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Interview: Heidi Waters - Director of Outcomes Management, Otsuka

We spoke to Heidi Waters about the evolving market access landscape, the impact of the Affordable Care Act, and her efforts to improve the way customer engagement tools are developed.

First of all, thank you for taking the time to speak with us today. Can you say a little bit about your role as Director of Outcomes Management at Otsuka?

Sure, I work in the health economics and outcomes research department, but not in a traditional research role. Half of my job involves taking the material - the studies and the data that the HEOR researchers produce - and turning it into resources for our field medical teams, both payer-facing and provider-facing.

I also assist our managed markets field force, in their work liaising with health plans here in the US. I’m not a part of that team, but I provide input to some of the tools that they use in the field.

What sort of tools have you been creating?

Economic models and payer-facing value decks, so-called FDAMA decks, and then unbranded disease state decks.

What format are you using?

We had been using PowerPoint and interactive PDFs for the decks and standalone iPad apps for the models, until BaseCase came along.

You’ve been working in this area for a number of years - can you say a bit about your perspective on the industry and how it has been changing?

I think there’s been a shifting focus towards the recognition of HEOR and the value of messaging to payers. I think that the traditional field sales role and the traditional model of selling is shifting. As you might know, the Centers for Medicare and Medicaid Services have decided to shift to paying for value rather than quantity of service, and they’ll be moving to a quality-based reimbursement system.

I think that with changes like that there’s been a move towards looking at different types of data other than the traditional randomized clinical trials, and looking at what happens in the real world. People are paying more attention to different kinds of data, and messaging to different types of customer - there’s more of a focus on payer engagement.

So it’s becoming more important to be able to use health economic data in the tools you are producing?

Yes, definitely.

One major development in recent years is of course the Affordable Care Act. Has that influenced your work significantly?

It has. Part of my work is producing quality focused and health services type research. I partner with payers and providers to do unbranded research to look at improving quality of processes, developing tools that will help them identify patients with the greatest need, for example.

This area of my work has been affected greatly by the Affordable Care Act, because payers and providers are open now to different ways of improving quality and they are really looking for help and guidance. They recognize that not one person has all the answers so they’re willing to engage in collaborative partnerships.

Would you say also that the customer engagement environment is more fragmented and dynamic now?

Yes, I would say it’s more dynamic, and I don’t think it’s a bad change. I think it’s actually very interesting, and the opportunities are greater, from a pharmaceutical industry perspective. But I think also in the healthcare industry overall, people are looking towards collaborative relationships and are understanding that the healthcare system is an ecosystem that requires input from a lot of different players and that one particular group can’t do everything by themselves. I think that the industry is growing in a healthier way, actually.

Are you then able to use the unbranded research to shape the tools that you produce?

It does shape some of the tools, definitely, we are able to create tools that highlight the ecosystem rather than one small part of it.

We also do that type of research to show that Otsuka is a valued partner in the disease states that we treat and that we are interested in patients getting better through many means - it’s not always going to be our drug. We are dedicated to trying to improve the lives of patients. We make medicines that treat a lot of difficult diseases, and we recognize that drugs are only part of the way to make people better.

What in your experience makes for an effective customer engagement tool?

I think the ability to interact with the tool is very important. Slide decks are fine to present information but they’re not didactic or interactive. Especially for economic models, it’s important for our customers to be able to input their own data and understand the impact on their own system, rather than just looking at the values that we’ve put in their as the basis for the model. They need to be able to tweak as many fields as they can to make it more resemble their patient population and the costs that they’re incurring.

I also think that transparency is another really important point. Oftentimes, payers don’t trust economic models, particularly if they’re developed by pharmaceutical companies, so being able to understand where the calculations came from, how they’re derived, what information was used as the basis for the model and them being able to change it is a really important part of them understanding it and seeing that it is impartial and objective.

In terms of making a tool that will have high uptake by the field team, what recommendations do you have? Do you find that they’re not comfortable with the complexity of the data?

Sometimes. I think that, if the calculations are too difficult to explain, or the base data were too obtuse and not straightforwardly pulled from the literature then I think that’s where problems occur in the field’s ability to discuss the model and answer questions clearly.

Does using BaseCase enable you to solve this problem?

Yes, because with BaseCase, I can build in pop-up screens that display the calculations or the literature reference for the initial values when icons are hovered over. Having that type of transparency built into an app will help our field teams in explaining exactly which data were used and how the calculations are done.

What was the main business need or challenge that motivated you to start using BaseCase?

We were finding that every time something changed in our models - if we had a label update, or our wholesale average cost changed - we were reliant on somebody else to fix the materials.

That involves many steps including getting it into our vendor’s workflow to make the changes, and being able to do that quickly enough to get it back to our promotional review committees, and we’d have to pull the tool from the field.

There were a lot of moving pieces, it was expensive and very time consuming, because we’d be reliant on somebody else’s timelines, we’d have to put addendums to contracts in place to get the changes made and it was just getting a little unwieldy.

Plus, to build a standalone app is really expensive.

So for you it was the ability to control the content and keep it up to date?

Yes, and control the costs too.

Did you use vendors to produce custom iPad apps?

We did, we had perhaps four or five standalone iPad apps that were our interactive economic models. Keeping version control straight was a major challenge. The same vendor didn’t do all of the modelling, so keeping the vendors straight, keeping everything flowing well was difficult, especially if we had three different models for one product. Then if we had a label change, we’d have to ensure updates were made by all vendors at the same time. It became difficult.

Can you say a bit about the apps you’ve been producing with BaseCase?

We have two going through approval, using the ‘BaseCase Launch’ workflow to expedite the process, and a third is in development.

All three are for Abilify Maintena, a long-acting injectable anti-psychotic.

Two of the apps are economic models, one of which assesses potential cost-savings stemming from decreased hospitalizations after switching to Abilify Maintena.

What has your experience been using the platform?

I actually love it. It’s very intuitive and very easy to use. It was quick to learn and the Customer Success Team at BaseCase did a great job with the training. They were very quick to answer any questions that I had. I really enjoy working on the platform a lot.

Are you producing apps completely in-house or are you using the app development team at BaseCase?

We are producing them in-house - I actually created the apps we’ve made so far by myself.

Going forward, we have several products for which we’ll be transitioning our materials to BaseCase. As our use of the platform increases, clearly there will be a point where I can’t do everything myself anymore, so we are training another person in my department to act as a BaseCase Developer and we’ll hire someone new as well. It’s a really easy-to-use system. Even just working on it by myself, it only took me a couple of weeks - and not working on it 24/7 - to get most of the app built. It hasn’t taken me long to get up to speed.

And how does that timeline compare with using a vendor to build an app?

That would take a lot longer, the process usually took a month and a half to get a draft. I probably got to the same point with BaseCase in about a week and a half.

Do you see a potential use for the platform for developing other kinds of tool at Otsuka - for example e-detailing or sales tools that would have a wider audience?

I do, and I think that once we gain some experience with it we will definitely be presenting the platform and our success with it to other teams to see if they would have a use for it as well.

I know that our European colleagues are eager to hear how it goes, because then they can use the same models that we built and customize it for their markets. It’s a lot of work to build models in the first place, and then to build standalone apps for multiple countries doesn’t make sense really. It’ll be very useful for our EU team. We’re hoping that the platform will facilitate us working more closely together.