Read the Conversation
EF: After leading IQVIA in Germany and Austria for the past six years with excellent results, what are your priorities for the upcoming year?
FW: IQVIA has evolved over the last 10 years; we have undergone a transformation, expanding our services to reach a broader space in healthcare: the industry, the payers, the providers, and government bodies. With this in mind, we have a 360° view of the healthcare system, and our key priority lies in using connected intelligence technologies to improve and strengthen the healthcare stakeholders’ collaborations for better patients outcome. Our key asset is the relationships with the different stakeholders across traditional borders of the healthcare system. We support and drive healthcare forward by improving patients' lives and managing costs appropriately within the system. We aim to keep the system affordable while still delivering quality patient results by connecting the information from multiple sources within IQVIA through connected intelligence. One example is the implementation of Real-World Evidence (RWE), which is of utmost importance for better decision-making on innovations, and new or advanced therapies. We bring all the stakeholders together, combining technology with clinical and our information business and services organization, to reduce the cost of health system engagement. We are a platform and partner for the system as a whole. While industry, payers, physicians, pharmacists, hospitals, and other stakeholders, all have their own perspectives, we provide holistic insights as we work with all of them. There are many opportunities today with the available data and technology, and though it is not an easy task, we are ideally positioned to offer a value-adding structure. We are probably the largest service provider for Sickness Funds and for the industry, and we are partners with healthcare professionals. We have an encompassing view and the assets to understand the needs and interests of the different parties. As valued partners, we try to be a balancing factor between them to arrive at a good solution for all parts. Our expert people are also key as they drive what we do.
EF: You recently published a report on the global use of medicines where you project a 3 to 6% global growth. How do you see growth in your region?
FW: The pharmaceutical market development has two key drivers: demographics and innovation. The population is getting older and with age comes higher morbidity, which drives demand. Additionally, Germany and Austria have a growing population because of inbound migration, especially in Germany. Secondly, there is a growing demand and supply of therapeutical innovations, which also will drive growth. Germany is still innovation-friendly, despite the new legislation being cost-containing. Most developed new chemical entities or active substances make their way into the German market. Germany will grow; generics will capture the volume growth locally, and the innovation pipeline will be even stronger with mRNA technology in oncology and CNS. We currently have mid-single-digit growth; it is hard to project future growth accurately because of the pandemic impact, the backlog of untreated patients, and the undiagnosed patient catch-up. There will be between 3 and 6% growth in value; volume will probably be in a similar range. The health sector is a key factor in the economy, roughly about 30% of the GDP in Germany and Austria. Home care, medical devices, medical supplies, care institutions, hospitals, and industry are all part of the healthcare system, making it one of the largest employment sectors. Innovation is important from the economic aspect, and the money is there for it. The environment is positive for growth and at the moment in line with the population's demographic.
EF: What are IQVIA's customers' biggest requirements and needs?
FW: Our services include a combination of information and analytics, which, added to our clinical capabilities and technology, makes for an extremely strong value proposition. The most innovative firms have chosen us as partners to drive their pipeline and bring their products to the market. Secondly, we offer solutions to our clients by combining analytics, data, and technology as well as clinical research expertise in different areas. We do a lot of outsourcing, digitizing, and creating transactional platforms. With data at the base, analytics, and the softer technology business, we offer a very strong proposition, which is very in demand from f. ex. providers such as hospitals that integrate data, vaccination centres, and other stakeholders across the healthcare system. The combination of our assets creates a connected intelligence that is very in demand. We have conversations with Medtech companies on how to use the data they generate for real-world evidence to learn from and improve tracking patients' treatment.
We are currently working on building AI models that use live data from procedures on patients from Hospitals, that will support HCPs. AI and Machine Learning are currently hardly present in the Hospital Sector. While the physicians are doing an intervention, they will get live recommendations on how they should proceed depending on the live parameters, sensor data, or procedure stage. We will use historical data from the AI model to make recommendations to the surgeon. This is one of the most ambitious projects we are working on for the upcoming months.
EF: Which other examples of digitalization or technology adoption do you see showing big advances?
FW: In Germany, you can see companies that are very into cutting-edge technology and those who prefer to keep traditional ways of working. We tend to overestimate the short-term impact but underestimate the long-term effects. We have been living in the era of digitalization for a long time now and since a few years, techniques like AI and Machine Learning (ML) have become more exciting because they become more applicable. IQVIA works with technology and machine learning in all areas where we engage, in production, clinical space, client engagement, and consulting. We are looking at dialogue systems and feedback from doctors using a natural language processor to structure the unstructured information to create data for the treating physicians. We use AI and ML to reduce manual processes, to do detection and disease progression.
As an example, we have modules that can be plugged into the physician's system to predict if a patient with osteoarthritis has a slow or fast disease progression. It can predict with very high accuracy as soon as the disease is identified how the progression will be, and with the information, the physician can make the right decisions in the choice of the best treatment pathway.
Adopting technology might be slower in the short term, but the impact will be significant. Recently graduated physicians had an increased awareness of how technology can aid them, whereas physicians on the job for 30 years don't. It will probably take another ten years for innovation to become embedded in all processes. With fewer people in the healthcare system and more women in practice, there will be a lot of support for healthcare treatment pathways, making things significantly different. Innovation will not be so visible in the future because it will be built into medical devices and software and embedded in the medical culture.
From a knowledge and research standpoint, Germany has a very strong environment. For example, there are very renowned scientists, like Professor Drosten, a virologist on Coronavirus. He worked on the subject for a long time and was the first to detect and describe the virus when it appeared in Germany. Later Moderna and BioNTech used this information to develop their mRNA vaccines. It was no coincidence that these vaccines -the most potent vaccines for Corona- were developed in Germany (and the US) because of the strong research history and community. Actually, there are opportunities for the mRNA platform in cancer and other indications such as malaria, immunization, and CNS. The near future possibilities are impressive and will certainly be assisted by Germany's positive research environment.
EF: Legislative changes are coming to Germany. Do you see the changes as an opportunity or a concern?
FW: In our previous legislation, a new EMA-approved therapy can be brought to market and have free pricing for the first year. A value dossier is created in the initial year, and a price negotiation is based on that. This year free pricing is shortened; however, the demand is higher, so a differentiation to the existing treatments needs to be demonstrated to charge more for the product, which is good because we expect value for money. The medical value must be shown, and the price must be negotiated based on that value. The general concept is any approved product can be brought to market, and reimbursement is immediately available. The Sickness funds will want the lowest possible price, whereas the industry wants the highest, and this is why data is important, as it shows the value-added benefit of the new product or treatment. The industry is becoming a victim of its own success. There are increasingly different shades of targeted therapies for smaller patient segments, and the cost to develop them is increasing. Therefore, the return expectation per patient must be higher, which in turn increases the cost per patient. However, the Sickness funds are only willing to pay more when the product is effective, eg. demonstrated by a biomarker and makes a difference to comparable therapies. The targeted population is getting smaller, making it more difficult for the industry to recover its development costs, and so the innovation that allows treating patients more accurately is becoming more expensive on a per-case basis. This is a big challenge. I see the industry's point and position, and I also understand the Sickness funds’ view in that their resources are limited and must balance out treating as many patients as possible.
EF: What were the key successes for 2022 and what are the key trends, and what will stand out in the German market?
FW: Post-pandemic, and looking at the last couple of years, I believe Germany has done well. It could be argued that from a political standpoint, certain long-term measures have not been as necessary as they originally seemed. Mask-wearing is still mandatory in some parts of the country as we speak, a matter of being overly cautious, even if initially warranted, while other countries have omitted its use. We did well at the time; decisions were quickly made, and they allowed us to move forward, and the push for vaccines was strong. The public administration part of the system has significant room for improvement from a digital standpoint and still is facing challenges in data exchanges. Another challenge was energy, which seriously impacts industry, as it must comply with certain standards, cooling, production temperatures, etc. Out-of-stock is another big concern; new legislation is being discussed, which opens up better pricing for specific areas, such as oncology, antibiotics, children’s medication, or specific in-demand critical medication to have a higher reimbursement for Europe-based production. Above all these challenges, there is a willingness to learn, and this will hopefully change the system for the better. There is an awareness of the need to do more to digitize the country, and I hope it is done sooner rather than later. The agenda is clear, which, if accelerated, will improve the situation for patients and the population. Ending on a positive note, companies like ours have many opportunities and work to do. I am, in general, very optimistic about the future of the country and IQVIA.
