Is the ROI the right measure of the impact of patient-centric initiatives?

Using new performance measures can unlock patient-centricity’s full potential and have more and better patient engagement initiatives.

By Selene Camargo Correa, PhD — Senior Consultant at A Piece of Pie

Medicine is for the patient… The profits follow. George Merck, 1952

What is the epitome of patient centricity nowadays? For many the answer is clear: personalized medicine. And it is not difficult to figure out why. In the last few years, the medical community has witnessed the advent of precision medicine and the rise of targeted therapies. Gene expression modulators, angiogenesis inhibitors or immunotherapies lead to survival rates and improve patient outcomes to levels that HCPs could only have dreamed of not that long ago.

However, advances in cutting-edge treatments have not always been followed by initiatives to support patients in taking ownership of their care, such as being better informed about their disease or feeling better equipped to take a more active role in treatment decision-making. Generally, patients still know very little about treatment options and let themselves be guided by HCPs and their expertise. Estimates drawn from the European health literacy survey (HLS-EU) indicate that nearly half of respondents display limited (insufficient or problematic) health literacy (a).

Some disease-specific developments show the way to go. For instance, in psoriatic and rheumatoid arthritis, the pharmaceutical industry has supported Rheumatologists’ work, patients themselves, and patient advocates developing quality-of-life indicators and patient-centered care standards while successfully measuring patients’ experiences (1).

Although engaging patients is good in itself, its real value lies in leading to more effective care and improved patient outcomes. Two figures to illustrate this: unengaged patients are three times more likely to have unmet medical needs and twice more likely to defer care (2).

ROI: Not fit for purpose

Measuring the “return” of patient-centric initiatives is a complex enterprise and this represents a severe obstacle for more and better initiatives. Despite much discussion and advocacy for patient-centricity, there is yet to be an agreement on how to measure its impact and benefits. The lack of consensus about the pharmaceutical industry’s performance metrics underlies the uncomfortable truth that the impact of patient-centric initiatives is not being assessed holistically and systematically.

Typically, pharmaceutical companies still use the Return-on-Investment (ROI) for decision-making regarding investments about patient initiatives. However, this performance measure does not seem to be fit for this purpose since it focuses on internal costs and the ease of implementation, failing to consider the broader impact of these initiatives and focusing solely on financial returns. Moreover, evidence points out that the cost or ease of implementing patient-centric initiatives does not always correlate with its impact (3).

Towards a new way of measuring impact

In order to find a way around the limitations of the ROI, we suggest shifting to the Return on Patient Centricity (RPC) instead. This composite measure takes into account 3 distinct dimensions of the benefits associated with patient-centric initiatives:

1) Return on engagement.

2) Ecosystem cost savings.

3) Reputational return.

1. Return on Patient Engagement

As mentioned above, patient engagement’s key benefits are better therapeutic results, improved patient outcomes, and better patient experiences in the care process. The good news is that at least in some diseases and/or therapeutic areas, there are existing tools to assess them:

  • Measuring patient’s outcomes through standardized Patient-reported outcome measures (PROMs) gathering disease-specific data to examine individual aspects of the condition and the impact of clinical and/or therapeutic interventions. In this sense, HCPs are naturally well-equipped to collect these clinical data.
  • Measuring patient’s experiences through Patient-reported experience measures (PREMs). PREMs are questionnaires that measure the patients’ perceptions of their experience whilst receiving care. Hospital pharmacists are well-equipped to collect these relational data (i.e., identifying key relationships with stakeholders during treatment) and functional data (e.g., use of available facilities or programs).

2. Ecosystem cost savings

Patient-centered initiatives report short- and medium-term economic savings for the healthcare system. Take the case of hospital managers and hospital pharmacists who consistently look for ways to optimize the cost-effectiveness of care in their hospitals.

Benefits such as fewer ER visits, more occasional no shows, shorter stays in hospitals, less resource-intensive hospitalizations, less specialist care, and better patient-doctor communication leading to time and cost-efficient visits may all amount to significant hospital savings, which in turn lead to potentially vast savings at a region or country level. In the context of highly strained healthcare systems, this is of great value to the healthcare ecosystem as a whole.

3. Reputational return

A company’s reputation strongly shapes the perceptions of healthcare stakeholders such as patients, HCPs, payors, hospital manager and hospital pharmacists. We are all witnessing this at the present stage of the pandemic.

Currently, pharmaceutical companies’ exposure is vast, and the value of investing in relevant initiatives that support patients’ engagement, reduce healthcare costs, and improve a company’s reputation is more than justified. Importantly, investing in your company’s reputation will strengthen your company’s strategic positioning and the willingness of stakeholders to engage with you in partnerships and acquire/use your products.

Beyond the actual measurement, using a more comprehensive metric to assess the impact of patient-centric initiatives emphasizes the benefits of patient-centric care for a range of stakeholders. In this sense, patient-centricity is much more than a way to increase patients’ engagement. Patient-centricity can also be the key to unlock the potential of collaboration with hospital managers and pharmacists. In fact, patient-centricity goes hand-in-hand with an ecosystem mindset in which pharma companies generate value for the ecosystem as a whole while occupying a central role in orchestrating a comprehensive approach to improve patient care and patient outcomes.

Looking for change?

At A Piece of Pie, we are committed to developing solutions that make a real difference in the lives patients while also fulfill the unmet needs of other healthcare stakeholders such as payors and hospital managers. We combine the social sciences with data science to understand what really matters to people, what needs to be measured and what the data is telling us.

If you are looking for ways to measure the impact of your patient centric initiatives in a more holistic manner, don’t hesitate and get in touch with us at


(a) In the referred survey, “health literacy” is defined as ‘the knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgments and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life throughout the course of life’ (4).


(1) Petersson, I. F. et al. (2014) ‘Development of healthcare quality indicators for rheumatoid arthritis in Europe: the project’, Annals of the Rheumatic Diseases, 73(5).

Betteridge, N. et al. (2016) ‘Promoting patient‐centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience’, Journal of the European Academy of Dermatology and Venereology, 30(4).

Dures, E. et al. (2017) ‘Important Treatment Outcomes for Patients with Psoriatic Arthritis: A Multisite Qualitative Study’, The Patient — Patient-Centered Outcomes Research, 10(4).

(2) Hibbard, J. H. and Greene, J. (2013) ‘What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs’, Health Affairs, 32(2).

(3) Stergiopoulos, S. et al. (2019) ‘Measuring the Impact of Patient Engagement and Patient Centricity in Clinical Research and Development’, Therapeutic Innovation & Regulatory Science.

(4) Sørensen, K. et al. (2015) ‘Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU)’, European Journal of Public Health, 25(6).

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