It Takes Five to Tango: From Competition to Cooperation in Health Care

IT TAKES FIVE TO TANGO

It Takes Five to Tango

Copyright © 2021 by Verena Voelter, MD.

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Voelter, Verena

It Takes Five to Tango: From competition to cooperation in health care / Verena Voelter, MD.

Paperback ISBN 978-1-989737-31-6

Hardcover ISBN 978-1-989737-32-3

eBook ISBN 978-1-989737-33-0

1. BUS010170 BUSINESS & ECONOMICS / Industries / Healthcare. 2.

MED036000 MEDICAL / Health Policy. 3. BUS070130 BUSINESS & ECONOMICS / Industries / Pharmaceuticals & Biotechnology.

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The material in this publication is of the nature of general comment only and does not represent professional advice. It is not intended to provide specific guidance for particular circumstances, and it should not be relied on as the basis for any decision to take action or not take action on any matter which it covers. Readers should obtain professional advice where appropriate, before making any such decision. To the maximum extent permitted by law, the author and publisher disclaim all responsibility and liability to any person, arising directly or indirectly from any person taking or not taking action based on the information in this publication.

IT TAKES FIVE TO TANGO

From Competition To Cooperation in Health Care

VERENA VOELTER, MD

TESTIMONIALS

In a Tango for Five, Dr Verena Voelter offers two fundamental reframes that will be critical in solving the American healthcare dilemma. First – the notion that we must include multiple perspectives and include the clinical, professional, policy and business lens – with the patient/consumer perspective being the primary one. Second – the notion that we need to reframe the relationships amongst the stakeholders, shifting from a competitive, isolating stance to a more collaborative, co-creative dance. I love the adoption of the metaphor of the Tango that Verena introduces us to. We – all of the various stakeholders in health care – need to join in this new dance and contribute to a whole that is far greater – not far lesser – than the sum of its parts. We need to Tango.

Zeev Neuwirth, MD, Chief Clinical Executive Atrium Health,

Author of ‘Reframing Healthcare’, US

In my 40 years of collaborative negotiation work world-wide in health care, I have often wanted to assemble the key stakeholders to devise a better approach. The major missing element has been a common vision of success. In this book, Dr Voelter has framed that vision and offers a process for its implementation. We have a lot of productive work ahead thanks to her insights.

Charles L Barker, LLM,

Managing Director of Prime Mover Associates, US

In her provocative and inspiring book, Dr Voelter weaves the fabric of health care: the interconnectivity of the five main decision makers – patients, pharma, payers, policy, providers – and how we can learn and understand the challenges ahead. More importantly, what we need to do to switch our incentive structure and how we can learn to offer a customer-focused solution. Her deep understanding of the health care industry – both from the perspective of an oncologist and pharmaceutical industry leader – offers unparalleled insights into the complexities of the problems we face, yet at the same time, it offers practical solutions.

This is the first integrative book of its kind and will likely be a standard in the field.

Maciej Lesniak, MD, Professor and Chair, Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, US

As a patient for many decades, I thoroughly and warmly welcome Dr Voelter’s insightful and visionary drive for a much-needed reform in health care. She outlines what’s needed for the future: moving from reactivity to proactivity through collaboration, trust and empowerment. The book delivers tangible advice – backed by both science and personal experience – making it a must-read for anyone who is involved in health care in any capacity. Let’s dance!

Hanna Boëthius, Diabetes Patient Expert and Founder at the Low Carb Universe, Switzerland

Through her research lens, and her focus on patients as a physician, Dr Voelter has written a passionate plea for reform in health care. Her experience as a founder and successful business leader reinforced her belief that cooperation in this complex ecosystem is a prerequisite for long-lasting success. She doesn’t tap dance around the basic purpose: improving clinical outcomes at affordable rates. Through plenty of lively examples from her own experience, she puts the possible solutions into the context of the COVID-19 pandemic. This book is a must-read for all those who feel compelled to change the course towards a value-based health care system.

Philippe van Holle,

Former President Celgene International, Switzerland

Dr Voelter provides an excellent framework and outline of what needs to happen for the health care quandary to be addressed successfully for all involved – especially patients! And, all 5Ps have to play their role to break down the bureaucracy and contribute value.

Nakisa Serry, JD, LLM, MBA, General Counsel Galderma, Switzerland

Health care as we used to know it, mostly centered around the doctor, is gone. Among other factors, the empowerment of health consumers, the emergence of digital technologies and the COVID-19 crisis have accelerated its transformation. We have now clearly entered a patient-centered, technology-powered, value-based era. Dr Voelter, in this landmark book, not only perfectly describes this ongoing evolution, she also makes it clear – through very convincing conceptualization, powerful illustration and ample stories of her own – what will make our systems more efficient in this new normal: the five key stakeholders – the 5Ps – learning to work (and dance!) together. For good.

Pascal Deschaseaux, MD,

CEO NewClin and GM Institut Carnot OPALE, France

The name of Dr Voelter’s book captures the essentials. She writes: "In my thirty year career in this industry, everyone whom I have encountered – be it in the public health sector or in the private life sciences sector – has chosen to work here for a reason". Oh Yes, that is exactly it. We have a shared mission and it’s time to focus more on cooperation around that mission. It Takes Five to Tango!

Verena writes eloquently from her own extensive experience and charts a compelling path forward: a path that is guided by great real-life examples and sharp research and analysis.

I can wholeheartedly recommend this book to anyone who feels passionate about improving health care.

Paavo Perttula, CEO and Founder at Gesund Partners, Finland

Dr Voelter provides a clear analysis of the shortcomings in our health care systems that became so apparent during the COVID-19 pandemic. These issues are inherent flaws in the current systems. Policymakers play an important strategic role to design a holistic framework that is the basis for re-setting our systems. The focus must be to bring important and sustainable value to society. This can only be done in close cooperation among the various actors patients, payers, pharmaceutical industry and academia – using neutral platforms such as public-private partnerships.

Katrin Rupalla, PharmD, PhD, MBA,

SVP Head Regulatory Lundbeck, Denmark

The complexity and interconnectivity of the health care sector require a holistic approach of all actors – with patient centricity and sustainable patient empowerment as the centerpiece to a resilient system. But how can we further develop our systems in a future-oriented way and overcome the existing hurdles? With her excellent book, Dr Voelter provides a purpose-based path to make health care more innovative, smarter, faster and more efficient. Now is time for all actors to act and to dance – together!

Ilka Dekan, CFO AOK Plus, Germany

The challenges of health care – access, affordability, equity, and the need to motivate and reward innovation – are daunting, and the stakes are literally life and death. Dr Voelter’s book could not be more timely. She makes a compelling case for enhanced coordination and collaboration among the multiple players comprising the health care ecosystem and offers practical advice for transformational change.

Jonathan Hughes, Partner at Vantage Partners, US

To Roger, my tango partner in life.

Contents

About the Author

Foreword

Preface

INTRODUCTION: Prioritizing health care for the benefit of our economies and societies

PART I: LEARN

CHAPTER 1: Restoring the broken balance between innovation and affordability

CHAPTER 2: Strengthening the interconnectivity of the top five actors in health care

PART II: DO

CHAPTER 3: Applying value-based principles to redesign a patient-centered health system

CHAPTER 4: Acquiring a digital footprint to eliminate inefficiencies and foster cooperation

CHAPTER 5: Adopting a playbook for multi-party collaboration to catalyze change behavior

CONCLUSION: Bringing it all together in a collaborative, value-based and smart Tango for Five

Acknowledgments

Glossary

References

Supplementary Materials

ABOUT THE AUTHOR

Dr Verena Voelter is a passionate oncologist and experienced business leader. With over twenty-five years’ experience at the forefront of health care, she has held key positions as an attending clinician researcher in the hospital setting, and as an executive leader in small and large biotech pharmaceutical companies across three continents: Europe, Asia and the United States. With her unique views on both the public and private sectors, she strongly believes in collaboration as the key to unlock the quandary in health care among patients, providers, pharma, payers and policymakers. Today, she brings credibility as a neutral mediator, executive coach and teacher to the benefit of all stakeholders, both as the founder of 5P Health Care Solutions® as well as an Adjunct Professor for Kellogg’s Public-Private Interface Initiative at Northwestern University in Chicago. Since she first outlined the Tango for Five concept, Verena has felt encouraged by the early feedback to continue sharing her stories and experiences in order to motivate others. This book is for all who wish to be part of the solution rather than part of the problem. Change in worldwide health care is possible once we dance it together as a Tango for Five – as you shall soon see in this book. Verena is curious to hear from you and reachable on her blog TangoForFive.com. Follow what’s new on the website 5PHealthCareSolutions.com and on Twitter @5PHCS.

FOREWORD

When I first received Dr Voelter’s manuscript, I was struck with the power and timeliness of her message to foster cooperation between various stakeholders with a unity of purpose: improving patients’ health at affordable costs. We spend a huge chunk of our public spending on health. The question can be asked: is our dollar, franc or euro well spent and are we making the right choices? Verena pushes the reset button while the iron is hot – during a pandemic.

What needs to happen to reconnect the dots and heal our ailing system? This core question invades Verena’s critical mind as a researcher, physician, professor, founder and successful business leader. This book is about solutions, not about gerrymandering stakeholders’ responsibilities. She tackles the backbreaking burden on her fellow physicians, inadequate health care systems particularly highlighted as a result of COVID-19, and the inverse relationship between costs and quality of care. Why haven’t we cracked the code in this nascent Fourth Industrial Revolution?

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This book highlights the fundamental lack of connectedness among the top five actors in health care to drive transformational instead of incremental change.

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One of the merits of this book is outlining the five stakeholders in almost all of the health decisions we make: patients, providers, pharma, payers and policymakers. However, due to conflicting agendas, there is a disconnect between these five stakeholders. According to Verena, we all came to health care for a reason: to care for patients and create value within the system by working together to create new health care solutions. What unites us is a strong, genuine sense of purpose. So, what needs to change?

Firstly, there are multiple conflicts of interest between the private and public health care sectors that need to be addressed. Then, we need to embrace the advent of the digitally advanced, smart policymaker, looking at those issues with a long-term objective. Unfortunately, that is one of the reasons why the health care engine sputters regularly. We face a constant dilemma between the short-term incentives behind our actions and the actual, long-term impact of our actions. Further, our democratic system requires politicians to concentrate too often on (re)election and therefore the immediate impact overtakes any long-term consideration. We need to find ways to depoliticize health care and allow experts to focus on what they know to do best: develop, deliver and drive health care to patients.

Lack of progress in health care has not been for lack of trying. However, efforts to reduce costs, to improve policy and to address quality have remained a tinkering at the edges (figure i).

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This book not only explores the responsibility of the patient, the importance of health literacy and the clinical components of health, but also outlines the social determinants of health, such as behavioral components and the importance of education.

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It showcases how the digital revolution in health care brings not only better coordination and restores efficiencies among the health care actors, but also holds great promise to empower patients and bring a greater level of cooperation in what today is an imbalance of bargaining power, with the patient being the weakest part in the value chain. Verena reminds us of the essence of health care: the empowerment of the patient and patient centricity in all we do along the value chain. Personally, I had to first retire before I started to visit my doctor and seriously take care of my own health. Our busy lives don’t always allow us to look after our body with all its limitations. Education is an essential factor here – from secondary school onwards. We learn history, geography and philosophy from a young age, but nobody can remember any school lesson about how to better care for our health (which involves not only diet and exercise, but also work-life balance). We get diplomas for entering the labor market, but we are illiterate when it comes to managing our body’s lifecycle.

One example: in the United Kingdom, childhood obesity costs the National Institute for Health Research (NIHR) $7.9 billion and wider society about $35 billion (or about four percent of UK National Health Service [NHS] budget and a much higher share of the health care budget due to direct medical costs), according to findings published by the National Audit Office in September 2020.¹ Some argue that school food is to blame. Probably so. However, I would go for an awareness campaign at schools, through creative and funny exercise-focused health apps, and sponsorship of video game companies to intermingle diet-related messages in their offerings.

Further, today’s young generation is the most ecologically and digitally sensitive. That same generation needs to call out the root causes of an out-of-control health issue! The long-term impact on cost reduction in addressing adult obesity, for example, will be exponential.