Webinar: Advanced Implementation Strategies for a Compliant Grant Process The Tipping Point: Incrementalism Need not Apply December 9, 2008 Mike Saxton, MEd, FACME Senior Director Medical Education Group US External Medical Affairs Mike.Saxton@Pfizer.com

Should industry support of CME end? Conversation Areas Should industry support of CME end? If it continues, how should it change? Options What steps Pfizer has taken? Lunch Dean mtg Large group

Should Industry Support of CME End ?

I personally believe commercial support of CME should end within 5 years? Yes No Abstain Answer Now 24 of 125

Relationship with Industry Collaboration or Cooperation? “First, industry relationships are essential, but they must be carefully managed. By developing clear and well-considered guidelines, we can optimize the benefits inherent in the academic medicine-industry relationship, while at the same time, minimize the risks. In other words, we need partnerships that are principled, productive, and transparent.” Darrell G. Kirch, MD, AAMC President and CEO [AAMC Reporter 2008; 17(2):2] We may not know what to call it, but we know what it looks like and for what purpose.

If Industry Support of CME Continues, How Should It Change? What is its purpose? What are the options for industry?

A Convergence of Interests Model for Commercial Support Business Needs Healthcare Provider Performance Gaps Patient Needs Ideal Area for Commercial Support Healthcare System Quality Gaps Overlapping zones of mutual value Accelerate adoption of new evidence based innovations that address a gap in healthcare quality Improve patient care and shareholder value simultaneously Win-Win Collaboration Defined By A Convergence of Interests Tactical to strategic Any partner might have needs in any or all of these areas. Tactical on the outer rings between where smaller level of convergence occurs – financial only, any transaction relationship Partnerships vs subcontracting on outer ring Strategic – shared goal, shared risk, blended competencies, Configuration of circles will vary by organization. Could shift circles to reflect different needs and show 3 or 4 on page. Something with high business need attached to HCS need for example.

Industry Perspective on Future Support Options Option Pro Con Maintain Continue current approach Less disruptive to CME providers More familiar to industry ACCME standards of accreditation currently not rigorous enough on organizational conflict of interest. Change is too slow for environment Industry criticism remains Low educational effectiveness Company compliance risk is highest Eliminate Stop industry funding completely Reduces perceptions of bias Helps alleviate budget pressures on industry No ability to support credible independent education that accelerates evidence based innovation adoption Removes a resource to help close healthcare quality gaps Current CME system dependency – phase out over 5 years if chosen Does not manage the majority of real conflict of interest in CME Transform Dramatically increase provider eligibility requirements relative to conflict of interest requirements Increase funding for Performance Improvement CME while reducing funding dramatically for single non-interactive methods Better educational effectiveness based on the evidence of what works Increases collaboration Encourages innovation Improves compliance significantly Supports direction of organized medicine (AMA/ACP/AAFP/et al PBLI model) Enhances credibility Colleagues will need to understand value of new approach and must have communication tools to handle any push-back. Current CME system dependency on traditional update CME funding model Internal and external pressure to still invest in some ineffective CME “Industry funding pooled and managed by independent party” The “pro” arguments include: Reduces prospects of COI Potentially less disruptive to CME providers The “con” argument : Industry support will be a charitable contribution at 5% of today’s funding level No accountability for dollars provided Less potential to influence positive change in CME practices

Pfizer’s New Medical Education Grant Policy To only support providers most likely to meet the highest standards of quality and independence defined by the medical profession To support the profession’s move towards performance-improvement initiatives that integrate education and quality Initiate a competitive grant review period for grant applicants to encourage more innovative, high-quality grant applications Review all major grants using criteria equivalent to ACCME’s highest level of accreditation Redirect resources closer to the point of care in order to better meet the needs of the new model of PI-CME To support the medical community’s call for balanced funding in CME by establishing organizational or grant dependency financial caps on commercial support As of July 1, Pfizer will no longer directly fund CME provided by organizations who do not have patient care as their primary mission ie Medical Education and Communication companies

Transformation: Rather Than Why, Why Not! More effective based on evidence in the literature Elevates importance of patient above current model Supports direction of ACCME, Macy, AAMC, etc Improves industry credibility with the medical profession and the public Significantly improves compliance Costs less – 90% in many cases How does it improve compliance Focuses on outcome rather than process steps as best measure of compliance Far less dependent on expert driven lecture based CME where relationships with faculty and focus on content are among the larger compliance risks we face Mitigates against many of today’s conflicted compensation systems that do not conform with the Assn of Fund Raising prof code of ethics by excluding business development practices of non-healthcare aligned organizations

Summary The Best Form of Compliance is Quality Education The Best Investment Is Education Most Likely To Improve Provider Performance In the Direction of Evidence that Aligns Our Interests with Those of Patients The Performance Improvement Model of Education Accomplishes Both