How to set your Pharma or Medtech product up for success in the US market

How can you ensure your product is set up for success from early clinical trials right through to launch and commercialisation? In this Global Whispers webinar we explore best practice commercialisation strategy for healthcare products launching in the US market.

Clare Foy (Director – Global Market Access, Mtech Access) speaks to Janice MacLennan (Pharma and Medtech brand strategist and founder of NMBLR) about how market access, HEOR and commercialisation leads in Pharma and Medtech can best support overarching product and brand strategy, with a focus on launch challenges in the US market.

We take a step back from the intricacies of market access and HEOR, to explore the role our specialism plays in broader commercial and product strategy. We ask: where does market access and HEOR sit in this broader picture, and how can market access teams best support their product and company brand?

Using the US market as our case study, we explore:

- How to set up your product for success
- Commercialisation routes in the US for Pharma and Medtech
- The relationship between brand strategy and market access
- What Pharma can learn from Medtech’s approach to commercialisation
- What Medtech innovators can learn from Pharma companies’ approach to launch

This episode was first broadcast as a live webinar in January 2024.

Learn more at: https://mtechaccess.co.uk/commercialisation-strategy-us-market/

Explore our work in the US market: https://mtechaccess.co.uk/launching-healthcare-products-in-the-us/

Discover how Mtech Access can support you global market access and pricing strategy: https://mtechaccess.co.uk/global-market-access-and-pricing/

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Transcript

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- Welcome to this Mtech Access webinar. At Mtech Access we provide health economics and outcomes research and market access services from strategy through to implementation. Get in touch today to discuss your market access goals. First, though, I hope you enjoy the webinar. Welcome everyone. Thanks for joining our latest Global Whispers webinar. Please see our YouTube channel for past webinars and look out for more content from us in the future. The topic today is Product Commercialisation Strategy for Pharma and MedTech in the US. I'm Clare Foy, Director of Global Market Access at Mtech Access. We have a great mix of audience today across industry and healthcare systems, and I'd like to particularly welcome our global affiliate partners who play a key role in the work that we do. For anyone that doesn't know us very well, Mtech Access is a global specialist health economics outcomes and market access consultancy. We have a track record and expert delivery and provide specialist support to pharmaceutical and MedTech clients, and we work as a collaborative partner to healthcare systems worldwide. Thank you for joining. Today we focus on commercialisation strategy for pharma and MedTech in the US and I'm delighted to welcome our guest speaker, Janice MacLennan. Welcome Janice, could you please start by taking a moment to introduce yourself and your background?- Great. Well, I'll certainly do that Clare. First of all, thank you very much for inviting me to participate with you in this webinar. So what's relevant, probably I have, I have two companies, both of which I'm the founder and CEO of, I've really both are focused on the industry, which I've been focused on for over 30 years. And my area of focus is strategy. So very pertinent to the topic we do today. And really the emphasis is all about helping teams to do strategy so that over time they can do it better themselves. So that's what I do.- Perfect. Thank you. Okay, so let's dive right in. I'd like to start by talking about the complexity of the US system. I know our clients and our listeners will be quite interested to discuss this topic. So could you start by outlining some of the challenges of launching a pharma or MedTech product in the US and tell us a bit about structure and the challenges there.- Cool. So let's start maybe off just with some of the challenges. I would say, first of all, the biggest challenge is getting regulatory approval and the regulation is changing all the time. So that makes it quite challenging. What's interesting that approval process is different for pharmaceuticals compared to MedTech. So with MedTech, you get classified, any MedTech product gets classified as class one, two or three and class three and that's based on risk, you know, risk of doing harm to the patient. And the class three requires clinical trials, so that's quite different to what's happened in the past. Whereas class two, all they need is, I think it's called a 510(k) Clearance, but basically regulatory clearance. And all they've got to do is prove equivalence to something similar on the marketplace. And in class one really, they just provide a bit of information and so forth. There's not a lot to it. So that's one the regulatory process, regulatory approval is challenging. The other thing that I think is also really challenging is market access and coverage, because in the US you now have got GPOs at what I think of at the top of the tree, IDNs, which are effectively, if I use the word covered, so the GPOs negotiate with the suppliers for great prices and the IDNs then who associate with that GPO benefit from those prices. And then within the IDNs you have your individual hospitals. Each hospital probably has its own value committee, and then you've got your key stakeholders at the bottom, you know, healthcare professionals and other interested parties. So clearly access is quite complex in that environment. Then there's pricing, which again is becoming, I think the US historically was always a market where people felt they could get away with pretty decent prices, whereas that is coming under challenge at the moment. So there's a lot more pressure and scrutiny on pricing and yeah, so that's something people have to take care of. You've got regulations like the Sunshine Act where you have to disclose any payment you make to physicians, so that is a consideration because we are clearly consulting with people as we develop drugs and do things. So there's something there. And then there's the different stakeholders that we have to engage with over time have, you know, they're just a plethora of different stakeholders.- Absolutely. Yeah, I think that's probably one of the biggest challenges is all those different stakeholders, different needs, different ways to engage with them, different evidence that they need. Okay and are there any changes happening in the US that you could describe to our listeners? Anything that we need to be aware of?- So again, you know, we live in a world, I think a world of change really. So the requirement for evidence is evolving. There's a real emphasis today on real world evidence as part of any submission and also patient reported outcomes are increasingly important. the shift, the change, which I think is really important is towards value-based care rather than volume-based care. And in fact there's, I dunno how many people are familiar with, I'm going to call it an organisation called ICHOM, I-C-H-O-M, but they're doing a lot of work around value-based care. And I think it's worth looking at, it tends to be more for disease states, but I think it's really interesting because they've engaged with patients and physicians around the world to develop what are the relevant value-based outcomes. So I think or patient outcomes, you know, the outcomes that we should be focusing on. So I think that works really, really interesting. The other change is really around digitalization of healthcare. We are sharing a lot more patient information. There are all sorts of cybersecurity risks associated with that need to be considered and a lot more regulation coming along in that area. Environmental sustainability, a big thing now, you know, we used to get away, if you think about inhalers and things, they are no longer really desired. So that's something that's important. And then probably also the move towards personalised healthcare. I think a change and has implications for all sorts of things like helping identify, you know, a tighter target population, et cetera, that you might want to develop your particular offering for.- Okay, a lot of things in that and very interesting. Thank you. And not all of those are unique to the US, particularly the environmental sustainability, digitaliation, yeah, personalised healthcare, all topics that will be interesting to people in multiple markets. So thanks for for mentioning those. Alright, so as a strategy expert, let's move on to talking a bit about the optimal pre-launch strategy, focusing on pharma first. So could you take us through some of the key early decisions that pharma companies have to make when they're preparing for a US launch?- Sure, and in fairness, Clare, so when we focus on pharma first what I'm going, can I make a suggestion? I talk about what's common because actually the decisions are common, whether it's far more MedTech, maybe you engage is going to be slightly different, right? So if I just start with the decisions, which I would say whether you have a pharma product or MedTech product, these are the key early decisions you need to be making. So I'll start off with where are you going to focus, where's the unmet need? What's your target, you know, target market unmet need that making that decision, that choice is really important early, very early on'cause that guides everything else. After that I would say vision. And the vision there is what does success look like? But not from an internal perspective but from an external perspective. So what does success look like for your customers, for your patients, you know, so from that external, I think that's really important. And when you describe your vision, I think the other thing that's interesting and an area for improvement is making sure that that vision is what I would call competitive. In other words, you feel better placed to realise that vision than anybody else, if that makes sense. So you don't have something that's very generic, but something that really lends itself to your strength. So that would be next. After that, things like positioning and value proposition, really important. Those choices are made very early on or they're going to influence your data strategy, they're going to influence which patients you study your drug in, et cetera, et cetera. So that's quite fundamental. The other decision we have to make is where we are going to focus for growth. So for example, there might be an area where you've got to change practice. So let's imagine it was just an, I'm thinking MedTech an arrogant solution, you know, something you use when you do procedures. If people are using a lot of home brew and you're trying to switch them away from home brew to pre-mix or you know, think about the good old drips, you know, so there are lots of things where, where you might have to change behaviour before you actually get them to adopt your particular product. In pharma you might need to increase diagnosis, you know, there are lots of disease states where people sort of circle around the system for many years. So that's something we have to understand to decide where the areas we have to focus for growth and how are we going to create value wherever those areas are. The other thing early on, and it's mentioning this because a lot of these things aren't decided early on, so there's the tension, but the other thing I would suggest is lifecycle management. How you thinking about evolving what you bring into the marketplace? Because sometimes for those medical devices that actually are classified as three, they might each do studies in a different device if it's going. So it has implications. So you need to think as you're mapping out your clinical trial programme, you need to think about when you're going to introduce different doses, different devices, indications, when do we see, you know, which one should we study first? So there are a lot of considerations that need to be made. And then I'm going to say last but not least, pricing. Because pricing, it's all about getting that balance right? But even when we think about patient, you know, access to whatever it is you are bringing to the marketplace, you've got to think about where that patient's presenting. You know, is the hospital, is it out in the community? Is it in a specialist hospital or just a general hospital? Who is that patient? Are they insured? Underinsured, uninsured? Now all these factors are going to influence some of the decisions you make. So I think that's really critical.- Yeah, that's a great summary actually. And you've described it in a sequential way, but I think in reality a lot of those things are being done at once and, you know, one thing fails, everything fails. So it's quite, it's quite a challenge. So I suppose it'd be interesting to hear your perspective on how companies can get the right balance in preparing for all of those different things. How the teams can work together and collaborate for success.- Yeah, great. So that's it. And this is where I think I'm going to introduce some differences between pharma and MedTech maybe. But first of all, I think what's really important is identifying those internal stakeholders that really need to participate at some point along the journey in the development of the strategy or the refinement because it's constantly going to be refined. I typically think of really breaking all stakeholders into four different discrete populations. Think about the core group. The core group do all the heavy lifting, are going to do the bulk of the initial thinking, come up with hypotheses or things they want to put in front of somebody else. Then you have an extended team. This is where I think it's really important to go out to people in the market. So if you are a global team even and you are working with your US stakeholders, they are part of that extended team without doubt. And really you want to use the extended team, in my view, to advance your thinking, to push your thinking, to make it better. When you involve the extended team, you're going to involve them for one of two reasons. It might be because you want more ideas, more choices, you know, you want them to add idea, add choice to the the conversation or maybe you want to actually start making choices. So you've got to be very clear when you hold a meeting, when you engage with anybody in the extended team that they understand what you need from them at that particular point in time. Right, is it divergent thinking? Is it convergent thinking? So I think that's really important. Then you've got your subject matter experts. So you need to know who are they or who might they be, who you would go to at different points along the journey.'cause they have a particular expertise that you need at a point of, and then not, not least important are the actual sponsors. The people ultimately going to sign off on the decisions that we're making. But also thinking about engaging them along the way. Again, I would suggest to push thinking to make sure that when you ultimately present there's no surprises that you don't present as a show and tell, but actually they've been part of it, you know, so that they feel they've been included along that way. So those are the internal stakeholders and that would be true for both MedTech and pharma. What is interesting, I've got to say, this is where I think pharma is probably a little bit ahead in the way they engage with their internal stakeholders. My experience in MedTech, every time I have an opportunity to facilitate a strategy meeting in MedTech, it's often the first time they've ever done something like that come together. So what they more likely to do in today's world convention today is more likely that somebody in commercial sitting at their desk doing things and then emailing it. You know, so it's not a process that's inclusive put in the way that I think. So I think that's quite interesting. And then clearly there are external stakeholders that we absolutely need to engage with along the way. So you've got your patients increasingly it's super important whether it's a medical device or pharmaceutical product, to actually get patient input into whatever it is you're developing. Payers early, early, early want to understand what they feel they need, what is the evidence they need and they would want to see in order to be willing to cover your product or your device or you know, so that engagement really critical. Clearly healthcare professionals typically through key opinion leaders, you know, we need their thinking and to be engaging with them from early along the process regulators today as well. I mean companies are going to regulators quite early to make sure that the way they think about that clinical trial design is appropriate and is going to be approved. And then if you, from a medical device perspective, GPO, so the payer community, I think they've got GPOs to think about and so should be engaging with them I think pretty early on as well to understand what they would want to see in order to support that. So I think that's it. I'm trying to think, is there anybody else that I might, I'm sure, I mean there are going to be others, but those are kind of the the biggies.- Yeah, I'm glad you said patients first as well. I think it's really important that we remember, that's why we're all here is to help patients to improve their life. So that's really helpful. You mentioned early on about how unmet need was a very important part of the strategy, defining that unmet need, making sure you have a product that's going to fulfil an unmet need. How can companies that would go for MedTech and pharma companies, how can they prepare for the competitive landscape at launch knowing that that will probably change over the intervening years and how do you advise clients to prepare for all of those changes and making sure that their product's future proof?- So that's such a great question and what I think is this is all about having foresight for want of a better description, right? As opposed to insight. So the whole foresight piece is actually first of all understand who your competition are going to be because they're busy. And today we know because everybody has to publish clinical, you know, you've got to register what you do. So we know who's out there, we know that the type, you know, if Becton Dickinson or Medtronic or Pfizer or you know, you understand who these people are, you understand a little bit about how they approach competition. So there's an understanding of that company and its culture and how it typically goes about doing things, which I think is really important. And that will help you understand how quickly they are likely to, if I can use the word drive adoption, change behaviour. Because really it's not the competitor that I'm bothered about when I'm thinking about my strategy, it's my customer, right? It's those patients and those physicians and those payers. And those are the people that I'm going to be engaging with and I need to be making sure that what I'm doing for them is more valuable than what my competitors are doing. So it's always, so we almost go back to the unmet need, but different stakeholders have needs. I'm always thinking how am I going to create differential value for that stakeholder over and above that being created by the others and making assumptions about what they might do based on what I've seen them do. Right? But it's fascinating. I think it's really fascinating. And only yesterday I read about Eli Lilly, I don't know if you've seen the coverage that they've got one of these weight loss works. I think was pretty approved backend of last year, yesterday there's an announcement that they've created this telehealth portal where patients can get direct access to the drug'cause they've set up doctors who can interview and advise patients virtually.- Yeah.- And they have to wait to get, you know, I think that's huge. Now that wasn't a decision they took after they got approved. They've been thinking about doing that for five or six years, you know what I mean? That yeah that idea is way back when.- Yeah.- But they've actually brought to fruition two months after the drug was approved,- Yeah, so have some strategies that you can put into practice as and when needed. Yeah and I think there's something to be said about making sure you understand the patients and you are addressing that need primarily as well as thinking about the competition. So I think that was really helpful insight there. Thank you. And you touched on this earlier about the possible trend to sort of speed up access to drugs and how some companies are trying to accelerate the pre-launch timeline, get faster access to patients and also obviously generate some revenue. We all know that it's very costly to develop new interventions. How can companies go about doing this kind of thing effectively?- So I think a lot of the speeding up is in R&D as in innovating research and development processes doing phase through in parallel, you know, your with medical devices doing your, you know, it's just making decisions earlier and doing things faster and taking more risk I think is the truth. Taking more risk. But I think from a commercial perspective, what's interesting is there's a risk that R&D are innovating and commercial art. So we could potentially slow down processes'cause we are saying, oh we haven't planned to talk to payers yet and you've already, suddenly I've got something I wasn't, you know what I mean? Like you've sped up that R&D process and my process hasn't followed. My process is really do a bit of positioning research. It takes us six months.- Yeah- Six months is too long now. Do you know what I mean? So I think our commercial ways need to change quite dramatically to support that idea of getting product to market earlier. And because we tend to operate in silos, you know, commercial doing what they're doing over here, I'm not sure they think of implications of R&D doing what they're doing speeding things up and then suddenly you get crunch point where there's tension because R&D want to go straight into phase two and you haven't done your positioning research yet. You know what I mean? It's definitely something I would say everybody needs to keep eye on and you really need to make sure that those processes support each other. The other thing from a commercial perspective, the industry, you know, we are really quite compliant. Some companies have got very consensus-driven culture for one. The challenge with that is the number of bodies or committees you have to circulate with that can take time. Earlier this week I was in the US and they were saying what's really interesting is they can't actually agree a deadline because when they can get approval depends on when that those people come together to have a meeting. And you think isn't that the wrong way around?- Yeah.- You know, they should come together because, you know, so it's just really a lot of behaviours that are in play that need to change for us to be more effective and efficient and do things that are in the interest of the patient, you know? Yeah.- Absolutely. I think you make a good point there about collaborating not working in silos. My next question is about making sure companies have the right evidence to satisfy all the stakeholders. And that of course is another example of collaboration between teams, making sure everything's available on time. What would you say on that?- So I think this is back to you've got to get payer input early and like, so to me I would, I would not want to go into phase two design without having extensively consulted with healthcare professionals, payers and patients and regulators probably.'cause what's quite interesting, if you are successful with your phase two study, you are unlikely to change that trial design for phase three. So if you've missed the opportunity going into phase two, the data you need for coverage, you're going to have to wait a long time for it's going to be an extra cost, you know what I mean? You're going to have to invest in something you haven't planned for. So that understanding that I think is really important. Also, when you engage, if, you know, if I think about that pay engagement for example is what you're trying to understand is how they making twists from their perspective and they might be thinking about the type of data they need in a way that you're not thinking about it. I think you can agree with them possibly. She says, not having ever had a conversation with a payer in my life, but I think you can agree with them that this is the standard of care that you could be using even if you anticipate, you know, so it's not today's standard of care, but based on everything they know what they want you to be evaluating yourself against, et cetera. So yeah, it's really important. And for MedTech companies, you know, if you think about this GPO piece, so a lot of the IDNs, well not a lot, there are IDNs who are not allowed to bring in drug until the GPO until there's a GPO contract in place. So you need to know which GPO, you know, what IDNs demand that'cause how you approach that has been different to where maybe you are allowed to use it, but you still ideally want GPO contract. You know, so there are going to be all these, if I use the word local variances across the US which you kind of need to understand. Right?- Yeah, no, it's a good point. Okay, so we were talking about patient access to new products and the challenges of that. You touched on obviously in the US we have a situation where most of the population's insured, but some are uninsured, we have different settings for different products. Could you talk a bit about patient access and how this might vary for different populations and what companies can do to ensure their innovations do meet, do come to the patients?- Yeah, so I think understanding the patient population you're serving is at the heart of it, which is why right at the beginning I started with the patient. And I think we need to understand those patients deeply. Like if whichever disease status, what is the predominant socioeconomics, you know, how many of them can afford, are likely to be insured? How old are they? What are the age, you know, because they may have access to Medicaid or Medicare, you know, so we need to understand how they're likely to access their treatments from a financial perspective because we programmes in place to help support that access. But there's also the access so to me there's the funding but there's also there can they get to the treatment piece? You know, there are communities who don't engage with the healthcare system. So how do we help them if this disease state is more likely to be there? You know, what are we going to do? Do we try and get them into the system or do we try and serve them wherever they are? And I have worked in areas where people are saying, well maybe we go to the church, you know, if that's where they are, that's where we go instead of trying to get them to come to where we are. So I think there are lot, you know, that deep understanding of patients who are you serving, where they likely to be, what are their actions and beliefs about their disease, about their treatment, about medical devices, I don't, you know, is about procedures. All of that we need to understand in order to start making some decisions about how we going to make sure this device or this product or this technology actually realises its potential.- Yeah, that's a good example. I've seen an example where healthcare professionals went to hair salons and barbers to talk to people'cause they're in there having their hair done, they're kind of sitting there talking to the hairdresser and they get talking about blood pressure or something and then they can have their blood pressure monitored. It's quite interesting go to where the patients are rather than waiting for them.- A lot more creative, right?- Yeah.- A lot more creative. And I do think I keep on saying to myself, you know, this idea of people always have to come and do things our way is so wrong.- Yeah.- You know, we've got to understand, and I think the same is with, you know, if you just think about as you're developing a drug, you're shaping thinking possibly you need to share your science. You know, there's a lot of communication that needs to happen with these stakeholders out there even anywhere before you get to the marketplace. And are we doing that in a way that works for the people we are trying to serve? I'm not sure that we are actually. And the language we use.- That's a great point. Yeah, that's a great point. Okay. We talked a lot about pre-launch and what companies can do to get a product on the market, but of course the story doesn't end there. What about post-launch up to loss of exclusivity? What kind of strategies do companies employ? How does it differ for pharma and MedTech? What are the kinds of things that you would recommend to clients to consider in this period?- So I'm a great believer in, I'm going to say branding, brand building. So the long thinking about things strategically, I think there's a real danger that many companies are too short term focused. So they're busy worrying about quarter, quarter results instead of actually thinking about where do we want to be and what are we doing to make sure we are where we want to be in five years time or six years even when they're the marketplace. So I think that is something people really need to think about is investing what I call in the brand, which is not going to necessarily give you sales tomorrow, but will longer term and investing in, what would you call them? Initiatives which are really like performing, where you're getting sales in pharma, you do something and you generate sales quite quickly. So it's finding that I think is really, really critical. I mentioned lifecycle management should really start being thought about, but the whole idea of how do we constantly innovate I think is really important with MedTech, I mean clearly you've got design, you've got lots of things you can do to really improve, you know, and all you have to do is think about computers. But I do know scanners, you know, think about any MedTech products, what they looked and felt like five years ago is very different the look and feel of them today, they're all quite slick, they're quite, you know, so there's a lot of thought that needs to go on to how we constantly innovating. Is there anything we can do with the formulation maybe to pick out some of the toxicities, introduce it in a different way, change the dosing. I mean there's so many things that we should always be looking if we say be constantly dissatisfied with the products you've got and think about how we can improve it to increase its value for both the healthcare practitioners and the patients. I think that's really important. And along the same lines, you know, evolving that value proposition, the very fact you get to market with a value proposition doesn't mean that that's going to keep you safe. You know, you have to be thinking, hey, what more value can we be creating on-- Yeah. And for this market phase.- Yeah, that's a really good one actually. And the next question I was going to ask has come in from the audience, and maybe it's related to this'cause they were asking what are the main pitfalls and how to avoid making those mistakes in the US?- So I think the thing that derails most strategies, right, or dare I say winning strategies is going to be about stakeholders, stakeholder management. And where things go horribly wrong is where you've got important stakeholders who feel either unseen, unheard or misunderstood and therefore they don't buy into and support your strategy. And that can make life extremely difficult. It can make decision making, the time to get a decision much longer'cause they're asking you to go back and do more work. They are, you know what I mean? You just haven't done what you needed to do upfront to keep it flowing. So I would say that to me is one thing that's really important. And if we go back to MedTech, maybe that's a massive, I mean it's a massive opportunity in pharma, but I think it's a huge opportunity in MedTech. So if in my experience where I've been working projects in MedTech, those relationships are not always good relationships, they're not healthy. Sometimes people, you know, functions disrespect each other because they're not listening to each other or they don't, you know, so I think that to me would be a huge, huge area. The other area for me is early decision making. So not many people are actually, when I say people, not many companies are good at getting position done before they go into phase two. Oh that might cost a lot money and what if it fails? But if we think about positioning as shaping your phase two, It's going to make you either, you know, so that early decision making really a lot the strategic thinking upfront early on, even before you've got something that you know is going to be effective and safe. I think understanding how you might make it accessible to patients. Are there technologies, you know, so today if diagnostics is an issue at the same time as developing your drug, you should be looking at, You know, you should, the other things you need to look at to maximise the potential of that, you know, make sure that gets to the people quickly, is adopted quickly. So to me it's probably those two things. Stakeholder engagement piece and invest in making decisions early. and one of the reasons I would say why that should not be a problem is because most companies do have follow on assets. So they're just prioritising. They think this one has the most potential, but if it falls, if it fails, they invariably have an interest in that disease state or in that area or a tech company, you know, take somebody like AbbVie, they're immersed in diabetes and you know, cardiovascular health, that's what they do. So any learning is valuable.- Yeah. You can share it with your other assets and other parts of the business. So I think that's important is to think about as investing in your understanding of patients and stakeholders in that area and that can be used anywhere.- Yeah.- And therefore really, does that make sense? Yeah.- Absolutely. No I think that's great. And thank you for your insight so far. I think we're coming to the close of our time now, but I just thought one final question from the benefits of your experience over 30 years, what lessons can companies learn from your experience? Have you got a couple maybe of anonymous examples of things that companies might wish to learn from?- Yeah, I think what I would, for me the learning is going to be background engagement. And I think this whole thing about being very intentional about who you engage and when being very clear about the purpose of that engagement. I mean everybody's time is valuable. That's my starting point, right? So why would I waste time here with somebody, ask them for input and I'm going to ignore it. Don't ask them.- Yeah.- So when you ask for input, you know what I mean? It doesn't mean you agree with me, but you process that input and end up, you know, actively considering it, et cetera. So I think that's really important. And then that mixture of online and offline, you know, I think is really important. Allow people, people of different personalities, make sure that you design the way you're doing things to cater to different people. So you need face to face, not a question, but you can also do a lot virtually you can do a lot offline, but what are you doing when and how. So I think I use the word designing, how you going about your strategy development is huge and most people don't. They slot into your process, this is what we do. They're not thinking about it, they're not thinking about the personalities involved and how they might change it, to make it rich, a better experience for those people. So that's one thing. And the other thing I'd see or say is we talk about creating value for our customers. Value comes through better patient outcomes, it comes through improving that patient experience, it comes from reducing the cost in healthcare and it comes from, you know, improving the healthcare professional experience. So it acts four ways in my head, there are four areas where I'm looking for how can I create value.- That's been so useful. Thank you. Thank you for a fascinating discussion. I've really enjoyed it today. I think you've got lots of good insights to share and hopefully the audience have enjoyed it too. So thank you to everyone for joining. We'll follow up with any of the questions that we didn't get to later on. We'd also be happy to signpost anyone who wants any further information. So please do get in touch if you want to continue the conversation. Yeah, all that remains is to say thank you to everyone and thanks Janice, and we'll hopefully see you all again soon.- Great. Thanks Clare. Great questions by the way.- Thank you. Thank you for watching. If you'd like to find out more about our work or how we could support your market access goals, please email info@mtechaccess.co.uk or visit our website at mtechaccess.co.uk.