A newly reorganized Pfizer Medical Education Group will now rely on a request-for-proposal application model to allocate approximately 90 percent of its budget for medical education. The other 10 percent will be used to support traditional annual conferences.

According to the MEG’s team lead Maureen Doyle-Scharff, MBA, FACME, CCMEP, the inefficiencies of the old model, which relied mainly on unsolicited grant requests, drove the need to develop the new, mostly RFP-based model. “Our old model was very passive, and it just wasn’t getting us as close to where we want to be in terms of impact fast enough,” she says. The MEG had been receiving between 3,000 and 4,000 grant request proposals annually, with about a 30 percent approval rating. With the new model, Doyle-Scharff expects that number to drop to well under 1,000 per year.

Although the group posts the company’s clinical goals and areas of interest on its Web site and holds a “First Friday” series of webinars to clarify what types of proposals it seeks to support, Doyle-Scharff says that the 70 percent that weren’t making the cut weren’t aligned with those goals or clinical areas, weren’t of sufficient quality, or didn’t focus on educational strategies that would address improving a healthcare professional’s competence, performance, or patient health outcomes.

“We’re really trying to make sure we’re spending dollars on initiatives that are going to make a difference,” she says. “We started by looking to see how we could flip from 70 percent denial to 70 percent approval.” The overall MEG grants budget, while decreased slightly, is largely intact, says Doyle-Scharff. The same can’t be said for the MEG team, which is losing 40 percent of its members as part of an across-the-board company staff reduction.

Going to an RFP Model
The track that will account for 90 percent of the grants budget will be solicited solely through an RFP process. Doyle-Scharff says they likely will narrow the focus from the 29 clinical areas the group currently supports to six core clinical areas that are important both to Pfizer and to societal health issues in 2012: vaccines, smoking cessation, infectious disease, pain and inflammation, lung cancer, and women’s health. Once the new model is ramped up, each area will publish two to three RFPs each year.

The group is still working on concentrating some of the broader categories, such as women’s health, to address the biggest performance and practice gaps in those areas.

The Track 1 process will be different in three ways:

1. The RFP itself.
The call-for-grant-application template the company had been using for the most part was fairly broad. The new RFPs will be very specific: “My expectation is that these RFPs will be multipage, robust, data-rich documents,” says Doyle-Scharff. “They will be evidence-based and data-driven, not 'Here’s what Pfizer would like to do,' but 'Here are the health issues, here are the areas where we have interest as company, and here are the data we’ve been able to gather through a variety of methodologies and mechanisms that look at various potential learner needs and practice gaps.'”

These requests for proposal might be national, regional, or international in scope. An example of what these might look like is a hospital call for grant application Pfizer recently did that required the CME provider to work with their hospital’s quality assurance department—and provide proof that they were working together by citing their own institution’s data for the needs assessment and developing an institution-specific outcomes strategy.

The proposal evaluation model also has been revamped to adopt the two-step process used by organizations such as the National Institutes of Health and the Robert Wood Johnson Foundation. An organization will submit a letter of intent—which will likely be limited to just two pages and five questions—in response to an RFP. The letter of intent will be evaluated based on how well it aligns with the RFP, then the organization will be issued a invitation to submit a complete proposal, a “thanks but no thanks,” or a notice that the evaluators had questions that need to be answered before making a decision.

2. The external review panels. The group will employ external review panels that will be unique to the six major clinical areas. For the vaccines area, for example, the review panel could include an MD clinical expert in infectious diseases and/or vaccines, an educationalist, and a public health administrator who has been involved in vaccine-related patient strategies. The panels also will include someone from the MEG team and a Pfizer medical staffer, but they will be in the minority. These panels also will advise the group as they develop the RFPs.

The current MEG education directors will serve as liaisons between the external community seeking support and these panels. While they will not broach any discussion of content, this may mean, as an example, suggesting that three organizations with similar proposals work together to submit a joint proposal. Providers can expect there to be a lot of “robust dialogue,” says Doyle-Scharff.

The panels’ decisions will be final. “Essentially, the outside individuals will make the decision on whether or not we support something,” says Doyle-Scharff. “It won’t go through a further Pfizer review where someone could in fact override that decision.”

3. “Uber-transparency.” This is what Doyle-Scharff calls her group’s intention to post everything—proposals; minutes of a review panel meeting; job descriptions and charters of the review panels themselves, along with their disclosures and any conflict of interest measures that were needed; and outcomes measures and reports. While she expects pushback from organizations that don’t want to share proprietary information, “To them, I say then don’t come into our system and request funding.

“We have nothing to hide. We want everyone to understand how we’re making our decisions,” she says. “If we’re going to invest tens of millions of dollars in an effort to close practice gaps and ensure it actually improves care through a variety of mechanisms including education, then we want to make sure people can learn from those successes. If someone’s figured out how to do this well, we want to share it with the CME or quality community so we can start to make a broader difference.”

Annual Conferences Still on Track
Susan Connelly, PharmD, MBA, CCMEP, a MEG director, says that this doesn’t mean Pfizer is abandoning the traditional annual conference. “When we looked at how new information moves from bench to bedside, from research to practice, most of that data exchange takes place at live conferences. So we felt it was still important to support that avenue of communication, recognizing that the main activity taking place is knowledge exchange. We’re not expecting any practice improvement from these exchanges, but it’s where everything starts.” So the MEG decided to create a separate avenue for requests related to annual meetings and congresses.

The majority of Track 2 requestors are expected to be associations or academic medical centers that host annual meetings that are key disseminators of information for specific clinical areas, Connelly adds. The group is doing away with its quarterly competitive review, though it will review Track 2 requests more frequently than the RFPs, which may only be published two or three times a year. The request process will be similar to the current model, where providers submit through the Web portal, though the questions will be different and the form will be shorter and more tailored to just what’s needed for live meetings. She adds that live meetings also can be part of an RFP.

No Longer CME-Centric
Doyle-Scharff makes it clear that the RFP initiatives won’t be limited to continuing medical education, though that may well be a key piece of an overall initiative. She adds that it won’t matter whether a CME piece is offered for credit or not. “What matters to us is that that there is a clinical problem that needs to be solved, the education is developed using solid adult-education principles, and the organization has done its due diligence to determine that education, or education along with other strategies, will help close those gaps. This is no longer a CME-centric model.” In fact, she says she “would be shocked if any one organization could pull off an initiative in response to an RFP.” Expect the RFPs to require collaboration, even to the point of designating specific entities Pfizer may want to work together on an initiative.

“We’re moving away from a model that has CME at the core to more of a patient-care model that recognizes that education can have a role, and finding its place within a broad initiative. We may get proposals that have no education at all, though I’d be hard-pressed to come up with an example,” she says. Connelly points to the example of the recent hospital CGA, where much of the activity involved assessing practice gaps and creating tools for the practitioners to use to address the gap. There may have been one or two educational sessions involved, but for the most part it was about addressing barriers in specific health systems and improving care.

However, says Doyle-Scharff, “This is not about cutting CME providers out. On the contrary, it gives CME providers a phenomenal opportunity to make what they’re responsible for more relevant to patient care. While education has a specific role to play, it’s not the only factor in closing a practice gap. The sooner CME providers figure out where they fit into the bigger picture, the more relevant their work is going to be in their larger organizations.”

Track 2 is planned to launch in January 2012, with the RFPs for Track 1 beginning to trickle out in the spring.

Editor’s Note:
This is just the latest in a series of pharmaceutical companies feeling the need to change their granting policies and procedures, from GlaxoSmithKline limiting the possible field of contenders to just 20, to Pfizer’s earlier decision to eliminate medical education companies from their grantee mix.

What do you think of the evolution of commercial support models? How have these changes affected the CME community? Please leave a comment below or e-mail editor Sue Pelletier at spelletier@meetingsnet.com.

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