By Susan Connelly, PharmD, MBA, CHCP, FACEHP, (Pfizer); Tamara Cooper (Lilly); Joan Emarine, BA, (Celgene); Jill Erickson, MPH, RD, (Takeda); Shunda Irons-Brown, Ph.D., MBA, CHCP, (Novo Nordisk); Patricia Jassak, MS, RN, FACEhp, CHCP, and Riaz Baxamusa, MBA, CHCP, (Astellas); Pamela Mason, BS, CHCP, FACEHP, and Sue McGuinness, Ph.D., CHCP, (AstraZeneca); Henry Rodrique (Merck) and Gail Triggs, MS, (Vertex)
This article highlights, from industry supporter perspectives, how the scope of what supporters are likely to fund has or has not changed over the last 10 years. In thinking of their programs and how they’ve evolved over the last 10 years, it was noted that, in 2006, most industry grants supported traditional forms of continuing medical education/continuing education (CME/CE). Some supporters were only able to provide grants to accredited CME/CE providers, and some remain under those same restrictions, while others were always able to support both accredited and non-accredited independent education. Some review multiple types of activities, such as quality improvement (QI), performance improvement (PI), research or patient education. Some of these funding requests fall under the same umbrella as CME/CE funding, while others fall under separate departments. It should be noted that industry supporters consider multiple factors when making support decisions beyond the type of request submitted. Grant requests are typically evaluated on several criteria (e.g., area of educational interest; educational strategy; educational needs and gaps; adult learning principles and preferences; budget; quality landscape/measures, business alignment, etc). The following key areas were examined: funding beyond traditional IME, changes over time, review of grant requests, evolving expectations, program evaluation, partnerships and thoughts for the future.
Beyond Traditional IME
A group of industry supporters were asked if they currently funded projects that would not be classified as “traditional CME/CE,” such as QI, PI, research or patient education. All those interviewed supported activities other than traditional CME/CE. It was noted that for those who support a wider range of activities, there should be an educational component within the request. All but one company indicated they support QI/PI projects (Lilly supports minimal QI and no PI). A number of companies (AstraZeneca, Astellas, Celgene, Merck, Pfizer and Takeda) are open to research projects. Patient education is considered by most but supported through other departments for Lilly, Astellas and Celgene.
Change Over Time
While there can be no argument that change is expected in any 10-year period, that change can be dramatic or gradual. When asked how the scope of their grant funding changed between 2006 and 2016, half described a gradual change, while the other half described points in time where they made purposeful efforts to change the mix of grant types funded. One company noted they weren’t even funding medical education in 2006. It is interesting to note that two companies described efforts to increase funding of PI programs but, based on reported outcomes, abandoned that strategy. For those noting a gradual change, all felt the changes were strategic in nature. When asked if grantors dedicate portions of their budget to programs not classified as traditional CME/CE, most indicated they do plan out their budget in some fashion based on a strategy. Three companies indicated they evaluate each request as received, noting that they don’t make predetermined decisions as to the mix of traditional CME/CE versus other programs funded.
Review of Grant Requests
Looking at the current landscape of how grant requests are reviewed, industry supporters were asked if they have a separate review process for different types of projects or if all submissions were reviewed through the same process. And if they did use the same process, they were asked if they used different criteria for different project types with regard to decision making. Only two companies (Pfizer and Celgene) have different processes for some grant types (fellowships and early translational requests for Celgene, all grant types for Pfizer). The rest use the same process for all grant types, while a couple (NNI and Merck) use different criteria for some requests (such as QI and research) and others (Takeda and Astellas) use expanded review panels for these requests. External reviewers are also used for some grant types (Pfizer and Vertex).
Grantors were asked about their expectations of grant applicants today and how they differ from expectations held in 2006. It was noted that expectations have moved beyond compliance concerns and are much more centered on the requestor’s ability to move beyond a cookie cutter proposal approach. What is critically important is that the requestor clearly articulate the needs assessment including data and analysis from a patient, provider and systems perspective (including financial incentives/drivers) and describe succinctly how the educational initiative will prioritize and address the identified knowledge, competence or performance gaps.
Expectations related to evaluation plans have evolved over time as well. Evaluation plans are critical and instead of seeing a simple description of what “level of outcome” the grant intends to measure, showcasing examples of previous outcomes can bring clarity to the reviewer related to the success of previous similar programs. Supporters have made increased efforts to take into consideration during the decision process the appropriateness of the outcomes evaluation assessments to measure the proposed program. Supporters expect more robust outcomes and the use of innovative technology to create a positive learning environment. An example includes patient education programs interwoven within the HCP education. Outcomes from previous programs have greatly influenced a supporter’s willingness to fund future programs. It was noted that some previously funded costly QI programs did not deliver adequate detailed outcomes and thus failed to provide impact and value.
Partnerships are often critical in more complex initiatives, and supporters want to feel confident when evaluating proposals with multiple stakeholders that the partnerships are strong and solidified during the submission process, not aspirational to occur following approval. One supporter noted that while in the past all grant applicants were individuals from a CME/CE office, today individual applicants range from researchers and clinicians to patient advocates, in addition to those hailing from a CME/CE office. For this reason, it can no longer be assumed that the applicant will use a common “lingo.” The applications must be assessed to ensure the authors do in fact have expertise in what they are describing. This involves comparing the authors’ credentials to the methodology proposed. Another supporter noted they still encounter requestors that do not fully understand what is being requested (e.g., questions about what is a needs assessment) on their application. As educational methodologies evolve, the costs of initiatives increase and it becomes important for grant applicants to be able to show 1) they have the structure in place to ensure success of the initiative; 2) they have the experience of successful implementation; and 3) they can clearly describe what the anticipated outcomes will measure. In addition, as geographic footprints expand, supporters are finding their expectations are modified depending on the origin of the applicant and are going back to basics in some areas, giving examples of needs assessments and expectations on program outcomes.
Simply put, as grantors continue to evolve along with the external environment, it is the expectation that the grant applicants and their proposed concepts will do the same.
Supporters were given the option to provide a few comments that they’d like to share with the readership. It was noted that IME continues to evolve over time. As we move forward, it will become increasingly critical for industry supporters to demonstrate the value and impact of our programs as we compete for company resources. Accreditors and educational partners can assist the industry by keeping this end goal in mind while developing innovative programs to close healthcare gaps. HCPs will have to demonstrate the impact of what they learned from programs by improving patient outcomes.
With the changing healthcare environment, non-traditional CME/CE will continue to play a vital role in the CME/CE community. There will be expanded roles for patient education. Learner preferences and technology are evolving. Our focus as educational providers and supporters must be to evolve to meet and anticipate the needs of the learners. QI can be difficult to do in areas where guidelines rapidly change, there are no clear consensus guidelines, or quality measures do not exist. When reaching out to expand into new areas, it’s important to consult with those that have expertise in that area and involve them throughout the planning process. Independence and accreditation will play a larger role in the global environment.
There will be expectations that higher level outcomes be demonstrated across grant types and that HCPs will be engaged through new technologies and activity formats. Requestors will be expected to aggregate more of their own data to illustrate how their activities are closing gaps or changing HCP behavior or elevating patient outcomes. If similar grants are requested each year for local/regional/ national type programs, requestors will be expected to describe what they have accomplished over time and how it is differentiated from other similar activities by another provider/requestor. It is possible the audience mix of activities may be altered in the future as the payer environment shifts/evolves with the potential repeal of the ACA, etc.
Be creative, innovative and thoughtful; look to personal experiences and strategies and tactics employed by other industries when developing educational concepts; determine the root/basis of an educational or practice gap first and design from there; think quality.
We have evolved as an education community in significant and positive ways since 2006. We cannot stop here. The healthcare environment continues to rapidly evolve, and we need to do the same. We must be constantly questioning how education can best be a catalyst for healthcare improvement and, importantly, remembering that we cannot do it alone. As supporters or providers, we need to actively invoke a learning mindset at all times. Learn from patients, providers, health systems, payers, government, other functions and business units within our organizations and from outside industries. Learn not just from reading, going to conferences, etc., but from meeting with diverse healthcare stakeholders and discussing issues in compliant ways. As we share our education expertise with others and they share their perspectives and expertise with us, we will form powerful partnerships to drive change and impact care in meaningful ways. This continued learning and application will further evolve the structure of our teams and how we support medical education in the future. As a community, let’s embrace this opportunity to keep evolving and improving the work we do.