While pursuing my Master of Business Administration (MBA) degree at the WP Carey School of Business at Arizona State University, I used the opportunity of class projects to explore how I could elevate my value as an MSL by integrating learnings from my coursework. In May 2021, I completed my MBA in the Professional Flex program with a concentration in the Business of Healthcare offered through the Executive MBA at the same university. I completed five courses in the concentration: Healthcare Economics, Healthcare Informatics/Artificial Intelligence, Healthcare Supply Chain, Healthcare Management, and Health Care Systems. Professor Alison Essary taught the Health Care Systems course. She is a faculty at the WP Carey School of Business and the Scrivener Family Director of the Research, Quality Improvement and Patient Safety Program at Honor Health Academic Affairs. She heads several Project ECHO (Extension for Community Healthcare Outcomes Model) programs. The Project ECHO is a framework developed at the University of New Mexico Health Science Center to increase access to healthcare in rural areas. The focus of ECHO is to provide training and support to health care providers from underserved regions by connecting them with specialists at academic medical centers to help them better treat patients with complex diseases. The ECHO model leverages technology, distance learning and shares best practices to reduce health disparities [1-4]. The ECHO model has been successfully applied at 43 universities in the USA and five other countries. It has been shown to have several benefits, including improving healthcare outcomes, increasing provider and patient satisfaction, and cost savings due to the telehealth approach. Overall, the model has been shown to improve minority health [1-4].
For my class project, I wrote about MSLs using this model of Project ECHO to address health disparities. I have adapted the original paper to fit my new role as a Senior Medical Science Liaison for Covis Pharma in the respiratory therapeutic area. I have chosen Arizona as a case example because I live here, and there are regional and state-by-state differences in health priorities. MSLs can consider these priorities in their territory plan and integrate them when operationalizing the medical plan and scientific messaging within their territories. The interactions that MSLs have with key opinion leaders are highly focused on scientific and clinical outcomes related to their therapeutic area of focus. However, disease management and successful pharmacotherapy do not exist in isolation from the socioecological factors impacting patients. In this article, I discuss the burden of asthma, health disparities, health priorities in the State of Arizona, and how MSLs can contribute to unmet needs by disseminating medical knowledge via programs such as Project ECHO.
The Burden of Asthma, Health Disparities and Health Priorities in Arizona
Asthma is a chronic respiratory disease that affects close to 300 million people worldwide . In the USA, 1 in 13 people or approximately 25 million people have Asthma. This is a disease that afflicts individuals of any age across the lifespan. About 7% of children and 8% of adults have asthma. In children, asthma is more prevalent in boys compared to girls. However, in adults, asthma is more prevalent in women compared to men. It is estimated that the economic costs of asthma exceed 80 billion dollars per annum . There are more than 3500 preventable deaths from asthma each year . There is no cure for asthma, but it can be controlled with pharmacotherapy and lifestyle interventions. In addition, asthma disproportionately affects people of color in the USA. Black, Hispanic and American Indian/Alaska Native people have the highest asthma rates, deaths, and hospitalizations . It is estimated that 12% of American Indian/Alaska Native and 11 % of Black people had asthma compared to 7.7 % of white people. Even though overall Hispanics have the lowest rates of asthma at 6.4 %, the rate of asthma for Hispanics of Puerto Rican descent is 14.2%. Hence, they have the highest rates of asthma compared to any other racial or ethnic group in the United States. Overall, mortality due to Asthma is highest among black women.
In Arizona, where I live, 1 in 11 people or 615,000 people have asthma. The Arizona Department of Health Services has identified Chronic Lower Respiratory Disease (i.e., asthma, emphysema, and chronic bronchitis) as a leading health priority in Arizona. Among youth 17 years or younger, 10.9% have asthma compared to 9.6 % of adults . The economic burden of asthma in Arizona is estimated to be 2 billion dollars per annum . Tucson, Arizona, is listed in the top 20 cities most challenging to live with asthma according to the Asthma and Allergy Foundation of America (AAFA’s) Asthma Capitals™ Report rankings of the largest 100 U.S. metropolitan areas . In 2019 there were 87 deaths from asthma in Arizona . In fact, Chronic Lower Respiratory Disease is the third leading cause of death in Arizona, responsible for almost 3,300 deaths a year . Furthermore, the 2021-2025 Arizona Health Improvement Plan focuses on Health Equity, Health in All Policies/Social Determinants of Health, Mental Well-being, Pandemic Recovery, Rural Health & Urban Underserved .
How MSLs can support ECHO programs to address unmet needs and health disparities
MSLs can include State public health priorities related to their disease area of focus in their territory plan and integrate it with the medical plan and scientific messaging. Project ECHO is an effective way to disseminate medical education that reaches underserved and rural populations. MSL interactions with KOLs and other health care providers (HCPs) focus on scientific discussions on disease states and clinical outcomes. However, the successful management of diseases like asthma does not exist in isolation from the socioecological factors that impact patients. For example, poor air quality, lack of access to care, and inadequate patient education contribute to asthma disparities. Effective interventions for asthma control, in addition to medicines, include implementing clean air policies, supporting home-based interventions, and educating health care professionals and the public about the disease . For example, the Missouri Asthma ECHO includes case presentations, didactics on asthma self-care and environmental home assessments, and the breadth of socio-ecological factors that impact asthma management. MSLs can become involved in existing ECHO programs or support the development of new ECHOs within the companies they work for. As field-based science experts whose primary function is to develop working partnerships with key opinion leaders (KOL), MSLs field activities include partnering with KOLs in educational events and journal clubs. MSLs can sometimes participate as speakers in Continuing Medical Education (CME) activities as many are licensed health care providers, including M.D.s or PharmDs, or are published Ph.D. scientists.
Secondly, MSLs can advocate for the development of new ECHO programs. Medical Educational Grant Funding mechanisms can allow academic institutions to apply to companies to develop CME ECHOs. Alternatively, the companies can establish non-CME company-led medical education ECHOs in collaboration with KOLs. There are several examples of how the industry is successfully supporting ECHO programs. For example, In September 2020, Pfizer released a call for applications to support academic institutions or professional societies interested in using the Project ECHO model to provide education and support oncologists treating patients with Renal Cell Carcinoma. They funded five proposals under the program. The grantees have already demonstrated successful outcomes.
Summary of Project ECHO Model benefits [1-4]
- Cost savings using telehealth model
- Rural areas have access to specialists in academic centers
- Team-based learning
- Interdisciplinary professional development
- Practitioners can gain Continuing Medical Education credits
- Dissemination of evidence-based practice
- Proven to improve health outcomes for patients and caregivers
- Best practice sharing to reduce the disparity
- Integrates adult learning theories so that participants are actively learning
- Combines learning material specific to patient’s needs
- The database provided through the ECHO website to monitor outcomes
- Successfully applied at 43 universities in the USA and five other countries
MSLs can foster Sustainability and Corporate Social Responsibility by Addressing Health Disparities
This figure is adapted from my previous article entitled: Developing Sustainable Medical Affairs in Regenerative Medicine.
Overall aligning MSL territory plans with public health priorities on a state-by-state basis and considering health disparities and disseminating medical education through Project ECHO may be an approach for MSLs to contribute to sustainability and corporate social responsibility. In the July 2021 issue of the MSL society journal, I published an article entitled: Developing a Sustainable Medical Affairs Department in Regenerative Medicine. One of the solutions I proposed was to pursue opportunities for unmet medical needs in health disparities and global health as part of corporate social responsibility. I have revised the figure from the article to reflect my current therapeutic area in the respiratory space. Covis Pharma is a specialty pharmaceutical company in multiple therapeutic areas, including hematology, oncology, and women’s health. There is more opportunity for MSLs to harness the “beyond the pill” mentality [13, 14] and provide value across therapeutic areas, further support internal stakeholders such as market access teams, and ultimately positively impact health care by ensuring that evidence-based medical products are used safely and efficiently.
- Socolovsky, C., et al., Evaluating the role of key learning theories in ECHO: a telehealth educational program for primary care providers. Prog Community Health Partnersh, 2013. 7(4): p. 361-8.
- Lewiecki, E.M. and R. Rochelle, Project ECHO: Telehealth to Expand Capacity to Deliver Best Practice Medical Care. Rheum Dis Clin North Am, 2019. 45(2): p. 303-314.
- Komaromy, M., et al., Extension for Community Healthcare Outcomes (ECHO): a new model for community health worker training and support. J Public Health Policy, 2018. 39(2): p. 203-216.
- Calo, W.A., et al., Reaching the Hispanic Community About COVID-19 Through Existing Chronic Disease Prevention Programs. Prev Chronic Dis, 2020. 17: p. E49.
- Dharmage, S.C., J.L. Perret, and A. Custovic, Epidemiology of Asthma in Children and Adults. Frontiers in pediatrics, 2019. 7: p. 246-246.
- Belova, A., et al., Estimating Lifetime Cost of Illness. An Application to Asthma. Ann Am Thorac Soc, 2020. 17(12): p. 1558-1569.
- CDC. Most Recent Asthma State or Territory Data. 2021; Available from: https://www.cdc.gov/asthma/most_recent_data_states.htm.
- Asthma and Allergy Foundation of America, Asthma Disparities in America. 2021; Available from: https://www.aafa.org/asthma-disparities-burden-on-minorities.aspx.
- American Lung association in Arizona ,Reducing the Impact of respiratory disease in Arizona: A three year plan. Available from: https://www.azdhs.gov/documents/prevention/tobacco-chronic-disease/reducing-the-impact-of-respiratory-disease-in-az.pdf.
- Asthma Capitals 2021. 2021; Available from: https://www.aafa.org/asthma-capitals/.
- Arizona Department of Health Services, Arizona Health Improvement Plan 2016-2020 Healthy People, Healthy Communities accessed [cited 2021 2/4/2021]; Available from: https://azdhs.gov/documents/operations/managing-excellence/azhip.pdf.
- American Lung Association in Arizona, The 2016 Arizona Asthma Burden Report. Available from: https://www.azdhs.gov/documents/prevention/tobacco-chronic-disease/az-asthma-burden-report.pdf.
- 13 Bedenkov, A., et al., Developing Medical Affairs Leaders Who Create the Future. Pharmaceut Med, 2020. 34(5): p. 301-307.
- Ghosh, R., et al., Preparing for the Next Normal: Transformation in the Role of Medical Affairs Following the COVID-19 Pandemic. Pharmaceut Med, 2021. 35(4): p. 197-202.
Eyitayo S. Fakunle, PhD, MPH, MBA
I have six years of experience in medical affairs and medical science liaison. I have been living in Arizona since 2015. My Therapeutic areas of experience are; cell therapy and regenerative medicine, stem cells, orthopedics, and cartilage repair. My dynamism is enabled by an undergraduate degree in chemical engineering, an interdisciplinary doctoral degree in cell and molecular biology, a master’s in public health, and postdoctoral training in bioengineering & regenerative medicine. Overall, in the last 15 years after obtaining my Ph.D. in 2006 from the University of Arkansas, I have gained experience in regenerative medicine spanning scientific research, public health, medical affairs & medical science liaison. I have a proven history of building relationships with thought leaders, clinical investigators, health care professionals, and academic centers through the provision of scientific information and disease state education. I graduated on May 3rd, 2021 with my Masters of Business Administration Degree from the WP Carey School of Business, Arizona State University, Professional Flex MBA Program, and completed the Executive MBA Health Care Electives available to cross-platform MBA students. I am a Senior Medical Science Liaison at COVIS. In the spirit of diversity and inclusion, I am spending my free time developing a sustainable social venture, “I am Pluripotent” providing after-school STEM programs to foster curiosity and learning and to prepare girls and diverse youth for future careers in STEM