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EF: You are in charge of Spain, Portugal, and Turkey. As you look ahead to 2024, what are the main opportunities and challenges that you identify?
JA: This year, we have set goals that align well with our mission to accelerate innovation for a healthier world. This is our company's mission statement, and it's straightforward. To put it simply, we help people live longer and healthier lives. With the necessary adjustments made in light of the unique characteristics of the Spanish healthcare system and the local circumstances of the clients we serve, we will concentrate on implementing the company's global strategy at the national level by 2024.
We are focusing on four priorities. Initially, to better serve our life sciences clientele, we aim to strengthen our ties with all clientele segments that are important to our regional expansion. This not only includes the Spanish subsidiaries of multinational pharmaceutical companies, but also - and this is crucial - Spanish headquartered companies with an international ambition.
The second priority, though less conventional for IQVIA, is our aggressive expansion among our diverse customer base, which includes our payer-provider and government business, which we launched several years ago. It is an important strategy for both our development and growth. We'll keep making organic investments to strengthen our capacities and address some of the most important problems facing payers and providers in both the public and private health systems. To assist them in changing while they are going through a major wave of change that includes digitization and the need to address issues of sustainability, care quality, and diversification among many hospitals and areas. Ultimately, we want to help them enhance patient outcomes.
And finally, people remain our top priority. We want to continue developing the outstanding talent we currently have. Therefore, everyone must know how important their contribution is to our mission and strategy. Given the difficulties facing the labor force these days, we sincerely hope to concentrate more on the employee experience and make sure that our company's size and diversity provide them with prospects for meaningful professional growth.
Since I am a general manager, ensuring that operational excellence is a constant obsession for the entire company—and not simply an internal concern—is the fourth priority. It also manifests externally in our interactions and relationships with clients by providing the best quality we can to create value for them. We will apply this to our internal processes by increasingly automating and using artificial intelligence to make them run more efficiently.
EF: Given that this is your third term in the position, this would make you the best qualified to discuss how you would describe the strategic importance of the Spanish market. Why is Spain so important?
JA: For several reasons, Spain is a crucial market for IQVIA as a global company. Spain is a clinical development powerhouse on a global scale. In 2022, Spain ranked second globally in terms of clinical trial activity, right behind the United States. Approximately 170,000 Spaniards participate in clinical trials. In this country, clinical studies received almost €800 million in funding last year. In a particularly specific field—complex studies—IQVIA oversaw more than 700 clinical trials in Spain for over 70 clients. Clinical trials in cancer research and rare diseases are the country's specialization.
Russia, Poland, and Ukraine come to mind when talking about clinical trials addressing conditions like cardiovascular or gastrointestinal disorders. For sponsors and clinical trial businesses, these are crucial. On the other hand, Spain is a true powerhouse in oncology, complex studies, and rare diseases. Over 280 of the 700 trials conducted in the previous year were in the field of oncology. Spain is a true powerhouse when it comes to clinical development, which accounts for little more than half of IQVIA's global turnover.
At IQVIA Spain, we employ about 1800 people, mostly in our two headquarters in Madrid and Barcelona. Due to its relatively good access to talent pools, languages, and talents, Spain is also home to a few global apps that serve teams globally in a variety of fields, including advanced analytics, master data management, consulting, finance, and human resources. Access to a large talent pool is comparatively easy. Due to these two important factors, Spain is one of IQVIA's most important international markets.
EF: Since you have worked for the company for several years, you have a unique view of how the IQVIA portfolio has changed over time. Tell us about the evolution of these services and how your portfolio is currently balanced between these various items.
JA: IQVIA is among the top 8 pharmaceutical marketplaces worldwide, demonstrating the significance of the market. Our largest clientele remains in the pharmaceutical sector. Larger markets like the US, Germany, France, and the UK have a wider range of offerings and solutions than the Spanish IQVIA portfolio. We are a top supplier of clinical research services, cutting-edge analytics and technology solutions, and life science sector solutions in Spain. In my opinion, the portfolios are sufficiently extensive to cover clinical development regulatory activity, assisting our clients with product launches, and optimizing the commercialization of their assets. For IQVIA, it is the same as the majority of the bigger markets. We also have expertise that allows us to support clients by assessing market needs or conducting primary and secondary research.
We work with specialists around the world and customize our solutions to fit their unique needs in every therapeutic area. In terms of portfolio evolution, we are becoming more specialized to better align with the undeniable trend that our clients are seeing. Given the tendency towards specialization and particularly next-generation therapies, research diverges to specialist items. Thus, we are getting more specialized to be more relevant for clients. Selling gene therapy, ARN, and all these new technologies are a few of these. Along with adding tech-enabled analytics and artificial intelligence capabilities, we are also expanding our range to include built-in technology. For example, our customer relationship management (CRM) solution has artificial intelligence built in to suggest the next best course of action or the next best solution for a medical situation, etc.
Regarding the evolution of our portfolio, I will point out that we have been evolving it over the years, particularly in the last three or four years that we have invested in it, through our payer, provider, and government capabilities, which we began around 2013 or 2014 through our inorganic activity and acquisition. We are evolving into an essential partner in the discussion of healthcare. Because we can offer evidence and draw attention to important issues that are currently at the center of the healthcare debate, our knowledge, skills, data analytics, technology, and subject matter specialists are extremely beneficial to the healthcare ecosystem. Restricted access to innovative medicines is a major problem in Spain. More public-private collaboration is needed, but it is still in its infancy.
We are leading the conversation around the early stages of the healthcare system's shift from an activity-based to a value-based system. The evaluation of health outcomes, the application of dividends to make decisions that are quicker, better, more agile, and more accurate—whether in the context of decision-making, public health, or healthcare institution management—as well as the communication of strategies for supplying or defending the value of medications. All of this is crucial to the ongoing healthcare discussion in which we play a significant role.
EF: You brought up both public and private collaboration. Given that you collaborate with a diverse range of individuals in the healthcare industry, what steps can be taken to enhance public-private partnerships?
JA: There is no option but to collaborate. Over the past 18 months, we have discussed the sustainability of the healthcare system and the challenges that arise when attempting to balance access, innovation, and sustainability. Following the COVID-19 pandemic, public healthcare services are underfunded, worn out, and have a backlog of patients that is still present and challenging to handle. It follows that the problems have gotten worse. Approximately 20% of physicians, nurses, and other healthcare workers will retire during the next five years, as is the case in many other countries. If we do not encourage public-private partnerships in the areas of healthcare financing and delivery, how will this problem be avoided?
Despite being one of the top 8 markets, Spain is a mid-sized nation with a unique healthcare system. The country's healthcare system is split up into 17 autonomous regions. Due to the geographical nature of healthcare delivery and decision-making, implementing a single strategy through some of these partnerships is even more challenging. We've been involved in some very exciting collaborative projects with public providers, private sponsors, and our organization. Through these initiatives, we hope to collect real-world data and evidence to demonstrate that certain healthcare interventions are ineffective and costly and that they don't significantly improve patient outcomes. The health care system receives feedback from this real-world data regarding which interventions are best practices worldwide.
To work with the entire system, some of these programs must start small with the private and public healthcare sectors. In many of the talks, we advise starting small and demonstrating the benefits of using data properly so that you may reap its benefits, be it enhanced clinical practice, better decision-making, or the implementation of strategies that prioritize value over activity. The only language that everyone understands is data or evidence.
EF: Could you elaborate on the CamOn initiative and the impact it has had?
JA: In these collaborations, the study's sponsor is typically a pharmaceutical corporation, which is the private-sector representative. Researchers in public hospitals who are passionate about enhancing patient care and the way evidence must be gathered, integrated, standardized, and presented in a way that makes it easy to evaluate the data and derive value from it. Researchers and physicians working in the public sector are provided with a tool to assess the quality of clinical decisions they have been making in the absence of data, as well as the decisions they will make moving forward. The advantage for the sponsor is that they have the evidence that the treatment will enhance outcomes for the patient. Everyone benefits from this. This new type of private-public collaboration initiative combines the methods of driving research and making it digestible and applicable to actual clinical practice with the approach of producing evidence about what would be most effective for patients. This project involves eight hospitals and 13,000 individuals with breast cancer, making it the largest breast cancer database in Europe.
This project lasted for three years. Eighty percent of the data is in free text format, so the data should be presented in the language that people use. It takes a while to collect, standardize, and convert free text data into a standardized format and then integrate the data.
EF: Given the title of our publication, "Roadmap to Sustainable Healthcare," what three major pillars would you establish as the pillars for a prospering and sustainable healthcare system in Spain?
JA: I would make the most of our strength in research and development since it saves a lot of money and adds significant value to state and research organizations. The majority of Spain's research sites are concentrated in Madrid and Barcelona. Certain areas are not given much relevance in clinical development activities, even though the information assets there are ideal for drawing in clinical development. If you are funding a clinical trial, you naturally want it to go as quickly as feasible. Finding participants and researchers for a clinical trial is one of the main delays. It will be quite significant if you can quickly complete the research and enlist the research participants.
Another pillar would be establishing as many systematic connections as possible between public and private players. If they have a common language and are concentrating on the patient, that should be their main goal. Public systems are underfunded, and commercial healthcare systems are willing to support public healthcare; there has to be greater collaboration between the public and private sectors. When it comes to addressing difficulties with care quality, data is crucial. The sustainability of the system will also be aided by comprehending the viability of care across regions, the reasons behind it, and how to close the gap by eliminating unnecessary expenses and activities within the system.
Across Europe, we can save more than a hundred thousand lives only by addressing inequality of care; there are disparities in patient care across borders. Reducing expenses and improving outcomes could be achieved by understanding the best healthcare techniques and applying them consistently to every patient. Reducing costs associated with systemic inefficiencies and allocating that money toward innovative medications that can enhance results.
