Why the 90% Never Gets Built: It Starts With How Leadership Decides

Every function is funded to win its 10%. The 90% belongs to no one's budget — because of the question leadership asks first.

The 90% of the patient journey — the long stretch between visits where persistence is actually won or lost — rarely fails because a team executed badly. It fails because it was never really built. And the reason it was never built traces further upstream than most persistence conversations go: to how leadership evaluated the work in the first place.

Watch the first question a pharma leader asks when a cross-functional intervention lands on their desk. More often than not, it's a version of: how does this help my team? Does it make patient services more efficient? Does it help market access hit its numbers? Does it give the field something useful?

It sounds like diligence. It's also, quietly, the reason the 90% stays unbuilt.

The single-function question funds the 10% and starves the 90%

The mechanics are simple. The 10% — enrollment, prior auth, first fill — belongs cleanly to functions. Ask "how does this help my team" and the 10% gives a clear answer, so it gets funded: each function's slice, optimized and resourced.

The 90% has no such owner. It's the space between functions — the handoffs, the coverage gaps, the long middle where persistence leaks. Evaluate a 90% intervention by "how does this help my team" and the honest answer is that it doesn't help any one team; it helps the patient stay on therapy, across all of them. So it looks underwhelming, and the diligent leader passes — not because the 90% doesn't matter, but because the question can't see its value.

The 10% gets funded because it's ownable. The 90% goes unfunded because it isn't. The single-function question is what sorts them.

And the instinct doesn't stay at the top

Teams take their thinking from leadership — not from what leaders say about collaboration, but from what they actually reward, fund, and ask about. When leaders consistently evaluate by "what does my function get," teams learn the lesson exactly: optimize your piece of the 10%, protect your budget, win your metrics. That's not the teams failing. It's the teams faithfully executing the lens they were handed.

So the 90% doesn't just go unfunded once. It goes unfunded structurally, because the entire organization has been taught to think in the units the 90% doesn't fit into. Every team watching its own leg of the 10%; no one watching the exchanges of the 90%. The patient falls through a seam that leadership's decision-making instinct, inherited by teams, quietly built.

The question that lets the 90% get executed

The leaders who actually get infrastructure built in the 90% tend to ask a different question first. Not "how does this help my team," but something closer to:

Who needs to be pulled in for this to work — and when?

That question can see the 90%, because it's a cross-functional question about a cross-functional space. It evaluates the intervention on the dimension that matters — the coordination it enables across functions — rather than the single-function bump it was never designed to produce. And asked from a position of leadership, repeatedly, it teaches the organization that the 90% is real, that the work lives between functions, and that funding it requires evaluating across budgets rather than within them.

The "when" carries as much weight as the "who." Pulling the right functions into the 90% conversation early — before the launch plan sets, before the infrastructure locks — is when the 90% can still be built by design. Pull them in late and you're patching a journey that already leaks. A leader who asks "who and when" early is the one who gets the 90% resourced before the patients start falling through it.

What this actually changes

None of it requires a reorganization. It requires a change in the first question leadership asks — because that question decides which parts of the journey get built.

Ask "how does this help my team," and you will keep funding a well-run 10% while the 90% stays a gap no one owns and no budget covers. Ask "who needs to be in the room, and when," and the 90% finally has a way to get built — evaluated by a question that can actually see it.

The 90% isn't unbuilt because pharma doesn't care about persistence. It's unbuilt because the question used to fund it can't perceive it. Change the question, and you change what gets built.

The next time a cross-functional intervention lands on your desk, notice the first question you reach for. It's deciding whether the 90% gets built — and your team is learning the answer from you.

Linked Patient Learning helps pharma teams see where persistence leaks across the 90% — and why closing those gaps starts with how leaders evaluate and fund cross-functional work, not just what they deploy.