Like some pharma companies, physician exploiters game the system. Physician innovators, on the other hand, are focused on addressing unmet patient needs as their first priority.
Outrageous pharmaceutical prices, driven by the most recent Epi-pen sticker-shock dustup, are, once again, front page news. This almost diurnal ritual has risen to the level of the presidential stump and some in the pharmaceutical industry have outlined the drivers and some possible solutions.
The clash of the pharma titans is between the innovators and the exploiters. Some pharma companies have become so financialized and Machiavellian, they seem more like banks selling drugs. A similar dynamic is playing out in medical services by physician entrepreneurs and hospital system administrators that employ some of them.
Like some pharma companies, physician exploiters game the system as effectively as possible by taking advantage of tricks or loopholes in reimbursement and coding schemes, manipulating payer mix, providing frank or marginally unnecessary care or, in some instances, stepping over the legal line by committing fraud.
Physician innovators, on the other hand, are focused on addressing unmet patient needs as their first priority, by pursuing opportunities where they can create user-patient-customer defined value through the deployment of innovation. Their pricing reflects their expectation that they receive a reasonable return on the value they provide and that compensates them for the risk they assume.
So, what are the answers? Are there similarities and overlapping solutions?
1. Encouraging and accelerating competitive markets by regulatory reform
2. Price transparency
3. Encouraging new models of care through reimbursement and payment reform
4. Value-based pricing that integrates cost-effectiveness, particularly as it applies to technology adoption and diffusion
5. Interstate licensing and credentialing reform to break up state controlled physician practice monopolies
6. Stop cost shifting from payer-to-payer and country-to-country in the era of global care and internationalization
7. Eliminate direct-to-consumer marketing and disclose, manage and mitigate conflict of interest around physician-industry interaction
8. Focus on real innovation, not “me-too” products with limited or no proven clinical effectiveness
9. Reform the clinical trial ecosystem to make it cheaper, smarter and faster, and that reduces the barriers to patient recruitment and retention. Rethink data ownership.
10. Win the PR war for the hearts and minds of patients who are angry and confused.
Here are 10 reasons why people fear physician entrepreneurs. Patients fear physician exploiters, not physician innovators and many think they are part of clinical cronyism as part of the medical industrial complex designed not to stick them with effective medicines, but rather stick it to them.
Financialization and other practices that place profits over patients is not just killing biopharma. It is also lethal to physician entrepreneurship.