The Role of the MSL to Impact Patient Value: Do MSLs Know How?
Is it possible for MSLs to impact patient value while remaining compliant? Should this be a priority for your organization?
Since January 2017, Innovara has been assessing hundreds of MSLs around the globe, for free. We are comparing their level of experience, what they value on-the-job, and their learning priorities across common MSL functional competencies. Even though the study is ongoing, we couldn’t wait to share some early findings with you. This post is the second in our 2017 series, Innovara MSL Development Needs Insights Study©.
Insight 2: There is a critical disconnect between most companies’ missions to be patient centric and their MSLs’ understanding of how to impact patient value.
In “Vital Directions and National Will,” a JAMA editorial on the National Academy of Medicine Institutes (NAMI) Vital Health report, Dr. Donald M. Berwick notes that three of the top four recommendations place patient focus at the heart of meaningful health care system reform.1,2 No surprise, then, that almost all pharmaceutical companies cite the patient as being at the core of their missions.
In earlier research, we found that companies had little knowledge of how MSLs can drive patient value while remaining compliant. Every head of Medical Affairs to whom we spoke said that focusing on the patient is critical. They believe that their MSLs do this well. Upon further evaluation, we found that neither these leaders nor the direct supervisors of MSLs were able to consistently and succinctly describe how they would know if their MSLs were demonstrating the ability to impact patient value.
MSLs Lack the Know-How to Impact Patient Value
In the IMSLA, we asked MSLs how much experience they have performing specific, compliant tasks that impact patient value. For example, they rated their experience in discussing possible care management strategies with assigned doctors, for patients who are at high risk of poor adherence to therapy. They also rated the value of being able to do this. Finally, they rated the degree to which this was a training/learning priority for them. We repeated the process for 10 tasks correlated to compliant patient health and care management improvements.
On average, MSLs rated themselves having less than moderate experience in these skills. We observed a direct correlation between their experience and value, as well as the degree of training/learning priority. For most, their answers were “low-low-low”. Despite the importance of patient value to their companies, these MSLs are not likely to impact patient value until they understand why these are important tasks and how to perform them. This also challenges the assumption by their managers that these are very important to the job of the MSLs, and that their MSLs are skilled at collaborating with their specialists to improve patient experience, care management and health outcomes.
Our preliminary findings from the MSL assessment suggest two things:
- It is not enough to simply state that the company’s mission or aim is to be patient centric. How each function contributes to advancing patient care needs to be translated into specific skills and tasks.
- KPIs need to be established for these skills and related tasks. For example, let’s say that COPD in a hospital in the MSL’s assigned area has a high rate of ED visits. 30- and 60-day readmission rates are high (public information available through CMS’ HospitalCompare.gov). MSLs and Medical Affairs management should be working with others to bring this information to the attention of area PCPs. They should develop programs coordinating hospital and network PCPs to improve the coordination and management of COPD patient care.
When assessing the MSLs’ managers on patient-related skills and tasks, we found that while they valued these skills for their MSLs’ jobs, they rated themselves as less experienced in these tasks, and also rated teaching their MSLs these skills as lower priority. This is a likely signal that they themselves are not confident in their own ability to coach their MSLs on how to impact patient value. Alternately, they are trying to avoid doing it or expect others in the company to do it for them.
Embedding Impacting Patient Value in the MSL Function
In companies where this disconnect exists between company mission and what the MSL does to impact patient value, we typically hear the “not-compliant” defense, or that it is the responsibility of positions such as clinical outcomes liaisons to focus on this. Every function at every company can be more patient focused and remain compliant. For example, Sanofi’s commitment to put the patient first is transforming the company and every position, especially the MSLs.
Even in companies where the MSLs do value this skill, they report another hurdle: the doctor is not willing to discuss their patient challenges with them. This is not an absolute, but more a consequence of the MSL not having the confidence or means to engage in this discussion and/or not being seen by the doctor as adding any value to him/her.
A great technique to train MSLs on this is to simulate the 3 D’s of shared decision-making—discuss, deliberate, decide—with the MSL taking the role of patient advocate.
- Discuss with the doctor what are likely values of patients
- Deliberate which medical options the patient may consider
- Explore ways to help the patient to decide the care plan based upon those patient values.
Here is an outstanding example of shared decision-making by the U. of Chicago/Robert Wood Johnson Foundation:
Holding back or reserving this responsibility for a highly-specialized function such as a clinical outcomes manager abdicates the responsibility of the MSL and his/her manager from having to consider ways to do this at the individual doctor level. It is at this level where only the MSL can do this for the company. In short, it is only through the collective efforts of all MSLs that real patient value can be realized. At the end of the day, isn’t that really the aim of every MSL, in any company?
Did you miss the first installment of the Innovara MSL Development Needs Insights Study©? Read it here: Want Higher Performing MSLs? Start by Fixing your MSL Onboarding Process
1VJ Dzau, MB McClellan, JM McGinnis, et al. Vital directions for health and health care: priorities from a National Academy of Medicine initiative. JAMA. 2017;317(14):1461-1470. doi:10.1001/jama.2017.1964
2DM Berwick. Vital directions and national will. JAMA. 2017;317(14):1420-1421. doi:10.1001/jama.2017.2962