EPISODE 9: What Can Be Done to Bridge the Gap Between Employer-Manufacturer Collaboration
- Whitney Vadeboncoeur
- Nov 21, 2024
- 21 min read
Updated: Mar 1
LISTEN BY CHOOSING YOUR PLATFORM
In this episode of The Only Healthcare Podcast, co-hosts Michael Navin and Randy Vogenberg, PhD, welcome esteemed guest Tonya Vyhlidal, a senior consultant with over 25 years of experience in building comprehensive health and wellness programs. Together, they dive deep into the components of employer and biopharmaceutical manufacturer collaboration and the benefits it holds for all stakeholders involved.
Key Highlights:
The Current Landscape: Understanding why collaboration between employers and manufacturers remains fragmented and what obstacles exist that hinder these essential partnerships.
The Role of Stakeholders: How employers, benefit consultants (EBCs), and manufacturers fit into the complex healthcare ecosystem and the significant influence each has on outcomes.
Access and Affordability: Why direct collaboration can lead to enhanced access to medications, more informed decisions, and cost savings that benefit both employers and employees.
Whole Person Care: The shift towards patient-centered care and the importance of aligning clinical pathways and treatment plans for holistic health outcomes.
Forecasted Outlook: The potential integration of medical and pharmacy benefits and how technology can act as a catalyst for innovation and improved access.
Tonya shares her firsthand experiences on how employer-initiated collaborations can yield financial, cultural, and operational benefits. This episode is a must-listen for employers, benefit consultants, and manufacturers looking to navigate and innovate within a complex system that demands strategic partnerships.
For feedback or to suggest topics for future episodes, reach out to us at onlyhealthcarepodcast@gmail.com.
About the Hosts:
Michael Navin brings 27+ years of experience in the pharmaceutical industry, specializing in commercialization. As the owner of a successful agency, he has launched numerous pharmaceutical products, making advanced treatments accessible to the public.
Subscribe now to stay informed and be part of the conversation on how we can drive positive change in the healthcare system.
Disclaimer:© 2024 Only Healthcare Podcast. All rights reserved.
This podcast and its content, including but not limited to audio recordings, images, and text, are the property of the Only Healthcare Podcast and are protected by international copyright laws. We appreciate all distribution and content sharing. Contact us at onlyhealthcarepodcast@gmail.com to access media kits, provide feedback, inquire about guest participation or to learn more. Thank you for listening!
Hosted by: Michael Navin & Randy Vogenberg, PhD
This Podcast is sponsored by:
Peek: Peek is reimagining access through innovation, technology, connectivity, and partnership. Peek offers a comprehensive and unique suite of solutions to help clients improve access and affordability for prescription drugs.
The Peek Meds Marketplace is one of Peek’s differentiated offerings that gives employers a revolutionary new approach to controlling runaway prescription costs for their employees by providing unprecedented transparency, simplicity - and cost savings. The Peek Meds Marketplace aggregates cash discount cards, manufacturer copay offset programs, and an employee’s insurance information to provide a holistic and personalized view of prescription price options. This easy-to-use platform offers a one-stop-shopping experience for prescription drugs.
Peek’s team has decades of experience in the pharmaceutical industry and offers various services to biopharma manufacturers, brokers, benefits consultants, third-party administrators and employers. Visit peekmeds.com to learn more.
Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.
Music by:Hanu Dixit, https://www.youtube.com/hanudixit
Episode 9 Transcript:
Ep9 mixdown
You are listening to the only healthcare podcast created to inform you on the why's, how's, and what's of healthcare. Hosted by industry leaders, Michael Navin and Dr. Randy Bogenberg, discussing why cost and risk are so high and who should be held accountable. How will technological advancements merge with the quality of care? And when does the public gain access to advanced medical treatments? Listen in as Michael and Randy answer industry concerns for the public and all stakeholders involved.
Good morning, everyone, and welcome back to the only healthcare podcast. Today's objective is really to continue on our theme of exploring creative ways and solutions and how employers and manufacturers can collaborate a little bit more intentionally. If you've listened to our last few, you're seeing a pattern, and we believe that this is a new concept, but an opportunity for everyone to think a little bit more strategically and more collaboratively in how patients can get more access to medications working directly with employers and manufacturers.
So just as always, I want to welcome back my co-host, Randy, and Randy, take it away. Thank you, Michael. This should be an interesting segment as we talk about what are some of the opportunities for employers and manufacturers to more intentionally collaborate, as Michael said.
And today, we have one of my longtime colleagues, Tanya Villadol, who has worked in most areas of the healthcare ecosystem, as I have, and we have crossed paths many times. So it's going to be a lot of fun having this conversation today. So Tanya, to start, why don't you just introduce yourself briefly and what you're doing today as a major consultant? Sure.
Tanya Villadol. I am currently working as a consultant primarily to employers. I do have history in the world of EBC, right? I was at an EBC for a while.
I was also with an employer for 11 years where I oversaw the entire entity of workers' compensation, well-being, benefits, all the things. Excited to be here today. Thanks for including me.
Oh, you're welcome. I'm glad to have you, Tanya. Why is there a lack of collaboration today between these two key parties of the biopharmaceutical manufacturers and the employers, whether they're self-funded or fully funded? Really, it's not for lack of either entity really wanting that to exist.
I mean, quite truthfully, we know that many manufacturers have employer teams. We know that employers are learning that the manufacturer is not the bad guy in this whole scenario, right? It's just that there are so many moving parts. It's a big chess game, unfortunately.
Through what has happened most recently with COVID, many organizations, employers who are the true payer are learning that manufacturers want to But we have to get all the pieces in order. And there's multiple people that need to be at the table a lot of times so that we need to include the EBC. We might need to include somebody else in that, whoever that middleman is, to make sure that that collaboration can happen effectively.
One of the challenges that I've seen over the years in my different roles is there's always different players that you have to include, and the list gets long real fast. How do we get collaboration started? Who really are the most important players? Yeah. The two most important players in this scenario are absolutely the employer, right? Because at the end of the day, they are the payer of everything that's happening.
And what is being done is many people are trying to actually make them happy. Whether they realize they have that kind of power or not, that's absolutely the case. And then the employer and consultants, the EBCs, because they are representing the employer.
And they are the one that really truthfully is making decisions on behalf of the employer many times. So where does the biopharma manufacturer fit in in that kind of ecosystem? Sure. Well, currently, unfortunately, it's a little far away from the employer, right? There's multiple players in organizations that land between the employer and the manufacturer.
But there are opportunities for employers to go direct to the manufacturer. There are conversations that can happen, and many times those conversations are happening, but we have to get the other entities involved many times to really understand what contracts look like, what the legal ramifications might be, what access to data they might have, what is the real possibility. There's just so many levers that have to be pulled in order for that to happen.
But there is possibility. It's a game of patience at the end of the day. It really is.
Well, certainly we know that healthcare is a complex environment to operate in, and there's lots of different aspects that have to be dealt with. And I know with some of the work that we've over the years through the Employer Provider Council and having these multiple stakeholder conversations has really been beneficial. So from your perspective, what are some of the benefits of this collaborative discussions that could be held between employers and manufacturers as a starting point? Yeah, I think there's many benefits to be had, right? One, it's to really understand each other, for the payer to understand the manufacturer, the manufacturer to really understand the payer, what those pain points are on either side, what they're held accountable to, all of the hoops that have to be jumped through in order for the right things to happen.
The other thing that I think would be beneficial for people to understand is at the end of the day, the goal really is to help the person. The goal and objective and the value story is, is we all want to help the person or the patient at the end of the day, right? So how do we best serve that individual? How can we shorten the pain point or reduce the pain points in order to help
that individual? And because the ecosystem is so incredibly large and complex, finding ways to partner and to lean in, right? A lot of times we need that employer to lean in and say, I absolutely want this to recognize their power, to own it and to lean in and get the right people at the table. I think that if we had more of those conversations and we better understood each other, we better understood each other's pain points, we might find that not only is there some financial opportunities, but there are also probably some really strong emotional opportunities.
We can reduce a lot of frustration and anxiety, quite truthfully. So the whole aspect of whole person care or patient-centered care that many of the stakeholders always talk about, certainly is one major opportunity of a benefit in having these collaborative discussions. Are there any others? Yeah.
I mean, opening access, changing access, reducing the price model, the pricing model, that's like a big, big thing. Recognizing that there is multiple ways to get what you need, not just during under the current model, that we can be creative and innovative without stubbing our toe essentially, right? You will also learn that if you are really wanting to, I think, be an organization that is looking at all the aspects of how you support your employee, and you're considering all the things that you have to weigh as an organization, all the financial responsibilities that you have, whether that be through healthcare, whether that be through the well-being of the individual, right? Whether that be through performance, whatever that is, that partnering with and collaborating with the manufacturer can actually reduce a lot of your anxiety and get you access to things that maybe you don't understand. Sometimes medications and opportunities are left off of formulary or they're set aside and there's other ways to access what you need, without me, right? So I think there's multiple ways to look at it.
I think there's a financial opportunity. I think there's absolutely a cultural opportunity for the organization. I think there is an opportunity just to learn and understand how you could possibly better operate and do business through a model that there is more direct relationship there versus working through that entire ecosystem that's so complex.
I think that point around access, we've seen the market make some of its own changes around at least the physical access or the distribution channel with what Walmart and Amazon has been recently offering into the marketplace. What's the perspective from both the employer and manufacturer around some of those changes in the distribution system? Both, and I would say definitely the manufacturer, are looking at that as a possibility and an opportunity to go more direct or have different channels of which they can get to the employer. Manufacturers aren't saying, oh, that's terrible.
We don't want that to happen. We need control. No, what is being said is we want open access so that anybody that needs medication, whatever that might be, has the ability to have access to that in a way that's not going to break their bank at the end of the day, right? The social determinants of health are a real thing.
Access is a key, important issue within that. That's one thing. As far as an employer goes,
they're going, whoa, wow, there's a lot of things opening up.
Things are new, but I'm suspicious. I need to understand what's that look like. I don't have all the information.
I'm held to be a fiduciary for responsibility for what's happening, right? I need to be careful, but I'm curious. I want to learn. If I'm an organization that has the ability to demonstrate innovation, I'm willing to step in and consider that.
Absolutely. Can I jump in here for a second? Really great information. Have you, in the employer, pharma, sort of manufacturer conversations, has the new transparency laws come up? For example, we know that there's been two lawsuits with J&J and with Wells Fargo.
We know though that the CAA laws for pharma have not taken effect. They're more on the transparency and for major medical procedures. Are you getting those types of questions around how can manufacturers work to provide transparent solutions for those fiduciaries so that they cover their behinds? Yeah.
I would say the conversations are absolutely happening at various levels. There's curiosity there and there have been multiple of those conversations. So my answer to that is yes.
Could I give you cited examples of those? Probably, but it would take a lot of time to do that. I would just say in the short term, a variety of different types of those conversations are happening and manufacturers are taking that very seriously as well as the employers. Comment you made earlier about the complexity of the decision-making where you have a benefit consultant, an employer, who's responsible at the end of the day.
We all know that the fiduciary is the employer in that case. So then who's the decision-maker in that web of complexity? In that web of complexity, the employer should always be the decision- maker. Many times, I think they feel like they are held hostage.
However, they are the decision-maker. And it depends on a variety of different things in that scenario. It depends on the size of your organization.
It depends on your brand. There's many things. It depends on who's leading your initiatives, what kind of CEO you have, all those things.
At the end of the day for employers, many times the EBC is making the decisions on behalf of the employer and leaning in on them, but the employer should and is ultimately the decision- maker. It's really about how they go about making decisions and how far they're willing to lean in. And they should.
They should be leaning in. They don't want to make a lot of noise. They're nervous they're going to upset the fruit basket.
I've got a good pricing model. I've got this. I've got a great consultant.
And that's vitally important. I know I've been there, done that. I was that.
But the right consultant is your champion ultimately. And I would say in many cases now, the manufacturers also want to be that type of champion. But again, the ecosystem is so large.
We're all trying to learn and we all need to get better at communicating with, educating, and partnering with not only the employers, but also the EBCs. And we just came off a large conference that talked a lot about whereas health technology and medications and research has significantly advanced and changed people's lives. They're still struggling to see the value proposition and how those costs are reducing outcomes, creating better outcomes and reducing costs.
And they're struggling with that. Being able to put their head around that saying, wow, everything just seems to be getting more expensive. Right.
I know it's been a big topic of conversation, I would say, especially as I'm consulting and doing new things over the course of the last 18 months, that, whoa, how could technology actually be a driver to cost reduction? How does that work? Right. Well, I don't think some are able to wrap their head around is, part of it is the accessibility that is provided through technology. And the fact that it does break down barriers to care.
It does break down other cost barriers, right? However, anytime anything new comes up and we think about technology, we also have all these past experiences that have happened that can sometimes get in the way. But I believe based on my experience, not only previously and now, that that is going to happen. It's just at which the speed of which it's going to happen, probably too many words there, right? Yeah, it's going to happen and it absolutely has to because there's no other way for us to spread access or get to the people that we need to get to and the way that we need to without it.
And as a manufacturer, there's no better time to be thinking about this being a tipping point for how you can support. And if you're not considering that and you're not advocating for that, you're going to be behind. But the concerns, I think what we hear is the concerns on both sides, right? So on the employer side, we're hearing they feel that if they're innovative or they're exploring innovation, that they could potentially have a backlash against their agreements with the PBM.
And I think the pharma manufacturers are saying the same thing. Like if we're innovative at getting medicines outside of using what I would say, alternative channels, right? We could just that they feel that there's like a negative backlash. So how do they handle something like that? How can they take control of the PBM arrangement and say, look, we get it.
We understand we have an agreement and we're going to adhere to that agreement, but we also see there are opportunities for us to save money with products that aren't maybe on the formula. Yeah. I think that's where it starts, right? There's products that aren't on the formulary.
And if you're not going to provide them on the formulary, we want access to those. So we don't have an obligation to you in that regard. And I need to find other creative solutions.
You need to get in that lane. That's where it starts is I know what I need. I know what my people need.
I know what we need access to. If you're not going to currently provide it and you're going to keep it off, I legally don't have an obligation to continue working through that with you because it's already not a provided. I can move a different direction.
The other thing I would say is, I mean, you shouldn't, unfortunately right now, a lot of people feel like they're being held hostage and they are. And anytime you feel like you're being held hostage and we know we're kind of walking on eggshells and we're not sure how things are going to go, you have to proceed cautiously. I always tell people, what do your contracts say? What legally are you held accountable to? What are your needs and expectations? Do you understand your data? Have you evaluated your data? Not only the data around conditions and prescriptions and what you need, but the financials related to that.
What is your current scenario really? Where is your performance scenario right now? And then what do we need to be different? Are we willing to be creative and innovative and do things differently? And if this new potential model exists that can supplement what you're already doing, you should absolutely be considering that. And I think you're doing an injustice to your organization if you don't. Yeah.
And with the advent of cash, patients obviously being consumerized where they have to take more of the financial responsibility. And you've seen the advent of products like GoodRx that came out, being able to get a cash capability. Those cash transactions don't get reported into the system.
So the employer nor the PBM will see that information. How does that have an impact from a manufacturer's perspective? It's a conversation. We absolutely know it exists.
And there's a focus point there. And it's part of the larger landscape of evaluation, but it's not a sticking point by any means. Because it's still small enough.
Yeah. Yeah. Yeah.
The larger transactions. Yeah. The larger transactions.
I mean, really, we ultimately are learning and teaching internally in the manufacturer organization too. Because when people say payer, they sometimes, especially within pharma, they think health plan. Right.
And so that's a whole teaching lever too. We're constantly like, well, let's remember who the true payer is in this scenario. And that's why I believe over the course of the last three to four
years, COVID kind of shoved this up everybody's noses.
It's like, oh, we need to be thinking differently, right? We need to think differently. We also learned technology is a driver to get access to people. I mean, unfortunately, we learned a lot of things during COVID that are reshaping how we do business, but also how we help people.
Ultimately, it's about helping people. If you can keep that at the front of your mind. And I would say most manufacturers know and want that.
The complexity exists in the middle between the employer and the manufacturer. That's a great point. I think your earlier point on the tipping point that we're at right now, which I also refer to as an inflection point, is real.
We're now looking at really plans for 2026 from the employer perspective. 25 is already set. Manufacturers are still thinking about 24 and 25.
They're behind the that regard. And to Mike's earlier point on the R&D side, it's like a disconnect within the manufacturers. So this ability to have better conversations, more realistic conversations, and look to where you want to be as opposed to where you're at today, it makes a lot of sense.
So a lot of these bottlenecks that we identified in this last few minutes really are small in the scheme of things. But one aspect that wasn't brought up is the idea of the small business complexities. We talk a lot about the large self-insured as an example, the large manufacturers, but there's a lot of smaller businesses, particularly in the healthcare ecosystem today because of the R&D drivers.
So how do the small business complexities, both on the manufacturer side and on the employer side, the smaller self-insured as well as the fully insured, where do they come into play when we talk about these conversations, Tanya? Yeah, my mind's racing on that one because I worked for a small to midsize employer for 11 years. And I learned at the end, I got more educated and I went through the ranks and built those relationships, et cetera, how much I can sit at the table and negotiate. If I came in prepared, so from a small to midsize employer perspective, we all know healthcare costs, I mean, it could be 50% of their overall expenses related for the year.
When you think about your financial design and what you're held accountable to as an organization, outside of payroll, healthcare is going to be your number one cost driver for your organization. So from that perspective, they need creative solutions in order to survive. And sometimes they're more nimble and they're more ready to move.
There's that, whether or not they're self-insured or fully insured sometimes is the issue. But I think people would be surprised how many small to midsize organizations actually are self- insured because they want to carry their own risk because they trust themselves a lot of times more than they're trusting other entities. Manufacturers are interested in small to midsize employers.
They know that that's the masses of the world. And when you look out into the world, quite truthfully, you have more organizations that way, but it needs to start with those jumbo and larges in a way that helps. Because a lot of times you need that momentum and maybe a large brand to make that initiative more known.
Not that there's not interest, I would just say that at current state, they're not the primary focus point, but never to be ignored. Absolutely never to be ignored. Those conversations are always happening.
I would tell you if a 1500 life group or 1500 employee group came forward to a manufacturer and said, hey, we want to think creatively. We've got the manpower, we've got the innovation, we've got all the things in order. They wouldn't be turned away.
Never, never. But they would want to make sure that the EBC was involved in that conversation because so many times those small to midsize employers rely very heavily on the EBC for support and decision-making. Definitely be another entity that's required at the table for that to take place.
Okay. So we've talked about understanding the major players, the employer benefit consultants or advisors, the employers, along with the manufacturers. What are some of the objectives when you start looking at these creative solutions that we've been talking about can be pulled forward and pressuring some of the existing third-party relationships? How do you start moving in that direction? Yeah, I think that stuff is already happening quite truthfully.
It's like running multiple marathons back to back. So before we see a lot of movement there, there's a lot more conversations that need to be had and a lot of level setting that needs to be done. I think the primary focus, well, there's two and there's more, and I'm sure Michael probably has things spinning in his head, but cost, right? Making sure that the cost related to any prescription of any kind or whatever a person needs has to be a primary focus point because we know that right now in this country, everything is expensive and things have blown up.
And so we want there to be affordability and that means different things to different people. So what does that mean? Making sure that things are affordable. Access is always, always, always a thing.
It will continue to be a thing, again, why we kind of lean back on technology. And I think partnership and collaboration and understanding how working together and modeling together will make for better impact long-term, but that's just going to take some time. I still stay on the two sticking points we were on before.
The other thing that from an employer perspective, I guess, and this may not even be in alignment with your question, Randy, but an employer has multiple things that they're considering when they are employing a person, right? And organizationally now, culture and
how they take care of their people is more of a priority than ever because there's such a talent war going on and we're seeing that people will jump to another job for a dollar more an hour and all the things. So in order for an organization to really be forward moving, to perform well, to meet its own margins, it really has to have a culture of caring for people and included in that is going to be wellbeing offerings. It's going to be health and benefits designs.
It's going to be prescriptions. It's going to be all the things, but it also means it makes it more complex for them because now they've got four to five different point solutions and they've got multiple different vendors and they got all these other things going on. And in addition to that, I need to be over here thinking about innovation and how I can do things differently.
So there's all these things that are expected of them. But at the end of the day, I don't think that they cannot not lean in because again, it comes down to, not only can we afford it, but can our people afford it? Do they have appropriate access? And are we going to be able to have retention of that employee in long-term if we're not considering being more innovative and thoughtful about how we go about this? It sounds like a lot of back to the future and deja vu. We've been there before.
Yeah, it feels like it's just this constant loop, but as the world changes and demand changes, I would have never thought five years ago that GLP-1s would be where they're at. We've been talking about obesity for feels like 25 or 30 years and we had all these lifestyle management solutions, right? And now look where we're at, like, bam, the GLP-1 craze is here, right? And I think that's going to be a driver also for how things will change because of the demand. I really do.
It seems for certain that change is going to happen whether we like it or not. It's here. In all areas of our economy, not just healthcare, change is going to happen.
Yeah. And I always hear, whether it's a manufacturer or employer, the confusion around the pharmacy versus medical benefit is another example of how do we get our arms around this whole thing, looking at it more holistically, as you were pointing out, and also juggling all these responsibilities. Do you ever see, looking into the future a little bit before we get into summarizing and wrapping up today, what's going to happen with pharmacy versus medical benefit? Where are we going to land on that? Are we going to have a single integrated benefit or some other whole benefit scenario than what we have today? Yeah, that's a great question.
My instincts tell me that down the road, long-term, like way down the road, we might have an option for that, but there's just so many barriers to break down before we get there, unfortunately. I still think they're going to be in their own silos for now. What's going to happen is the employer is going really have to be responsible for making sure they fully understand their plan design and what they can do here and what they can do here.
Something as simple as a vaccine. Do I go to my doctor? Does my doctor cover? Oh, if I go to the pharmacy, it might not be covered here, although the pharmacy is closer to me, so
therefore I'm not going to get vaccinated because I don't have access to my doctor. This is something as simple as vaccine is like that.
So I guess my answer is in the short term, I don't see that changing that significantly. What I see changing primarily is how we open up access and also how we manage those benefit plans. I think long-term, there's a possibility we could see integration, but man, there's a lot of barriers to break down before we get there.
And a lot of people have to play in the same sandbox and they're not even in the same playground right now. So that's its own thing. It's true.
We're not even meeting at the same playground right now, so it's going to take a little bit of time. Yeah, that's a great point. So just as a quick summary before I turn it back to Michael to wrap it up, what we tried to do, I think we did a pretty good starting point of looking at, well, where are these collaborative opportunities for these discussions? What are some of the benefits that come along with that? The bottlenecks that we're going to run into, time issue that you just mentioned, are we all in the same playground or not? And ultimately we got to get to creative solutions because this change is going to happen.
And there's a lot of benefits both to the employer as the plan sponsor or the purchaser of the plan, as well as to the manufacturers who are trying to sell their therapies or their products. This has been a great conversation. I really enjoyed it.
I'm going to turn it back to Michael. Yeah, the last two.
This file is longer than 30 minutes.
Go Unlimited at TurboScribe.ai to transcribe files up to 10 hours long.
www.onlyhealthcarepodcast.com. You can subscribe to the use of our podcast, as well as you can follow us on Spotify and YouTube to see, the episodes. And also if you have a LinkedIn page we'll be advertising, clearly, on that as well.
00:16:57:13 - 00:17:10:02
So don't forget to tune in and listen and, get some good information. And finally, if you have feedback or material you'd like us to cover in future episodes, please let us know.
Comentários