Editor’s Note: In the fall of 2022, GreenBook’s IIEX Health event took place in Philadelphia, bringing both useful and inspiration content to insights and analytics professionals spanning the healthcare, pharmaceutical, medical, and wellness industries. Attendees found the content so valuable that we wanted to make much of it available to all who could not attend this in-person event. Don’t forget to sign up for the upcoming IIEX Health event now!

If you aren’t in those industries … how might you apply the learning within your own? At GreenBook, we believe that IIEX is more than a conference series. It’s a mindset. These are the forums in which the most important insights innovations are revealed, demonstrated, debated, and championed. What starts at the events drive change in our world. It is in that spirit that we bring you, directly, some of the poignant content we heard at IIEX Health.

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Enjoy our On-Demand Video

Jonathan Weiser, Vice President and Healthcare Practice Lead at Buzzback, and Courtney Rice, Principal at Acadia Strategy Partners, to discuss the health implications of the overturning of Roe v Wade. Click to view the video (courtesy of Civicom).

View more 2023 IIEX Health content!

Whether you were able to attend, or you were not, join us online to see what was shared by some of the biggest brands, the newest startups, and expert-level researchers across healthcare, pharma, and consumer experience. Here’s just two of the amazing sessions you’ll find on-demand:

Online you’ll find other fantastic sessions by speakers from Pierre Fabre Group, Novartis, Hinge Health, and more! If you want to stay on top of the trends in the healthcare industry — one of the largest spends in market research — you won’t want to miss IIEX Health!

Not familiar with the Insight Innovation Exchange (IIEX)?

Ten years ago, GreenBook embarked on a simple idea: Could we create opportunities for market research leaders to share ideas and collaborate to define the future of insights?

If there was something new to our industry — a company, methodology, or platform — that didn’t exist 10 years ago and is now considered a “best practice” … well, you probably saw it first at an IIEX event.

What starts here will change our world!

Transcript

(Transcript courtesy of TranscriptWing)

Diana Manfredi: All right. Welcome back everyone. Good, my mic is working. So, I’m Diana Manfredi. I’m going to be your host for the next five sessions. I’m a local health care consultant here in Philadelphia. I’m very pleased to introduce the first session of  this track called the Unintended Consequences of Reversing Roe v Wade. With the overturning of Roe v Wade, there has been speculation and anecdotal evidence  that there will be unintended impacts on primary care in the United States. 

Through research with PAs and MPs in primary care and O-BGYN practices, Buzzback has captured and quantified some of the unintended implications providers and patients may face. So, please welcome Jonathan Weiser, Vice President and Healthcare Practice Lead at Buzzback, and Courtney Rice, Principal at Acadia Strategy Partners. Welcome and thank you. 

Jonathan Weiser: Hi. Well, thank you all for joining. As mentioned, I’m Jonathan. I lead our healthcare team at Buzzback, and this is Courtney. We have been working together  for years. Courtney has been my client and partner in crime in this. So, Courtney, if  you want to say a few things.  

Courtney Rice: Yes. I’m a 20-year strategy consultant working primarily in this specialty space. A lot of work in rare diseases as well and partnered with Jonathan primarily for many, many reasons. There isn’t a primarily, of course, but we’ve had great  experiences with the quant-qual approach so that we sort of satisfy everyone on  our own internal teams. 

Jonathan Weiser: Great. We’re going to talk today about a pretty big issue. We are going to focus not on politics, but really on the health implications of the overturning of Roe v Wade. There are few things we want to mention as well. These findings that we’re going  to take you through today and some of the implications are very, very early. This is something that’s in the first few months of inception. We also want to talk today about – typically, we work with a lot of different clients. We have a lot of very, very specific business implications. This is a case where we’re going to focus a little bit more about some of those downstream unintended consequences, unintended  implications, and really get to the point where we think about overall market  disruption. 

We went out to both HCPs and patients; we’re going to focus a little bit more on  our HCP research. We looked at things by specialty, by gender, etcetera. I would  say one of the more interesting analysis that we did is we looked at physicians in different states based on whether abortion was legal, banned, if there are  restrictions, or pending, and we’ll see that this has a lot of specific implications.  It’s even going to talk about sort of that cross-border approach to care. 

We are going to go first talk about very high-level perceptions and early  experiences. It’s not surprising, we’re going to see that this really, really varies a  lot based on who people are, what they believe in, where they live. Then we’re  going to focus on three key areas. Courtney’s going to talk about the increase in  mental health concerns that we’re seeing from patients. We’re going to talk about  the shift in patient physician communication and what that is looking like. We all  know that patients and physicians have very little time together, and the impact on  that conversation and that shift has downstream effects. We’re going to talk about  more tangible and more measurable changes in the contraceptive market. Then  we’re going to take a bird’s eye view, think about what this means for the industry.  Frankly, we’re going to ask you all to talk about what you have started to see in  your business. 

So, as I mentioned, we’re going to start with just some very high-level differences  of what we see. This is where we start to see things, sort of not surprising. Those  who are more conservative, males, et cetera, and this is both with HCPs, and  patients tend to see that there’s going to be – or feel that there’s going to be less  impact on their practice, less impact on their health. This is a more concrete  example, which I think is very interesting when we look and compare OB-GYNs to  PCPs in particular. So, we actually see that OB-GYNs are far more likely to have  already seen some of the impacts in their practice. This is where you start to see  things that are kind of fairly obvious, fairly what you’d anticipate or expecting. I  think when we start to look at things that are a little bit more behavioral based  and a little bit more with the lens of where people live and where they practice, things start to get a little bit more interesting. So, I’m going to call out a few specific things. We see that 78% of those who are – this is HCPs – who are in states  where abortion is legal, are willing to treat patients from another state. We also do  see that 57% of HCPs and banned are willing to recommend that out of state care.  Actually, we see that about 20% of HCPs in legal states have actually started to  treat patients from other states. 

What does this mean? So, you start to see a little bit more of this sort of cross  border approach to care and you start to see – you get to the point where people  are used to relying on their local health care providers, etcetera. The reasons that  we’ll talk about, that is possibly shifting a little bit. Another point that I think – as  we think about what could impact some of this cross-state approach to treatment,  we actually found that nearly half of OB-GYNs, that they would consider relocating  if there are essentially more things imposed, restrictions, et cetera. So, we start to  get a sense of not only could this impact where people are getting their care at the  moment, but down the road, it could ultimately impact this supply and demand of  where health care providers provide care. Now, I’m going to turn over Courtney  who’s going to talk a little bit more about the impact on patients’ mental health.  

Courtney Rice: Good. All right. So, patients’ mental health may see a decline as their uncertainty  grows about their medical rights. So, 61% of physicians – and we’ll just put this in  perspective. The Dobbs decision came down June 24th. So, this is very fresh  movement that we’re monitoring here, kind of nascent trends, and only time will  tell where they go, but physicians are seeing an influence on patients’ mental  health. I think the interesting thing here too is, because there’s a – it’s a shifting  landscape and we don’t know exactly where the laws will land in any given state  and what the requirements are around seeking care outside of that state, or also  mail order, there’s a lot of complexity. So, we see that reflected in HCPs’ sense  that patients are reticent or less willing to be forthcoming. That could relate to a  past procedure, things like that, where they’ve gone across state lines or leveraged  telemedicine or mail order or whatnot. 

So, we just see – this goes back to Jonathan’s point about changing landscape in  how that brief 10- to 15-minute interaction with a physician is changing and what it  sends to the periphery, I think. 

All right. So, we see “In their own words… provider perspectives.” I think the interesting quote here is – some of these clinics that deal with unwanted pregnancies are already stressed and in demand, and then when you add to that,  this idea that folks are traveling across state lines, you threaten to further stress  and already – it already stretched thin provider population, and we heard that from  multiple HCPs. It’s just sort of the changing nature of this in the last 4.5 months or  so. 

Good. So, “Patient concerns mirror HCPs.” All this just reflects – these are not  shocking per se, but it reflects we have over half of respondents saying that they’re worried about the future of their medical care. 46% report feeling on the edge  regarding their reproductive health care. It’s all uncertainty, right, and that’s  where we see this sort of anxiety. I don’t know what I can say to a physician versus  what I can’t. Physicians – and we’ll talk about this in a moment – aren’t even sure  how necessarily to advise patients. Is there some liability or concern about  referring to someone out of state or directing them or steering them towards  alternative access to care? 

Jonathan Weiser: Great. So, thanks, Courtney. Courtney spoke about the impact on patient mental  health. I’m going to kind of take that one step further and dive in to get a sense of  how that is impacting, as we mentioned, the conversation. So, Courtney  mentioned, I mentioned earlier, typically you have about 10 to 15 minutes with a  physician, frankly, sometimes a lot less. What we see now is that physicians are  having more conversations about contraception. They’re advising patients about  their rights. If you think about this, this is something that physicians haven’t  typically had to do as part of their roles. They’re having more sort of earlier  discussions about family planning. I think what is interesting here, about 50% are  having more in-depth conversations with patients who don’t want children, with  younger patients, and I think that’s really interesting here. So, Courtney mentioned  that patients are a little bit more reticent to share this information. We’re seeing  here that there might – could be more conversations that are happening. I think  what this demonstrates is that even if there are more conversations that are  happening, the information that people share, so think of like the quality of the  conversations, may be at risk. So, it may be that there are certain cases, like, let’s  say a woman goes across state lines to receive care. Is that woman going to come  back and share that information with their doctor? So, I think questions to be  determined about sort of what riff in this conversation would exist.

Another key area that came up is that we saw that there was a sizable proportion  of OB-GYNs who are actually having conversations. Not just more conversations  with their patients but with their HCPs within their practice to try to really figure  out how do they address this. When we looked through some of the qualitative data  that we collected through this, we almost got the sense that a lot of health care  providers are kind of scrambling. Again, as I mentioned, this is giving them sort of  responsibilities that they previously haven’t had in their role. They are physicians,  they’re not legal experts, policy experts, et cetera. So, this whole element, they’re  trying to figure out what they can and can’t do. How do they ultimately provide the  best care is something that they are also trying to figure out in this moment. Now,  Courtney is going to talk again about some of the more kind of measurable  differences, shifts that we’ve seen in the contraceptive market. 

Courtney Rice: Good. Now, to add to what Jonathan just said. Traditionally, and I’m speaking with  market researchers, we’ve understood HIPAA as this umbrella, this sort of safety  umbrella. Now it’s getting more complex, right? Because beneath HIPAA, you’ve got  all these state-by-state rules. We’ve got cross state travel, those kinds of things.  So, it is getting complex. I laugh because we say it’s another thing to put on doctors  because they have a lot of free time, right? So they can absolutely take on  becoming a lawyer at the same time. So, what we’re seeing here, changing sort of  demographics in the conversation but also changing nature.  

So, HCPS report patients are asking about contraceptive methods and they’re prescribing more and expecting additional changes. Long-acting reversible  contraception, we may see sort of resurgence in the IUD. It’s had a different kind of  evolution over the years. There’s the early 70s for those that remember the Dalkon  Shield. That’s quite a ways back. But we’ll see these longer acting. We may see  these longer acting birth control methods experiencing sort of a resurgence. As you  see here, just increase in dialogue, proactive, earlier and younger, longer acting.  Those are the kind of takeaways from the type of birth control changes we’ve seen. 

Again, shifts and contraception, long acting reversible. There was some discussion  of sort of non-reversible and with younger patients, that brings up all kinds of  ethical quandaries. So, another thing to add for the physicians with all their free  time. Then this idea that younger patients are coming in and they want longer term  solution. So, it’s not just a typical birth control pill conversation. It’s a little bit  wider than that and it’s about sort of securing or preserving access. Just not knowing what’s coming next. We’ll see this, I think the next slide talks – yes. So, again, these conversations are happening pretty early in the visit. They’re  happening on every visit. Whoever initiates them – it was sort of a mix – it was half  and half whoever initiates it, but it is getting done. I thought it was interesting  here as well that they mentioned “I expect Plan B will also become illegal or very  hard to access.” Plan B is over the counter. So, again, it just underlines there is a  lot of uncertainty here. We don’t know what’s going to happen in a given state, but  that uncertainty leads to anxiety and we’re seeing it in these kind of mental health  questions that we asked. 

Jonathan Weiser: Fantastic. So, we’re going to talk through a few sort of high-level implications. I  mentioned this earlier. We’re going to also ask the group to talk about if you have  seen, whether it’s in your business life or personal situations, implications of this. I  think part of the interesting aspect of doing this is recognizing that – as I  mentioned earlier, in a lot of client specific projects, we have very specific  implications that we’re trying to measure, and this is something a little bit more  broad here. So, Courtney’s going to talk about these first few. 

Courtney Rice: Sure. So, the focus on prevention, right, is just doubling down on the idea of  preventing unwanted pregnancies, knowing that other options may not be available  or at least their certainty is not guaranteed. Greater need for mental health  services. Again, we interviewed or we surveyed women of childbearing age, so I  don’t know that we can comment necessarily on folks that are not women of  childbearing age, but I think this just sort of compounds – we’re emerging from  COVID and these mental health issues are there and they take up time in an  appointment. So, you have to kind of wonder, “All right. What else gets pushed to  the periphery?” Right? Is it breast health? I don’t know the answer, but we’re going  to see these trends play out as time progresses. Then finally, just the timing and urgency. As I said, someone’s bringing it up, right? As an appointment starts,  someone’s bringing it up. Whether it’s the HCP or the patient, it doesn’t really  matter. It’s sort of front and center right now because of that uncertainty. 

Jonathan Weiser: A few other kind of implications that we want to talk about. These are a little bit  more kind of even bird’s eye view. So, one thought is, we anticipate – I think the  research has showed that there will be more unplanned pregnancies, complications, maternal mortality, One thought that I had, so we work with a lot of  clients, let’s say in the pediatric vaccine space. So, if I try to put myself in their shoes, we may recognize or they may recognize that there could or likely will be a  cohort of parents that maybe didn’t spend as much time planning, etcetera. So that  group of sort of unplanned pregnancies that arises, what does that company then  need to do to engage parents about pediatric vaccines, etcetera? So, just trying to  think through some of the more indirect consequences. 

Again, we talked about the geographic shift of both sort of where patients are  getting their care, but then where physicians may choose to practice. So, think  about physicians who are, let’s say, graduating medical school. Are they more likely  to go to certain states, whether it’s legal or not legal based on their personal  opinions or the care that they want to provide, etcetera? These are just things that  as we kind of take a step back and think about what does the geographic landscape  look like for where women get their care, how much is that going to shift in the  upcoming years? We also have been thinking a lot about telehealth in the last few  years, especially with covid. I think my personal view is something like this is going  to further solidify the role that telehealth has as you think about people crossing  state lines, etcetera, and just sort of recognizing what does that mean for our  clients. So, if you’re in primary care in certain areas or even if you’re in more  specialty care, how does that impact what you do? What does that look like? I think  the world’s been kind of figuring this out for the past three years. I think this is just  one example of something that could kind of further solidify this trend. 

So, as I had mentioned, at this point, we have, frankly, probably more questions  than answers. This is so new and, frankly, so groundbreaking and so different from  most physicians what they have been trained. So, I think we want to sort of hear  from you out there. Have any folks sort of seen anything or have your businesses sort of talked about the impact that this could have on your wider business? Yes,  yes. 

Courtney Rice: [Laughter] The meet in the middle approach. 

Female 1: I’ll just mention two. One, because I’m also an academic and teach at the university  here, the choices that young women will now make when it comes time to choose  the university, are they going to a place where they can get care? Then also, I’ll  relate to something to industry back in the day. I was at Merck where I worked as  one of the recruiters to bring people into the company. There was a time when  pregnancy care in the Philadelphia area was practically nonexistent. It was very difficult. OBs were dropping out of practice and doing only GYN. So, a young  woman could not count on OB care should she become pregnant, and it was one of  the challenges that we faced in recruiting young women at the time when we were  – actually, we were trying to become a more diverse workforce and that was one of  the things in our way. So, I just mentioned those two. 

Courtney Rice: Wait. Glenna is not a plant, but that is a fantastic story. I just want to be clear, I  do know her, but that was not a plant. The recruiting implications because we  talked a lot about the business implications. 

Jonathan Weiser: I would just say, to point one, the financial times had an article, I think it was  either late last week or earlier this week that Courtney sent me about how  employees at Eli Lilly are coming together to think about switching locations and  things like that, and I get the little anecdote of talking to my sister about where  my 16-year-old nephew may go to college and I went to Wisconsin, and I was like,  “Oh, that’d be exciting.” She had kind of gave me a look and said, “That could be a  little bit threatened now in this point.” Even as a male and I think that’s really  interesting, that shift and where people choose to have their jobs, get care,  etcetera. I know that Courtney has a few other examples as well. 

Courtney Rice: Where physicians, I think, to choose their fellowship training as well. If you were to  go for OB-GYN fellowship training, will that influence your decision? I think – poor Jonathan, I’ve been blowing up his phone the last couple of weeks. “What a great  topic. Look at this.” So, there are 30 companies, generics manufacturers in a  region of India that produce mifepristone, which is what we used to know as RU 486, I recognize I’m dating myself with all these references, but nevertheless,  they’re seeing demand. Direct dropship, they got to do it quick. They got to get  over borders quickly, right? Time matters. But also, we’ve been talking so much  about shifts among states. We’re seeing shifts that are shores, and there’s even  specific instructions on how to label these packages coming in so they’re not  intercepted. So, this is global, right? There are some business implications and  repercussions on outside of the States in which the decisions are being. 

Jonathan Weiser: Absolutely. Anyone else have any thoughts about…? 

Denene Rodney: Yes. Good morning. I’m Denene Rodney, Zebra Strategies. I don’t know if I heard – we know that this reversal will impact poor women of color the most, right? So, I’m wondering if you had any insights. I didn’t see that the data was cut up around  that. If you have any insights around that speaking to the physicians. 

Jonathan Weiser: So, we actually looked some of our patient data and that came up a little bit more  clearly. We’re going to share that next week a little bit more in the webinar, but  we did see that. When looking at the women data, women of color were far more  concerned about impacting their access to future care. That came up clear, physicians seconded that as well. So, I think as you think about the impact on  disparity, that definitely came up through. I think… 

Denene Rodney: The socio-economic issues too, I suppose. 

Jonathan Weiser: Absolutely. 

Denene Rodney: That women of color that are going to be more largely impacted by this, right? 

Jonathan Weiser: The emotional impact as well was something that’s shown out there. So, I think  those few points, definitely, are something that we’ll be highlighting in next week’s  session. 

Denene Rodney: When we think about prioritizing the implications and the disruption, we have to  kind of center that because they’re the ones that are going to be the most  impacted by it. 

Jonathan Weiser: Yes, absolutely. Thank you. 

Courtney Rice: Good point. Great. 

Female 2: One quick question from the app and then we’ll have to wrap.

Courtney Rice: Okay. 

Female 2: You mentioned that 40% of OB-GYN in legal restricted states may move if their state becomes more restrictive. Did you break that down by practice profile, i.e., more OB versus GYN and any differences?

Courtney Rice: We did not call it… 

Jonathan Weiser: We have not. We have not looked at that in terms of OBs versus GYNs. It’s  something that we could – yes. It’s something we can certainly look at and see  what that could look like. 

Female 3: All right. Well, thank you very much. 

Courtney Rice: Good. Thank you. 

Male 1: I’ve got one question. [Unintelligible]. If an OB-GYN is leaving that state, they’re  taking all of that care with them. Not just the OB, they’re taking GYN here too. 

Jonathan Weiser: Exactly. 

Male 1: Interesting data. 

Jonathan Weiser: All right. 

Courtney Rice: Thank you. 

Jonathan Weiser: Well, thank you. 

Diana Manfredi: Jonathan and Courtney, thanks so much. 

– End of Recording –