Article: COVID-19 and the Health Impact (and Pharma) - April 2020

By Mark Bard and Joe Farris, The DHC Group

The Past 2 Months Have Been a Shock to Our System

The past two months can be described many different ways – but “shock to the system” is a description that fits on many levels. Our daily routines, our ability to move or travel, our interaction with the overall economy, as well as our interactions with the health delivery system have been radically altered. While our routines will likely return to some version of normal – some sooner than others, it’s clear this shock will have lasting effects on various parts of our economy and health delivery system.

DHC Group leadership have been following the adoption of digital health since 1999 and witnessed a significant amount of change and disruption in the past two months. Covid-19 has acted as an accelerant and provided cover for ‘riskier’ transitions to digital. We have outlined a few observations for your consideration that we think will ‘stick’ once the pandemic has subsided. Look for a much further drill down on each from the DHC over the next few months.

7 Observations We Think Will ‘Stick’ After Pandemic

1. “No touching” …

The move to a contactless existence outside of our home will continue to accelerate as more businesses and service providers give us the ability to avoid touching surfaces, buttons, screens, or people (if it can be avoided) through the use of technology or voice guidance. The impact in health care will be felt on the smart phone, as many of those traditional mundane activities move onto an app and into the cloud.

The remaining paper office payments, check-ins at the physician office and interaction with the pharmacy, as well as data transfer (such as remote monitoring) or a download from our mobile health tracking. With volumes more of health data being created and relied on more, privacy issues, security of data become bigger issues. Ultimately, this turns into an issue of data ownership – does the patient have a voice in how it is used?

2. “The Three Amigos” … Hospital, Pharmacy, and Physician Office Data in Harmony

One of the biggest complaints by physicians in the US is the lack of shared clinical data across the health system (and lack of standards in how it is captured, recorded and stored). Their EHR is not linked or shared with other parts of the system and if they want to see a view (or access data) from another stakeholder it may involve a fax (or the modern online equivalent), phone calls, and perhaps an in-person visit from the individual seeking the data to be shared.

As we transition towards widespread tracking of COVID-19, lab, clinical, and testing data becomes critical as a shared resource. Through pressure by physicians, patients, and payers, data will become accessible – and shared. Government mandates of interoperability will also influence future software and data store requirements. Maintaining a walled garden of data as an EHR vendor is great for profits – not so great for public health.

3. “It’s for the Greater Good” … Your Health Matters to You … and Your Employer

Yes, companies have always cared about population health and making sure they invest in their employees to maintain productivity and minimize absence (and illness). However, COVID-19 has shown employers the impact can go way beyond the individual employee. As companies, health professionals, and our government debate the future of in-person meetings and events, companies must structure the workplace, events, meetings, travel and interaction in a way that helps them to avoid future spread of person to person contact.

Yes, the initial focus will be COVID-19 but the impact will have a positive effect as well on preventing influenza and other workplace illnesses that spread in closed office environments. Public health and epidemiology, which have largely been academic and not part of the make-up of corporate or decision making at the will move front and center and become the filter for which many (if not all) decisions with pass through.

4. Patient Heal Thy Self … Your Health Matters to You … and Your Family

While the panic buying of Lysol, Purell, and Clorox may not have matched the reality of the health risk of COVID-19 to the average person, we have now entered a world where virtually everyone is aware of how a virus (or bacteria) can spread, infect, and be spread again from one person to another. As we finish out 2020 and head into 2021, infection control and wellness will become a reality with most consumers. Does that mean the US will start wearing surgical masks (most often to prevent spread of something from someone already sick) like most Asian countries?

Probably not – but we will see a sustained ramp in people cleaning their hands, making an effort to avoid spreading illness (to others), and increased awareness of how little things can significantly reduce your likelihood of being infected (with anything). Another side effect of the pandemic is that many chronic underlying conditions (the slow killers) have been made acute (Covid-19 comorbidities). Many of these have a lifestyle component – as individuals take an increased role in their healthcare, expect wellness to play a larger role as we transition some “sick care” to healthcare.

5. Take Two and Email Me in a Month …

Anyone with regular interactions with a health professional has most likely been using a little – or a lot – of virtual consults in March and April this year. As a number of offices have been closed, or limited to emergency situations only, physicians have embraced the use of virtual consults to fill the gap with patients – or to transition their practice to 100% virtual until social distancing measures have been relaxed at the local level. A key question – how will virtual visits be used in the “post” COVID-19 era?

While most physicians will not use virtual visits at the same level as they are in Q2 2020, it is very likely there are quickly learning when, where, and how a virtual visit can replace an office visit. As long as the virtual visit is being reimbursed (payers have stepped up to make sure virtual is being covered), it is likely we will see continued adoption of virtual visits by physicians. Will it be 20%, 30% or 40% of their patient mix? That remains to be seen. However, it is very likely the use of virtual visits in 2021 will be much higher than the historical utilization rates of virtual consults.

6. Pharma Be Nimble, Pharma Be Quick

It’s often said – the best cure for complacency is a crisis. It’s hard for people – and companies – to make big structural changes when things are going “fine” and there is risk in making changes that may ultimately lead to less benefit compared to the status quo today. However, inject a crisis into the situation and people (and companies) are forced to rethink the situation and determine the best path forward if the old path is no longer a viable option for the near, medium, or long term. It’s clear that pharma companies must adapt to a world today where sales reps do not have access to a physician office. They must adapt to a world where millions of customers may be in a situation where the co-pay they could afford in January – may not be a reality in July.

The good news is that pharma companies are at the core of the solution to solving the COVID-19 crisis – as therapy for treating symptoms or through the creation of a vaccine. That public boost to credibility must not be squandered with physicians and patients. It’s up to pharma to step back and rethink the customer experience – from the customer point of view. It’s not comfortable to make change when things are working. As pharma ponders their restart and reentry strategy, it will take the chance to not let historical thinking limit innovation.

7. Will Digital Finally Get its Due… Rethinking the Detail Force – with Digital First

Something happened in March and April – that has never happened before for a sustained period of time (beyond a few days or weeks). Pharma reps are prohibited from accessing their customers in the office, hospital, or at conferences. Whether this period is 3 months or 6 months, it has created a situation where physicians and hospitals are being forced to not only rethink access policies – in a world where social distancing may remain for a while – but also the role of the pharma sales rep overall. DHC has conducted research with physicians in May and April 2020, and most see a slight – or moderate – reduction in access by pharma reps going forward. In fact, very few see it going right back to the “way it was” before this pandemic. Is this the end of the sale force?

No – of course not. But it is a wakeup call for pharma leadership to rethink the sales force model in this new world. Do we need less reps in the field? That will be a company by company decision. Can the physician use technology to complement or replace many of things the rep offers today? Yes, that has been happening – slowly – for decades. If you ask physicians why they still meet with reps in person – “samples” typically comes up in the conversation very fast. If the primary motivation to meet can be made more efficient (and customer-centric), companies can rethink how to invest in and motivate a “high end” sales rep that truly delivers and exceeds the customer expectations. The technology does not replace the rep – it just makes the ones left in the new world order that much more powerful, intelligent, and impactful.

To learn more about Mark Bard and Joe Farris visit, Mark’s LinkedIN and Joe’s LinkedIN.