clinical significance -- than those on semaglutide (HR 1.76, 95% CI 1.68-1.84). They were also over two-fold and three-fold more likely to achieve at least a 10% and 15% total weight loss, respectively (HR 2.54, 95% CI 2.37-2.73, and HR 3.24, 95% CI 2.91-3.61)." https://lnkd.in/g99vHcxT

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What does it take to stay viable and vibrant as a contributor in the ever-evolving #specialty #healthcare space? What qualities do leaders need to have? What gaps do they need to fill? While researching our latest 20Sense | Consulting report, I had pleasure of asking seasoned Canadian leaders to weigh in on these questions. Martine Elias, Executive Director of Myeloma Canada | Myélome Canada Canada, Julia Brown, Vice President, Oncology Sales and Marketing at Johnson & Johnson Innovative Medicine, and 2023-24 ISPOR—The Professional Society for Health Economics and Outcomes Research President Brian O'Rourke, graciously shared their thoughts in this article https://lnkd.in/gNy6KicP #specialtypharmaceuticals #Canada #patients #patientsfirst #healthoutcomes #data #healthcare #pharmaceuticalindustry #outcomes #innovation #access #drug #drugaccess #realworldevidence

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Healthcare costs are staggering, especially for patients in need of specialty products – like oncology. This week I’m sharing an article that caught my attention about the annual cost of cancer diagnoses in the U.S. and the subsequent debt that these patients and their families often endure. We need to continue to focus on and help patients navigate both access and affordability to the life changing therapies we support – let’s connect if you are planning for or optimizing your patient service program approach! https://lnkd.in/gtJTbZTW.

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One of the best places to engage with Key Opinion Leaders (KOLs) is at medical conferences. Agree? Some of you have noted that you have a reduction in the number of conferences you can attend. Last week's poll asked how your congress attendance has changed for 2024. The results: 40% of you reported a reduction in attendance 34% report similar to previous years 26% report an increase in attendance What is one way a #medicalscienceliaison facing less ability to travel to conferences can innovatively engage with KOLs? Share in the comments. #medicalaffairs #medicalcongress #keyopinionleaders #pharmacist

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Today AstraZeneca revealed its bold ambition to deliver $80 billion in Total Revenue by 2030, up from $45.8 billion in 2023. This will be achieved through significant growth in its existing oncology, biopharmaceuticals and rare disease portfolio, and by launching an expected 20 new medicines before the end of the decade. To drive sustained growth beyond 2030, the Company will continue investing in transformative new technologies and platforms that will shape the future of medicine. AstraZeneca will maintain its strategic commitment to R&D while focusing on productivity throughout the Company, driving operating leverage and enabling the delivery of its ambition for a mid-30s percentage Core operating margin by 2026. Beyond 2026, Core operating margin will be influenced by portfolio evolution and the company will target at least the mid-30s percentage range. Pascal Soriot, Chief Executive Officer, AstraZeneca said: “Today AstraZeneca announces a new era of growth. In 2023 we delivered the ambitious $45 billion revenue goal set a decade ago. With the exciting growth of our innovative pipeline, which has the potential to transform millions of lives, we are now aiming for $80 billion by 2030. We are planning to launch 20 new medicines by 2030, many with the potential to generate more than $5 billion in peak year revenues. The breadth of our portfolio together with continued investment in innovation supports sustained growth well past the end of the decade.” As AstraZeneca continues to grow across all therapy areas, it will continue to decouple its carbon emissions from its increase in revenue. The Company has already reduced its greenhouse gas emissions (Scopes 1 and 2) by 68% from its 2015 baseline while growing Total Revenue by 85% over the same period. By 2026 the Company will be carbon zero for Scope 1 and 2 emissions and by 2030 halve its Scope 3 emissions, on the way to science-based net zero by 2045 at the latest. #AstraZeneca #WhatScienceCanDo

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The cancer care gap is not just a healthcare issue; it’s a societal challenge. Through strategic partnerships and a shared commitment to universal health coverage, we can build healthcare systems that offer timely screening, early diagnosis, and effective treatment to every individual, regardless of their socio-economic status or geographic location. Learn how collaboration can bridge the gap: https://lnkd.in/dJ3XJZ69

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