John Guarino holds a BS degree in Biochemistry from California Lutheran University and an MS in Management from Rensselaer Polytechnic Institute. He spent 20 years at Amgen, a Biotechnology firm in California and held many positions at Amgen including Manufacturing, Sales, Trade Manager, Corporate Account Sales Leader, and Director of Payer Marketing.
John left Amgen in 2010 and went to work for inVentiv Health, where he worked up from a strategy consultant to starting an agency for them, and eventually managing Market Access for the entire enterprise. Following his time with inVentiv he made a stop at Omnicom before going out on his own and founding Peregrine Market Access. He is also an Adjunct Assistant Professor at the University of Southern California, teaching coursework in the Health Care Decision Analysis program. Prior to entering college, He was a soldier in the US Army’s 82D Airborne Division as a paratrooper.
Peregrine Market Access was founded in August of 2016. As a person in a healthcare industry Market Access marketing role, John was underwhelmed by the options he had to choose from when engaging a communication and strategy partner. It seemed that there were agencies that were good communicators, maybe they came from a large brand agency, but they really didn’t understand the business. Or He could choose a company that understood the space, maybe they were a spin-off of a data company or a consultancy, but they were not good marketers. They couldn’t deliver the robust communications tactics necessary to succeed in today’s complex market. Another problem with the marketplace was that the commercialization partners he needed were very fragmented, and the industry had no means to help integrate itself. It was up to the manufacturers to align disparate offerings to solve strategic problems.
“Some of the large holding companies said they could do this, but that wasn’t really my experience. So, we founded Peregrine. A “Blue Ocean’ strategy company that solved for each of the challenges that existed in the marketplace.”
Pharmaceutical industry consulting
Peregrine is a full-service pharmaceutical industry consulting and communications agency. Peregrine was built to disrupt the siloed nature of our industry, which creates more problems than it aims to solve. Effectively servicing our market access clients requires a robust knowledge of our industry. It is important to be able to tap into different disciplines, such as consulting, market access communications, value chain public relations, market insights, contract account sales, reimbursement solutions, digital modeling, and publication strategy to define and execute a market access strategy that wins.
John asserts, “At Peregrine Market Access, the “what” that we deliver (our 8 pillars) is one of our most innovative and differentiating features. We are a group of companies that functions as a fully integrated team of experts. We are not a holding company of disparate offerings, each with their own operating instructions, P&L, and initiatives. We are a fully integrated team of professionals, each helping the others be better at their jobs. We have consultants who inform our agency tactics. Our value chain public relations group helps us understand the broader perspective of value for a larger set of stakeholders. Our contract sales team removes the hypothetical world of advisory boards and allows us to pressure-test our strategy, concepts, and messages with the payers we are trying to influence.”
He further expresses, “We know that not every client will need all of our offerings (some do, but not all of them). Whether they do or not, we believe that we need all of our offerings in order to do our best work for those clients. Having all this expertise in-house and in touch with each other makes us a more strategic organization because we understand the value of each of these services and how they support each other. We are a company that was built from the ground up. So, we don’t have the same challenges other holding companies have like misaligned incentives, cultural disconnection, and lack of collaboration. Collaborating is in our DNA.”
A current development they are very excited about is adding a division that can drive their contract commercialization offering into a broader potential client set by assuming some of the risks associated with commercialization. This allows them to invest their own resources with our clients forming real partnerships. It eliminates the fee-for-service paradigm that drives so much of this industry and allows them to tie their success to clients.
Peregrine BioPharma will invest in their clients and share in the success of their brands. And improving their current offerings is always a goal. Training, learning, innovating.
“We value being smart. The intellectual horsepower that helps us compete and win. We take pride in, and work hard at, being smarter than our competition.”
Goals and Strategic Vision for the Company
John’s long-term vision for the company is to maintain that “Blue Ocean” strategy and stand up each pillar as a standalone entity that can win and execute business in each of their respective businesses. Steven Deny’s book “Killing Giants” is a great read that helps to define how to win and turn your Startup into an up-start. Changing the industry.
“The vision is to be committed to each other. It is our organization’s first value; we value each other. And anchor everything we do in the mission to change the way healthcare is valued in America and the world. Staying true to the idea that valuable things should be valued and are worth paying for.” he says
John is pulling together an entire organization of people passionate about helping sick people get their medicine.
Peregrine Market Access’s goals for the next three to five years include the integration of big data and analytics to their offering to help clients make informed strategic decisions. Their modeling and analytics capabilities are second to none and are only scratching the surface of what is possible. In a marketplace where resources are becoming more and more constrained, being strategic won’t be a luxury anymore, it will be a necessity. They will also continue to compete and win with their contract commercialization offering. Integrating each of the Peregrine pillars and forming a company that can actualize each facet of the commercialization process will drive the value to clients and help their brands win and spare valuable resources.
A Great Leader
The way John helps his employees connect to the vision is to be charismatic about communicating it, sharing it, and teaching it. His background as a professor helps him share his passion with them and ultimately, He feel the best thing a leader can do for his team is give them the opportunity to succeed… to win.
According to John Guarino, Great leaders have four attributes they should be striving to deliver each day:
- Direct the organization – Ensure the organization knows where it is going, and the path it will take to get there. Take the time to map out what success looks like and what are the things we need to do to achieve it. Translate the Client’s strategy into challenging, actionable objectives and plans. Convey a sense of purpose and mission that motivates others. Maintain direction, balancing big picture concerns with day-to-day issues.
- Build the best team – This isn’t just hiring. Although it is critically important to hire the right people. But once you have them, train them, set high expectations for them, reward them, and most importantly empower them. Build a diverse and empowered team.
- Deliver results – Consistently achieves results in line with our Values. Focuses their team on high impact activities by clearly communicating expectations. accountabilities, and responsibilities. A leader has to be driven to win, to work tirelessly for their team to help them win.
- Be a role model – Live our values and set expectations for others to do so. Strong leaders display self-awareness and seek self-improvement. They demonstrate technical mastery of the job. They possess a deep knowledge of external and internal operating environments. And they champion opportunities for change and innovation.
Leader’s Way to keep Workplace Motivated and Clients satisfied
John believes that, “In our industry, one thing you can do to keep people motivated is help them feel safe. This business is very unstable. Companies are either growing or dying. And there are frequently layoffs, and lack of stability from a pay perspective. The best thing we as leaders in this space can do is win. This drives the engine. I also think setting a high-performance bar is very important. Companies with swagger win. It becomes self-fulfilling. It’s a funny question because you can’t “guarantee” these things.”
“We have processes in place to evaluate TQM and workflow, we analyze the books aggressively. This is how we drive efficiency and remain productive. But motivation is a totally different thing. Motivation is the why behind those other things.
A properly motivated person can move mountains. But achieving that is hard. Especially in a company like mine where we value diversity and have been aggressive in delivering it. Pick a type of diversity and it exists here, age, gender, sexual orientation, ethnicity, experience, job skill & requirement. This is the nature of the pharma agency/consultancy world. But in that diversity lies the challenge of motivating this team. To do it successfully leads to amazing results, all of us are stronger than any of us. But some people are type A entrepreneurs, and some are staff. Some want to change the world and some just want to do a good job, be appreciated, and rewarded. One of the main keys to success here is to have an empowered, strong leadership team that is charismatic about the vision. Without strong leadership, you have a giant ship with a very small rudder.”
“I don’t respond to disagreements and criticism well. One of my flaws is frequently making the assumption that everyone understands the vision and, if they don’t execute it, it was a deliberate act. Not always true. The thing I’m working on is making sure I’m listening. This isn’t easy. Growth organizations are moving fast. It takes time to stop and be present. To listen. It’s a balancing act. We have to be religious about the company’s values and vision. The work. But we have to also look after each other. To ensure the empathy we talked about before is omnipresent and driving all interactions. Even the tough ones.”he says
Peregrine Market Access has a TQM process that creates a constant feedback loop. They have done innovative things to address industry needs and client issues. One thing they do is project-based billing. Where other companies bill by the hour, like a law firm, they bill by the project. This allows them to focus on the work and not their timesheets. They get to do their best work first. And this approach leads to a more ethical and honest approach to the work. Clients love it, they can never be surprised by a bill.
They do regular client reviews and post mortems on new projects, to create that institutional learning. This doesn’t come without its challenges. Many of the people here have come from other companies in this industry. The problem is there are no other companies like them. So, they wind up learning new things continuously. This can be very compelling to the right type of person, but also unsettling for those who have a set way of doing things or seeing the work. What is important is creating an environment where people can be smart, trusted, valued, and still ask questions. Constant learning, that’s the key.
Challenges and Risks Faced
The pharmaceutical industry is constantly being barraged by a negative campaign designed to undermine the value of the products, and to vilify the manufacturers in the eyes of the public. Yet, pharmaceutical care only represents 16.7% of total healthcare spending. This is forcing the industry to be dogmatic about value proposition development and understanding the health economics associated with a product, device, or assay and how it contributes value to the system. Unfortunately, because of archaic thinking and lack of capability from an economic understanding perspective, manufacturers, consultants, and agencies are having inadequate and unhelpful conversations.
He says, “If we don’t do a better job of demonstrating value, the government and insurance companies will continue to make subjective, uninformed decisions and ultimately, provide poor quality care. Seeking the lowest possible cost ignores important parts of the decision faced by the insurer community. The three priorities of healthcare delivery—cost, quality, and access—need not be at odds with each other.”
John states that, “The most important risk we took was launching the contract commercialization offering. We went at risk with a client and tied our success to theirs. This was what Deny calls “bringing the giant over the thin ice”. Not only did we beat three of the largest holding companies in our industry in the pitch, but we also went at risk for the work, demonstrating we were confident in our abilities. Taking that risk, has launched the most profitable part of our enterprise so far. Allowing us to stay in front of our competition.”
Team of Pharmaceutical Professionals
Peregrine’s greatest strength is their professional team. They have the best people in the industry. A team of entrepreneurs that deliver the industry standard in thinking, strategy, and resources. They are smart, dedicated to quality work and value each other.
He asserts, “It’s not easy to be leading an industry. It requires that we always be pressure testing our ideas, processes, and deliverables. Always looking for the edge, the big idea that differentiates us from our competition, who are made up of billion dollar holding companies. We have to outthink them, out hustle them, and stay in front. At the same time, we have to deliver flawless execution of the day-to-day, blocking and tackling work that keeps the lights on.
John has tried to build an organization that puts the people here above all else. Peregrine sets the industry standard for time off, and has competitive salaries. They pay 100% of the health care costs for employees and their families. Not just the premium, all of it, copays deductibles… everything. They have a flex schedule policy that allows staff to be remote if they need to, and they are going to open a daycare this year, to help staff who have those needs. But empathy and vulnerability aren’t just giving things to them. It is also trying to understand where they each are in their career and life journey.
“The best thing I can do for these folks is understand them and put them in a situation where they can succeed. I think one of the most rewarding and motivating things in a person’s life is the notion or idea that they are good at what they do. I try to ensure we are aligning talent to task, and that we are helping people win. You really can’t do this for folks unless you understand their “why”. A person’s why is the foundational ethos that drives them. Why are we here? Why do they behave the way they do? And ultimately, understanding that. Although our jobs, careers and callings are important, these things are just what we do for beer money. We have lives, families, and passions outside of work. The organization has to be healthy and winning, or it can’t help anyone. But it is important we understand this, so important, other parts of a person’s life and support it.” he says
Piece of Advice
My advice is to establish your leadership ethos early, because whatever you do in life, if you’re good at it, they are going to put you in charge of others that do that work. Be a voracious learner. I’ve been in this industry for 33 years and I have always studied and worked at learning and understanding. We are in the real world, we are not Evel Knievel, we don’t get paid for the attempt. Be competitive and win. Be true to your vision, but test it, work it, evolve it, and make sure it is sound. Put in your time, as you are coming up, don’t always look for the right company, try to be the right employee. Read “Mamba Mentality” by Kobe Bryant. He talks about having a relentless work ethic. Being smart isn’t enough. It’s important, but the world is full of genius baristas. You have to work hard and master your craft. Be maniacally committed to work quality and each other. But ultimately have fun. Enjoy the people and the ride. Remember this is just what we do for beer money.