I am so proud to be part of the pharmaceutical industry where our leaders were the first movers on reform and without their early efforts, the law would never have passed.  Yes, our industry, which has been under so much pressure over the years, provided the initial financial impetus to make it all happen.  Take a look at this piece from the Huffington Post and just see if it doesn’t make you feel just a little better.

In our industry, like everywhere else in our country, we have those who agree with and those who disagree with the ACA.  Some think it should go away and some think it should go even further and begin to move closer to a single payer option.  I would have loved to have seen it rolled out with everyone working hard to make it better for people and easier to access.  I would have loved every state to have adopted the expanded Medicaid option and really eliminate the uninsured almost completely.  But perhaps I need to be patient and allow the system to progress step-by-step so that all sides feel comfortable with the change.

Regardless of which side of the political spectrum those in our industry fall, I have always been impressed with the overall concern those I work with have for the patients who benefit from our products.  Everyone embraces indigent programs, co-pay cards and program that help make those who need our products lives a little better.  I love the global HIV-AIDS and vaccine initiatives.  I am proud of the way medicine had increased the number of years people live and the quality of lives in all corners of the world.

After writing more than 200 blogs on marketing and healthcare it is now time for me take some time and listen to what others are saying and to spend time helping my clients prosper in this new healthcare environment.  I will be taking a brief break from this blog so that I can act more and talk less, which is not always easy.   I truly appreciate all the comments and feedback I have gotten from those who have followed my blog during these many months.  I am always available to continue the discussion or help in any way.  Just call!  Let’s keep doing good and driving positive change in the healthcare world.  So much depends on us!

Obviously, you are not alone.  Take a look at this piece in the New York Times last week written about doctors who are having the same issues as the rest of us.  Can you identify with the physician who is thinking about other patients, paperwork, phone calls and a ton of other issues while his patient is begging for his attention?  Can you see how frustrating this must be for both the physician and the patient?  Note the point made about the high level of burnout, substance abuse and other more serious results from this behavior.  It really is scary and demands some attention.

The article points out some preliminary work being done with “Mindfulness” training to help the doctors live, think and experience the present moment.  This work is not just for doctors.  Google “Mindfulness” if you aren’t fully aware of what it is all about.  Look at the work done by Jon Kabat-Zinn and see if it makes sense.  Note that there are links to Mayo and other prominent medical centers.  There is a ton of free information on the Internet that could get you thinking about and perhaps even starting the practice of mindfulness.

Living life fully every moment takes some real effort.  Being able to really be present for other people and to be able to fully concentrate on one task at a time takes a lot of work.  It is so counter intuitive in today’s workplace where everyone seems to be working like a hamster on an exercise wheel.  It is very important to note that although the hamster is going like crazy he is not getting anywhere.  If you can identify with any of this, I challenge you to take the time to explore this topic further.  You and everyone you associate with will be thankful you did!

This lack of healthcare coverage is a major drag on the pharmaceutical industry as this group of 48 million definitely will not be purchasing brand name pharmaceuticals at a cost of thousands of dollars a year.  It just won’t happen.  The key point to consider is who are the uninsured?  Keep in mind they are not the poorest of the poor as those patients will be eligible for Medicaid.  It seems to be the people living on the edge of poverty and perhaps those who work at jobs without insurance who have the greatest chance of being uninsured.  There is even 8% of people with family incomes over $75,000 who are not insured.  Why is that?

So much debate over the last year has been around the role the government plays in healthcare and how this hurts the free market forces.  Even before the passage of the Affordable Care Act, the role of government was extremely significant with Medicare and Medicaid covering between 30-40% of those insured.  In addition, and this is critical, government provides a further boost through their tax support of corporations that provide insurance for their employees.  In so many ways, government already ran and will continue to dominate healthcare policy in our country.  The concern is not about that but rather the lack of a “free market” opportunity for individuals who want to buy their own insurance.  The health insurance exchanges run by government and those run by private industry should help rectify this situation.

Having everyone insured is not just a feel good thing we should strive for but rather a driver for fiscal stability in our economy.  In the vaccine world there is the herd immunity concept that might provide a model for the health insurance world.  The concept is that the more people who are vaccinated, the less chance a disease will have to break through the barrier and that the overall success against a disease is actually higher than the number of folks vaccinated.  Having people uninsured hurts everyone in the system as it drives up costs for the insured.  Making sure everyone is covered and having the opportunity to get medical care before their problems get too advanced helps avoid the catastrophic costs that impede the progress of healthcare economics in our country.

Selfishly the pharmaceutical industry wins when more people are insured and have access to medications.  The earlier this intervention happens the better for the industry as drugs provide tremendous value preventing disease and minimizing the progression and the costs associated with no treatment.  This is a win for everyone and the industry should do everything possible to promote coverage for everyone.

Take a look at this Chicago Tribune article that reports Walgreens will move 180,000 employees to the Aon Hewitt exchange which consists of a wide variety of plans and tons of choices for the employees.  Although not the government run exchange set under the Affordable Care Act, it will run pretty much the same way.  Note the advantages mentioned for both the employer and the employee discussed in the article.  Walgreens will get to see a cap in their healthcare spending and over time this could shift a considerable burden to the employee if costs on the exchanges go up rather than down.  Employees are offered choice and although they will be compensated for a “silver” plan they could spend more and upgrade or spend less and keep some of the compensation.  Time will really tell how this all works out for both sides.  Oh and by the way in case you were thinking Walgreens is alone, look at Richard Vanderveer’s blog from last week where he points out IBM is going a similar route for some of their colleagues using Towers Watson’s exchange.

So what does this all mean for the pharmaceutical industry?  Well in some ways it might be good as there will be increased competition in the payer world which should drive down costs and weaken some of the power big insurers have over the industry.  This may be an opportunity for creative contracting and aggressive marketing to help capture new patients during this period of chaotic change.  On the flip side, studies have shown that employees, when given a choice, will often opt for less coverage which in this case might mean selecting plans with formularies that are less friendly to brand name drugs.  But could things get much worse than they already are today with over 85% of all prescriptions being filled with generics?

Perhaps the key is for the industry to convince patients to select plans that provide good drug coverage as that will save them a lot in the long run.  Also, if they are leaving solid employer plans they should at least try to keep their drug coverage solid.  Industry should also try to convince insurers that they need to provide as attractive a drug benefit as possible as this is where their new customers will look to see which plan is better than others.  It could be a real competitive advantage for insurers.  It really is all about marketing, public relations and customer relationships.

Whether we are talking about the government health exchanges or those run by private entities, we seem to be on the edge of some major change.  Those that embrace the change and try to stay ahead of the inevitable will win.  Those who ignore what is happening, close their eyes and hope things will not change are taking a huge risk.  Which side are you and your company betting on?  Take a look at your business plans for 2014 and if they look like those in 2013 (or even 2004) you may be vulnerable.

Take a look at this Noreena Hertz Harvard Business Review blog that discusses the critical role a “Challenger in Chief” needs to play for both organizations and individuals.  First, it is critical that we see and understand how most people and leaders of organizations (who are people!) tend to surround themselves with those who agree with them rather than challenge them.  The examples given in the blog around Facebook friends and who we follow on Twitter are quite compelling.  Think about those you hire as vendors and who you have on your teams.  My bet is that they are there because they agree with your thinking rather than challenge you.

The concern is when looking at the research it shows that you make better and smarter decisions when there is dissension rather than consensus.  When there is an environment where people are constantly trying to poke holes in your theories rather than just always “going along,” the business thrives.  Perhaps the most visible example of this was seen this week when, after considerable pressure from the US people, Congress and the international community, the president backed off, at least temporarily, from using military force in Syria.  Different points of view led to a different path forward.

The blog goes on to talk about a number of very interesting ways bias enters the decision making process and how a challenger can help point out those blind spots.  When you are excited, don’t get enough sleep or your blood sugar is off there is the chance your decisions are influenced by factors other than solid thinking.  The more challengers you have the better the chance these mistakes can be averted.

Perhaps the key to this is to fully recognize the spirit in which the challenge is given.  It is very interesting that those who criticize my blog “opinions” are usually those I am closest to in the industry.  These are people who have endured both the downsides of business and the successes with me and perhaps this has shown them the importance of always trying to improve the thinking that goes into business strategy.  When challenges come in this way, they are viewed as a gift.

The world we live in, both within the industry and outside, is extremely complex and constantly changing.  There are very few simple problems that only require minimal thinking to solve.  The first idea or plan is seldom the best.  The old ways of doing things should be viewed as just one possible way.  New thinking needs to be constantly welcomed.  Organizations and individuals need to seek out diverse and different points of view.  We all have to get better at challenging and listening to challenges.  The stakes are really too high to ignore this lesson.

Tri-sector leadership is not something that automatically happens.  It takes careful career transitions and long-term planning.  It may mean balancing a set of competing motives such as making money and developing a stable economic situation with taking the chance to work in government or a nonprofit.  Skills need to be developed that can be utilized in each of the three areas and there also needs to be some skills attained that are very specific to only one of the areas.  Networks need to be developed in each of the sectors so that there are sets of “go to” people in each area that can help with strategic initiatives in each area.  This is just a taste of the concept but with some research and introspection I think you can start to recognize the depth of the idea.

Take a look at some of the people who have been able to move between the sectors and you will begin to see the importance of this concept.  Look at the way Michael Bloomberg has moved from business into government.  Bill Gates moved from business into the social sphere with a huge play in the government area as well.  President Obama started out in the nonprofit world before moving to government.  Some move in and out of different sectors and some just constantly float between them.

This is a concept that is critical for the pharmaceutical industry because we exist and survive squarely in all three areas.  Yes, the industry is clearly a profit-making enterprise with one significant goal being to enrich the shareholders.  But at the same time, it is recognized that the industry is heavily regulated by government and this in so many ways is a make or break situation.  On a more grandeur note, you might say that both the government and the industry are working together to constantly improve healthcare for everyone in the country.  Likewise, there are significant connections between the industry and the advocacy and support groups that work with the patients who use the drugs the industry discovers and commercializes.  This triple-sector relationship is prevalent in every therapeutic area but is perhaps most visible in areas such as HIV-AIDS, vaccines and cancer.

On a more personal note, how would you rate your skills in each of the three areas?  Have you designed your career path to be able to touch each of the three areas?  Do you understand or have you worked for a nonprofit?  Have you served on a nonprofit board?  How closely connected are you with the politicians in your area?  Do you understand how things work?  Have you studied how the industry and government connects and are you an expert on the rules and regulations that control the way the industry operates?  These are all important questions and if you want to become a true leader in the industry or in the broader healthcare world you might want to think about these concepts and develop a personal growth plan.

The HBR article concludes with the fact that this triple-strength issue is an area where the US and Europe are falling behind China, Brazil, Singapore and other countries where the integration of the three sectors is more embraced.  This may be a big opportunity on both the personal and the corporate level!

McKinsey did a survey of 60 major corporations and noted that women made up 53% of new hires, 40% of managers, 35% of directors, 27% of VPs and only 19% of executives in the C-Suite?  Why?  This seems to be taking way too long to equalize out.

A recent Catalyst study looked at high potential hires from business schools and noted that on average men’s projects were twice as big as women’s and had three times as many staff members.  Men were more likely to get budgets greater than $10 million, have actual P&L responsibility and have projects that garnered attention from the C-Suite.  It seems women are put at a disadvantage even though both men and women were viewed as having the potential.  Why?

Women in sales earn only roughly 2/3rd of what men earn according to the Bureau of Labor Statistics.  This is noted as strange as sales income was always viewed as being less biased.  It turns out a Wharton study, looking at two large stockbrokerages, showed women were given accounts with less potential, denied support staff and had fewer mentors and other amenities to help them perform better.  Why?

This lack of promotion is especially perplexing since consultants Jack Zenger and Joseph Folkman analyzed 360-degree leadership effectiveness evaluations of 7,280 executives and revealed that at every management level the women were rated higher than men.  It is also interesting that the higher the leadership level the bigger the gap.  Women were rated higher in 12 of the 16 traits that were shown over a 30 year period as the most important to leadership success.  Again, why would this be?  Is it because only the very best of the best are getting promoted?

Women with children, when matched in a stringent way with those without children, going for the same job were significantly less likely to be hired.  If they were hired, their starting salary was $11,000 less than women without children.  Men with children were not penalized in any way.  The same researchers also noted that female reviewers, but not male reviewers, judged women with children as less likable than men or childless women and this also led to fewer offers and less money.  How can this be explained without noting bias?

I guess we could go on and on but I think the point has been made.  Something just doesn’t seem right.  Do we really have the best possible people leading our organizations?  Are shareholders being cheated by this bias?  Are colleagues in these organizations having their careers hurt by having less than the best possible leaders?  It certainly is worth taking the time to consider.  Again, how long will it take to get this right?

The key is in today’s world, everyone is doing and saying the same thing.  Our drug is effective.  It is safer.  We have managed care coverage for so many million lives.  We have a co-pay card to offset patient costs.  We have samples.  Our clinical research involves so many thousand lives and we have so many patient years of experience.  You see, it all kind of sounds the same and every product has just about all the same stuff.  The value is not popping out.  It is not obvious.  For physicians, it is often not worth the effort of step edits and prior authorization work.  For payers, it is not worth changing the formulary or paying a little extra.

Take a look at this very interesting piece on stacking.  It points out that to really differentiate your product or yourself, you may need a combination of differentiators, not just one.  This, plus this, plus this and this makes us different and worth the price you pay.  A product may need to be more effective and easier to use and yes maybe even less expensive, before it is truly differentiated in a customer’s mind.  Take some time and really examine your product and try to develop a small stack of things that together truly differentiate your product from the competition.  Be realistic and understand your competition is doing the same thing.

Take this thinking just a step further and see how it plays out in your career.  You may need to stack a number of differentiating points together to get the job you want or the promotion you think you deserve.  Again, realistically look at everyone else who is going for the same job or the same promotion and examine how you can stack up a select few items to truly differentiate yourself.  This might be a little tougher than you think as most of the competition is doing exactly what you are doing.  Everyone went to a good school and got good grades.  Everyone has some experience in different functional areas and everyone claims to have won all kinds of awards and contests.

When trying to differentiate either yourself or your product, out of the box creativity is clearly needed.  For now, I will leave the product differentiation up to you and will give you a few ideas about your career.  What type work do you do outside your job?  Are you a master gardener?  A beer brewer?  A leader at a nonprofit in town?  Have you taken kids on volunteer outreach trips?  Have you worked on a political campaign?  Have you spent time with homeless folks to understand how they get healthcare?  Have you run a small business to truly understand profit and loss?  The list could go on and on.  Keep in mind that these are items that must be stacked on top of all the obvious points of differentiation and not substitute for the obvious.

As the summer season draws to an end, it might be worth taking some time to think about differentiation and all its aspects.  If you are really serious, and are willing to take the risk, ask a friend or a colleague to help you out!

With the October 1st date rapidly approaching, there are a ton of articles out there both blasting and supporting the reform.  It is going to save huge amounts of money while at the same time costing incredible amounts.  Employers are all trying to figure out ways around the law.  Workers are concerned about their plans.  Everyone has an opinion but very few have any understanding of the law and the scope of the reforms.  Even those in the healthcare industry are confused about what is happening and how it will impact their profitability in 2014 and beyond.

For those of us who work in the healthcare industry, we better work aggressively to make the ACA work, because if it doesn’t the next set of reforms could be devastating.  Take a look at this piece in Forbes last week.  It is a very simple article with a very uncomplicated set of facts that should be considered in great detail.  The study shows that both Singapore and the United States have similar life expectancy, with perhaps Singapore being slightly better.  The interesting fact is that Singapore spends 4% of its GDP on healthcare while the US spends 14%, according to this study.  It is very difficult to look at this and a million other similar studies and see that change is not needed.  Big change.

The striking argument and the point of the article is really about what each country covers under what they call insurance.  Where is the line drawn?  In the US, we cover almost everything and call it insurance.  In Singapore, they cover only those things that are unexpected and that could really hurt someone financially.  To understand this difference take a look at your auto insurance policy.  It covers accidents and theft.  It does not cover gas, oil changes, tires, car washes and all of the other relatively small items needed to keep a car going.  Health insurance on the other hand now covers almost everything, even those things that are totally predicable such as annual physicals, office visits, drugs and vaccinations.

Pharmaceutical executives are well aware of the advantageous situation the industry has in the US where drugs are covered as part of the insurance system and covered in most cases even before a deductible is reached.  They also understand the huge benefit the industry has with the Medicaid rules as they currently exist.  In Singapore, pricing is much more transparent.  The free market sets the prices based on what patients can and will pay, not some behind the scenes insurance company.  Take some time to think about the comment from the physician within the article as it hits the core of the argument.  The point being made is that as insurance companies start to pay for the more predictable, they artificially raise prices as everyone must make a profit.  Think about how much gas could cost if it was included in your auto insurance and then consider how much the gas stations and insurers could mark up the price of gas because the driver wouldn’t care at all.

The ACA is an incredible win for the status quo.  Those in the industry today, if they maneuver correctly will continue to prosper.  Drugs continue to be covered as do most other aspects of healthcare delivery, even the most predictable.  The key is the system must work.  If the ACA fails, the next set of options may look more like Singapore.  If consumers really had to pay for drugs like they do for gas or oil changes, the industry would come crashing down.  Maybe that is why the pharmaceutical executives were so supportive of the moderate reform we see with the ACA.

Matt Ehrlichman, the CEO and founder of Porch, has a very interesting piece in Fast Company where he looked at the factors that lead to a “stinky” company culture.  Yes, the title caught my attention.  Take a look at the blog and see if you agree with his thinking and if any of the six signs are present in your company.  Is gossip (and cliques) prevalent and what impact does it have on morale?  Does your leadership team have bad habits?  Do managers actually work or just watch others?  Does your company play together?  How nasty is the competition between employees?  Is there any “school” spirit?  These are very interesting observations on what leads to a stinky culture and they are worth some serious reflection.

The interesting part to me about culture is really how much of it is actually driven by all the people in the organization.  Unlike goals, strategy and mission that are often driven from the top down, the culture is often driven from the bottom up.  Yes, the leaders play a role but they are often influenced by the activities, spirit and whims of those lower in the organization.  Even Queen Elizabeth, who perhaps symbolizes the stodgiest of cultures, agreed to do the James Bond skit during the Olympics.  I am totally sure that was not her idea.

For those of you who have worked with or at several companies, think about the differences noted in the cultures.  Who “controlled” the culture and how did the different personalities play into the work environment?  What was good and what was bad at each place?  How did you contribute to the culture?  How can you do so in your current company?  Can you make your workplace more inclusive?  Can you make diversity a competitive advantage?  How about increasing the level of fun everyone has at work?  Can you help everyone think their work is worthwhile, needed and appreciated?  Do you help set a tone of balance between work and the rest of life?  Recognize that everyone plays a role in the culture in either a positive or negative way.

The final line in the Ehrlichman piece is worth reading several times.  When an employee stops believing in the organization and the significance of their job, the castle is about to fall!  How solid is the castle where you work?  Are you building it up and fixing all the small cracks before they are even noticed or are you standing back and watching others control your destiny?  Just thinking about it and taking some small steps is a great way to start.