Discipline|Data and Analytics , HCIT , Payor/Risk-based Care
Stages of Finance|Venture Capital
In October 2020, Curation Health announced a Series A round financing. Curation Health is a clinical decision support platform designed to assist providers and health plans in navigating the transition from fee-for-service to value-based care.
In July 2020, Sema4 announced its Series C financing of $121 million. Sema4 is a patient-centered health intelligence company founded on the idea that more information, analysis, and engagement may improve the diagnosis, treatment, and prevention of disease.
Industries|Diagnostics , Healthcare IT , Healthcare Services
Discipline|Data and Analytics , Digital Health/Tech-based Services , Diagnostics , HCIT , Provider Model
Stages of Finance|Venture Capital
In May 2020, LetsGetChecked announced a Series C round financing of $70 million. LetsGetChecked is a health insights company that allows consumers direct access to a wide range of testing options and clinical services from home. By combining health data and diagnostic results, LetsGetChecked provides rich health insights to enable better healthcare decision-making, empowering people to take an active role in their health.
Deerfielders Weigh in on a Safe Return to Work Policy Amid Covid-19 Crisis
Antibody testing provides a data-driven path to getting people back into the economy
The availability of point of care antibody testing—also known as serological testing—may provide a feasible roadmap for getting people back to work safely following the COVID-19 crisis, according to an editorial published in the journal Contemporary Clinical Trials Communications.
“You can’t stop the economy forever,” asserted Governor Cuomo in a recent news conference, according to STAT. “So we have to start to think about, does everyone stay out of work? Should young people go back to work sooner? Can we test for those who had the virus, resolved, and are now immune, and can they start to go back to work?”
whether they already have immunity to the virus, millions of Americans may try
to return to work, potentially undoing all the benefits of the shutdown,
suggests the editorial.
Antibody testing, the authors argue, could clarify a person’s status quickly in real-time and reveal whether they have been exposed to COVID-19. Accordingly, a person who mounts an IgG positive response (suggesting the presence of immunoglobulin G antibodies) would most likely now be immune to the virus and an IgM positive result would point to the process of developing immunity in someone who more recently became infected.
“Unlike the PCR tests (a measure of virus material), the immediate results and unconstrained supply of antibody tests could fundamentally change the way we manage this epidemic,” says Robert Jackson, MD, a co-author of the paper. “And from an economic perspective, it could lead to a tractable path for people to return to work. Collecting the data and tracking individuals longitudinally, in order to confirm the hypothesis, will be necessary.”
And barring any
HIPAA concerns, the authors propose that persons
with positive antibody tests during periods of social distancing could get a
bracelet, which indicates that they are immune-protected and can return to
work. Those without a bracelet would still be asked to practice
social-distancing and not yet resume their normal activities. But this approach
could potentially get at least some portion of the economy back running again,
suggests the authors.
According to the
authors, the antibody tests are cheap, easy to administer, and could be made
available at every hospital.
“Broad testing is in society’s best
interest,” says Alex Karnal, a co-author of the editorial. “Until we make serological
tests available in a robust way, it’s as if we are flying a plane without
Authors of the editorial, titled, “Let’s Get Americans Back to Work Again,” are: Alex Karnal, Partner and Managing Director; Robert Jackson, MD, Partner and Chief Science Officer; and Joe Pearlberg, MD, PhD, Vice President of Scientific Affairs, all at Deerfield; and Amitabh Chandra, PhD, McCance Family Professor at Harvard Business School and Weiner Professor at the Harvard Kennedy School.
Deerfield Contributes Insights to Peer-Reviewed Study on Access to Life-Saving Drug, Buprenorphine, Examining Growth and Distribution of Waivered Providers
Despite Evidence Showing the Opioid Crisis Disproportionately Affects Rural Areas, Prescriber Growth There Remains Considerably Slower
Research Bites|February 2020
Despite Evidence Showing the Opioid Crisis Disproportionately
Affects Rural Areas, Prescriber Growth There Remains Considerably Slower
there has been an uptick in the number of U.S. clinicians having waivers to
prescribe the potentially life-saving drug, buprenorphine, the total number of
waivered prescribers in 2017 still represented fewer than 10 percent of all
primary care providers, found a report published online in the January 7 issue of
the Annals of Internal Medicine.
although rural communities have been shown to be disproportionately affected by
the opioid epidemic, the growth in the number of providers having this required
certification there remains strikingly low, compared to more urban areas.
Authors from the RAND Corporation suggest a need for more targeted efforts to
increase access to the medication.
assess the growth in buprenorphine-waivered providers by region and
demographics, the investigators leveraged insights from analysis performed by
the Deerfield Institute.
population estimates from the 2010 U.S. census and total physicians per capita,
the researchers calculated the total number of waivered providers per 100,000
from 2007 to 2017. Statistics from the Census Bureau were also used to
determine per-capita sociodemographic characteristics.
decade studied, the researchers found that the number of waivered providers, in
general, increased from 3.80 to 17.29 per 100,000 persons. Growth rate of
waivered providers was markedly slower in small, nonmetropolitan areas, as it
was in communities with lower levels of education.
The Food and Drug Administration approved
buprenorphine for treating opioid dependency in 2002. According to Kaiser Health News,
once physicians secure the waiver, they can prescribe buprenorphine in a range of
settings, including primary care offices,
community hospitals and correctional facilities. Compared with methadone,
Buprenorphine is less likely to result in fatal overdoses.
The federal government is undertaking a
number of efforts to increase the amount of buprenorphine prescribers.
authors of the paper are Ryan K. McBain, PhD, MPH, Andrew Dick, PhD of the RAND
Corporation in Boston, Massachusetts and Mark Sorbero, MS, and Bradley D. Stein,
MD, PhD of the RAND Corporation in Pittsburgh, Pennsylvania.
Discipline|Cardio/Circulatory/Pulmonary , Data and Analytics , Diagnostics
Stages of Finance|Venture Capital
In February 2019, Cathworks announced a $30 million Series B financing led by Deerfield. CathWorks is a medical technology company focused on applying its advanced computational science platform to optimize prophylactic cranial irradiation therapy decisions and elevate coronary angiography from visual assessment to an objective fractional flow reserve-based decision-making tool for physicians.
Discipline|Ancillary Services , Data and Analytics , Digital Health/Tech-based Services , HCIT , Payor/Risk-based Care , Payor Model , Provider Model , Software/Saas Offering
Stages of Finance|Venture Capital
In January 2020, Vesta Healthcare announced a $30 million Series A financing co-led by Deerfield. The Company is a 24/7 technology and clinical services organization dedicated to supporting caregivers and connecting their insights to the rest of the care team. Vesta Healthcare identifies the need for additional support in the home and provides 24/7 telehealth support for caregivers and care recipients, with a focus on high-need, frail senior populations. The Vesta program partners with home care, health plans and providers to create value-based population health programs that emphasize clinical quality, improved health outcomes and personalized engagement.
In the 2nd quarter of 2018, Deerfield participated in a $26 million Series B financing round for Strata Oncology. The company provides an end-to-end clinical trial platform for precision oncology that expands patient access to precision oncology clinical trials and accelerates clinical trial enrollment.
The company expects to deploy this capital to expand access to precision trials in new hospital systems, fund the FDA approval process for in vitro diagnostics and further develop its technology and analytical capabilities.
In December 2017, Deerfield invested in Concert Genetics, a healthcare information technology firm focused on developing software and analytic tools for genetic testing. Concert Genetics is developing a digital infrastructure to enhance the transparency and efficiency of genetic testing for clinicians, hospitals, laboratories and health insurers.
Rethinking The Sales Force Business Model In A Dramatically Changing Environment .
In Focus|September 2017|
By Brent Bernstein, Commercialization, and Christine Livoti, Senior Research Manager
Pharma sales representatives (reps) are one of the
most integral components to a manufacturer’s commercialization plan. They
have long been the voice in determining and shaping the adoption curve of a new
drug. However, the “good ol days” are in the rearview mirror for reps as
there have been efforts to curb dollars and gifts that reps can shower upon
physicians and their staffs, as well as both fewer and lower quality touch
points with the decision makers with purchasing power and/or authority on drug
choice, particularly when there are multiple options in the same therapeutic
category. Here, we will try to put the role of the rep in context and provide
some perspective, conceptually, on where the sales model may migrate in the
future, and what issues will need to be addressed.
Companies spend significant amounts of time, energy
and resources dedicated to planning and building out the sales force
optimization plan. Specifically, the commercial team oversees multiple teams to
plan the success of the sales rep. Activities that contribute to this success
Market research to quantify the opportunity and
understand the behaviors and triggers of doctors to prescribe:
Identify potential points of push back from
Segmentation of doctor mindsets that can drive
training of the sales reps – i.e. identifying high vs low likelihood to
prescribe and pyschological drivers that sales reps can use to trigger
Sales training to ensure the rep is
knowledgeable and help drive rep performance
Analytic teams analyze physician productivity to
ensure reps are calling on doctors that will yield the greatest return:
Spending time with doctors who are loyalists to
the therapeutic class and/or may have affinity to a certain type of therapy
within a therapeutic area
Identify high density geographic areas that may
require heavy sales force deployment
Sales leadership teams develop:
Incentive compensation plans (performance-based
plans above base salaries) to further drive excellence
Determine call planning strategies (who to
target, and at what frequency)
Ensure operational effectiveness and execution
is in line with overall strategy
Managed care teams drive appropriate
reimbursement coverage and facilitate sales training around
reimbursement-centric adoption strategies:
How to combat doctors wary of reimbursement
Selling the value of the drug in relation to
Help the doctor navigate the prescription
journey from their office to the pharmacy counter for their patients
In the past, the sales rep had many tools at their
disposal to engage and sell their products to physicians:
Grand Rounds (sponsored lecture series in the hospital setting)
Lunch and learns
Literature leave behinds
The rep had the ability to access the majority of
not just physicians, but importantly those with autonomy and decision-making
authority, and the nature of the detail (industry lingo for reps providing
doctors with the details of a drug, including approved scientific information,
benefits, adverse events, etc) evolved around the clinical efficacy and utility
of the product. Reps were trained on the mechanism of action of their
product as well as competitors, all the key clinical data in the therapeutic
area, and how to convey their product’s differentiation. This last part is
significant as training also focused on breaking down clinical studies, with
successful reps well-trained in how to handle any objections raised by doctors
around use of their product (ideally identified ahead of time by the
manufacturer’s market research), and able to rattle off why one product may
have a better p-value (measure of statistical significance used in clinical
trials) or better efficacy at symptom resolution, among other product features.
Simplified schematic of common commercial team structure
Level and types of rep-doctor interaction have
Reps historically had an environment that was for
the most part without many restrictions, which is increasingly no longer the
case. The ability of the sales rep to develop a relationship with doctors they
called upon was easy and simple due to the tools at their disposal. However,
over the past two decades, there have been considerable changes in both the
ability to access and the types of activities the reps can use to engage with
doctors. These changes have come about in an effort to clamp down on what has
been viewed as inappropriate influence over docs by industry reps.
Any payments made to physicians by drug and device
companies must be reported under the Physician Payment Sunshine Act, signed
into law in 2010 along with the Affordable Care Act, and the data is made
public by the Centers for Medicare and Medicaid. While these payments can be as
seemingly benign as research grants, it can also include things like travel and
accommodations around medical conferences and scientific or advisory board
meetings, food and beverage, and consulting fees. Details on the types of
payments are included in the public data set. Now the public can see if
physicians are receiving what might be perceived as healthy sums of money,
which whether innocently or not, can be perceived as doctors being “in the
pocket” of big pharma, and a potential PR concern for their institutions.
Physician access has been on the decline due to
consolidation of independent physicians into heath systems
Most academic medical centers do not allow reps to
call on their physicians on site, though there may still be some level of
doctor-rep interaction if the doctor maintains an off-campus practice location.
One industry report from ZS Associates found that 56% of physicians in the US
have either restricted or severely restricted who can visit them, with some
specialties even more restrictive. Integrated delivery networks (IDNs), systems
where the provider network is also the payer, and group practices, are also
increasingly locking out reps. Further, physicians’ prescribing autonomy in
IDNs and group practices is not the same as in an independent practice, with
decisions around drug purchase and utilization instead made by higher level
This trend is likely to continue as cost pressures
have made it more and more difficult for independent physician practices to
remain financially viable. Independent physician practices have been on the
decline since 2000, according to a 2016 analysis by inVentiv Health Consulting.
While 57% of physicians were independent in 2000, this decreased to 37% in 2013
and was expected to continue sliding to 33% by the end of 2016.
The sales call has migrated from a pure clinical sell
to addressing reimbursement
When reps are still able to get interactions with
doctors, the nature of the sales call has shifted from a clinical sell to
putting the rep more in the role of a reimbursement navigator. Price never came
up as a major topic of the sales detail, whereas now it may be the primary
focus of the conversation, as it is often easier for a doctor to simply pick
the drug that is cheapest for their patient – “is it covered by insurance and
how much will the patient need to pay?” The use of co-pay cards, which reps can
drop at the physician office to reduce financial burden for patients (discussed
in a past issue of this newsletter), was largely unheard of until more recent years.
Still, co-pay cards are not a panacea, and doctors remain skeptical of the
overall utility of these cards. Patients often encounter issues at the pharmacy
when they try to use these cards, and may ultimately abandon any attempts to
get the drug they were prescribed in the first place. These co-pay cards are
off-limits to Medicare patients by law (but fair game for those with private
insurance), and so might only benefit a fraction of the doctor’s patients.
Put this all together, and reps now have less time
to discuss more complicated topics like reimbursement during their detail. The
question now to ponder is how will the rep model evolve with the environmental
dynamics at play. Specialty reps in the device sector that are required to
train docs in the surgical area will continue their business as usual, but
there will be a need to evolve the model overall in many sectors.
There is probably not a one size fits all strategy,
and that current strategies in the therapeutics sector need to be adjusted to address
some of the key challenges outlined below.
The model needs to pivot from a single point of
contact between rep and doctor to one where the sales team has a multi-touch
point strategy to various customers in the ecosystem.
Customer will be cross functional, including
buyers and influencers, not just the physician:
Chief medical officers
The ability to both articulate what constitutes
value for patients, doctors, and their institutions, and to create a more
holistic approach that drives value throughout all key customers will inform
What services, tools, and business offerings can
the commercial team offer to doctors and institutions to drive pull through and
adoption of their products?
How to generate a more ambitious patient-centric
Realignment of commercial organizations and
build out of the talent pool in key functionalities and responsibilities will
take on added significance.
Need to create cross-functional business
operational teams vs. more independent/siloed groups
Re-calibration of the managed markets and sales
force groups to more of an account management team that can foster
relationships with all key stake holders
Ability to trouble shoot and bring customized
approaches to physician groups
More sophisticated sales rep that can work with
a cross functional team and have stronger business acumen:
Upgrade to drive toward more sophisticated
approach to independent docs
Move away from reliance on business-to-business
like model that some pharma companies have started to adopt (while
acknowledging there are some specific areas where this may still have utility)
Hypothetical schematic for business management-centric approach to commercial organization
Where are we in the continuum with the shift to a more holistic approach? Our observation is that manufacturers acknowledge and discuss that we are at a tipping point, with some having piloted various more integrated approaches to drive behavioral change. Some of these pilot approaches have yielded positive returns but we have not yet seen a full migration over to a new model. What we do believe, however, is that the environmental factors at play will eventually force a significant change for all pharma.
Message from Deerfield Managing Partner, James E. Flynn
Over the course of the last few months, images of unimaginable human loss in the midst of a pandemic have been continuously in front of us. The impact, however, has not been evenly distributed. Here in Upstate New York, over 17% of the deaths from Covid-19 have been among Black people, despite the fact they represent less than 10% of the population.
These data serve to highlight the deep biases that remain embedded in society that relate to access to care. The imbalance in the composition of leadership and boards of healthcare companies demonstrates clearly that this bias is just as strong when considering access to opportunity.
Recent disturbing acts of violence have brought added focus to how Black people and other minority groups are treated, even in the hands of those whose job it is to protect. While these acts have gained greater attention in recent weeks, partly because of the outrage expressed by people of every demographic, each day there are uncountable acts of this nature that go unnoticed.
We must capture this moment of raised awareness and heightened energy to effect real change. We must do better. Not only because we have to, but because we want to.
At Deerfield, we are strong advocates for diversity of backgrounds and ideas, and we are deeply committed to maintaining an inclusive work environment for people of all races, ethnicities, genders, religions, and sexual orientations.
Through our Deerfield Fellows program, we have proactively engaged a diverse group of students from the City University of New York (CUNY) to create opportunities to learn about careers in healthcare finance and entrepreneurship. We now count many of these talented individuals as our colleagues.
Through the Deerfield Foundation, we’ve made investments that address the social determinants of health in communities of color, both here in the U.S., as well as in Africa and Asia. In addition, we have created Break into the Boardroom and Women in Science programs to drive change in gender diversity in the boardroom and entrepreneurship.
However, we, too, must do more, and will. We believe that providing platforms for the voices of a diverse set of stakeholders introduces new, and better ideas. And in the case of healthcare, it could spark more inclusive and creative solutions to the industry’s complex set of challenges.
We must address society’s social inequities, including in patient care. We must partner with our local communities in the fight against racism and other injustices. We must acknowledge the pain, grief, and fear that many families are feeling now, and we must listen to those families. Only then can we begin the path toward sustained structural change and healing.
The times ahead will be tough, as our nation continues to face many public health, economic, and social challenges. Despite these challenges, we must find a way to use this time of despair as an opportunity to come together and create solutions.