‘India is the hub of our global delivery network of services’

Reportedly the world’s largest CRO, 34-year-old Quintiles has been through many phases. As its founder Dennis Gillings, CBE makes his farewell rounds of the company’s global locations, his successor Tom Pike, CEO, talks about India’s strategic fit in the company’s future blueprint as a healthcare services leader, with Viveka Roychowdhury

What percentage of global revenues comes from India? Where does India fit into the company’s plan as it evolves further away from a traditional CRO into a healthcare services leader?

We serve two segments of the market. One is the Phase I-IV clinical development services or product development services, where the  market size  is about a $100 billion. Approximately 74 per cent of our revenues come from product development services. The second revenue stream is integrated healthcare services, where the market size is around $101 billion. We expect our markets (product development and integrated healthcare services) to grow at six-eight per cent per year from 2015-2018. As a company, our aspiration is to grow faster than our markets.

Asia, and that includes India, has been our fastest growing geographic market. We have been growing faster than the market growth, which has been significant, in the mid teens. Interestingly, here in India our growth is two fold. We do provide clinical development related services and laboratory services, but a lot of our growth in head count has actually been to be the service centre for the world in Quintiles. We have around 6400 people here in India and most of them help the global business processes to make sure that we are as efficient, as effective and as high quality as we can be. India is the hub of our global delivery network of services.

Where are the other hubs besides India?

Our general strategy is that while we are very global, we are also very local. The work that needs to be done locally with physician investigators will be done on the ground in those countries. But much of the other work can be done in more standardised processes in cost efficient locations. So, we’ve created a global delivery network that consists of Eastern Europe, South Africa, India, China. There are other locations that we are looking at bringing in. What we try to do is bring very consistent processes and technologies so that we can do the work where ever it makes the most sense. We can shift work to different locations, for load balancing and generally do work more cost effectively for our customers.

About a decade back, India was pegged to be a major global clinical trial hub. These expectations are now tempered by more stringent regulator oversight. Though there have been some signs of a more moderate and transparent approach of late, how do you see that evolving in India?

We are pleased with the progress under Prime Minister Modi. When we look at the last couple of years, we think there has been progress on the issues that  slowed and in some cases even stopped clinical research in this country. We still believe that our industry can be very helpful for India. There continues be a great burden of disease and our industry can provide solutions to that burden of disease. We are hopeful that the practices and policies that this government is putting in place will help open up the clinical research environment again.

It’s not without some caution that I say that because I don’t think that every element has been solved yet. There are certain issues around informed consent, around investigators making sure that inspections happen according to global quality standards; that we think probably need a little more work. But that being said, we are pleased to see the progress. We are hopeful, that we will have a healthy industry again because of the opportunity for both MNCs as well as India.

The pendulum has swung a little bit and there are signs of positive movement. The issue now is to instil confidence in our customers and even internally. There was so much unknown about what was going on. Now it is a matter of education, talking to our customers, etc. And we’re already seeing some of the positive movement come through. It will take a little bit of time for us to get that back in place. Provided the government consistently moves along that path it will be helpful to all of us.

It’s been said that in India, you can do two trials for the cost of one. But cost cannot be a differentiator in the long term, because there will always be a destination where it can be done cheaper. What do you think should be India’s USP when it comes to regaining stature as a globally trusted clinical trial/ research destination?

If as a global executive, I take a step back, I see some wonderful and unique things about this country. You have a relatively young country in terms of the workforce, a couple of hundred million highly educated individuals. You have this mixture of socio-economic levels associated with the country that give both the opportunity to have people who have good means financially to be able to access the latest medicines and care. But at the same time, we have the real need to take care of the indigent population here.

I think that it is a unique opportunity for India to, over time, become one of the world’s leading players in drug development and drug manufacturing and production. If we think about helping this population with this burden of disease and really taking innovative medicines like immuno therapies, to those areas of the economy and socio-economic levels where it make sense to do it, I think it is a great opportunity. And on the manufacturing side, you’ve got experienced manufacturers here who have the opportunity to get into innovative drug development and become global leaders.

I personally think that the sky is the limit for this country. I’ve been visiting India for a long time. I helped develop Accenture’s strategy around India and I think there is a tremendous potential for this country to be one of the world’s leaders associated with drug development and manufacturing.

What is your impression of the talent pool for CROs in India? There has been some talk that the pool is not deep enough or wide enough and certain roles need to be sourced from outside the country. And since Quintiles was one of the earliest in this field in India, it has been the poaching ground for competitors. Some of your top management recently left to turn entrepreneur, like Dr Ferzaan Engineer, who has now set up his own home health venture. How do you keep filling your pipeline of internal leaders as well as attract and retain talent?

That’s true. What we are trying to do is use the same techniques as other world class professional services firms. So at times we will introduce some expertise from outside of the company. For instance in areas like biostatistics. Obviously, there is a tremendous population of mathematicians in this country but biostatistics for our industry is somewhat nascent here. We’ll infuse biostatiscians from other parts of the world.

We’re also working to bring in high quality talent and train them ourselves. As the market leader, we have an obligation to be a trainer of resources, and not just poach people from other companies. We’re doing this on a global basis, not just here in India. We feel we have to have high quality training programmes, career mapping and pathing, programmes that make managers better executives. We are trying to offer a complete career opportunity for our people from the campus all the way to executive management. As the leader, that’s the torch that we carry.

What will be Quintiles’ next strategic milestone towards the vision of making ‘a meaningful difference in health and patient outcomes’?

Our vision is to bring people and knowledge together for a healthier world. So, while we are clearly the leader in the CRO industry right now, I’d like us to be viewed as a healthcare services leader on a global basis. A key part of that will be how we help the pharma industry bring medicines to patients but over time, I’d like us to be able to use our deep expertise to help population health and make sure that the right medicines get to the right patients at the right time. Many of our physicians have a deep interest in working on care pathways for healthcare provision. I’d love to see us in the long-term work all the way from the biopharma industry to the practice of medicine and really help patients.

Could you give us an example of what that would mean?

A little known fact about Quintiles is that we are already working with hospitals to examine the care pathways they use to figure out which ones the most effective. This ranges from evaluating physician effectiveness, to care pathway effectiveness, meaningful use guidelines. The lion’s share of our business today lies in making sure that our medicines are safe and that they work. We are trying to bring that knowledge all the way out to market access and helping providers be more effective.

This April, you complete four years in Quintiles, in April 2012. Did it help that you were considered an ‘outsider’ with no experience of working with pharma or CRO industry?

I have actually consulted with the pharma  industry since 1994 when I headed the healthcare practice at Accenture. We looked at the sector as an intersection between the pharma industry, the payer and the provider. This gave us a very rounded view of how all these revolve around the patient and the electronic healthcare record. We believed that the information that drives the industry is consistent between all of those players.

And one of the things that is happening right now is that is very much becoming true. The information about where patients are, things like registries, are becoming a centrepiece of both clinical development all the way to population health. I think that background positioned me well for where we are taking Quintiles.Quintiles has been fascinating. It’s got 36000 people around the world. We’ve actually grown since I’ve joined by 8000 people. The story of Quintiles, which completes 34 years this year, is that we’ve been a pioneer of the clinical development industry since our founding.

This parallels what we’ve done here in India. When we set up base in 1997, we were one of the pioneers in clinical research here in India. What we are trying to do today, is see how clinical research and commercialisation is evolving. We want to be the leaders as our industry continues to evolve.

You spent 22 years at Accenture and were on the leadership team that prepared Accenture for its IPO. Quintiles too went through the same phases, of going public, then private and then you helped take it public again a year after you joined. What was your mandate when you took over Quintiles from the company’s co-founder Dennis Gillings, CBE, four years ago? Can you take us through the highlights of the re-structuring process?

Essentially, around 2003-2004, Quintiles went from a public company to a private company. The company had done many acquisitions and during that period of time, the stock markets were swooning after the tech bubble. It was a great time for the founder to take the company private and he did it very successfully. I often like to say that our founder is very much like a Harvard Business Review case study in himself for the way he managed the company through this period.

During the time that we were private, there was a lot of restructuring done which involved changing the revenue profile and the margin profile. For instance, we got out of the pre-clinical business and focused on clinical. We got out of the investing business because as a public company, it’s difficult to be an investor and a services company simultaneously. We spun out the investing business and today it exists as a very successful independent entity called NovoQuest. We did some other restructuring and in 2013, we took the company public again. We’ve had a very successful run since then.

What are the top pain points for your client companies? How has Quintiles positioned itself to address these pain points?

If you think about what we do, we help design trials very effectively. We have the deepest scientific therapeutic expertise in our industry: over 1100 doctors, (actually have over 250 are here in India), plus 800 biostatisticians. We have an exceptionally strong group of experts in the science of our industry who help us design trials effectively.

We also have a global technology-enabled network, enabled by people, that lets us perform the trials really well. For all those players in drug development and medical device development, the key is a well-designed trial (so you increase the probability of regulatory approval) and then also executing it as effectively and efficiently with as high quality as you can.

As you said, Quinitles has been a pioneer. It has also evolved from the time that Quintiles was founded in 1982 ‘to do statistical analysis work on a contract basis for pharmaceutical companies.’ How would you define a CRO and specifically Quintiles today? A consultancy? A financier? A commercialiser because Quintiles is also into marketing development of some of the molecules it takes through trials? Or is it all of the above?

I define ourselves as a professional services firm. So if you go back to our early days, we were a consultancy. But then over the course of time, we got more into services and now we are the leader in our industry, a Fortune 500 company, one of America’s most admired companies and we recently won an award as one of the Most Ethical Companies in the world. We’ve really become a Fortune 500 services company and our goal is to provide great services to our customers. In fact, our tagline is: Improving our customers’ probability of success. Because, we feel that in every service that we provide, if we are helping them be more successful, and improve their probability of success, then we’ll be a winning company.

You mentioned that Quintiles recently won an award as one of the Most Ethical Companies in the world. So, how does Quintiles resolve potential areas of conflict of interest as it evolves further down the path of financing drug development and then also playing a role in the marketing of these drugs alongside your pharma clients?

Right now, Quintiles does not invest in molecules. We are in the professional services business. Think of us as being from first-in-man (trials) all the way to the provision of healthcare. We help patients all along that continuum. We follow Good Clinical Practices (GCPs), ethical guidelines to make sure products are safe and that they work. Once they get approved, we help track the medicines through real world data, to check if they are as safe in the real world as they were in the trial. We do help the pharma firms think about how to get market access, how to commercialise the products. We even have a smaller business that helps providers associated with electronic healthcare and population health. We bought a company called Encore which provides these services.