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Let's give the 'it's all so complicated' angle a rest

Instead, help your healthcare context learners by taking it one layer at a time

One of the core things I do for Union is to oversee the development and delivery of our Healthcare Strategy Bootcamp. It's an educational offering for anyone who is new to role, new to healthcare, or new to sector. We offer this because so many people, every day, often as part of something else they are doing, are working to build their business/strategy contextual knowledge in healthcare. All are trying to be conversant enough in the core set of relevant topics to carry out their roles well.

The more time I spend building teaching materials, the less patience I have with a common, and in my view, deeply unhelpful feature of the healthcare information environment. I am talking about graphics, articles, videos, podcasts, or speakers that focus their time or graphical real estate emphasizing for the learner how incredibly complicated it all is.

This dynamic shows up a lot of places, but to illustrate the problem—and start talking about solutions--let's zero in on the world of drugs/pharmacy, and a kind of nemesis graphic that lives there.

Let's use drugs/pharmacy as an example of the problem—and some solutions

One cannot avoid drugs/pharmacy as a topic. It’s a huge segment in the industry, a newsmaker, and a make-or-break factor in organizational and even national economics (not to mention a matter of life and death to patients and families). But, one can be a very experienced healthcare industry professional, and still dread open-ended conversations in this area. This is because while all healthcare strategy topics feature arcane language, complex business processes, and sensitive market politics, these things are in extra supply in the terrain of drugs/pharmacy.

All this is why we made the decision to develop drugs/pharmacy as an early module for the Strategy Bootcamp curriculum. And, it is how I came to be thinking about supposedly helpful resources that intimidate more than they teach—because of the particularly egregious example that lives in this topical terrain. I hereby point an accusing finger at: The ultra-complicated pharmacy supply chain/value chain map.

The ultra-complicated pharmacy supply chain/value chain map: A learner’s nemesis

If you've spent any time in this topic, you have probably run into some version of the offending graphic, which always tries to show the flow of both drugs and dollars across players. Many different people and groups have produced a version of this graphic (which I won't link to; google it, if you must). Suffice it to say, some of these are awesome teaching tools. But many are .... not awesome. The problem with the not-awesome versions is that they include a ton of nodes, solid, dotted, and different colored lines, and (the worst part) arrows that turn in on themselves.

These types of graphics spark two reactions in the learner who is trying to figure out which way is up in the drugs/pharmacy world: ‘Holy [cow], drugs/pharmacy is a totally [messed-up] terrain,’ and ‘I personally will never understand this.’

Let's not make graphics that mainly teach how complicated a thing is

I get it: The drug/pharmacy value chain all these graphic-makers are trying to depict is, structurally, a ridiculously complex part of the healthcare industry. That is a persistent fact of the market that learners need to know.

But most learners already know that the world of drugs/pharmacy is complex—in fact, that’s probably the one thing everyone already knows for sure. And, graphics that only serve to communicate that overwhelmingness do not serve learners. It's simply not a constructive insight to impart.

One can be comprehensive and comprehensible: Just take it one layer at a time

When the topic is packed with complexity, what the learner needs is a resource that makes it accessible by breaking it down into intelligible pieces. Consider architecture, or human anatomy: Is it helpful to make a graphic that describes many complex overlapping structures and systems all at once? Usually not, because such an illustration will either be overwhelming or tremendously oversimplified.

Instead, it’s more helpful to see things in layers. One can get oriented to how a skyscraper works one layer at a time: Structural features. Wiring. HVAC. And so on. Similarly, if you’re trying to understand the workings of the human body, it’s helpful to take a look at a series of systems. The anatomy and function of the skeletal system. The muscular system. The circulatory system. And so on. This is the way you can at least get a handle on each system, before progressing to a next-level understanding of the interplay among all these systems.

Turning back to the challenge of learning about drugs/pharmacy, or any healthcare business/strategy topic: The concept of breaking things into layers can help in two ways.

First, it can be used to break complex structures and processes (such as the 'value chain') into manageable pieces, as described above.

Second, and in a more general way, one can begin to de-mystify the whole segment or topic piece by piece. For example, by establishing a "major players" layer, a "main industry conversation topics" layer, and so on. In our experience, picking the right set of layers (and of course, populating them with correct and succinct information), makes it feasible to help interested learners get conversant.

Applying layers to the pharmacy value chain graphic

Applying this fix specifically to the drugs/pharmacy value chain, we need to separate the ‘value chain’ into at least two main layers: (1) manufacturing, distribution, and dispensing, and (2) pricing.

Advanced learners would need at least one more graphical layer: the issue of drug rebates. While the pricing graphic above does touch on rebates, they are more important conceptually, and more complex, than this simple version can communicate. (Rebates are the factor most responsible for that whole "arrows-curving-in-on themselves" problem I mentioned earlier on. Otherwise known as the specific graphical element in the value chain map that is most likely to crush learners' spirits.)

Tackle the ‘who’ of drug/pharmacy – major players – in its own learning layer

A graphic that shows the ‘value chain’ briefly lists broad player categories such as ‘manufacturers’ and ‘pharmacies’. In the real world, of course, it’s useful to understand these player types in a little more detail.

Our solution for the Union Strategy Bootcamp is to make a ‘major players’ learning layer. We put organizations into a few big categories, and then pick representative organizations to get to know in each, case-study style. What kind of organizations are these, what kind of economics do they have, what keystone people/stories do industry insiders tend to know about them?

An informed set of players in drugs/pharmacy will include both organizations that are often in the headlines and organizations that fly under the radar unless you're in the know. For example, take wholesalers such as Amerisource Bergen, McKesson, and Cardinal Health. As our go-to drug/pharmacy expert Lindsay Conway, Director at Vynamic, puts it: "These are the biggest, most influential organizations in pharmacy that most people don't know anything about." All three of the above companies are among the top-20 largest companies in the U.S.

People like to say about organizations, ‘if you know one, you know one’, but in my opinion, getting to know one organization in a category is a huge leg up on understanding any industry sector at large. After all, once you have foundational familiarity with one, you’re in a position to compare and contrast with others in the category. To take a drug/pharmacy example: if you understand what GoodRx does as a drug/pharmacy disruptor, it’s much more feasible to add Marc Cuban's CostPlus and Civica Rx to your repertoire, gaining different angles and nuances on the general theme of drug/pharmacy disruption.

A look at the topic layer in pharmacy shows conversations are dominated by cost

To be conversant in any healthcare strategy topic requires having a basic familiarity with the major current topics of conversation in the industry. For drugs/pharmacy, the dominant topic is cost, with a number of important subtopics and related topics that radiate out from that main challenge. I’ve listed in the following graphic what we think are the five or so that, at a minimum, someone needs to be prepped to recognize and talk about in order to get around.

For anyone wondering why Union’s Strategy Bootcamp module on drugs/pharmacy covers PBMs as a topic, rather than including them as a player: there is a logic. We do this because you must understand the topic (and related current developments, like regulatory scrutiny and the advent of specialized PBM startups) to be conversant in drugs/pharmacy. And generally speaking, if you understand PBMs as a topic, you can understand the players.

In conclusion: It is possible get conversant on this, and every other challenging strategy topic in healthcare

Drugs/pharmacy is probably the healthcare strategy topic in which it is most likely that someone will try to cram all the complexity into one discouraging graphic. But the issue isn't just about graphics; in general, watch out for any teaching that spends most of its available teaching space underlining how hard a thing is to learn.

Instead, keep optimistic that it is possible to for you or your learners (board, investors, physicians, sales team, etc.) to participate substantively in healthcare strategy and market conversations. Just take it one layer at a time. And let us know how we can help!

Do you have some learners who need a boost on healthcare strategy topics?


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