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How we can lower healthcare costs


Two-step approach needed to lower healthcare costs, says Vanessa Dekou, a Cambridge MBA alumna (MBA 2002) and Managing Director of Clinical Services International, in the Careers Takeoff Series of webinars at Cambridge Judge Business School.

Group of business professionals in a dark room standing in front of a large data display screen with information.
Vanessa Dekou.
Dr Vanessa Dekou

Lowering healthcare costs requires a two-step approach that focuses on both productivity and improving the balance between healthcare supply and demand, says Vanessa Dekou, a Cambridge MBA graduate (MBA 2002) and member of the Cambridge Judge Business School Advisory Board.

Vanessa heads pharmaceutical firm Clinical Services International (CSI), which provides “comparator” drugs to pharmaceutical firms conducting clinical trials.

Productivity only one step in a complex ecosystem

Productivity means greater outputs in healthcare provision, but that is only one step in tackling what is a “very complex ecosystem”, says Vanessa, a native of Greece who set up CSI in London in 2017 after working for two decades in drug development.

The second part of the puzzle – better balance of supply and demand – requires a better focus on patients rather than aggregated costs as the “unit of analysis”, says Vanessa.

Focus on the cost of individual treatment, not hospital departments

“Basically what this means is that you should look at the cost of the treatment of the individual patient, let’s say the breast cancer patient, rather than the costs of the departments, the individual departments that might serve this patient,” she says.

“The pharmaceuticals, the biotechs, all the service providers try to have the patient in the heart of anything and everything they do. Therefore, what we need to do, we need to map the entire path, the entire progress, the entire process of the individual to identify the costs.”

Vanessa Dekou was guest on Careers Takeoff Series

Conrad Chua.
Conrad Chua

Vanessa was the guest in a recent edition (“Better ways to lower healthcare costs”) of the Careers Takeoff series of livestreams hosted by Conrad Chua, Executive Director of the Cambridge MBA programme at Cambridge Judge Business School.

“They say the only things that you can’t escape in life are death and taxes. So that means that all of us will definitely in our lifetimes interact with either the tax authorities or health care professionals,” Conrad says in his webinar introduction.

Beyond her two-step approach to reducing healthcare costs, these are some of the issues Vanessa addressed in the webinar (edited partial transcript):

If you map the path of the individual patient, then you can bring efficiencies in the process. If we are looking at the overhead costs or the entire costs of specific units or the total department, I’m not really sure we can identify the areas of improvement. So what I am proposing is a process of re-engineering that all parties involved in healthcare have to undergo, and therefore to identify where we can improve the entire process.

Changing hospital culture is very difficult. I think there is an intrinsic reluctance to change. Although the doctors, the nurses, the people who are involved in the running of the hospital might wish to introduce change, we have to look at the immense regulations around the running of the hospital as well as the bureaucracy. It might take six months to approve a purchase order, even though you might have funding. That is the case and there is also a tremendous increase in demand: this is because we have an ageing population and there is a lack of infrastructure to support it.

There are a lot of healthcare technologies available, but they are underutilised. In order to use new technologies, you need to have extensive training, even with the simple medical devices. The biggest failing factor is people are not very well trained and especially doctors. When there are all the risks involved, they might be more happy to use an older technology that they know works well rather than something new.

Medical education expands much further than new technologies. We also need to educate the prescribing physician for the appropriate use of a new medicine and how much this affects cost. I think it’s all part of the process of learning and improving.

Watch a recording of the livestream

Conrad [00:00:00] Welcome. I’m Conrad. Before we get started, if you’re new to the show, you can put your questions in the comments field. Whether you’re watching us on LinkedIn or YouTube, you can start by writing down where in the world you’re watching this from today. They say the only things that you can’t escape in life are death and taxes. So that means that all of us will definitely in our lifetimes interact with either the tax authorities or healthcare professionals. Today’s guest has spent an entire career in that second category. Vanessa Dekou is the managing director of Clinical Services International, and she’s worked in various parts of the healthcare industry. So welcome. Vanessa. 

Vanessa [00:00:53] Hello. Thank you very much for having me. I’m very excited.

Conrad [00:00:58] So, Vanessa, today we’re talking about the trying to lower the costs of healthcare and hopefully also increasing the quality of care. And you’ve got some ideas about how we can look at or approach lowering the costs in healthcare.

Vanessa [00:01:18] Yes. So first of all, what I would like to say here, if anyone wants to have an in-depth understanding about costs in healthcare, I can think of nothing better than going and reading the papers of Michael Porter. Michael Porter was a professor at Harvard, and he has spent the past 30 years analysing costs. So on this occasion, and I’m a big fan of him, so on this occasion, on lowering about costs of healthcare, you have to consider that healthcare is a very complex ecosystem so that many there are so many parameters involved. So all of this has to be taken into consideration. But in order to lower the cost of healthcare, what I would propose here is a two step approach. So, first of all, to see how we can increase actually productivity. Productivity means we will have greater outputs and therefore also to improve the functioning and the better balance between the supply and the demand of the healthcare services in the past and what is used in many places in the world, also in this country, is that we are looking at aggregated costs, in my opinion, and to the opinion of many scholars, is that the patients should be used as the unit of analysis rather than the aggregated costs. And we can spend a lot of time elaborating in this, but basically what this means, you should look at the cost of the treatment of the individual patient, let’s say the breast cancer patient, rather than the costs of the departments, the individual departments that might serve this patient.

Conrad [00:03:05] Hmm. What would the difference in approach be if you start looking at the patient as the unit of versus looking at, you know, the cost of the oncology department in Addenbrooke’s Hospital. 

Vanessa [00:03:19] So now more than ever before, is a very patient centric approach to business. Okay. So the pharmaceuticals, the biotechs, all the service providers try to have the patient in the heart of anything and everything they do. Also, if you think about it, the insurance claims are for the individual. Therefore, what we need to do, we need to map the entire path, the entire progress, the entire process of the individual to identify the costs. And another very important thing to consider here is that now more than ever before, insurances pay for outcomes and the outcome again is defined by the specific outcome of the individual. Would you agree with me? 

Conrad [00:04:08] Yes, I think so. Having gone to a hospital and being shunted from one department to another while they try to look out for and figure out what was wrong. I can totally see how each department probably only had a sliver of the costs, but they never added it all up to like how much it would be for someone like myself. But before. Yeah, sorry. Go ahead. 

Vanessa [00:04:31] Please. 

Conrad [00:04:33] Before we go on to other your other points. The I think Erin has a comment. Erin says: is this something the aggregation of that costs is something tied to funding, I guess tied to the amount of budget that goes into, say, oncology versus cardiology. Do you think that’s is that one of the drivers? 

Vanessa [00:04:58] I’m not disputing that. But then you are looking at overall costs, and I think that’s where a lot of inefficiencies come, because in my opinion, if you map the path of the individual patient, then you can bring efficiencies in the process. So if we are looking at the overhead costs or the entire costs of specific units or the total department, I’m not really sure we can identify the areas of improvement. So what I am proposing here is a process re-engineering that all parties involved in the healthcare have to undergo and therefore to identify where we can improve the entire process. Obviously we need to look at the overall costs, but the funding requirements do not necessarily bring efficiency.

Conrad [00:05:52] Yeah, good point. I know you want to talk about ideas to increase productivity. Before that, just wanted to give a shout out to some of our viewers. We have Sara, who is a current MBA student, and she actually was a medical doctor at Addenbrooke’s, so she was at the front lines of healthcare. So thanks very much, Sarah, for joining. We have John from Ghana, Kokumi. Erin, we already saw from Surrey, Victor’s from India. Renato is from Zurich. 

Vanessa [00:06:29] Switzerland.

Conrad [00:06:30] Yes, we have Olive, who’s it’s very must be very early for her out in Orange County, California. And I know Olive is also a medical training. Training to be a medical doctor. So, again, someone on the forefront or frontlines of healthcare. Thomas is from Hong Kong and Kymmins from Istanbul. So thank you. Thank you, everybody. And just a reminder, if you have any questions for Vanessa, please put them in the chat or comments. Vanessa, you have some ideas about how to increase productivity in healthcare. Can you talk us through some of these points? 

Vanessa [00:07:12] So again, I think if we continue with the idea that the patients should be the unit, so hospital productivity is always measured is the ratio of outputs to inputs. And of course, we have to define what is an acceptable output. And acceptable output might be measured as increase in life or quality of life, the so-called quality, quality. So these are all instruments that are used extensively, effectively, to measure the output related to the quality of life of the patient. Having said that, productivity in the hospital and I know this because I’m on the board of a big hospital for 7 years now, is defined as the time it takes to bring the patient in to book an appointment. How long it takes for somebody to go through the A&E and what is the time frame for a patient to leave the hospital? So it’s something really, very, very complex. But what I would suggest here is that the outputs really capture quantity and quality of care for hospital patients. And the inputs, as we discussed, they might include hospital staff, the equipment and also the capital resources applied to patient care. So of course, I agree with the comments of our viewer previously that the overall capital resources are very important. The question is now how we can actually reduce the healthcare costs. So while reducing the costs, we increase the output. If we can do that, I think we will be doing very, very well. And the costs are both in private and in public insurance. And private insurance, especially in the United States, is a very hot topic. And, you know, governments have tried really very, very hard to put legislation to improve patients people’s lives. Even when you are hiring somebody, the first thing they ask is what insurances you offer. So especially in the United States, health insurance is really in the forefront. And last but not least, another thing we need to consider is the prescription drugs and the prescription of drugs or vaccines. And we saw it very clearly with the COVID hit, the tremendous impact in the input, the cost associated, but also in the output and the improvement of people’s life. 

Conrad [00:09:46] Thanks so much, Vanessa. We have a question from Sarah. Right. And Sarah, as I mentioned, she’s a current MBA student. Before just before the MBA, she was at Addenbrooke’s doing her rotations and trainings. So Sarah asks, What do you think about the current system in the UK where clinical commissioning groups decide which treatments will or won’t be funded? Is this an efficient way to do things? 

Vanessa [00:10:16] So I’m really very, very patient about it, but very about the patient. And there are a few things to consider here. First of all, as you know, the government, the UK government allocates a certain amount of money per year for each one of us. And I think at the moment, this is about £28,000. Also, as this is the quality also is, you know, usually the 20:80 rule applies. Ie 20% of the population absorbs 80% of the funding. So we take for granted that there is funding available and there is limited funding. On the other hand. Now more than ever before, we have the so-called magic bullet. So you have the monoclonal antibodies that they are unfortunately very, very expensive. So you can have one vial of the cancer medicine that can easily cost 5 or 10,000 sterling. This is very expensive. So the treatment of these patients can easily be half a million pounds. So then somehow it has to be a cost benefit analysis. If you were to ask me, of course, I would say that all patients deserve the best available treatment, irrespective of the cost. But unfortunately, there isn’t such a budget, so I don’t really have a clear answer to give you. I will tell you what I would do, but unfortunately I’m not running this country. If I was, I would certainly increase the health budget. Another thing I would like to mention here is that, as you know, commissioning groups are very, very sensitive towards rare diseases, especially rare diseases in children. So if you have somebody with a rare disease, even if the cost can run into 2 million sterling a year, more often than not it is approved. We also have the postcode lottery, etc, etc. So I think there is no easy answer, but certainly as a nation we should favour best available treatments where possible. 

Conrad [00:12:26] Thanks so much, Vanessa. I always. Someone told me before that something like 80%, 80% of my lifetime spend on expenditure on healthcare will come in the last six months of my life. Or something like that, right? Yeah. Yeah. But but. But that’s cold comfort because nobody wants to be thinking like that on an individual basis. But I can totally see how from insurance or from the Health Secretary’s and Treasury Secretary Chancellor’s perspective, they need to make those tough choices. You have some ideas about this idea of costs and the steps of which to measure the costs. What is the what is this slide that you have telling us? 

Vanessa [00:13:12] So this is pretty sort of like high level technical. And I think we touched upon most of this previously. So I mentioned before that the we need the total process re-engineering, i.e. up the processes over patients over the cycle of care. Then we need to identify the resources used. But what I would emphasise here is the resources used for the individual treatment of the patient measure, the cost of resources measure the times the patient spends with these resources, and therefore get an overview of the overall cost and somehow, if possible, compare the amount spent with the outputs. So this is a pretty straightforward, you would imagine, exercise. And I’m pleased that we have physicians with us today because I think although on their literature level, this is quite straightforward. Hospitals find it really very difficult to measure costs based on the individual. 

Conrad [00:14:18] Okay. And you obviously have a lot of experience working with a particular hospital. Uh, do you want to talk us through what was, has been your personal experience on the board of the Chelsea Westminster Hospital? 

Vanessa [00:14:32] So the Chelsea Westminster Hospital is one of the largest, the NHS hospital trusts in the country. It is probably the best and the busiest HIV hospital in Europe and we have almost 20% of the babies born in this country, born in the Chelsea and Westminster Hospital. We have a first class now intensive care unit, privately funded. There is a very active board who is always looking for ways to improve how the hospital operates. We have a director of improvement, the director of innovation, and I think these are all means that not every hospital has in the country. Despite that, I think there is an intrinsic reluctance to change. So when you run such a busy hospital, also, it’s very, very difficult to introduce change. And although the doctors, the nurses, the people who are involved in the running of the hospital, might wish to introduce change, we have to look at the immense regulations around the running of the hospital as well as the bureaucracy. It might take 6 months to approve a purchase order, even though you might have funding. Why is that? Don’t ask me. But you know, this is the case and there is also a tremendous increase in demand. This is because we have an ageing population and there is a lack of infrastructure to support it. So, you know, this is something that we all have to take for granted, although there are a lot of technologies that are available, they are underutilised. And why is that? Because in order to use new technologies, you need to have extensive training, you know, even with the simple medical devices. The biggest failing factor is people are not very well-trained and especially doctors. When there are all the risks involved, they might be more happy to use an older technology that they know works well rather than something new. You know, there’s always time involved. Another thing you need to consider is that it takes two generations to bring a new molecule from bench to bed. This is a tremendous amount of time and hopefully later on I will address some of the things that we are trying to do now in order to reduce the time. And in my opinion, the last question, but very important is that doctors and nurses, especially in this country, they are doing their very best. But is this enough? You know, we have tremendous pressure on costs. I think Brexit has hit the NHS harder than most other big institutions. So there are many challenges. So what I would like to say here is that the people who have chosen to have a career in the healthcare are very committed, very motivated. They really do their utmost for the patient. As such, if all of us can support them with bringing new technologies, innovation, efficiency and maybe reducing the costs of very expensive drugs, ultimately we will all work towards one single aim, which is to benefit the patient. 

Conrad [00:18:06] Very, very, very good, Vanessa. And I didn’t realise, I didn’t know this about Sarah but she says she. Oh yes. So she has a very personal connection with the hospital that you serve on. And she also asked the CEO in 2015 if the CEO had an MBA, and she said she personally didn’t. But everyone who came after her would and recommended that Sarah pursues one. And she’s now here in Cambridge. So well done. Yeah. On this idea point about doctors and nurses, we have Caroline who I think is also a student at CJBS. She talks about there’s the nurses, I think, as very valuable resources and. There’s that health, that incredible benefit of human interaction. Do you have any thoughts about this? 

Vanessa [00:19:06] Absolutely. Look, I mean, at the end of the day, each one of us working for an organisation, we are a resource. We are never a full functional unit. So I think this is the reality. Having said that, especially in the healthcare profession, people really give an enormous amount of themselves to do this job well. It’s not a job. It is a vocation. So there’s an enormous good they are doing to the patients and to the society are they are always valued and appreciated and rewarded both financially, or with career progress, etc., as they should be. I don’t know if you want to ask me. I would say probably not. But also they are aware of the restrictions when they enter this profession. So, yes, I do agree with you that the human interaction is very, very important. And again, from my experience with the Westminster Hospital, we have an army of volunteers that goes and spends time with the patients, reading them books, taking them to the in-house cinema. We bring sometimes our dogs to the hospital. So we do anything, everything we can to normalise the environment. 

Conrad [00:20:26] Hmm. So that’s wonderful sort of thing. And we will come back with I promise we’ll come back to the point about dogs at some point. But of Vanessa, you’ve you’ve done you spent a lot of your career in one part of the healthcare side, which is drug development. So can you tell us a bit about what this chart or summarise what’s what’s in this chart? 

Vanessa [00:20:53] So, look, this is this is a very busy slide. I don’t particularly like it. But what I would say here is that the process of drug development is very, very complex and it takes many, many years and about 2 and a half billion dollars to bring a new drug in the market. And in every step of the process, you need the expertise and the input of highly skilled, well-trained people. So from this point of view, I think the Judge is really a leader in the field because I know very well there’s a tremendous amount of research in biotechnology. AstraZeneca is around there as well as this school has a very entrepreneurial approach to teaching. And also you’re bringing a lot of people. So if anyone is interested in healthcare, I can’t think of any better place than the Judge. But it got, regarding now the process of drug discovery. This is where artificial intelligence fits in. This is where data analytics fit in. This is where having the ability to collect data in real world setting fits in. And that’s where we have a pretty good picture of the very complex ecosystem to bring new medicines to the market. For example, you have the biotechnology companies that usually produce innovation. You have the pharmaceutical companies that they are phenomenal machines in bringing a new drug in the market. And also in the process, you have a lot of specialised suppliers like CSI Clinical Services, that they will supply the medicines to the trial. They will find the patients, they will collect the data, they will analyse the data. And then last but not least, go to the likes of EMA or FDA to get the drug approval. So also for all of you considering a career in the healthcare, you can find yourself and build a very nice, nice expertise in every single one of these phases involved in drug discovery. 

Conrad [00:23:10] Great. This. One question or comment from Olive about medical the level of medical education and behind I guess basically what you mentioned before about how when you have new technologies, how do you train or teach medical professionals to use them and gain the confidence to use them rather than sticking to the tried and tested? Do you think that’s an area that needs to be looked at in greater detail? 

Vanessa [00:23:42] Look, I think the likes of Philips, all these big providers, they spent an enormous amount of time and resources educating physicians or people working in the hospitals to use the equipment. But I think that medical education expands much further than new technologies. We also need to educate the prescribing physician for the appropriate use of a new medicine and how much this affects cost. I don’t know, but I think it’s all part of the process of learning and improving.

Conrad [00:24:28] Okay. And the next part, you were talking about the clinical the CRO clinical market. Can you tell us a bit more about what this chart is? 

Vanessa [00:24:40] So Conrad you asked me this question, that’s why I put all this together. So the market has become very, very complex for drug development. And therefore you have multiple players playing an important part in this whole process of drug development. So the innovation clearly will come from biotechnology or pharmaceutical companies. Well, then, usually, more often than not, they prefer to outsource the conduct of the clinical trial. And therefore there is a very large industry out there called clinical research organisations that basically they find that patients for the study, they do all the analysis and they submit the data on behalf of their client. What you will see here, which is quite interesting, we have a very significant aggregation in the market over the past few years. You have some very large, dominant players.  U.S. clearly is the largest market, but also you have some further players. So these are, I suppose, the largest companies. Each one of them employs tens of thousands of people. They are usually listed multibillion companies and they are intrinsically linked to the process of drug development.

Conrad [00:26:12] And I think this the emergence of the CRO market has really helped the drug discovery side because we had a previous livestream on where we talked about the the role that biotech startups play in drug discovery. So and one of the key things was really being able to use something like CROs to do that sort of testing, whereas before Big Pharma had, you know, had all the resources vertically integrated, all in-house, and they were doing this, this everything in-house. Whereas now with biotech start-ups that could try different things and then they use those. So if anyone is interested in that livestream, you can, can go on to the QR code on the upper right hand corner and you can watch this after I watched that after this particular livestream.

Vanessa [00:27:05] Another thing I would say here regarding the CROs is that you can have completely virtual biotech companies, very successful, but they have a product, but clearly they don’t have all the in-house expertise to progress their product. Therefore, CROs become an extension of their in-house capabilities without the fixed overhead costs. And this is their business model is also very valuable. When you have, for example, just listed, you have to have milestones, etc. 

Conrad [00:27:41] Great. And here you have some a bit of a more of a breakdown in terms of where the clinical services growth is.

Vanessa [00:27:51] Absolutely. So you can see here that the again, this is pretty detailed, but I think it’s a very important part of the drug development pro cess. Clinical monitoring absorbs 20-30% of the market, payments to investigators also important. Laboratory, all the testing, the data management, very important as well as project management and a big part of the other, and I suppose that’s where also CSI sits in, the other, also plays a very important role. So the others might involve technology, might involve supply chain, might involve later on the real world evidence. So I think this is a pretty accurate segmentation of where the growth is in the drug development process. 

Conrad [00:28:45] So, Vanessa, you’ve mentioned CSI a couple of times already. Do you want to maybe talk a bit about what CSI Clinical Services International does?

Vanessa [00:28:55] Yes. So this is the this is a company I set about 5, 6 years ago. And after having spent about 20, 25 years working in drug development and in the in a fund, I realised there was a clear gap in the market about supplying the medicines to clinical trials. Everybody’s focussing on finding the patient. But guess what, if you can’t dose the patient, you can’t have your clinical trial. So I set up this business and the thanks to everything I learnt at Cambridge Judge Business School has been a phenomenal success. We have now offices and warehouses all over the world. Very proud to say that we have supplied about 1000 trials over the past five years. And what makes us who we are is really as a team. We have a phenomenal team. It’s a little bit of California style. So, you know, we have dogs and children in the office and people work Fridays at home. Maybe not today, but we try to have the team in the heart of anything and everything we do. It’s a very specialised process, what we do because the supply chain is highly regulated. It’s complex and it involves significant funding. But as an organisation, we are very passionate about quality and about understanding drug development. We are all scientists and therefore we are not dealing with a commodity. We what motivates us, what gets us out of bed in the morning, is that patients are waiting for the medicines that we urgently need to supply.

Conrad [00:30:52] And I noticed you’re also certified by WP and women owned. Can you talk tell us a bit more about what that that entails.

Vanessa [00:31:01] It’s interesting you touch upon this because I’ve been in this country for 30 years. I’m Greek, but I suppose now I’m more English than most English people. I never I never saw the fact that I’m a woman as a barrier or as an impediment in what I wanted to do. And I have also been very lucky because the likes of Cambridge, the likes of UCL, warmly welcomed me and they created a lot of opportunities for my career. Having said that, I can also tell you that even nowadays it’s very challenging to be a professional, to have children at home, to have a house, to run, so on, so forth. So I wanted to create an environment where we value diversity. We value people from all different parts of the world because guess what? Each one of us has something to offer, and it’s this collective experience that makes us who we are. So diversity is very important, and equitable treatment of all people is very important, as well as inclusivity. It’s very important that you feel valued. You feel appreciated and rewarded for everything that anything that you do.

Conrad [00:32:24] And I have, that at this point mentioned that while CSI is quite a has supported you to 10 employees, there is a – 

Vanessa [00:32:32] We have more than that.

Conrad [00:32:33] More than that. More than that. Yes, but yes. Can you tell us a bit more about your chief wellness officer?

Vanessa [00:32:39] Yes. We also have a chief wellness officer. So this is Bruno. He comes to the office every day with me. He’s very passionate and very knowledgeable about healthcare, and if only he could speak. But again, joking aside, this is important to show that people should feel comfortable in the way they work, in the environment that they work, and organisations should be welcoming of people’s differences.

Conrad [00:33:10] Well, well said. Obviously, COVID has hit every part of healthcare, I mean, and probably hit healthcare quite, quite, quite a lot in terms of obviously the demands on doctors, nurses and healthcare systems. What was the post-COVID trends in the CRO market that you saw?

Vanessa [00:33:30] So COVID hit us hard, but also details a great favour, really helped us to innovate, to become more efficient. So if you think, for example, the time it took for the COVID vaccines to come to the market, this was phenomenal, has never been done, but hopefully we can apply the lessons learnt from that process to the entire process of drug development. So as I say here, the first three months of 2020, the market really stopped because patients could not go to the hospitals, so on and so forth. Further to that, the markets bounced back really, really strong and effectively now there is a tremendous backlog. And the biggest problem that the C.R.O. market has is a shortage of people, of devices, of expertise, so on, so forth. So I think we learnt a lot from COVID. That’s another thing to the right hand side of this slide. Also, it helped us to really apply technologies to the best service of the patients, for example, the so-called decentralised trials. So whereas in the past a patient would always have to go to the hospital to see the treating physician, then this, so on, so forth. Now we use extensively either telemedicine or actually the physician or somebody who is responsible for the treatment goes to the patient. 

Conrad [00:35:10] Oh. And we also have some of these E-clinical market trends. Is this what you mentioned in terms of that things that have happened after COVID? 

Vanessa [00:35:21] Yes. So again, we have a tremendous expansion of everything E-clinical. And that’s why now more than ever before, data analytics, artificial intelligence technologies have the opportunity to flourish. So the big pharmaceuticals actually looking for best in class, whereas in the past, the largest the providers were probably dominating the market. Now, even within these large providers, you have specialised departments that they offer a lot of the clinical. Also, there’s increased complexity in the clinical trials more than ever before. The ethics are very robust and requirements of the FDA are very significant. So the entire ecosystem had to think of ways to introduce efficiencies. 

Conrad [00:36:19] Hmm. And the other part of it would be how this landscape is changing. And when you talk about this slide, I think you also mentioned before the show that there’s lots of areas where business school graduates could go into. Yes. So if you could also touch on that.

Vanessa [00:36:38] So this slide and also a few more slides further down. The entire pharmaceutical industry now is focussed very much on specialised services. Specialised services might mean the project management might mean the patient recruitment. And for each one of them, there’s a whole industry with technologies, with analytics, trying to do everything better, efficiently and with less resources. So we also have the commercialisation. And commercialisation is the process that you actually bring a drug to. The market is very important. You get the best possible pricing for your new product. So these are all areas that if I was starting my career again, I would certainly consider as a potential route. 

Conrad [00:37:33] Yeah. And, you know, we’ve been talking a lot about that drug discovery process and how that can, you know, things like CROs could help maybe increase the speed and reliability and then hopefully lowering the costs. We actually have a couple of comments which I think talk a bit about more the human cost in healthcare policy. So some of the structural bureaucratic costs. So Sarah, again, she says, I like your business paradigm. In my experience, it’s variable how available new drugs are. And MonoClonal drugs have been given to patients in the NHS for free for compassionate use. And she’s seen the breast surgery team refer patients to other hospitals for such treatments that the local CCG in Cambridge don’t fund. And it’s really a lot a bit of a lottery. So can you talk a bit about how even if we were to have such efficient systems with CRO outsourcing, etc., ultimately that final part of the process, right, with hospitals and funding, how that can tip the scales in terms of costs and quality of healthcare. 

Vanessa [00:38:50] Especially in oncology. I think biomarkers more than ever before should be an integral part of the evaluation of the patient and. I don’t really I’m not up to date with. How how how are these biomarkers used, especially in this country? But of course, before giving an expensive medicine to a patient, you need to see that this patient responds well. And actually, I was in a conference this week, very interesting Israeli company. They have built a kit that does this with almost 99% accuracy when this kit will actually come to the UK market, it’s a big question and there are other kits around there. So what I would say here, I think effectively the pharmaceutical companies should integrate this whole process of analysis and evaluation of the patient. So the treatment with what is the most appropriate treatment go hand in hand.

Conrad [00:39:58] And linked to this. I know the link to this earlier part that we talked about. Caroline says we should think about the human productivity in the context of care as she talks about how. You know, there’s no way you can play a quartet faster, which, you know, you always need four people. Right. And is that one of the big stumbling blocks in terms of lowering the cost of healthcare? Or do you think all that e-clinical things that you mentioned has an impact?

Vanessa [00:40:30] Look, there, the human factor in anything and everything that we do is very important. After COVID or during COVID, a lot of people, it’s very well documented to have suffered from anxiety, from depression, and they cannot go back to work. So we use tremendous resources that potentially could contribute to the advances of our society. So that’s something we really need to take very seriously. Ultimately, everybody, it would be great if everybody was healthy and happy. What I would also say here is that the individual nowadays has also very many tools available at his disposal to look after his health and regarding the contribution of the individual. Also, I can say about that Chelsea and Westminster, but also many other trusts that they are really very much focussed in mental health.

Conrad [00:41:30] Yes. And I, I must I would think Bruno has a someone like Bruno would have a great role to play over there. But we have, I think, time for one last question, which is something that in your area, do you see any notable difference in how regional CROs differentiate themselves when pitching to pharma companies? Is there any difference from across those from Asia, Europe or us?

Vanessa [00:41:58] A look, in my experience. Asia has always been a very challenging market for US and European companies to penetrate, and that’s why usually they have local partners. I met actually with a fantastic company from Asia yesterday. They have tremendous outreach in Asia, but they are very poor in Europe with the CROs big doesn’t always mean better. What you need ultimately are people who know the investigators, who know the sides and who will do a good job. And after you look after you and your study. 

Conrad [00:42:42] So thank you so much for that. Vanessa, we’re coming to the to the end of the show. But I wanted to say that there’s so much expertise and people working in this sector from. And if you are a CJBS alum, who’s interested in the health and biotech, you can go to the QR code at the upper right hand corner. It will get you to the Alumni Health and biotech linked in group. And it’s a private group, but. And so our head of alumni will get you through if you’re an alum, but you can definitely carry on the conversations there. Vanessa, you were about to say something. 

Vanessa [00:43:21] Yes. I’m really very, very passionate about helping, mentoring people, offering any advice I might have. So also, please do reach out. 

Conrad [00:43:34] Great. And I said we had one. We had the last question, but let’s squeeze this one in for William. And William’s asking, do you think new regulations on price, cap and drugs will have a major impact on innovation in biotech? I guess he means we’re going to mean a drop in innovation. 

Vanessa [00:43:54] And if you are a biotech, you don’t want to have your your the price of your medicine caps. So this might have a negative impact on innovation. Having said that, when you are going to develop a new product in a specific therapeutic area, most people would have done very specific analysis on what is available on the market and therefore would have pretty clear expectations. You don’t want a me-too pricing. You want clearly to differentiate. So I think if there’s phenomenal innovation, improvement in extension or quality of life, people should also command a premium price. 

Conrad [00:44:41] Thank you so much, Vanessa, for giving us your time and for such an excellent and thought provoking tough talk. And as I said, if any of the if any one of you are alarms and you want to connect with others in the healthcare and biotech area, please join the LinkedIn group. So with that, I just want to thank everyone in the audience for your questions, your comments, and of course, to Vanessa for sharing such a wonderful, wonderful career and your insights with us. Thank you so much. 

Vanessa [00:45:17] I’m very honoured. Thank you.