Healthcare Roundtable: The power of teamwork

In an era of globalization and budget limits, no single entity can solve medical crises. Industry leaders gathered in New York City for this Kyne-hosted event that underscored communications' role in facilitating multi-stakeholder partnerships.

-Gabrielle Fitzgerald, former director of global program advocacy, Bill & Melinda Gates Foundation
-Amy Fry, VP of public affairs and communications, Boehringer Ingelheim
-Ray Kerins, SVP and head of comms and public affairs, Bayer
-David Kyne, CEO, Kyne
-Matthew Lynch, director of Global Program on Malaria, Johns Hopkins University
-Dan McIntyre, SVP of public affairs, Biogen Idec
-Charles Stokes, president and CEO, CDC Foundation
-Jack Watters, VP of external medical affairs, Pfizer

A strong foundation
Gideon Fidelzeid (PRWeek):
What is the core component that ensures all parties in a healthcare partnership work together effectively?

Charlie Stokes (CDC Foundation): Transparency. Without it you cannot build trust, which is absolutely essential in healthcare partnerships.

David Kyne (Kyne): You must look at the assets being brought to the table. Some of the most successful partnerships marry a state-level public health organization that knows how hospitals run with a more local group that understands community health. It’s finding entities and matching their expertise around the problem.

Amy Fry (Boehringer Ingelheim): We have a partnership with Ashoka, a global network of social entrepreneurs. The key to partnering is getting to know each other and understanding everyone’s goals, how they work, and how they arrive at decisions. We spent the time up front to be honest with each other and truly learn what the other side wanted. That has gotten us through some very challenging conversations. When looking to establish healthcare partnerships, corporations must show they are not only out for themselves.

Gabrielle Fitzgerald (formerly of the Bill & Melinda Gates Foundation): It’s really hard to get eight people to do the same thing simultaneously. In the world of rowing it’s called "swing." How do you get that swing where everyone pulls together? It takes a lot of practice, trial and error, and being truthful about what works, what doesn't, and working through those problems together.

Jack Watters (Pfizer): Everyone needs to know their precise role in the partnership. Moreover, you shouldn’t assume that, because everyone knows their stated role, they’re fulfilling it. There must be check-ins built into your process. There must also be an opportunity to course correct in case things aren’t working out the way they should.

Dan McIntyre (Biogen Idec): The way I measure success of a partnership is when something goes wrong, do our allies know and trust us well enough to validate our position? I always start by identifying something the partner I wish to pursue is passionate about that has no benefit to my organization whatsoever – and I just do it to help them out without asking questions. You earn the right to build from there.

Ray Kerins (Bayer): It’s like dating. I’m not looking for organizations at which to just throw money. We take a longer-term view. The key is knowing whether or not you’ll go beyond that first stage. It takes intuition, but identifying shared value between two entities is always a good building block.

If you enter a healthcare partnership, you must be all-in. It’s not about the money. It’s about finding where can we bring other resources and expertise to the situation that have nothing to do with our bottom line.

Matthew Lynch (Johns Hopkins University): Everybody entering such coalitions comes with a history. Moreover, in public and international health, it’s a fairly small group of people who work on the same disease over time. You can bet some people have had arguments in the past. Everyone has to be very clear about how they will work together and what really matters. Everyone must articulate what will be gained from this and what they will contribute to that end, which can be remarkably hard. However, if done, it is a very useful first step.

At home, around the world
Fidelzeid (PRWeek):
How have private-sector partnerships helped your organization achieve the CDC’s objectives?

Stokes (CDC Foundation): Once you’ve built a trusting partnership, all kinds of side benefits accrue over time. Take our long-time partnership with UPS, which just helped us ship some personal protective equipment to West Africa that Henry Schein donated. Years ago, just after SARS cost the global economy billions of dollars, the CDC put together a toolkit for businesses to deal with such outbreaks.

Because of our relationship with UPS, I could call the head of international HR and simply run the toolkit by him. He took a look and said, "This is extremely helpful. This is kind of helpful, but why is this here?" That feedback allowed the CDC to develop a great product. No money changed hands. It was quick and efficient.

Multiple audiences – including citizens, the press, and donors – expect all partnerships involving a taxpayer-funded organization to be crystal clear and ones all can be proud of. The challenge is to recognize when a partnership may be starting to veer from that path and pulling the players back together. We must make sure science reigns supreme for the public health good.

Fidelzeid (PRWeek): How do you approach healthcare partnerships on a local level?

Lynch (Johns Hopkins): Relevance is the key. Whatever actions a healthcare partnership wants households in a community to take must be relevant to those people’s daily lives. The extent to which we can make that connection, ideally on an emotional level, the more successful we will be.

My focus is on malaria in Africa. In terms of hitting an emotional chord, it’s fairly easy since virtually every household there has lost someone to the disease, or is close to someone who did. You can craft a message around that to make sure you can develop a social norm or enabling environment to make the desired behavior fairly easy for people to do.

With a public health tool, the ultimate goal is its actual application. In terms of prevention, it lives and dies in the households because that’s where it will be used.

Fidelzeid (PRWeek): What about global partnerships?

Fitzgerald (formerly of the Gates Foundation): The key word is global. I’ve seen many efforts seek "global" impact, but really focus on the US or Europe. However, I have been part of some truly "global" campaigns recently.

The Gates Foundation’s top priority is to eradicate polio. It works with the CDC, WHO, Rotary International – traditional entities for such an effort. But it was some unusual partners that really stood out. We worked closely with the Crown Prince of Abu Dhabi, Sheik Mohammed bin Zayed al-Nahyan, who not only contributed money, but also made introductions to government officials who have access to regions in Pakistan that no other traditional partners had.

Last April, we cohosted a global vaccine summit with the UN Secretary-General and the Crown Prince. Also taking part were representatives from UAE, the Islamic Development Bank, the Minister of Health from Afghanistan, the Sultan of Sokoto, Nigeria’s top religious leader, and government officials from Europe. That’s a truly "global" healthcare partnership.

Built on a strong foundation

Prior to the panel discussion, CDC Foundation president and CEO Charles Stokes delivered a keynote in which he discussed the evolution of public-private healthcare partnerships and the lessons he has learned in his 20 years in the role. Below are some key takeaways:

•The impetus behind the foundation:
The foundation’s goal was to build these partnerships on behalf of the CDC in a way that brought resources and expertise to the organization that would not compromise its ability to do its work. In the early 1990s, the CDC went to Congress and introduced legislation to create this foundation. We wanted congressional approval and a blessing of this idea of public-private partnering.

•Accomplishments thus far:
To date, we have created almost half-a-billion dollars in public-private partnerships for 720-plus programs in more than 73 countries around the world. It wasn't easy getting to this point. And among the first lessons I learned was that when seeking funding, we couldn’t start at the CDC. We needed to start with the problem. That’s what I mean by starting in the middle.

•Communications’ role in empowering partnerships:
Several factors are crucial to partnerships. Among them is communication. It is impossible to over-communicate in any kind of partnership, particularly a public-private one. There will always be friction and communication is the best tool to dissipate it. There is also trust, which is so closely tied to communication.

•Key points to focus on for the future:
Disease has no boundaries. Take Ebola, which went from an outbreak to an epidemic, exponentially increasing. The need to be flexible on the ground became paramount. In addition, speed and flexibility are becoming increasingly important. Time is of the essence. Solving problems can’t wait and they shouldn't have to with the connectivity we have today.

Click here for more from Stokes’ keynote address, where he offers examples featuring major brands including Cargill and Amgen to further underscore the power of healthcare partnerships.

Patients are a virtue
Fidelzeid (PRWeek):
How can partnerships maintain focus on the patients who spurred the alliances?

Watters (Pfizer): We often talk about epidemiology, which is the study of disease and populations. However, the best way to describe a disease’s impact is by looking at an infected individual and saying, "Here’s what meningitis looks like." That makes it very real.

We must bring patient advocacy groups to the table in all public-private partnerships. I have to give kudos to ACT UP. I admire what it has done to bring the patient experience of those with AIDS to our attention. Such groups remind us the focus must be on the suffering person whose life we’re hoping to save.

Fry (Boehringer): Our external affairs group’s mission is to bring patients’ views in to improve our insights as a business that creates medicines.

Their role in R&D is huge. Advocacy groups bring patients in to talk to our researchers. Patients will often reveal, "Well, actually, our biggest issue is not what you’re trying to solve. It’s something else." This really helps researchers solve what the patient most needs solved. And with clinical trials, the importance of having a diverse group of patients is paramount to bring a product to market.

Fidelzeid (PRWeek): Partnerships sometimes involve very complex, scientific components to address larger medical questions. How can you facilitate broader understanding and that goals are met?

McIntyre (Biogen Idec): Over the years, I have come up with three basic principles on this very closely related to working with patient groups. The first is to be strategic and to make sure the partnership is not only mutually beneficial, but also long term and not transactional.

Second, it has to be justifiable. It has to be easy to understand, compelling, and able to survive all the filters it will go through, not the least of which is the media. A key to that: the story you are telling must be functionally true. Many companies come up with an external narrative that sounds good in the conference room, but doesn't meet the pressure test when made public.

Third, it’s about respect. The patient groups we work with are involuntary members of their communities. Nobody with ALS chose to become a member of the ALS community. They are vulnerable. Because of that we have to be as respectful and attentive to their reputation as we are to our own. 

Common ground
Fidelzeid (PRWeek):
What are the keys to unifying entities with different agendas?

Kyne (Kyne): So many people enter into coalitions with an end goal for them in mind. "This is the bit I want to do. I want to get funding for this part. This is what I excel at. I can do all these things." Inherently, that is where the challenge lies. The key is to identify the right person or entity for the right role.

And the partners must be the ones who create the coalition from the ground up. When it’s "Here’s our campaign. Advocacy group, please put your name on it and this is what it will look like," it often doesn't work most effectively. It must start with, "This is the problem. Here are all the assets. How can we build something and get it funded together?" That way, the partnership belongs to everyone involved.

Fidelzeid (PRWeek): What role do healthcare partnerships play in getting third-party influencers to spread a message?

Kerins (Bayer): Our industry’s greatest challenge is its own credibility. It’s our reputation and our inability to do enough to change it and to get engaged. I’ll often get asked, "Where are the third-party voices to back us?" You want third parties to stand up for you? As an industry, we need to stand up for ourselves first. You can’t fully focus on anything else until that is solidified.

McIntyre (Biogen Idec): Years ago when I was at Bayer, we developed a PR program to support our antibiotic Cipro, focusing on proper hand-washing to prevent infections. The program, Operation Clean Hands, was a joint effort with the CDC and the American Society for Microbiology. We started it in 1995.

Two years after we began it, the CDC was dealing with a hepatitis outbreak in Michigan caused by tainted strawberries. They needed a supply of hepatitis immune globulin, which the only manufacturer had stopped making. The CDC doctor, remembering Bayer from Operation Clean Hands, called us.

At the time, we didn’t have anything for hepatitis, but we did make a tetanus immune globulin to treat it, which is five times the cost. We called the CDC and said, "How much do you want? Where does it have to be sent?" And we charged them what they would have paid for hepatitis immune globulin.

Nine months later, the immune globulin shortage had become a crisis. Companies were called before Congress. Major media were all over it. I was able to call the CDC physician to tell him what was going on. He spoke to the media, flew to Washington, and testified about our commitment before Congress. He did it because trust was already established. That partnership paid a very unexpected dividend when we really needed it.

Impact of technology
Fidelzeid (PRWeek):
How has technology changed the healthcare partnership landscape and, in turn, the broader way health issues are addressed?

Lynch (Johns Hopkins): There’s the availability of information, but also – thanks to emails, search engines, and mobile phones – the ability to vet that information through more people. We can easily get a couple of minds to check a document now – and two minds are better than one. So the quality of information has improved, though there’s so much, it’s difficult to manage it and turn it into effective action.

Technology is a tool for partnerships. It’s not the purpose of the partnership. In the end, you still get back to the human beings sitting around the table. If you have a trusting relationship between partners, technology can certainly make things easier.

Kerins (Bayer): With technology, there is unprecedented ability to mobilize. Need I say more than the Ice Bucket Challenge? Some people see technology as the devil, but it can also be the angel or savior, whether it be through fundraising, dialogue, or just sharing information. It amplifies grassroots efforts to a whole new level. And I’m not just talking about the US. Cell towers throughout Africa, India, and elsewhere are getting information to people who weren’t receiving it before.

McIntyre (Biogen Idec): My company works with the worst diseases: MS, ALS, and hemophilia. We’re working in conditions that are extremely isolating and crippling. Social media networks provide a lifeline for people to create communities in ways they never really had before. It’s quite heart-rending to see the depth of emotion expressed through tools you would never expect.

Watters (Pfizer): The core competence of the pharmaceutical industry is to develop new medicines. That’s why I entered this industry 35 years ago. Back then you dealt with case report forms in remote locations and you literally had to travel all over the world to collect and bring them back to your center. If you found mistakes, getting corrections was a major ordeal.

Today we have electronic case record forms. We have corrections in real time. It’s still a difficult, time-consuming, and expensive process to develop new medicines, but you can make decisions so much faster. On so many levels, technology has helped us do what we’re supposed to do – develop new medicines.

Fitzgerald (formerly of the Gates Foundation): At the recent Clinton Global Initiative, President Clinton spoke about the democratization of information. As applied to the issues we care about, it really has been a game-changer in terms of helping private citizens advance the social agenda.

We mentioned the Ice Bucket Challenge. Before that it was Kony 2012. And the group that did that, Invisible Children, didn’t just stop at a video, which was viewed 100 million times in a matter of weeks. They have a major policy agenda. They’re talking to the White House all the time. It’s inspiring the role public citizens are taking to make global change. 

Fry (Boehringer): An interesting development in the space is with a company such as Walmart stating its intention to be a leader in integrated healthcare. The retail sector is actually quite well positioned to be a very dominant player because of the technology it has, its access to data, and the position it is in to help patients manage their way through this.

It’s exciting, but also daunting, especially in terms of figuring out what this means to patients and how companies such as ours work with them. It also forces us to up our game with what we do for patients through technology.

Kyne (Kyne): The story of Gavin Glynn, a young cancer patient in Ireland, really illustrates some things technology has enabled in the health world, but also how much more can still be accomplished. [Editor’s Note: Glynn passed away on October 21.]

Gavin’s is a very rare form of cancer [Embryonal Rhabdomyosarcoma, a cancer of the muscles attached to the bones]. Over a year period, his father searched everywhere for treatment. So much information was buried in scientific literature. He went to Germany, Switzerland, and the UK. Gavin was in hospitals in Ireland, but it was all trial and error.

His father then started to blog about his experience. Eventually, MD Anderson Cancer Center in Texas contacted him. Gavin was able to get to Texas for experimental treatment. Social media is the only thing that could have facilitated this. That said, it shouldn’t have taken almost a year to get to that point. There are still way too many silos in research, treatment, and other areas.

Different sectors within healthcare must use technology to pool their information.

Stokes (CDC Foundation): Technology has opened up a whole new range of possible partnerships. The CDC is currently working with Georgia Tech to use some of its technology around 3D printing, as well as some of its supercomputer technology to enable us to analyze data 300 times faster than we can now.

In Tanzania, we have a project called mHealth that focuses on using cell phones to better educate women around maternal and child-health issues. That couldn’t have happened 15 years ago. 

Kerins (Bayer): We started using technology this year in dealing with AE [adverse event] reports. With these you are monitoring what’s being said on social. This has prompted us to start reaching out to patients directly on Twitter, in chat rooms, and other such places with members of our medical team. We can tell them, "This is Dr. X. I see you posted some comments. I’d like to talk to you about those. Please contact me." The whole idea is that we do care. More than that, it’s about the patients we serve, not about us. Technology is the cornerstone that gets us directly to those patients to find out exactly what is happening with them.

Click here for more from this roundtable, including an in-depth look at the keys to healthcare partnerships tackling unmet health needs at home and abroad.

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