Healthcare Disrupted

“During a time of tremendous change and uncertainty, Healthcare Disrupted gives executives a framework and language to determine how they will evolve their products, services, and strategies to flourish in a increasingly value-based healthcare system. Using a powerful mix of real world examples and unanswered questions, Elton and O’Riordan lead you to see that ‘no action’ is not an option—and push you to answer the most important question: ‘What is your role in this digitally driven change and how can your firm can gain competitive advantage and lead?’”—David Epstein, Division Head, Novartis Pharmaceuticals

“Healthcare Disrupted is an inspirational call-to-action for everyone associated with healthcare, especially the innovators who will develop the next generation of therapeutics, diagnostics, and devices.”—Bob Horvitz, Ph.D., David H. Koch Professor of Biology, MIT; Nobel Prize in Physiology or Medicine

“In a time of dizzying change across all fronts: from biology, to delivery, to the use of big data, Health Disrupted captures the impact of these forces and thoughtfully develops new approaches to value creation in the healthcare industry. A must-read for those who strive to capitalize on change and reinvent the industry.”—Deborah Dunsire, M.D., president and CEO, FORUM Pharmaceuticals

Healthcare at a Crossroad: Seismic Shifts, New Business Models for Success

Healthcare Disrupted is an in-depth look at the disruptive forces driving change in the the healthcare industry and provides guide for defining new operating and business models in response to these profound changes.

Based on original research conducted by Accenture and years of experience working with the most successful companies in the industry, healthcare experts Jeff Elton and Anne O’Riordan provide an informed, insightful view of the state of the industry, what's to come, and new emerging business models for life sciences companies play a different role from the past in to driving superior outcomes for patients and playing a bigger role in creating greater value for healthcare overall. Their book explains how critical global healthcare trends are challenging legacy strategies and business models, and examines why historical leaders in the industy must evolve, to stay relevant and compete with new entrants.

Healthcare Disrupted captures this pivotal point in time to give executives and senior managers across pharmaceutical, biopharmaceutical, medical device, medical diagnostics, digital technology, and health services companies an opportunity to step back and consider the changing landscape. This book gives companies options for how to adapt and stay relevant and outlines four new business models that can drive sustainable growth and performance. It demonstrates how real-world data (from Electronic Medical Records, health wearables, Internet of Things, digital media, social media, and other sources) is combining with scalable technologies and advanced analytics to fundamentally change how and where healthcare is delivered, bridging to the health of populations, and broadening the resposibility for both. It reveals how this shift in healthcare delivery will significantly improve patient outcomes and the value health systems realize.

Preface ix

Acknowledgments xiii

Introduction xvii

Then, Now, and Potential xviii

Emerging Models xxi

Disrupting and Reshaping Responsibly xxii

Part I The Tsunami of Change 1

Chapter 1 Why and How the Healthcare Industry Is Changing So Rapidly 3

Opportunities 5

The Signs of Change 6

A Closer Look at Healthcare Reform 7

Real Reform: Why This Time Will Be Different 9

From Reactive to Proactive 19

Chapter 2 Strategic Choices No Healthcare Company Can Avoid 23

Market Positioning: “What Market Will My Organization Seek to Shape and What Will It Take to Influence That Marketplace?” 24

Differentiating Capabilities: “What Internal and External Capabilities Does My Organization Need in Order to Gain and Maintain a Leading Market Position?” 31

Performance Anatomy: Pivoting the Operating Structures to Patients and Ensuring Differentiating Capabilities 37

A Responsibility for Your Company’s Future 40

Part II From Strategy To Value With New Business Models 43

Chapter 3 Old Models and New 45

A Profile of the Old Way (The Starting Point for Many Organizations) 47

Fundamental Shifts in the Operating Environment 47

The New Models Array Themselves on Value and Payment Dimensions 51

The Emerging Business Models 52

Hybrids and Other Novel Solutions 60

Chapter 4 Lean Innovators 63

The Generic Chassis and How It Evolved 64

Shifting Opportunities and Rising Pressures 66

Enter the Lean Innovator Model 68

Early Challenges to the Lean Innovator Model 74

The Techniques of a Lean Innovator 76

The “Lean” Operating Model Position: Execution, Execution, Execution 79

Lean Innovators: Spoilers or Value Vanguard? 83

Chapter 5 Around-the-Patient Innovators 85

Identifying Unmet Needs 88

Innovating to Meet Needs, Fill Gaps 94

Examples of Emerging Around-the-Patient Innovators 100

The Questions That Around-the-Patient Innovators Ask and Why They Ask Them 104

The Around-the-Patient Operating Model: Innovating the Therapy and Patient Care 108

Around-the-Patient: New Commercial Model or Value Vanguard? 113

Chapter 6 Value Innovators 115

A Mindset Shift (“Health” as Opposed to “Disease”) 116

Value Innovators: The “Living” Service Providers 121

Better Operators: Examples of Emerging Value Innovators 125

How to Succeed as a Value Innovator 127

Suites of Solutions 129

The Value Innovator Operating Model Is Integrated, Digital, and Services- and Outcomes-Centric 129

The Value Innovator: Value Partner and Services Provider 135

Chapter 7 The New Health Digitals 137

Digital Gone Healthcare 139

Healthcare Gone Digital 142

Start-Up Digitals 145

Digital Economics in Healthcare 146

Implications Now, Soon, Later On 147

Working with the New Health Digitals 149

Health Digitals Positioning, Capabilities, and Anatomy 150

The Health Digitals: Disruptions and New Foundations 156

Part III Building New Organizations 157

Chapter 8 Toward a New Model of Collaboration and Competition 159

Critical Innovations from “Without” 161

Value Innovating with Your Customers 162

Driving Convergence: At the Intersection of Therapeutics, Devices, and Process 166

Mapping Big Digital: Where Digital Consumer and Digital Healthcare Meet 170

Competition: Protecting the Business 174

Change Catalyzing Collaboration Catalyzing Change 176

Chapter 9 Talent Strategy for the New Healthcare Ecosystem 179

Transforming through Talent 180

Recruiting 183

Onboarding 186

Skills to Create Value 188

Part IV Looking Back—Looking Forward 191

Chapter 10 A New Age of Healthcare—Placing Patient and Value at the Center 193

New Future 195

New Language 198

New Economics 199

Your Starting Point, Your Strategies 200

Glossary 203

Notes 219

About the Authors 253

Index 255

JEFF ELTON, Ph.D., is the Managing Director of Accenture Strategy and global lead of Predictive Health Intelligence and Patient Pathways practices. He is a founder and board member of several therapeutics and healthcare companies. He is a frequent author on topics of health innovation, analytics, and value. He is currently a board member of the Massachusetts Biotechnology Council and recent lecturer at the Boston University, Questrom School of Business, Health Management Program.

ANNE O’RIORDAN is the Global Industry Senior Managing Director of Accenture Life Sciences and a member of the operating board of Accenture’s Products business. Based in China since 2007, she has worked throughout Europe, the United States, and Asia for the past 25 years, helping pharmaceutical, medical technology, and consumer health companies rethink, reshape, and restructure their businesses to deliver better patient outcomes. She has published numerous articles on the life sciences industry.

The global healthcare industry is undergoing a profound and fundamental shift from rewarding volume of sales, procedures performed, and patients treated towards a focus on improving overall health, patient outcomes and value for the health system. Healthcare Disrupted is the much-needed, authoritative guide to the massive transformation taking place, how to prepare for what’s to come, strategies of the new leaders, and our roles as individuals, executives, policy leaders, investors, innovators, entrepreneurs, and educators.

Based on original research conducted by Accenture, this cutting-edge guide delves into the convergence of economic, social, and technological forces upending traditional business models and creating new ways of caring for patients.

Performance- and value-focused business and operating models will win the day as the new standard for competitiveness, and Healthcare Disrupted is the critical road map for profitably navigating this new landscape. C-suite leadership, entrepreneurs, investors, and everyone involved in healthcare will gain valuable insight from the in-depth coverage on how health and healthcare will be redefined. Healthcare Disrupted defines the basis of new value-centric performance and business models, tracks the accelerated evolution of leaders from product-centric to value- and services-centric, and how the requirement for outcomes and value will impact all organizations—care delivery, payers, services, technology, and life sciences—and how they necessarily need to work together.

Conveniently organized into three parts, this comprehensive resource first looks at how and why the healthcare industry is changing, then examines four front-running business models to succeed in the new landscape, and finally details how to build organizations fit to collaborate and compete in the redefined markets. Concrete, actionable advice supported with illuminating examples of how strategies play out in the real world show you:

• Why this confluence of changes will fundamentally shift the industry’s focus from value to volume
• The critical questions a company needs to consider in order to gain influence and a competitive edge
• How to develop solid, progressive, and flexible strategies to effectively transform organizations for success
• What established, successful businesses in other industries are now finding lucrative in the healthcare market
• How to recruit the talent and develop the performance systems for the new value-focused organization

Healthcare systems that reward value and patient outcomes can have tremendous benefit to the economic productivity and long-term performance of countries all over the world. Healthcare Disrupted ensures your company can adapt, stay relevant, and gainfully contribute to the new age of digital medicine.