Throughout 2021, site-of-care shifts evolved in light of the pandemic and trends that preceded it. While not new in health care, their acceleration has changed where care is delivered—and by whom.

More complex surgeries are shifting from the hospital to freestanding ambulatory surgery centers (ASCs), especially in orthopedics, CV, urology, pain management, and general surgery. The growth in these service lines is notable as ASCs have historically been driven by GI and ophthalmology volumes. In fact, our modeling projects an 11% growth in ambulatory surgery volumes by 2026, compared to a 2% decline in inpatient volumes.

However, site-of-care shifts extend beyond ASCs. Physician visits are shifting from the office setting to virtual visits via telehealth, or occurring in urgent care centers, retail clinics, and other alternate sites. Such sites of care are also expanding their offerings to include more chronic care management, cardiovascular, trauma, and orthopedic services. Additionally, imaging and lab services are also shifting from hospital to ambulatory sites.

As a result, many health systems and IDNs are directing patients to these settings to access new clinical innovations and/or cut costs—and clinicians are using products in a more dispersed range of clinical and non-clinical settings. For example, many next-gen cell and gene therapies are administered in freestanding Centers of Excellence, rather than traditional academic medical centers (AMCs). Robotic surgeries and procedures involving implants or medical devices are occurring in freestanding ASCs, rather than in the hospital. These shifts also expand the set of influencers over product use to include pharmacists, nurses, and advanced practice providers (APPs) who play an increasingly critical role in care delivery.

Impact on life sciences

As HCPs and clinicians use products in more disperse settings, life sciences leaders must understand how demand for diagnostics, drugs, and medical equipment is changing across sites of care. Additionally, they must integrate these shifts into their customer engagement strategies. This means that reps and field teams must expand the types of institutions that they work with, and the decision-makers with whom they work, to share evidence, information, and support.

Life science leaders must also recognize how site-of-care shifts occur at different rates across markets. They can no longer take a one-size-fits-all approach to how they serve their customers. Moreover, they must actively assess whether increased care fragmentation creates barriers to care or friction for patients, who may need additional support. For example, life science leaders can play a critical role in supporting patients’ medication adherence or post-surgical care.

Site-of-care shifts will also create new demands for medical evidence that supports product use and utilization in alternate sites. Life sciences leaders must integrate such questions into their evidence generation strategies to help customers understand product safety and efficacy in atypical settings.

Questions to consider

• Do we understand how site-of-care shifts impact where our products are used? Are we actively preparing for further site-of-care shifts in our respective markets?
• How are site-of-care shifts changing who holds decision-making power over product coverage and use? Where are our top decision-makers located today, and how is that changing?
• Are we actively engaging customers across a wider range of clinical and nonclinical settings? Are we broadening the types of decision-makers with whom we engage to include members of the care team (e.g. pharmacists, APPs, NPs?)
• Have we adapted our communication strategies to account for a broader range of decision-makers and sites of care? Do we need to adapt our value messaging and evidence to better resonate with customers?
• Are we generating evidence about how our products work in a growing set of sites of care (e.g. home-based care, ASCs)? What customer questions do we receive that can inform our future evidence generation strategy?
• How can we help customers streamline supply chain operations and management in new sites of care?

Telehealth took hold during Covid-19, but the change in care delivery will outlast the pandemic. Driven by new competitive pressures, consumerism, and health care payment reform, many provider organizations continue to invest in telemedicine programs that support virtual patient visits of different kinds. Specifically, spikes in telehealth utilization for physician visits, urgent care, and triage are further shifting care delivery from brick and-mortar sites to digital platforms.

As telehealth adoption accelerates amongst physicians, payers, and telehealth vendors, IDNs will lose market share, direct revenue streams, ownership of patient relationships, and control over patient care. They may also lose their ability to control whether physicians adhere to clinical guidelines and care variation reduction initiatives – directly impacting medical product utilization. Consequentially, IDNs and health systems may start to respond to such shifts by reigning in control over telehealth policies or finding ways to maintain their share-of-wallet.

Moving forward, long-term utilization of telehealth will be heavily dependent on changing regulations, consumer preferences, and coverage and payment decisions—and how IDNs respond to these moves. While Advisory Board analysis estimates that the greatest shifts toward digital-first outpatient care will be in psychiatry, general surgery, dermatology, and pediatrics, nearly all specialties can be impacted. Now that patients have experienced the convenience of and learned to use telehealth, there will be going back.

Impact on life sciences

The impact of telehealth on life sciences’ customer engagement and evidence generation strategies is at an inflection point.

On the one hand, as providers increasingly use telehealth, it’s harder for life sciences leaders not only to engage their customers and have meaningful virtual interactions, but also to identify who has “influence” within organizations. Without insight into how HCPs operate within the context of the broader hospital, health system, or site-of-care, targeting the appropriate decision-makers proves increasingly difficult.

On the other hand, HCPs are already shutting their in-person doors to reps (due to Covid-19 restrictions, burnout, and other factors) – and telehealth creates more opportunities for life sciences leaders to engage their customers remotely and on-demand. Medical device reps may even be able to utilize telehealth to remotely assist with procedures or surgeries. However, whether these virtual interactions complement – or replace – in-person interactions, and how that impacts the relationship between life sciences reps and their customers overall, remains to be determined in the post-Covid world.

Further, as providers embrace remote patient monitoring and other digital tools to track patients outside of the hospital, a plethora of opportunities for real-world data collection arise – especially for longitudinal outcomes tracking, patient reported outcome generation, and the collection of digital biomarker data. Life science leaders can even partner with hospitals and IDNs to identify novel opportunities for data collection and synthesis.

Questions to consider

• How are we identifying and connecting with virtual-first providers? Do we understand which of our customers are increasingly seeing patients virtually, and how that impacts product utilization and clinical care?
• How can we support provider organizations as their physicians increasingly shift towards virtual care? What evidence, information, or wrap-around services do they need to best understand how to use our products?
• How will our customer relationships be impacted if HCPs restrict rep access in the post-Covid world? How will we understand who has influence, who the right decision-makers are, and how to engage these individuals?
• How does increased telehealth use impact referral patterns and patient steerage, and who ultimately provides in-person care? What impacts do those shifts have on who uses our products?
• Have we adapted our communication strategies to better identify and engage virtual-first providers? Are our reps prepared to have engaging and productive virtual-first customer interactions?
• Are we working with hospitals and IDNs to leverage data collected from telehealth and remote patient monitoring to generate real-world evidence? How can we leverage relationships with our top accounts to form collaborative partnerships for evidence generation?

The global supply chain didn’t see much relief in 2021 as the pandemic and its ripple effects created critical product shortages once again. Not only are lists of unavailable goods expanding, but disruptions are also occurring at more points along the supply chain – from raw material gathering (e.g. active pharmaceutical ingredients, semiconductors, medical device parts), to component part manufacturing, to distribution. Today’s shortages are both more widespread and unpredictable, making it more difficult for provider leaders to anticipate when and where the next shortage will occur.

As a result, there’s often steep competition among providers when product shortages arise. Hospitals, sometimes in the same system, fight for limited supplies, while competitors from other industries with far greater scale and financial resources quickly deplete stock levels. These challenges are further complicated by a lack of resiliency and visibility across the supply chain, preventing flexibility in times of crisis and creating friction between life sciences manufacturers and their customers.

Impact on life sciences

For life sciences leaders, increasing visibility is key to enabling a more efficient and flexible supply chain and being a better partner of choice to customers. In practice, this means prioritizing efforts to communicate clearly and frequently, sharing necessary data about shortages, backorders, on-time delivery, and recalls, and working directly with provider supply chain and clinical leaders to discuss stock levels, manufacturing capacity, and transportation timelines. It also means alerting customers when shortages exist and helping find viable substitutes or work-arounds.

Such efforts are critical for helping customers anticipate and accommodate spikes in supply, gain confidence that the right products will be available at the right time, and reduce unnecessary waste. The importance of price isn’t going away, but a supplier’s transparency, flexibility, and reliability will factor into customers’ “total cost” equations.

Efforts to build resilient supply chains and build trust with customers also mean that life sciences may need to evolve the role that their reps play in customer interactions. As reps must maintain trust and their strong relationships with their customers, they should assess opportunities to unlock new collaborations – such as increased data sharing between parties. Life sciences leaders must also think about how to work cross-functionally across commercial, medical, and operations teams to support customers holistically.

Questions to consider

• How are we working with our partners to share information related to product demand, availability, and sourcing?
• Are we leveraging our internal data and information to help clinicians predict product availability, understand changes in expected supply, and adapt accordingly?
• Are we alerting providers when we expect shortages and helping them find alternative products and viable substitutes?
• How can we support providers in making demand planning more adaptive?
• Are we actively identifying key customers with whom we can build more strategic, less transactional partnerships?
• Do we need to generate any new evidence or information about how alternate products may work in case of shortages?

Home-based care has long been an area of interest for the health care industry. Patients often prefer to receive care in their homes, and several models have demonstrated the ability to lower health care costs while providing the same or better-quality care.

The Covid-19 pandemic created more urgency to shift all types of care to the home, from acute to primary care. Policy and regulatory changes, such as CMS’ Acute Hospital Care at Home Program waiver, open the door for greater reimbursement of home-based care. Payers have continued negotiating bundled payments and reduced DRG rates for coverage. Providers are forming JV arrangements between health systems and home care companies, and new technology creates opportunities to orchestrate logistics and determine patient eligibility.

Despite the promise held by home-based care, it’s important to note the ripple effects it can create on downstream hospitalizations, post-acute care utilization, and specialty care needs. Further, home-based care shifts can exacerbate health disparities. To receive home-based care, patients must have stable, safe housing located within a defined service area. These requirements can lead to disparities in access, disadvantaging non-dominant groups.

Impact on life sciences

Life sciences manufacturers must prepare to support their customers as care moves into the home. This can include helping providers determine which patients qualify for home-based services, leveraging home infusion and other services to deliver treatments directly to patients, and utilizing technology to assist with adherence and post-surgical follow up.

Additionally, life sciences leaders may need to generate evidence about how products work in home-based settings. As more pharmaceutical products and medical equipment are used outside traditional care settings, decision-makers may need to see evidence of safety and efficacy before allowing use in the home.

Questions to consider

• Are we supporting our provider customers as they increasingly treat patients in home-based settings? Do we need to adapt our communication strategies to better share how and when our products can safely be used in home-based settings?
• What types or subpopulations of patients who use our products might prefer care in the home, and how does that impact utilization of our products?
• What barriers might this patient population face in receiving this care at home? Where can our organization provide additional support?
• Are we generating evidence to demonstrate that our products can safely be used treat the target patient population in the home setting? What are the most important outcomes metrics we should be tracking?
• What outside factors (regulatory change, staffing shortage) could affect whether our products are successful in home-based care?