The US healthcare landscape has dramatically transformed, accelerating trends that began a decade ago. The convergence of value-based care, digital health, and regulatory changes has fundamentally altered how life sciences companies must engage with integrated delivery networks (IDNs) and health systems. The traditional pharmaceutical commercial model, reliant on volume-driven sales, broad promotional campaigns, and key account management, has lost effectiveness in a market now dominated by consolidated provider organizations, standardized formularies, and outcomes-based reimbursement.

To remain relevant and competitive, pharmaceutical companies must move beyond incremental adjustments and embrace a systematic, partnership-driven approach to health system engagement.

This shift requires answering four foundational questions:

• What is our differentiated value proposition for integrated health systems?
• How do we identify and prioritize the right system partners?
• What does successful, measurable collaboration look like?
• How should we redesign our engagement model for long-term, mutual benefit?

Companies that act now to build robust, partnership-based engagement models will be best positioned to thrive as the US health economy continues its shift toward integrated, outcomes-driven care.

Opportunity and challenge in today’s market

The rapid consolidation among providers, spanning physicians, hospitals, and health plans has created formidable barriers for traditional pharmaceutical field teams. Access to decision-makers is tightly controlled, and the influence of individual prescribers has waned as care pathways and digital formularies dictate therapeutic choices. The widespread adoption of electronic health records (EHRs), AI-driven clinical decision support, and population health management tools further diminishes the impact of conventional sales and marketing tactics.

Simultaneously, the vertical integration of retail pharmacy, specialty distribution, and pharmacy benefit managers (PBMs) has eroded the leverage pharmaceutical companies once held through contracting. Health systems now demand clear, evidence-based demonstrations of clinical and economic value, ideally supported by real-world evidence (RWE) and digital health solutions that drive measurable improvements in patient outcomes.

While many pharmaceutical leaders recognize these shifts, few have developed actionable, system-oriented engagement strategies. Treating IDN engagement as an extension of key account management or focusing solely on cost-offset models fails to address the fundamental changes in health system economics and priorities. A new approach, rooted in partnership, data, and shared outcomes, is now essential.

Redefining the value proposition for integrated health systems

The provider business model has shifted decisively from volume-based to value-based care. Health systems are now evaluated on their ability to deliver better outcomes at lower costs, as measured by quality scores, population health metrics, and risk-based reimbursement contracts.

Pharmaceutical companies must align their value propositions with these priorities, moving beyond efficacy and safety to demonstrate how therapies improve disease-specific and population health outcomes; the impact of interventions on total cost of care (e.g., reducing hospitalizations, emergency visits, or surgical interventions); integration with digital health tools and care pathways to support adherence, remote monitoring, and patient engagement; and the ability to generate and share RWE that supports continuous improvement and regulatory compliance.

Discounting alone is unsustainable. Instead, pharma must be willing to tie reimbursement or contracting terms to real-world performance, sharing risk and reward with health system partners. This means developing value propositions that:

1. Connect drug utilization to expected clinical effects across all relevant service lines
2. Offer clear, measurable improvements in outcomes based on tangible interventions
3. Aligning with metrics that matter to providers (e.g., disease-specific outcomes, Triple Aim, quality scores)
4. Translate clinical gains into cost offsets or revenue upside for the health system

For example, a cardiovascular drug’s value should be assessed within the entire cardiovascular service line, considering its impact on hospitalizations and long-term health costs. Similarly, high-cost therapies for chronic diseases must demonstrate their ability to reduce downstream expenses, such as emergency care or surgical interventions.

Identifying and prioritizing the right partners

Integrated health systems are highly variable in structure, mission, and digital maturity. Effective partner identification requires a nuanced, data-driven approach that considers degree of integration (such as ownership of health plans, breadth of service lines, HER, and analytics capabilities); strategic priorities (e.g., population health, specialty care, digital transformation); decision-making structures (centralized vs. decentralized, clinical vs. administrative leadership); and willingness and capacity for innovation and collaboration.

For instance, large academic medical centers may offer tightly integrated, service-line-driven decision-making, while distributed community hospital networks may rely more on corporate leadership and local market dynamics. The system’s mission, local provider landscape, and financial alignment with physicians all influence the feasibility and structure of potential collaborations.

Mapping these factors enables pharmaceutical companies to prioritize partnerships with systems most likely to benefit from and co-invest in collaborative programs, rather than simply targeting those with the highest sales volume.

Defining and measuring successful collaboration

Success in health system collaboration is defined by the alignment of long-term objectives and the ability to measure and communicate mutual value. Effective collaborations typically fall into one or more of the following categories:

• Direct operational cost improvement (e.g., reducing readmissions, optimizing drug utilization)
• Joint research and RWE generation (e.g., pragmatic trials, outcomes studies)
• Digital health and care coordination support (e.g., remote monitoring, patient engagement platforms)
• Clinical pathway co-development (e.g., AI-driven protocol optimization)

Each partnership should be designed to produce tangible, publishable results that can inform broader system strategy and regulatory compliance. For pharmaceutical companies, benefits include improved access, brand differentiation, and risk mitigation as health systems gain greater influence over drug selection and utilization.

The business case for investment in these partnerships extends beyond immediate sales. Durable collaborations can secure formulary access, foster clinical momentum, and create operational integration that is difficult for competitors to displace. Moreover, investing in these relationships allows companies to navigate ongoing system reforms and evolving market dynamics.

Rethinking the engagement model

Legacy engagement models—fragmented by channel and focused on sales volume—are increasingly obsolete. The new model requires cross-functional teams with expertise in clinical science, data analytics, digital health, and value-based contracting. It also calls for incentive structures aligned with partnership objectives (e.g., outcomes achieved, program adoption, RWE generated), and adaptive engagement strategies tailored to the structure and maturity of each health system partner.

One also cannot forget about the regular, structured input from health system stakeholders to co-design and refine initiatives.

For example, academic medical centers may require highly scientific, research-oriented teams, while community-based systems may benefit from teams skilled in operational improvement and local relationship-building. Internal management structures should mirror the organization and objectives of the health system partner, whether service-line, research, or population health-focused.

Crucially, pharmaceutical companies must proactively seek input from system partners in shaping engagement models, objectives, and tactics. This collaborative approach transforms the relationship from adversarial to mutually beneficial, positioning industry representatives as resources to achieve shared goals.

Organizational implications and the path forward

The transition to partnership-based engagement is a significant undertaking, requiring new capabilities, organizational structures, and cultural change within pharmaceutical companies. Early adopters will be able to shape the future of healthcare delivery, while those who delay risk being sidelined as health systems consolidate purchasing power and clinical decision-making.

The shift from promotion to partnership is now a defining trend in US healthcare. Pharmaceutical companies that embrace this reality by building system-oriented value propositions, prioritizing the right partners, designing measurable collaborations, and reinventing their engagement models will secure a durable competitive advantage in the evolving health economy. The time for action is now; those who move decisively will shape the next healthcare innovation and delivery era.

About the Authors

The views expressed in the article are those of the authors and not of the organizations they represent.

Partha Anbil is at the intersection of the life sciences industry and data & analytics, including GenAI/ML/NLP. He is a Senior Advisor to NextGen Invent Corporation, an AI, data analytics, and digital transformation company. He has over 25 years of experience in the industry.

Kamini Anbil is an experienced consultant in the life sciences industry. She spent six years with ZS Associates, a top boutique global management consulting and technology firm specializing in the Life Sciences sector.