Garth Sundem   00:00

Welcome to this episode of the Medical Affairs Professional Society podcast series: “Elevate”. I’m your host Garth Sundem, Communications Director at MAPS. And today we’re talking about medical impact with Diana Morgenstern, MD, Fellow of the American College of Physicians, member of the MAPS EvGen Domain Team, and Executive Strategist at IQVIA, US Medical Affairs Center of Excellence, and also with Javier Lopez-Molina, MBA, Senior Director of the US Medical Affairs Center for Excellence also with IQVIA. So, medical impact is something the MAPS organization has been working on lately, most recently, with the theme of our immune meeting, being from action to impact, but also across our working groups, across our domain teams, and even in our executive Consortium. So Diana, why in the world is impact such a hot topic right now?

Diana Morgenstern   01:05

So it’s a really interesting question Garth, and the more I think about it, the more I understand about it, I think, you know, truthfully, we’ve been thinking about this question for quite a number of years already. And in my previous roles in both US and global Medical Affairs, you know, various sorts of companies, both large pharma, small Pharma. I mean, we were being asked, I guess, more often how to demonstrate our value and, and it was really kind of a conundrum, right? So, so it was always the thorn in my side. But I think really, what this is, why the drumbeats have gotten so much louder, all of a sudden, are is actually a really positive thing. It’s not just what show me that what you do is worth it. It’s Medical Affairs role has really blossomed, right, as leaders, we all know, we are strategic leaders, we’ve evolved, we’re there. And that wasn’t always true in the background, so nobody cared that much. If they saw you as purely a supportive function. You know, you could measure how many how many reviews I did for MLR, or whatever, but now, we’re trusted voice, we’re medical and and we can’t just put a finger up in the wind and say, yep, that makes a difference in what I do. And so the really, there is a, you know, an impetus to think critically about the strategies that we that we come up with an action. So So I think it’s really a reflection of the evolved role that we’ve had. You know, there, there are a couple of really germane questions when you think about that. Because you have to understand why why right, you have to understand the purpose of measuring the impact. And so I think that gives us the opportunity to think about it most importantly, about how do you adapt the work that you do? So medical strategy is iterative, right? You know, and I constantly have to assess if I’m doing it the right way. So I need to have a way to measure that. And, and as the flip side of that, I have to make sure that I know how to spend my budget, appropriately on

Garth Sundem   03:31

And justify spending your budget.

Diana Morgenstern   03:33

Yeah, you know, I have budgets and and in a time when resources are particularly tight, I get back to the why now, why is it? Yeah, yes, we’ve arrived, we’re strategic leaders. And at the same time, and resources are, you know, are relatively lean, and a lot of the places that we work, but I think, I don’t know, Javier? I think there’s some other considerations here as well. About why now that I know you spend a lot of time thinking about.

Javier Lopez-Molina   04:03

Yeah, I think when I think about why this hasn’t been done before, I think that part of it is the complexity of the universe, right? If, if our ultimate goal and you see this a lot in Medical Affairs, we want things to be patient centric, we want to make sure that the impact has happens on the patient, and that there’s, at its core medical impact is sort of like putting our money where our mouths are, is, you know, that that, that we’re actually we actually want to measure an impact on the patient. And I think up until now, like, if we’re trying to measure a change in diagnosis rates, for example, there’s a host of reasons why diagnosis rates may go up or down, that have nothing to do with your field force or your publication plan or anything that you’re you’re spending money on and and you know, I think there’s a there have been a tendency to throw your hands up in the air and say like, the universe is too complex. We’ll never really be able to, to know and this is something that I we asked We, as Diana and I have been chatting, we call this the attrition. i Sorry, the AHA. Now not the aha moment. The the, the attribution problem, sorry, I’m searching for the right word, the attribution problem. Yeah. Because, you know, you’re trying to attribute. It’s like, awesome causality you’re trying to the, your activity to an outcome. Yeah. And I think up until recently, we have only been able to sort of tease that apart using more complicated and more advanced analytics. So I think, you know, with machine learning now, we can actually take we can we can create attribution from things that we may, we may not have been able to before.

Diana Morgenstern   05:48

And that’s something I think, are that traditionally, in medical, we wouldn’t have thought of right? We would, or even our commercial colleagues, like, I think there was a tendency in the past to say, Well, I did XYZ promotional activity, and look, all these prescriptions are written. Well, I mean, that’s anathema to to medical, we, but even, you know, we would never do that for it’s not why we do what we do. But at the same token, I mean, they were making a mistake, potentially, too, right. That’s, there’s probably some association between at the fact that they did this activity, and then I don’t know, yeah, when they sold X, Y, Z, you know, radiation oncology machines. But that doesn’t mean that the two are are, how they’re related. And so what I hear from what you’re saying, Javier is that it’s the advances in analytics, fact that we’re in the AI ml world that has really made it of the here and now.

Javier Lopez-Molina   06:57

It’s now something that’s possible.

Garth Sundem   07:00

It’s not something that’s possible. Okay. We have a lot to talk about. There’s about 15 things in there that I would like to follow up on Diana first one thing I heard you say is that when we were a support function, we could count our actions and show that we were supporting, and it sounds like maybe that was enough to show our impact, because we were just saying, We’re doing this for you. Here’s what we’re doing. And now that we are strategic, we actually have to show the impact. So is that your perspective? Did we only used to have to count our actions. But now that we’re strategic, we have to demonstrate our impact.

Diana Morgenstern   07:42

So you’re asking me a loaded question, Garth, because the interesting thing is, when I joined the industry, we were probably closer to that dark ages of support function. Yeah. Fortunately, I never understood my role as supportive, right. I, I’m a physician, I always did things with a purpose in mind. But yes, I think that’s right. Right. So so very simplistically, if you think that you’ve attended MLR. Committee, and you reviewed 100 pieces that quarter, well, gee, you know, and they couldn’t have done it without me. It’s very obvious. But But that’s, you know, as you become a strategic leader, you also do probably less of those core repetitive tasks, or you can, you can, those can be counted elsewhere, it’s still important work, it still has to happen. But, you know, but I can’t count the number of thinking sessions I’ve had, and say, here’s, here’s the difference I’ve made in patient outcomes. So I have to find a way to actually tell that story with, you know, with with, with probably other pieces of information, other sources of data that are not simply accounting exercise. And yeah, you know, but people care, like I said, it’s, it’s, we want to make sure we’re doing the right thing to make a difference in the end from a patient patient outcomes standpoint, and also that we are using our resources in a smart, appropriate way to get there.

Garth Sundem   09:20

Okay. And so, Javier, I wanted to follow up on so I hear Dinah’s saying that we still there’s still a role for counting the things that Medical Affairs does, and I’ve heard that mostly from a KPIs per sec perspective, you know, we need to show that, you know, our employee productivity, but you’re saying that, now, we may count these things. And we may then use AI and machine learning to draw the line of causality out to the outcomes. So isn’t it Okay, okay, okay, here’s one.

Javier Lopez-Molina   09:54

I would I’m so cautious about using the word causality because We have we have a lot of conversations with folks in the industry right now who want to use impact measures to measure individual performance. Yeah, I think it is a possibility. But now you’re talking about adding causality and individual performance. And I mean, we’ve we’ve, I think we’ve all been just like anecdotally, we’ve all been in places where like, we know that we can do something, but we’re having a meeting with an HCP. But if that HCP isn’t paying attention to us, and they’re distracted, or it’s just not the right time of day or something, like there, there are other factors at play. And we don’t want to draw a giant causal inference based on a data like based on what we’re doing, right? This this activity of measuring impact. Like if we want causality, there are there are study designs that will measure causality. And this This is at its best, a retrospective database study. Let’s be clear, right? I think we have an intervention, we have multiple interventions, we can we can measure like, you know, the MSL field force or your publication plan or whatever. But you’re not this is not randomization, right? Where we are. Causality I think is is I stand away from that.

Garth Sundem   11:10

Okay, okay. So maybe we won’t talk about drawing causality from individual actions to something like number or percentage of appropriate patients on treatment, which is something I’ve heard a lot about. I think we’ve talked about the medical perspective of why this needs to be done. But Javier, you’re coming in from the MBA perspective as well. So from the business perspective, they do why do we need to know the impact of Medical Affairs?

Javier Lopez-Molina   11:43

So I’ll kind of link it back to this idea of causality. But I just trashed a second,

Garth Sundem   11:49

I thought we were getting away, okay let’s go back to causality.

Javier Lopez-Molina   11:52

Well, no, I don’t I don’t want to go back there. But what I kind of want to go back to that concept of like, you know, what, when I interact with folks in Medical Affairs, and I come from this background, too, like I come from a scientific background, I want the study to be perfect, right? I want to, that’s my background, I if I’m going to design an experiment, I want that to precisely measure the outcome. And I think in the business world, we don’t have, we’re not always going to have 100% answer. And in fact, we need to make business decisions on incomplete information often. And I think it’s that that’s one of these aha moments that like Diana, and I had when we were talking about this is that like, what we’re doing isn’t, don’t don’t let the perfect be the enemy of the good for what we’re doing here, right? We’re not, we need to sort of give up on this idea that we’re going to have perfect attribution, or that we’re going to create the world’s best data set that’s going 100%, showing you the entire, we were aiming for directionality to inform a business decision. And I think the world that we that we want to live in is a world where we make decisions even in Medical Affairs, we make decisions on where to invest our effort and our time, so that we’re improving and maximizing our effort to improve patient outcomes. That’s the world we want to live in. And if we can use data to inform that that’s the kind of business decision I’m talking about. Sorry, go ahead.

Garth Sundem   13:12

Okay. Well, no, for both of you. So is is that I know, there’s not one answer, but is a panacea is one version of an answer, to start from measuring patient outcomes. And then just look at how Medical Affairs impacts that process every step along the way. What do you think?

Diana Morgenstern   13:34

Well, I, I think that’s the utopia. But we live in a complex world, right? So first of all, patient outcomes. Population Health is the long game. Right. So and and the other thing that I think is important, it makes me think about in your question guard is that every situation is, is unique, right? Is is its own situation. So I take us back to thinking like Medical Affairs, you know, when you put together a plan or a strategy, you always start with a situational analysis. Right. So So yeah, I mean, essentially, in broad brushstrokes, you’re right, but you have to be very specific about it. What is the patient outcome? What is the outcome that you that you desire for that particular therapeutic area? asset, whatever it is that that that we’re supporting? And are we and if it’s a very long game, is there an outcome that we can use that might be a proxy or surrogate that helps that that actually allows you to back into to it and measure it?

Javier Lopez-Molina   14:48

I will go back to my concept to have like the universe is a complicated place right so you’ve got your action in Medical Affairs. I’ll use the MSL as an example right, the MSL is having an interaction with an agent With a physician or an HCP, that physician or HCP is having an interaction with the patient. And then that patient is going on to, through the course of their disease to then have some sort of outcome. And there’s a whole universe of things that we know impacts the patient and their progression to outcome or whatever is going to happen. It could be wealth, it could be their geography, it could be comorbidities, it could be genetics, like, you know, this is the universe of possibility. And, and then that’s just around the patient. Now, what about the HCP, there’s the universe of possibility around the HCP, too. And so because you’ve got all of these different steps, this is why when, when we think about it, we think you’ve, you have to, you have to use the correct technology, if that’s your goal, and that is our goal. Either way, you have to use the correct technology and the correct analytics to, to tease apart the, the the complicated decision tree that exists in that it for each of those patients, right, and for each of those physicians. And I want to say it’s possible, and it can be done if you have the right data, and if you know your disease, so it was just like you’re going to run a trial and COVID, for example, you know that a modifier of outcome is whether or not patients are vaccinated or not vaccinated, well, in your data set, you better know whether or not that patient is vaccinated about vaccinated because that affects your outcome. Same thing here, you’ve got a bunch of data variables, you know, your disease, you know, your therapy area, you know, which data variables are going to impact the outcome, you got to put them into your, your your dataset, include them in your model.

Diana Morgenstern   16:35

So maybe we can come up with a, you know, sort of a concrete example of how this might work. But somewhat simplistic way that this might proceed, because I’ll pick something Garth that, you know, it’s very mundane, because it’s just easier to to think that way. But to your point, let’s say, you know, let’s say I’ve got some sort of advanced and care that helps improve the treatment of, I don’t know, secondary hypertension, you know, can can make that up. And so I know, to your point, that my whole goal in life is to get more patients access to the therapy and more patients with the condition treated right, I already know that that’s ultimately the outcome. And somewhere along the way, I’ve identified as well that I believe that it is under diagnosed. So So now Okay, so now I’ve got an outcome of improving diagnosis. Right. So, you know, how might I approach this thinking about what’s the medical impact? What can How are my activities working? So I’ve decided in my last year’s annual medical plan that I’m going to put on a webinar about to educate about secondary hypertension and its diagnosis. But now I want to see if it really, if it’s worthwhile to continue to invest and do this again. Yeah. So So I so to your point, Javier, I think the first thing I have to do is identify which data points which pieces in this particular situation actually mattered to me, I mean, you might be able to, to speak to this more clearly, from a business perspective of what for example, you could measure?

Javier Lopez-Molina   18:14

Yeah, exactly. You need you need to think about what are the data elements that you need in your analysis, and then what kind of analysis and let’s go to the data elements, because I think it’s good to sort of have that real world exercise. So who attended, and from a link ability perspective, because this is important, because you’re going to be pulling that diagnosis rate later, you need to know the NPI of those physicians. So who attended that that webinar by NPI. And then now we’re starting to think about perception metrics, because when we think about webinars and medical education, we want to understand whether or not they retained information, whether or not their perceptions have changed. So some of those perception lecture metrics are important to those will be collected by a survey, you want to make sure you’ve got a survey. So what are the perception changes of the HCP by NPI? What was their knowledge change, but of the HCP by NPI. And then we get into the real gold, which is was there a behavior change? And I think it’s, it’s easy to say, let’s just grab the diagnosis, like the number of diagnoses, and that is something that you can do and should do. But as Diana said, population health is a long game, you’re not going to necessarily see that diagnosis change immediately. So are there surrogates, surrogate data elements that you can pull in, like in this case? Could it be labs? Are there specific labs that might tell the story of like, okay, this person is, is making that diagnosis for secondary hypertension. Okay, so now you’ve got all this data, right? What kind of an analysis are you going to do? Are you going to look at your cohort that was included versus before exposure? So let me do a pre post. Are you going to measure that cohort versus co work that wasn’t exposed that’s contemporaneous. I mean, it all depends on on your context. But I think that’s, that’s the next step.

Garth Sundem   20:06

I mean, you make it sound challenging, but doable. I mean, we how it’s totally doable. So why aren’t we doing it? What’s what holding us back? What is holding us back from doing a? Why are we having this conversation and all of our meetings and all of all of our podcasts now, why aren’t I?

Javier Lopez-Molina   20:24

I want to challenge that actually, I actually think that people are starting to do this. You know, yeah, I think people are starting to do this. And they’re starting to do sort of the individual activity by activity basis. So like we’ve done we’ve had conversations for folks who are already starting to do this for I think there was one was a continuing medical education, people have been talking about it for MSLs. For a long time, I think people are starting to do it. I think more people haven’t yet woven things together is at the portfolio. When we think about bringing everything in at the portfolio level, that’s where I don’t think I’ve seen anyone do it yet. And the reason why that’s important to do is because in Medical Affairs, you don’t do your activity in a vacuum. Right. So whether or not your contribution to diagnosis rate is really from, you know, your, your effort, or from the publication or from, you know, the CME you need to have all of that kind of in your model, if you’re running a machine learning model in your model, and then that model will help you say, Okay, well, the major contribution was actually from MSL, or the major contribution was actually from, like this other initiative that you ran.

Garth Sundem   21:39

Oh, that’s interesting. So not just measuring the impact of MSL actions, or just measuring the impact of publications. But saying here was the overall impact. And then, you know, this at a portfolio level is how all of these activities combined to create that impact. Ooh, now, that is interesting. And I can also imagine very, very useful data. And I see you nodding, what, what is holding us back? Well, I

Diana Morgenstern   22:04

I do I agree with Javier, it’s, you know, initially is we had to be able to get our minds around this right. And then we had to have the tools that enabled us to, to try to tackle some of this complexity, right. So I agree, people have started to do it. But now they’ve got to be brave and jump in. And we’ve got to start somewhere. You’re right. I always say it’s a journey. But you can’t get to that that other place until you get into the car and start to drive. Right. And so we have started to drive. We’ve got to we’ve got to start modeling this and it will grow. Right, but But you know, so yeah, what’s been holding us back, because we didn’t have the tools we didn’t have, perhaps sometimes I hate this word, but the empowerment to think in these leadership ways, but I think we do have it now. And now we gotta just be brave and go forward.

Javier Lopez-Molina   23:02

I think there is an upfront cost in building the thing, right? So we’re talking about combining a bunch of data tables. And like, sometimes, if you’re doing this work, sometimes you may realize, hey, I don’t have the data that I need, like I mentioned, oh, we need that perception survey. Well, that means I got to feel that perception survey. So it’s it’s important to sort of do that thinking beforehand to be like, oh, I need these different data elements in order to be able to do my analysis.

Garth Sundem   23:28

Okay. Well, I’ll bring us back to the beginning here at the end and say that maybe the reason we’re having all these conversations right now is because now’s the time, it’s actually possible. And you know, maybe the reason the impact is so hot is that finally we can do something about it. So all right, thank you, Diana and Javier for joining us today. To learn more about how your organization can partner with IQVIA, Visit IQVIA.com. MAPS members, don’t forget to subscribe. And we hope you enjoyed this episode of the Medical Affairs Professional Society podcast series: “Elevate”.