Wednesday, December 30, 2009

5 simple things to consider in Market Access

Still time to wish you a very happy New Year!

Thank you for visiting my blog. May 2010 be as prosperous and exciting as you wish.

As the year approaches its end, I’m resuming my posts in this blog. Look forward to readers’ comments! 

Market Access to whom?

The term “Market Access” is very often used by the World Trade Organization to define the conditions agreed by governments for the entry of specific goods into their markets.

In Health Care, it defines the processes through which companies access (sell to) specific markets. Note that I use “specific markets” and not countries, governments or regions because you may find several different markets within the same geographic location. For instance, while the National Health Service (NHS) embraces the three health care systems in Great Britain, health care delivery and improvements are decided by local Primary Care Trusts (PCTs). And there are more than 30 PCTs in London only.

The point here is that you may have a good idea of what Market Access is. But you won’t be able to develop any solid Market Access strategy before knowing who your specific market is.

Patient population

Every day companies target patients with market campaigns and strategies. The issue is the fact that not all patients are the same. I remember a large campaign to promote blood glucose monitors for Diabetic patients. As part of the team, I raised some questions that, although seemed obvious, had yet not been considered.

  • Are we targeting Diabetic patients type 1 or 2? (easy one…)
  • In the public or private market? (started to get a little bit complex)
  • At what stage of the Diabetes?
  • With or without co-morbidities?

As a former colleague used to say…”obvious things must be said twice, at least”.

None of the individuals in the team could go beyond the 3rd question, which clearly meant they didn’t know to whom they were attempting to sell their products.

It is crucial to know your patient population, and the first step to do it is to understand the disease and how it affects people. When I was working in a Hepatitis Vaccine project for Substance Abusers, the first thing I noticed was that not all Substance Abusers were the same (again, pretty obvious, but…). Injection-drug users were much more likely to be infected by Hepatitis than alcohol abusers, for instance, and that meant a completely different Access strategy.


Once you understand the disease and your patient population, everything becomes very linear. The next step is to define the relevant stakeholders and what they value in health care.

This is a very important step for those working with Value Dossiers. Quick question: can you develop Value Dossiers if you don’t know what value means for your relevant stakeholders?

(And yes…You cannot define the relevant stakeholders unless you know your patient population.)

Let’s take the example of a minimally invasive surgery (MIS) versus open surgery. Under the patient perspective, a minimally invasive approach results is less scaring and shorter length of stay in the hospital.

On the other hand, MIS tend to be more expensive than open surgeries. If speaking to a health plan, should we promote its aesthetical benefits? Sure patients value that, but is this valued by these payers? On the other hand, the shorter length of hospital stay as compared to open surgeries may translate into economic benefits, as health plans will pay for fewer room days. Eventually, this benefit may overcome the cost of surgery, making the MIS overall (surgery + hospital stay) cheaper than open procedures.

This is a very basic, but real, example. I’m not saying we should all look for the ONE single powerful value. On the contrary, we need to assess different stakeholders with different values, and approach each of them independently. This is the real Value Dossier mission.

In a nutshell

1)     Understand the disease
2)     Define the patient population
3)     Identify relevant stakeholders
4)     Assess patients and stakeholders values
5)     Develop your Value Proposition

The future?

It is always good to write about the future at the brink of an ending year.

About two weeks ago I was asked what I thought about the future of Market Access. I found this a very interesting question, especially because I worked for several years in Marketing only.

I inverted the question to answer it. In my opinion, the future of Health Care is Market Access.

More and more expensive health care technologies are launched each year, populations get larger and older, new diseases occur and many other aspects take place over limited financial resources to guarantee access to care for everyone. It doesn’t take much effort to see that the traditional Marketing efforts will not work anymore in a few years.

In a few words, I’m happy to be a Market Access professional. There is no doubt that my (our) expertise is becoming more and more valued each day. And if there is something certain about the future of Health Care, is that we won’t have enough money to pay for everything for everyone.

And this is where the ultimate mission of Market Access comes: to enable patients access to health care. We’ll talk more about this.

Happy New Year!!!

Ernesto M. Nogueira