Pharma companies are as excited as anyone about the shift to value-based care and the ways that technology can enable it, but they’re increasingly skeptical about the speed of that change. At Health 2.0 this week in Santa Clara, California, at a panel moderated by Kian Beyzavi, principal investor at KBeyzavi and Associates, several innovation executives at pharmaceuticals talked about value-based care, as well as about their current digital health strategies and the challenges they face.

Michael Nohaile, SVP of strategy, commercialization and innovation at Amgen, identified two major roadblocks to value-based care.

“Part of the problem is the adjudication,” he said. “Even if you can strike a value-based deal that looks good on paper — ‘We prevent heart attacks’ — a lot of the value gets burned up in adjudication because they fight over every single case. Was it a heart attack? Who coded it? How did it code? All those sorts of things. That and, of course, the time horizons may not match well. We try to do a deal on a drug like Repatha, which is our drug. That may save you from a heart attack in 10 years, but the fact that the average patient is only held by a health plan for two or three or four years makes it hard to get to the value.”

Delthia Mckinney, senior manager of digital at BTG, said the misalignment between the rhetoric and the reality around value-based care can present a challenge.

“Because it’s so slow, but we feel it’s coming, it’s really hard to tell our company ‘You should be prepared for this’,” she said. “Because we’re really trying to sound the alarm and everyone’s like ‘I’ve heard this before. I heard this two years ago.’ So that’s been a challenge from our digital team’s perspective.”

All the panelists said their companies are largely pursuing digital health efforts through partnerships.

“One of our strategies is to partner, not build. We try not to create bespoke solutions, but to look at some technology leaders and then partner with them,” Mckinney said. “We try to step into the shoes of our partners and try to understand the challenges they face as well as understanding, what does value mean to them.”

Partnerships aren’t just a matter of outsourcing a project to a startup. Instead, through various means they bring partners into their organization so they can learn from them and adapt their culture, thereby becoming less like a traditional pharma company and more like a startup.

“We’re trying to move more in a tech speed, try more things, minimum viable products, and then scale from there,” Nohaile said. “That’s been quite an education. It’s not how a company like Amgen works [where] you make a drug and you might spend a billion or two billion dollars and it may take 10 or 15 years. This whole concept of minimum viable product is not something the company takes on well.”

Larry Brooks, director of Digital Health at Boehringer Ingelheim, said his company launched a digital lab just this year to capture that spirit of innovation.

"BIX is a corporate initiative where we formed a new entity in order to do digital health design, development, and data science work," he said. "I think the spirit of it is essentially it takes the value of a startup and a pharma company into one unique entity. ... An in-house development shop that puts programs forward in a set of sprints will enable people within BI to see it and touch it and experience it and hopefully that’ll gather the right momentum within the organization to carry things forward and still be enabled by a lot of external groups."

In terms of where pharmas see the value of digital health interventions, Nohaile said a lot of opportunities exist in clinical trials and in identifying patients for treatment. Mckinney pointed to wraparound services that support the patient through the patient journey, such as her company’s collaboration with HealthLoop. Brooks said that digital will help pharmaceuticals differentiate their products.

“You look at industries like the car industry and every single year they come out with a new product,” he said. “In pharmaceuticals we don’t do that. You might have a line extension or new research incorporated over time, but the product’s the product. I think digital health is an opportunity to innovate on the underlying customer experience continuously, and ultimately to differentiate it.”

One area where pharmas still haven’t found a digital solution they’re happy with is medication adherence.

“We’re sort of early in our adherence journey,” Brooks said. “We’re doing a roundup review as to what is the current state of the adherence literature. But I’m still waiting for the team to come to me and say, ‘This is the state of the art in adherence.’ Because everyone has a theory, but there’s very little good data that I’ve seen so far.”

“I’m really interested in adherence, … but we don’t know what really works in adherence,” Nohaile said. “I mean I haven’t seen it — if you guys have figured it out, please come and talk to us because I’d love to see it — but I’m still waiting for the killer app there that really drives it over the line.”