15th National AOA CME Sponsors Conference Trends and Future of Commercial Support January 8, 2009

1. 15th National AOA CME Sponsors ConferenceTrends and Future of Commercial SupportJanuary 8, 2009

2. Conversation Areas Recognize Trends in commercial support and environmental issues Understand industry response to environment Compare different future options for commercial support Consider a new model for commercial support Predictions and tips to improve grant success

3. Should Industry Support of CME End ?

4. In the last year, commercial support of CME in my organization has� Increased > 25% Increased < 25% Stayed about the same Decreased < 25% Decreased > 25%

5. % Commercial Support

6. Evolving Environment 2002 PhRMA Code on Interaction with Health Care Professionals 2003 OIG HHS Compliance Program Guide for Pharmaceutical Manufacturers 2003 AdvaMed Code of Ethics on Interactions with HealthCare Professionals 2004 ACCME Updated Standards for Commercial Support 2004 Conjoint Committee CME Task Force Recommendations 2006 MEG created 2006 ACCME Revised Accreditation Standards 2007 Senate Finance Committee Report on Use of Educational Grants by Pharmaceutical Manufacturers

7. Are you familiar with the Macy Foundation report on CME? Yes No

8. Accelerating Pace of Scrutiny and Change 2008 ACCME accredits CME providers and requires them to adhere to standards for independence that now keep industry supporters from having any input on the content of CME programs or selection of speakers. ACCME accredits CME providers and requires them to adhere to standards for independence that now keep industry supporters from having any input on the content of CME programs or selection of speakers.

9. My organization no longer accepts commercial support for CME. Yes � we do not accept No � we continue to accept Currently under review

10. I personally believe commercial support of CME should end within 5 years? Yes No Abstain

11. If Industry Support of CME Continues, How Should It Change?

12. Who receives the largest percent of commercial support? State providers Academic medical centers/medical schools Medical Education and Communication Companies Medical Specialty Societies

15. Relative Educational Value of CME Support Investment � What Serves Patients Best?

16. A Convergence of Interests Model for Commercial Support Accelerate adoption of new evidence based innovations that address a gap in healthcare quality Improve patient care and shareholder value simultaneously Win-Win Collaboration Defined By A Convergence of Interests Tactical to strategic Any partner might have needs in any or all of these areas. Tactical on the outer rings between where smaller level of convergence occurs � financial only, any transaction relationship Partnerships vs subcontracting on outer ring Strategic � shared goal, shared risk, blended competencies, Configuration of circles will vary by organization. Could shift circles to reflect different needs and show 3 or 4 on page. Something with high business need attached to HCS need for example. Accelerate adoption of new evidence based innovations that address a gap in healthcare quality Improve patient care and shareholder value simultaneously Win-Win Collaboration Defined By A Convergence of Interests Tactical to strategic Any partner might have needs in any or all of these areas. Tactical on the outer rings between where smaller level of convergence occurs � financial only, any transaction relationship Partnerships vs subcontracting on outer ring Strategic � shared goal, shared risk, blended competencies, Configuration of circles will vary by organization. Could shift circles to reflect different needs and show 3 or 4 on page. Something with high business need attached to HCS need for example.

17. Industry Perspective on Future Support Options �Industry funding pooled and managed by independent party� The �pro� arguments include: Reduces prospects of COI Potentially less disruptive to CME providers The �con� argument : Industry support will be a charitable contribution at 5% of today�s funding level No accountability for dollars provided Less potential to influence positive change in CME practices �Industry funding pooled and managed by independent party� The �pro� arguments include: Reduces prospects of COI Potentially less disruptive to CME providers The �con� argument : Industry support will be a charitable contribution at 5% of today�s funding level No accountability for dollars provided Less potential to influence positive change in CME practices

18. Transformation: Rather Than Why, Why Not! More effective based on evidence in the literature Elevates importance of patient above current model Supports direction of AOA & ACCME, Macy, AAMC, etc Improves industry support of CME credibility with the medical profession and the public Significantly improves compliance Costs less � 90% in many cases How does it improve compliance Focuses on outcome rather than process steps as best measure of compliance Far less dependent on expert driven lecture based CME where relationships with faculty and focus on content are among the larger compliance risks we face Mitigates against many of today�s conflicted compensation systems that do not conform with the Assn of Fund Raising prof code of ethics by excluding business development practices of non-healthcare aligned organizations How does it improve compliance Focuses on outcome rather than process steps as best measure of compliance Far less dependent on expert driven lecture based CME where relationships with faculty and focus on content are among the larger compliance risks we face Mitigates against many of today�s conflicted compensation systems that do not conform with the Assn of Fund Raising prof code of ethics by excluding business development practices of non-healthcare aligned organizations

19. No More One and Done CME Support

20. Pfizer�s New Medical Education Grant Policy To only support providers most likely to meet the highest standards of quality and independence defined by the medical profession To support the profession�s move towards performance-improvement initiatives that integrate education and quality Initiate a competitive grant review period for grant applicants to encourage more innovative, high-quality grant applications Review all major grants using criteria equivalent to AOA & ACCME�s highest level of accreditation Redirect resources closer to the point of care in order to better meet the needs of the new model of PI-CME To support the medical community�s call for balanced funding in CME by establishing organizational or grant dependency financial caps on commercial support As of July 1, Pfizer will no longer directly fund CME provided by organizations who do not have patient care as their primary mission ie Medical Education and Communication companies As of July 1, Pfizer will no longer directly fund CME provided by organizations who do not have patient care as their primary mission ie Medical Education and Communication companies

21. Medical Care Like Politics Is LocalAligning to Understand Regional Needs

22. Relationship with IndustryCollaboration or Cooperation? �First, industry relationships are essential, but they must be carefully managed. By developing clear and well-considered guidelines, we can optimize the benefits inherent in the academic medicine-industry relationship, while at the same time, minimize the risks. In other words, we need partnerships that are principled, productive, and transparent.� Darrell G. Kirch, MD, AAMC President and CEO [AAMC Reporter 2008; 17(2):2] We may not know what to call it, but we know what it looks like and for what purpose.We may not know what to call it, but we know what it looks like and for what purpose.

23. Predictions and Suggestions for Future Grant Success

24. Future of Commercial Support Predictions Much greater scrutiny on conflict of interest will lead to further tightening of regulations but not the elimination of commercial support from CME Organizational dependency Faculty who participate in promotional speaker�s bureaus Scrutiny will lead to public transparency being the norm rather than the exception After rising to historic levels, declines in commercial support will start being reported in 2008 ACCME data (June 2009 release) Decline % will accelerate for the next several years resulting in approximately � of peak commercial support levels Increases will not occur again until outcomes reporting through PI CME activities becomes the norm

25. Future of Commercial Support Predictions Level 3 ACCME equivalent providers will dominate the receipt of commercial support by 2013 A much greater % of commercial support resources will be provided to providers who represent organized medicine and/or are closer to the point of care Traditional �one and done� CME will face increasing hurdles to outside funding More efficient mechanisms will be found to secure commercial support via mechanisms like block grants

26. Suggestions To Improve Grant Success Balanced funding improves grant approval success Do not limit focus to traditional �one and done� meetings Provide outcomes data Increase provider collaboration Identify measurable performance gap target of educational initiatives Consider block grant approaches

27. Familiarize Your Organization with Fact Sheets CampaignThe National Task Force on CME Provider/Industry Collaboration Fact Sheet # 1 Continuing Medical Education: Providing Valid and Independent Evidence for Clinical Decisions Fact Sheet # 2 Continuing Medical Education: Addressing Conflict of Interest (COI) Fact Sheet # 3 Pharmaceutical, Biotech and Device Company (Industry) Support of Continuing Medical Education (CME)

28. With respect to the issue of commercial support of CME, as a result of this discussion, I � Will not change anything we are currently doing Will change some minor operational procedures Will challenge my staff to fundamentally rethink the way we currently use or see commercial support in the future

29. I would like to be more actively involved in a continuation of this strategic dialog about the future of commercial support? Yes No Undecided

30. Dialogue