Five Ways Medical Affairs Can Impact Clinical Change & Outcomes
The goal of all Medical Affairs activities is to improve patient outcomes. That said, until recently, we have measured our progress toward this goal by fairly distant proxy — for example, tracking the number of MSL/HCP interactions as a proxy for providing education that we hope will result in changes in clinical practice. In this episode of the MAPS podcast series, “Elevate”, Ariel Katz, co-Founder and CEO of H1, provides a more linear and streamlined vision for how Medical Affairs can impact patient outcomes — and how to measure the results of our actions.
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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 of MAPS. And today we are speaking with Ariel Katz, Co-Founder and CEO of H1 who has joined us before. Ariel, welcome.
Ariel Katz 00:17
Excited to be here. Thanks for having me.
Garth Sundem 00:18
And this is a question that comes up a lot, because the end goal of Medical Affairs existentially as a function is to improve patient outcomes. But I know a lot of our members have a question, how can we actually draw the line from our activities to patient outcomes? What can we do to improve patient outcomes? And how can we show that we are improving patient outcomes? So maybe maybe the first first, how can Medical Affairs improve patient outcomes?
Ariel Katz 00:55
Yeah, excited to talk about it. Really, since we started H1 and working with Medical Affairs teams, it was always the Holy Grail. I was like, Yeah, measuring Medical Affairs impact, but it’s like for what end goal to drive better patient outcomes. And used to be filled MSLs, we engage with stakeholders and thought leaders at academic medical centers to educate them and we publish peer reviewed publications do it is all these different things to ensure that people are aware of the latest scientific and medical research and technology to improve patients lives? What we’ve learned over the past five or six years is we do think there’s actually a way to measure this and ensure that we’re doing this. And so at h1, we think about it in really five different buckets. Okay. The first one is identify the stakeholders, the the healthcare professional, as well as systems of care in hospitals and health systems, where the right medicine is not being practiced. They have the worst patient outcomes, patient comes in with heart failure. Are they treating those patients correctly? How many of them survive, patient comes in with non small cell lung cancer? Are they treated with chemotherapy or they’re diagnosed three ways to get the right therapy, you can identify using information to understand which health systems in which doctors have worst patient outcomes. So you don’t wanna spend your doctor that knows everything. You want to know who’s not treating patients correctly, that’s really where you can move the needle for the world.
Garth Sundem 02:22
So guideline adherence, so is that what you’re looking for, like a…
Ariel Katz 02:27
A whole range of different things. So you want to look for generally speaking, guideline adherence, but even one level below guideline adherence, you want to look at, like mortality rates, a piece of patients that come in with certain with her to triple net and triple negative breast cancer compared to another place, you want to look for infection in the surgical room. And why that happens at a given health system are given with the given Doctor compared to other ones, really benchmarking everything from like the dynamics of care, the type of care they’re getting, so standard of care, so guidelines and local protocols to cost of care and if they’re being treated with the right therapy across the board for hospitals and healthcare professionals.
Garth Sundem 03:03
That’s interesting. I don’t want to go too far into the weeds here. But you know, would you be looking for anomalous poor outcomes, what I’m wondering is if they’re if it’s hard to disentangle poor outcomes from societal and system wide healthcare issues that create across the board, lower outcomes, or what you’re really looking for is an anomalous her to positive low outcome for for young women’s breast cancer. And there, you know that you could make a difference.
Ariel Katz 03:38
The way we think about in the world, what we see in the data is like a Duke Health System. Great Health’s great medical center, great health system, if they are systematically, patients systematically with non small cell lung to stage three non small cell lung cancer, die earlier, and live less years and have to spend more time in the hospital, then City of Hope. MSK Mount Sinai, NYU, MD Anderson, and it’s lower by 30%. You have to ask why. And at Duke, for example, it could be because their protocol level is wrong and you’d want to engage with someone that’s thinking about the local protocol at Duke. If you look at Duke, or if tickets city of hope and MD Anderson generally equal outcomes, but if you look at the 30 on call it or the 100 oncologist at MD Anderson, there’s 10 that have significantly worse outcomes for patients. MD Anderson’s protocol levels not wrong. It’s those 10 healthcare professionals that an MSL should go and talk to, and educate them on the latest treatment for how to treat some of non small cell lung cancer. What tests and diagnosis should you run to know what treatment is best for them? Like you’d really want to be able to understand it at a system level and a doctor level and look at different outcomes depending on the indication. So it’s different for someone with psoriasis and non small cell lung cancer then LP little a and rheumatoid arthritis. They’re all different. So you want to look at the definition of good patient outcomes across the board. and look at it at a doctor level and a hospital level.
Garth Sundem 05:03
Okay, so you identify these areas, so outcomes, identify areas for possible growth. It sounds like each of these opportunities for growth could have a different mechanism to bring them back up to par, or is it just an MSL is gotta go talk to him?
Ariel Katz 05:24
No, it’s very different. So if there’s 100 oncologist and MD Anderson, 10 of them have worst patient outcomes in bladder cancer. That’s an MSL should go and educate those 10 why they’re while they’re giving them chemotherapy instead of the latest immuno oncology treatment or targeted oncology treatment. If your health system has written a protocol that systematically does not diagnose patients properly with that are at risk of heart failure, it’s probably a research activity that could get involved could be scientific publication. It’s all controlled by Medical Affairs, by the way, but there’s different and then maybe an MSL or someone engages with Duke and someone at Duke, but it’s not going to you can’t change the needle at Duke by an MSL engaging with a thought leader, cardiologist at Duke coach won’t do anything. You’re running into the wall? Yeah, well, let’s get to the next bucket. So we’ve identified these ages, we know where the gaps are, then the next bucket, which we’re hitting on is, who are the stakeholders that can change that. And sometimes it is an individual healthcare professional, sometimes it’s an administrator or department had a service line headed a health system, but sometimes it’s those 10 HCPs at a regional health system that don’t literally just don’t understand what it is medicine, and the efficacy and the safety profile of it. So you want to identify who the stakeholders are. And sometimes it is okay, well, but not all the time. And we’re seeing Medical Affairs change their stakeholder landscape. And we’re seeing great change a stakeholder landscape to the people that can drive better outcomes for patients where we were gonna take what the gaps are. So identify who the stakeholders are, knowing where the gaps are, could be a system level, it could be an HCP, it could be a Kol. Then the next bucket is you want to make sure that you understand what these people care about how to use artificial intelligence, to chat GPT like technology to say, what is going to be most relevant to these stakeholders. The next and I believe most important bucket is measure that change over time. What is the impact of Medical Affairs, making sure patients get the right outcomes, if you’re engaging with stakeholders at Duke, and you see they actually change their protocol, which changes the outcomes for 1000s of patients in cardiology at Duke, or you 10 Talk to those 10 stakeholders at MD Anderson that change the way they practice medicine to lead to better or above average care for patients. Because now they understand how to treat those patients diagnosis, patients send referrals properly. That’s an unbelievable impact. And you know, Medical Affairs is changing lives of patients compliantly you’re not looking at script data. You’re looking at education of systems and HCPs. And if you’re not measuring it, it’s hard to know if you’re improving.
Garth Sundem 08:02
It’s almost like we’re overlaying. So we’ve always done these things. Right. We’ve always had MSL, you started with this, we’ve always done MSL HCP, Kol interactions. You know, we’ve always published research in peer reviewed journals to disseminate our latest scientific knowledge. But it’s almost like applying a layer of strategy to the activities that we’ve already been doing. Directed so that the strategy points directly at patient outcomes. So I I don’t hear that we need to change all of the activities that Medical Affairs does, is this just another strategic layer?
Ariel Katz 08:43
This is a way to understand the impact of all the activities that Medical Affairs does. No longer can we look at how many meetings in MSL had with an HCP that mean anything if they met once, but they changed the way that that HCP practices and understands medicine, that’s worth more than 100 meetings where they buy them coffee. And so it’s understanding the impact of all these activities. If there’s a investigator sponsored study at Duke, where they want to show to the Duke admin, as an administrator at Duke, why it is the right thing to do to diagnose a patient with a certain test before they treat them for LP little a, because there’s now technology that if you treat them and they are come up positive for this test, there’s a better treatment and Istat and that that now you understand the impact of your activities. And so that’s the and it’s all coming together because Medicare’s wants to do this. We’ve been talking about it. And now it’s coming together for us to all the pieces stakeholder landscape is changing. Diversity and Inclusion mix. You’re not just talking to Kol is when you’re talking to people in different communities. But really what you want to do is make sure that you are engaging where people are really struggling to understand how to treat patients properly and help you we want to help identify that.
Garth Sundem 09:59
You know, so here’s here’s, and this, again, might be going into the weeds. But so we have this layer of strategy overlaid on to the activities, Medical Affairs, pointed at patient outcomes. And it’s very HCP kale, well, system focused, but you bring up engagement with communities. And I wonder, just as a health care in the Provider, individual or system, you may be able to identify that they’re underperforming, you know, is this same workflow or mechanic applicable to populations that are underperforming, and perhaps looking at at not underperforming, HCPs and healthcare systems, but bringing underperforming outcomes in patient populations back up to
Ariel Katz 10:54
100%. So what you’d want to slice when you’re identifying, so five years ago, an MSL or Medical Affairs team would have a list of 1,000k wells they’re engaging with predominantly at academic medical centers. Over the last five years, the stakeholder landscape has changed. Now they’re engaging with treatment leaders, digital opinion leaders, you name it. next five years, they’re going to be engaging, we believe with HCPs communities, the individuals that need Medical Affairs help the most, if there’s a cardiologist at Ascension health system, best patient outcomes in the world, it’s probably not worth the time of a pharma company or Medical Affairs team to chat with them, maybe they’ll want to learn and educate but I wouldn’t spend all my hours with them, I’d spend it with the person next door who has bad patient outcomes. So you could actually make an impact on patients lives and that HCP. And it could be that it’s for a certain segment of the population could be a certain community. It could be that’s where diversity and inclusion, which will have super important comes into play. That first step has never really been there. That first step has like identifying who to engage with has always been, well, who publishes the most who speaks on the stage at the top medical conferences, which is important and we can’t forget that but we need to, we believe the future is more of identifying where patients are not going to treat him properly. And that’s going to be deeply influential on where Medical Affairs spends their time.
Garth Sundem 12:15
So are we granular enough with our data as a function that we could say, Okay, here’s an underperforming, underperforming, that’s a terrible word here, here’s an HCP, that happens to have worse outcomes in patients who are over 65 or inpatients from a racial or ethnic minority or, you know, has poor outcomes poor than expected outcomes in patients who happen to be you know, from a low socio economic status?
Ariel Katz 12:48
We, so this is all publicly available outcomes benchmarked by CMS has guidelines for like what is a above average or below average outcome for a patient above the age of 65 that comes in with intestinal cancer? Like there are benchmarks for like, what does it mean for mortality rates, readmission rates, hospital infection rates? Procedural right, like all those things that you would imagine it’s all benchmarked by both CMS and HEDIS. And so those are all short answers. Yeah. It hasn’t been integrated into Medical Affairs workflows yet. And we think that’s going to change soon.
Garth Sundem 13:28
And what what I was wondering is if you could say, using your your vast resources of data, and tools to make sense of it all, that you individual as HCP are treating this subset of your patients non optimally. And here’s a way to treat that subset of your patients optimally.
Ariel Katz 13:51
That’s the job of Medical Affairs in our mind, that we could help someone in medical care say, this pulmonologist is in the bottom 10 percentile for patient outcomes with COPD and asthma. Here’s how here’s the expected life of patients with COPD from this doctor compared to different pulmonologist. Yeah, you should go and talk to them. And their patients that come in they’re identical patient with preexisting conditions, all these things, but like they are well below average. And you could target at you could look at a hospital level and an HCP level.
Garth Sundem 14:29
Okay, well, let’s let’s put it let’s put a point on these on this workflow here. So what is it you have to identify the HCPs and orgs that are underperforming tickets, tickets through the buckets? And then we’ll…
Ariel Katz 14:39
The buckets are identify the HCPs and hospitals and health systems that have worse patient outcomes? Yep. Identify who are the stakeholders that can help really ensure that those outcomes improve, which can be an HTP and admin Kol whomever it is, make sure you’re using a personalized engagement strategy, with content with research with how you’re reaching helps them when when they want to talk to you and all those various things. And sure how that’s changing over time to show that you’re having an impact.
Garth Sundem 15:07
All right, Ariel, well, it is always a pleasure to talk to you. Let’s leave it there for today. To learn how your organization can partner with H1, visit H1.co. MAPS members. Don’t forget to subscribe and we hope you enjoyed this episode of the Medical Affairs Professional Society podcast series: “Elevate”.