In the past nearly a year, AstraZeneca China has made many structural adjustments, with the county business bearing the brunt.
In addition to the split and merger of some disease lines, AstraZeneca has reorganized its huge county business. In November 2021, AstraZeneca split and divided the county business into the oncology business and non-tumor business, on the one hand, merged the oncology business of the county into the oncology division, and on the other hand, integrated the county chronic disease business and the retail, community, and flying eagle business to establish a new omni-channel business unit.
For this series of structural adjustments of AstraZeneca, the outside world generally believes that it is a strategic "retreat" that it has to take in the context of collecting and falling standards and reducing the price of medical insurance, and the focus of the retreat is the county market. As well as the split of the county business and the change of the main person in charge of the team, these seem to be the "evidence" on the table. More media said that this was a "rout" of AstraZeneca's grassroots strategy.
There is no doubt that grassroots strategy has been the main line of AstraZeneca China's development in the past 10 years, and it is also the most unique label of this multinational pharmaceutical company. So, whether this round of structural adjustment and personnel changes means a shift in the strategic level, how the newly established omni-channel business unit will operate, whether it is a simple department merger or there will be business integration and innovation, with these questions, we chatted with Liu Qian, vice president of AstraZeneca China and head of the omni-channel business unit.
△ Liu Qian, Vice President of AstraZeneca China and Head of Omnichannel Business Unit
Shift from high-altitude sowing to intensive farming
Founded in 2015, AstraZeneca's county team was one of the earliest multinational pharmaceutical companies to deploy grassroots.
At the beginning of its establishment, this team was only a few hundred people, but from 2019, with the country's emphasis on graded diagnosis and treatment, the vast grass-roots market has become a must for major pharmaceutical companies. AstraZeneca has rapidly expanded with the innate advantage of more drugs and earlier start-ups, and by 2020, the county team has covered 1850 counties in 28 provinces across the country.
Even now, AstraZeneca is still the only foreign pharmaceutical company to have all county representatives stationed in the county. Liu Qian told Eight Point Jianwen that the biggest gain in the past 3-5 years of deep cultivation is not how many drugs have been sold, but that AstraZeneca has a more accurate understanding of China's county market, from the population, economy, and medical insurance policies of the county to the local medical environment and medical habits, and these cognitions are groped out in countless attempts and do not exist in the database of any consulting company. It is also based on such insights and cognition that there will be this adjustment of the county business.
△ Liu Qian was photographed on a business trip, and now the county town is not the backward economic conditions that people imagine.
"Our main thing is to adjust our business model. In the past, we all felt that the county was relatively backward and the economic conditions were limited, so we were more from the perspective of solving the economic burden of patients, or cooperating with the local government, hoping to improve the local medical level and medication level relatively quickly. This works, but it is not enough. ”
For example, Liu Qian said that in the past, the common scene was to support the county government's disease screening and integrated diagnosis and treatment management projects, and also invited experts from provincial and municipal hospitals to give lectures in the county, in this way to help improve the diagnosis and treatment concept of grass-roots doctors. But later they found that although the Health Commission and the county hospital actively promoted, the following doctors still did not dare to use the new means of diagnosis and treatment after returning, and in a few days they would retreat to the old road. He calls this model "flying an airplane to sow seeds on barren mountains," and although it can sprinkle thousands of acres of land a day, the survival rate of seeds is very low.
"Medical care is still a very rigorous field, it is not as we think, relying on government projects and expert endorsement can be changed, grassroots doctors still need to maintain regular exchanges with him, pass on academic concepts, in fact, this is also the academic promotion model in urban hospitals."
Liu Qian said that in order to turn "high-altitude sowing" into "relatively fine artificial farming", AstraZeneca will take some strategic adjustments to strengthen academic promotion, especially in counties with large market potential.
"This will inevitably involve the layout of the company's county business and the corresponding post adjustment, but it is definitely not what the outside world calls a 'strategic retreat'." The county market is still an important position for AstraZeneca, and you can understand that we want to do something thoroughly. Counties that were previously laid out will still be stationed to ensure access to medicines. AstraZeneca's product prices are already very grounded, and the vast majority of them are also in the medical insurance and basic drug catalogs, which is very suitable for the drug demand of the grass-roots market. Liu Qian said.
The essence of pharmaceutical retailing is service
In addition to the county market, the retail business is also a hard bone to be gnawed upon after the establishment of the omni-channel business unit.
In the past few years, with the expansion of the national collection policy and the rise of pharmaceutical e-commerce, offline retail pharmacies have been attacked by the enemy and the situation has become more and more difficult. As the largest segment among the four business units of the omni-channel business unit, how to improve the performance of the retail end is the topic that Liu Qian thinks about the most after taking over as the head of the omni-channel business unit.
"If patients go to pharmacies just purposefully to buy drugs, what happens is just a transaction behavior, and retail pharmacies are only used as a channel to sell drugs, then doing such an action wants to continue to make high profits, which makes no sense." Retail pharmacies are now slowing down, and in essence, there is something wrong with the model, and we must think about how to create greater value for patients, especially some online transactions cannot replace the value. ”
In Liu Qian's view, retail pharmacies are mainly engaged in chronic disease drugs, and should look for breakthroughs in chronic disease management. There are many retail pharmacies that are also talking about "membership management", but just by sending text messages to patients and reminding them to repurchase when the drugs are running out, they are far from qualified chronic disease management.
"The idea we're proposing now is to empower retail pharmacies to be transit points between patients at home and in community health facilities. For patients with chronic diseases, go to the hospital once in 3-6 months, so in normal times, if you are uncomfortable, want to consult, or do a simple examination, can you solve it through the terminal of the pharmacy? Chinese are actually reluctant to go to the hospital, so why don't you make a "light medical service" outlet that everyone is willing to come to. ”
It's easy to say, but it's not easy to do. Most retail pharmacies, due to cost and business scope considerations, will not allocate professional medical personnel, and naturally cannot undertake medical consultation and chronic disease services. At this time, the role of the establishment of the omni-channel business unit is reflected, through internal resource coordination, AstraZeneca hopes to support the promotion of community health agencies and retail pharmacies linkage, from the management of chronic diseases from one kilometer away from home (community hospital) to one hundred meters away from home (pharmacy), to meet the needs of patients at the doorstep of the consultation.
Liu Qian said that this model is in the process of pilot promotion, and if successful, it will be another successful case of AstraZeneca's backward model innovation from mechanism innovation.
Patients are found at the most basic level
Compared with the county and retail businesses, the community and the flying eagle, a capillary rooted in the city, a remote corner covering the countryside, are all more grass-roots medical diagnosis and treatment units, but also with a more grass-roots personality label.
The fault of diagnosis and treatment capacity is a common disease in primary medical institutions, especially in township health centers and village clinics, which are the third terminals far from the city. In the past year, Liu Qian has traveled hundreds of times, mostly in remote areas such as Guizhou's Qianxi County. In these places, although the material standard of living has improved rapidly, patients who have lost their sight or even amputated due to improper treatment of diabetes can still be seen.
"From our observation, at the level of the township health center, its diagnosis and treatment capacity is even regressive compared with 20 years ago." Doctors with highly aged knowledge can simply see a headache and brain fever or treat a wound, and even the most common chronic diseases such as diabetes and hypertension are not actively treated and managed, and will only continue to prescribe drugs. ”
The reasons behind this are, of course, varied. Patients are running to county hospitals or even third-class hospitals, poor treatment in the townships cannot recruit qualified doctors, and the health awareness of the grass-roots people is weak. These seem to be the old and difficult problems that have plagued medical reform for many years, but whether it is from the perspective of the country's strong grass-roots policy or from the perspective of protecting the lives and health of the people, such a situation needs to be changed as soon as possible.
AstraZeneca's strategy is to use the Internet to support the promotion of content education for grassroots doctors. Liu Qian believes that the needs of a village doctor and the chief doctor of a county hospital are different. Doctors at the level of county hospitals need to understand the mechanism of disease and corresponding drugs, as well as more cutting-edge treatment concepts. But for a village doctor, he only wants to know what the symptoms of the disease are, what medicine to treat, what effects and side effects. "But now the vast majority of online medical education platforms are doing academic promotion of clinical trials, and there is a huge knowledge gap between the two."
Similarly, this matter will become easier after the establishment of the omnichannel business unit. After the county chronic disease, community, flying eagle and other departments are opened, the doctor education and product promotion of these grass-roots medical institutions can be integrated, and with the policies of the national medical community and the medical federation, the county hospital experts can answer questions for the grass-roots doctors from the clinical operation level.
For AstraZeneca, such an attempt is also conducive to the deep development of the grass-roots market. For example, there are about 120 million people with diabetes in China alone, but less than a third of them are actually treated. The remaining more than 80 million patients, many of which are scattered in rural areas with relatively poor medical resources, AstraZeneca hopes to truly benefit these grass-roots patients by helping to improve the diagnosis and treatment of grass-roots doctors and chronic disease management capabilities.
Primary care in China has a lot to offer
Since its official establishment on January 1, the omni-channel business unit has been running smoothly for two months.
In terms of scale, it is a large business group of more than 3,000 people, which includes almost all products except tumors in all sales channels of AstraZeneca except for the core hospitals in the city, accounting for one-third of the total sales volume in China. According to Liu Qian's estimates, if all goes well, the consolidated omni-channel sales will increase significantly compared with last year, and per capita productivity will exceed other markets.
Liu Qian's optimism comes from the integration effect between departments. The four major departments under the jurisdiction of the omni-channel business department, county, retail, community, and flying eagle all belong to the category of "big grassroots", with similar business scenarios and more resources that can be deployed. At the same time, the pain points of the grass-roots business are similar, nothing more than weak diagnosis and treatment capabilities, outdated treatment concepts, lack of chronic disease management tools, etc., which also means that once a department has a new creation and invention, it can be used by other departments.
"Being able to integrate together to do things that are more common across channels is why it is important to set up this business unit." We still want to run this model through, to prove that the grass-roots channels are not only promising, but also promising, compared to the urban market that has been killed into the Red Sea, here is still a blue ocean. If this reclamation is successful, it will have a great role in promoting the entire industry. ”
There is no shortage of returns for betting on primary care in China. Not long ago, AstraZeneca announced its 2021 financial report. In the past year, AstraZeneca has achieved revenue of US$6 billion in China, ranking first among all foreign pharmaceutical companies. In terms of proportion, AstraZeneca's revenue in China accounts for 16% of the world's total revenue, which is also far ahead of other multinational pharmaceutical companies.
The adjustment is for a better departure, and as for where this road can go, it is still too early to judge. But looking back, like AstraZeneca's several "wilderness"s in the past, success or failure, it is always pushing the industry in the right direction.