ICSs: improving patient and market access at a local level

Integrated Care Systems (ICSs) – 42 partnerships of health and care organisations who will plan and deliver more joined-up services for their locality in England from 1 July 2022 – will touch on every issue that is shaping healthcare today.

“A lot of things are happening in the environment right now and all of the key issues at the national level are relevant at the sub-national – ICS – level. Whether it’s the levelling up agenda, economics, social care and population health management and more, ICSs are front and centre of everything,” Steven Ferguson, head of Market Access UK and Ireland, IQVIA.

Ferguson was joined in a pharmaphorum webinar by Uday Bose, country managing director and head of human pharma, Boehringer Ingelheim, Matthias Winker, former head of Integrated Care System Strategy, Buckinghamshire, Oxfordshire and Berkshire West and Jim McCardle, commercial director, Interface Clinical Services, IQVIA. In a panel discussion moderated by Dr Paul Tunnah, chief content officer and managing director UK, Healthware, they discussed the opportunity for collaboration between ICSs and life science companies to improve patient and market access at a local level.

The Panel

Read bios here

Uday
Bose

Jim
McArdle

Steven
Ferguson

Matthias
Winker

Dr Paul
Tunnah

Fundamental change in mindset

The move to ICSs has been ongoing since 2014 and the change that the formal adoption of ICSs brings is fundamental. “This is a significant change for how health and care services are being planned, commissioned and delivered, with a focus on collaboration rather than competition, around the health of the entire population,” explained Winker.

The ICSs will operate through an Integrated Care Board (ICB) – an organisation with responsibility for NHS functions and budgets – and an Integrated Care Partnership (ICP) – a statutory committee that brings together all system partners and who will produce a health and care strategy.

Winker noted, “ICBs will have increased commissioning responsibilities [versus CCGs], particularly on specialised commissioning. We saw the intention last year from NHSE&I to delegate pharmacy, optometry and dental services to ICBs, which will happen in this financial year. More specialised commissioning services will follow in the future years, subject to decisions by NHSE&I.”

The ICSs are in a position to deliver on the patient-centricity agenda because of a shift in mindset that comes with thinking about the system, not an organisation. Such system thinking can unlock more value – with the patient at the centre – than a siloed approach.” We’re breaking down the barriers, the mental barriers, we’re not so much looking at what’s best for the organisation, but what’s best for the patient,” explained Winker.

The priority for ICSs when they formally take on their responsibilities in July 2022 is to set out their strategies. Each ICS will have to consider the priorities for the NHS – the NHS Long Term Plan is still a key touchpoint for everyone in the NHS – but through a strategy that reflects the specifics of their local population and circumstances.

These strategies will be required reading for life sciences companies because it will enable them to see how their products and services can fit with the ambitions of each ICS. Winker explained, “We will know more by the end of this year. By December 2022, all ICSs will have their ICS strategies developed with defined priorities and approaches to meet their responsibilities. This will provide industry more certainty of the direction of travel.”

A key opportunity is in how ICSs will be able to deliver uptake of medicines that are safe, effective, high quality and when approved by health technology assessment body, NICE, cost-effective too. That’s because it’s often at the local level that there can be challenges to overcome.

Bose explained, “you go through a rigorous process of regulatory and NICE review, but the frustration for all of us, especially for patients, is when you don’t get access to those medicines. We’ve learnt it is very rare that the challenge that is facing the health care system is the profile of the medicine itself. The challenge is at a local level, how to bring those NICE guidelines to life.”

More opportunities for collaboration with life sciences

New ICSs mean new opportunities for joint work with life sciences companies. McCardle said, “Life sciences companies can act as a system enabler, to help the ICSs with their agenda.”

“Life sciences companies need to make connections with the health and social care players,” Winker added.

Joint work has a long history in the NHS but the change to ICSs offers a new basis for that work in recognising the value that life sciences expertise – and their products and services – can unlock for the system, not just an organisation.

It should not be more of the same, rather the challenge was put to the life sciences industry to ensure that their offer is tailored to the ICSs. “There are many life sciences companies that already partner with the NHS and there are wonderful examples. But are these programmes of work fit for the new ICS agenda?” said McCardle.

Yet there are challenges for life sciences companies to overcome to deliver the very best joint work that offers a triple win, for patients, the system, and the company.

McCardle said, “Local knowledge is paramount for life sciences for who to engage with, where and why.”

The solution is out there though. Winker pointed out, “we should not disregard our colleagues at AHSNs [Academic Health Science Networks], they have great expertise in the adoption of innovation; they should be brought in early.”

A genuine opportunity for joint working will only come when there is value on offer for both the ICS and the company. It sounds obvious, but it needs to be crystal clear to all just what that value is. “Be very clear what the offer is and which particular the problems it will solve,” said Winker. Bose echoes the sentiment, “life sciences companies need to be clear what their value proposition [to the ICS is]. They need to be clear what the value is not just to one organisation but the system and not just for two to three years, but the longer time horizon.”

Collaboration also means just that, starting with co-design. Bose pointed out, “it’s incredibly important to have the insights of patients. Their insights and their input at the design phase of pilots is incredibly important.” Winker added, “bring people in early on, clinicians, local authorities, third sector, to design the product or service.”

Collaboration in practice can unlock value for all partners: Oxfordshire’s experience

A pilot of an enhanced NHS multidisciplinary integrated respiratory team was trialled in Oxfordshire with joint work between the Oxfordshire Clinical Commissioning Group (CCG) and Boehringer Ingelheim (BI). Respiratory illnesses were more common in the North and City areas of Oxfordshire. Chronic obstructive pulmonary disease (COPD) hospital emergency re-admissions within 30 days of discharge were also far higher than the English average and prevalence was lower than seen at the national level, prompting a pilot of an enhanced NHS multidisciplinary integrated respiratory team.

Building on the local services already available the pilot put in place a new integrated team with staff from across the community, hospital and primary care and linked in with the third sector.

Boehringer Ingelheim (BI) worked with partners to design the pilot and provided co-funding.

Just some of the benefits for patients included improvements in anxiety/depression scores as well improvements in their experience with care delivered faster closer to home and not in the hospital. Patients were also able to access support for cold and damp homes. More than two-thirds of patients in the pilot died in their preferred place of care/death.

For the NHS, the pilot allowed them to identify patients with respiratory diseases and identify improvements to the care of patients by changing the way the ‘system’ worked together. These flow into savings. Small sample analysis revealed that 33 per cent of patients with chronic obstructive pulmonary disease (COPD) had a CAT score improvement that could lower the use of the NHS by £1,257 to £1,837 a year. Ninety per cent of patients with asthma had a CAT score improvement that could translate to lower use of the NHS by close to £600 a year. There were fewer outpatient referrals too.

BI was able to test new concepts and build their knowledge and develop a deeper understanding of the changing NHS landscape. This knowledge can be leveraged in future joint work by BI but also the pilot could be scaled to be used nationally, enabling spread and adoption.

Life sciences companies wanting to reap the benefits of joint work in the new integrated NHS should:

Involve and engage local stakeholders early in new pathways and agree on priority outcomes
Share progress often with the pilot holding six-weekly board meetings and monthly implementation meetings
Anticipate the need to respond to questions from patients, staff, local media and others
Plan for a planning phase to ensure data accuracy and access to data as needed
Build-in time for navigating NHS governance processes

Any organisation embarking on joint work needs to start with the end in mind. It’s not enough just to run a successful pilot, that would miss the opportunity to scale up benefits across all ICSs. Bose said, “The perennial problem has been scalability. How can you take what looks good from a pilot and scale that up? There is a tremendous appetite for this.”

Yet that does not mean that life sciences companies must do it all as they need to work with ICSs to understand what works. “What we can absolutely do is pilots and projects. That’s incredibly important. It’s a safe environment for us to test different ways to optimize the patient pathway and evaluate the impact on outcomes and efficiency,” said Bose.

ICSs themselves will need to take on responsibility for a lasting legacy from such pilots. “I don’t think that the life science industry can ever promise that it will provide a long-term solution, but it is about showing the art of the possible, what the system needs, and getting the ball rolling, to create a value proposition, prove it works in this ICS, but it’s not their job to keep it going. It should be a business case for the NHS then,” said Ferguson.

Bose also put in a request to ICSs to collaborate with life sciences companies to focus on where they can add value by focusing on the work, not navigating potentially different processes to enable joint working. “With 42 ICSs there is a risk that everybody tries to do their own thing. It’s incredibly important we have consistency for the approach to joint working. If every single ICS has a different approach that will add time and complexity. There needs to be some specificity for the locality but wherever we can simplify processes to accelerate access to innovation that’s important.”

The promise of richer data

Data is an enabler for all stakeholders. For life sciences companies, data can help them to shape their offer so that it’s tailored to the ICS that they are working with. Ferguson explained, “We all need to be a bit smarter and a bit more intelligent about what is going on at the local level. We need to use data and insights to understand the problem at the ICS level, which will allow us to align value propositions to the local needs.”

For ICSs data is the bedrock for their work when it comes to developing strategies and commissioning. There are ambitions to improve on what’s already available. Winker explained, “ICSs will be driving forward the data and digital agenda. They will be developing shared care records over the next two to three years, which will provide a much broader and more detailed picture of patients and their pathways.”

The payoff from investment in data this way is not only in the depth of the data but the breadth of decisions that data can support. “We can use this [improved data] for regulatory decision making, commissioning of services, but also research and designing and monitoring interventions,” Winker said.

Conclusion

As the panellists pointed out, collaboration is key. That is what will enable not only work to be done with individual ICSs but also to spread that work across ICSs too.

“Collaboration is at the core of the ICS, life sciences need to make those connections, that’s absolutely crucial. We’re looking for partnerships to deliver on the big challenges. Life sciences can bring their expertise from their therapy areas with expert clinicians, economists, epidemiologists and academics. They need to demonstrate their subject matter expertise and show how they can be complementary [to the expertise in the ICS],” said Winker.

Bose sees the opportunity too to help counter variation in uptake of NICE approved medicines. “There is variation in terms of how NICE guidelines are implemented. There are local interpretations of NICE guidance that can add delays. At the local level, collaboration and support is needed to bring those medicines to patients,” he said.

Uday Bose, country managing director and head of human pharma, Boehringer Ingelheim. Uday Bose is a highly experienced and successful leader in the pharmaceutical industry within the human pharma sector, with over 25 years’ experience spanning general management, health economics, sales and marketing roles with National (UK/Ireland), Regional (EMEA) and Global accountability. He has significant speciality care experience, including all aspects of commercialisation for early and late stage assets including 15 launches across 6 products. Since November 2018, Uday has held the position of country managing director and head of human pharma for Boehringer Ingelheim UK & Ireland. In May 2020, Uday was appointed to the Association of the British Pharmaceutical Industry (ABPI) Board of Management. He is also Chair of the European Medicines Group.

Matthias Winker, former head of Integrated Care System strategy, Buckinghamshire, Oxfordshire and Berkshire West. Matthias is an internationally experienced professional at a senior level in the healthcare industry with a focus to create value for public and private provider organisations, commissioner, life science companies, governments and authorities. He worked in the NHS on provider corporate and clinical services strategies. In his current role, Matthias heads the strategy function of an Integrated Care System and works on the future positioning of the ICS to deliver better outcomes, improve population health and drive economic and social growth throughout the health and life sciences eco system. He holds a Master’s degree in health economics and is an alumni of the Henley Business School.

Jim McArdle, commercial director, Interface Clinical Services, IQVIA. After qualifying as a pharmacist, Jim worked across many sectors of pharmacy both in the UK and internationally. In 2006, Jim joined Interface Clinical Services as commercial director, responsible for strategy and growth, and was a key factor in the success of the organisation. A passionate proponent of the role of clinical pharmacists, harnessing data to inform clinical and commissioning decisions, and patient centricity, Jim is viewed as a true innovator in healthcare. He has led on many projects designed to improve the lives and wellbeing of patients across primary and secondary care and recognizes the value in collaborative working between the NHS and life science sector to bring innovative solutions to health economies and to patients. Jim has a BSc in Pharmacy from LJMU and a Masters in Business Administration (MBA) from the University of Liverpool.

Steven Ferguson, head of Market Access UKI, IQVIA. Steven heads up IQVIAs Market Access function and brings extensive Industry experience after 25 years in the Pharma Industry, most recently from Merck where he led on Market Access across their broad portfolio.

Dr Paul Tunnah, chief content officer and managing director UK, Healthware (moderator). Alongside his work as a recognised author, speaker, moderator and industry advisor, he founded the industry-leading publication pharmaphorum in 2009. Dr Tunnah also holds a BA in Biochemistry and DPhil in Biological Sciences from Oxford University, where his work focused on identification of novel anticancer therapies.

IQVIA is a leading global provider of advanced analytics, technology solutions and clinical research services to the life sciences industry. IQVIA creates intelligent connections to deliver powerful insights with speed and agility — enabling customers to accelerate the clinical development and commercialization of innovative medical treatments that improve healthcare outcomes for patients. With approximately 77,000 employees, IQVIA conducts operations in more than 100 countries. Learn more at www.iqvia.com

Download IQVIA’s latest brochure to understand the landscape of Integrated Care Systems in the NHS and how IQVIA’s suite of solutions can help address business needs for Life Sciences companies in response to the changes.

Leela Barham is a researcher and writer who has worked with all stakeholders across the health care system, both in the UK and internationally, on the economics of the pharmaceutical industry. Leela worked as an advisor to the Department of Health and Social Care on the 2019 Voluntary Scheme for Branded Medicines Pricing and Access (VPAS).

Don’t miss your complimentary subscription to Deep Dive and our newsletter