Healthcare Innovation Viability: On the Edge of a Knife

January 2009, Vol 2, No 1 - Editorial
Robert E. Henry
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On October 10, 2008, we convened the First Annual American Health & Drug Benefits Summit on Healthcare Stakeholder Integration—The Return to Deep Science: Pharmaceutical Research & Development in a Value-Based Healthcare System. The proceedings are published in a special supplement accompanying this issue of the journal. The summit brought together leaders from many sectors to evaluate the prospects for the future of healthcare innovation, which is fundamental to the viability of the healthcare system.

Consensus across all stakeholder lines is the ultimate purpose of AHDB. The summit was convened to allow a multidisciplinary faculty to present a composite picture of the state of drug discovery and development. The top-heavy resources of healthcare are making it increasingly difficult to balance the process of care. As all aspects of medicine become increasingly complex, it becomes correspondingly harder for all stakeholders to work collaboratively. The trend has often been one where each party tries to impose its agenda on the healthcare system unilaterally, an approach that is not working. Thus, the very divergent nature of the summit's presentations imparted a picture of unity to the entire healthcare community—clinical, business, and regulatory—to help guide all parties toward a strategy that makes possible new and productive drug therapies for diseases most in need of innovation.

Innovation is facing many obstacles today; the market for new drug discovery and development has become risk adverse to an extreme. Some pharmaceutical manufacturers have reacted to this market condition by retreating from real innovation. Payers, meanwhile, must make sense of new drugs coming before their Pharmacy & Therapeutics Committees. They and the purchasers funding health and drug plans have hard decisions to make: Should formularies and benefit designs stress short-term cost-saving or quality? If the latter, how will quality and value be measured? What are the governing dynamics that will incentivize pharma to pursue needed innovations? And, what, in turn, will be the response by payers, providers, patients, purchasers, and regulatory agencies? Will innovation be rewarded?

The summit's presentations covered a powerful range of inquiry that explored the confluence of forces that comprises the environment in which pharmaceutical research and development (R&D) takes place. Like the rest of the healthcare system, R&D is undergoing great changes to stay viable and provide medications relevant to patient needs. The presenters sought answers for the preservation of the great institution of drug discovery and development through a collegial sharing of stakeholder needs, data, and propositions. Each group benefited from understanding the incentives and conditions of the other groups. They appreciated that what is needed to ensure success is to understand the new "rules of engagement" between stakeholders, and to work together in common purpose to heal patients in need.

The summit was another step toward healthcare system viability, based on the premise that all stakeholders must regard the others as possessing answers, not obstacles, to their interests. The remarkable findings from the summit showcased in the supplement confirm the belief that collegiality turns insular, contentious debate into a civilized and productive examination of how to organize resources into a process that produces new valuebased medicines that serve patients' needs.

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