What Is TPO? A Medical Affairs Framework for Closing Care Gaps

Key Takeaways

• A care gap and an unmet medical need are not the same thing. TPO methodology requires quantifying gaps by patient movement, not just naming the problem.
• TPO expresses the proportion of patients at a defined care journey stage as a percentage, making progress measurable and cross-functionally legible.
• Teams do not need perfect data to begin. A credible signal is enough to set a baseline and course-correct over time.
• Compliance guardrails are easier to design early in the patient journey, before activity approaches treatment-adjacent territory.
• Methodology accounts for roughly 20% of a successful TPO program. The remaining 80% is organizational change: roles, routines, and cross-functional alignment.
• A short readiness meeting before committing resources is one of the most practical steps a team can take before launching a TPO initiative.

Medical Affairs teams have spent years talking about impact. The harder question is how to build the systems, goals, and accountability structures that make impact repeatable, not just aspirational.

Troels Sørensen (Global Head of Clinical Practice, Boehringer Ingelheim) joined Scott Thompson, Co-CEO of Acceleration Point, for a webinar on care gap analysis and Target Population Output methodology. Drawing on over 25 years of experience applying this framework across Roche, AstraZeneca, and Novartis, Troels walked Medical Affairs leaders through how to define meaningful care gaps, translate them into accountability-based goals, and build the organizational structures that turn methodology into daily practice. Over 62 leaders submitted questions during the live session. This article breaks down the core concepts and practical guidance that came out of that conversation.

What Is the Difference Between a Care Gap and an Unmet Medical Need?

A care gap and an unmet medical need often get used interchangeably, but the two concepts call for different responses. An unmet medical need describes what is missing in scientific or clinical terms. A care gap is something more specific: a quantified statement about where patients are in their journey and how many are not progressing as they should.

Troels pushed for this precision because precision is what enables action.

"My proposal is that whatever you call it, you define it by movement of patients. The moment you define it by movement of patients, you can plug into the language of the organization.”

— Troels Sørensen

This is where Target Population Output comes in. A TPO expresses the proportion of patients at a specific point in their care journey as a percentage. Not a vague sentiment about what is missing, but a measurable, trackable figure. That percentage format matters because it lets Medical Affairs speak the same language as commercial forecasting without crossing into commercial territory.

How Do You Prioritize Care Gaps When Data Is Incomplete?

One of the most common roadblocks teams raised was imperfect data: incomplete registries, lagging claims data, inconsistent real-world evidence. Troels was direct about reframing the bar for action.

“We need to learn to step out of our comfort zone, that data’s not always perfect, but what is enough data for us to be able to start acting?”

— Troels Sørensen

Rather than waiting for statistically airtight datasets, Troels recommended starting with whatever credible signal is available, including survey data in markets without claims data, and using it to make a reasonable prioritization decision. Teams that stall are often the ones trying to centralize rigid measurement standards across every market. Teams that move are the ones that let prioritization be a local decision, grounded in just enough evidence to set a baseline and course-correct later.

Acceleration Point’s Medical Impact consulting work reflects this same principle: the goal is building a measurement system that generates useful signal, then refining it as more evidence accumulates.

Where Does Compliance Fit in a TPO Program?

Perhaps the most pressing question for any Medical Affairs leader applying this methodology is where the compliance line sits. Troels was clear that the further a TPO sits from the actual treatment decision, the more straightforward the compliance conversation becomes.

“The earlier in the patient journey you are, the easier it is to have the compliance discussion, because you’re far away from the use of the asset. As you get closer to what would be the use of our assets, that’s where you need to be a little bit more clear and create the guardrails.”

— Troels Sørensen

The practical guidance: bring legal and compliance into the conversation early, not as a final checkpoint. Troels noted he has never had a compliance partner shut down a TPO project outright, but he has had many help shape one into something defensible. The key distinction to hold throughout is attribution versus contribution. Medical Affairs is not trying to prove it alone caused a shift in care gaps. It is demonstrating a credible, compliant contribution toward a shared, health-system-wide goal.

How Does TPO Methodology Change Accountability for Field Teams?

Setting TPO targets raises questions about accountability, especially for MSLs and field medical teams who do not control every variable affecting patient movement through the journey. Troels addressed this by drawing a clear line between accountability and blame.

“This is not about accusation or blame. This is about achieving the target. It’s not about attribution. It’s about how we’re doing jointly to achieve it.”

— Troels Sørensen

For MSLs specifically, this methodology reframes the role itself. Rather than tracking generic activity metrics, MSLs are positioned to understand exactly where patients in their territory are stuck in the journey and who they need to work with to move things forward. Troels shared that reframing field teams as accountable owners of their territory’s patient journey, rather than just activity executors, created visible excitement and innovation on the ground.

The companion piece to that accountability is psychological safety. When a target is missed, the conversation should center on understanding why and what to change next, not assigning blame.

What If Closing a Care Gap Helps a Competitor?

A recurring concern Troels hears from teams: what if closing a care gap benefits a competitor as much as it benefits you? His answer reframes the premise.

In specialty care, the idea that helping a competitor today means they will come back and take business tomorrow rarely holds up. Most competitors are only competitors within one disease area, not across the board. Beyond that, if closing the gap is good for the organization on its own terms, whether it also benefits a competitor becomes far less relevant. Testing channels of communication, education, and engagement before launch builds credibility that earns the right to engage later.

Troels also made the ethical case directly: even in scenarios where a product fails in late-stage trials, years spent improving care gaps and TPOs leave behind more patients diagnosed and treated with the best current standard of care. That is a positive footprint regardless of commercial outcome, and a more durable justification for the work than competitive anxiety ever was.

What Does It Take to Make TPO Methodology Stick?

Getting the methodology right is, by Troels’s own estimate, roughly 20% of the work. The other 80% is organizational change: building the roles, routines, and cross-functional alignment that make care gap thinking part of how a team operates day to day, not a one-time workshop.

Scott Thompson echoed this from his own experience helping teams adopt the framework, pointing to a simple but often-skipped first step.

“One of the things that we’ve done, and I would encourage you to do, with your teams, is to have a really basic, simple, don’t overcomplicate it, readiness meeting. We won’t start a project without first doing a readiness meeting to make sure we don’t get into this, dedicate all of our time and energy to it, and then all of a sudden it gets canceled.”

— Scott Thompson, Co-CEO, Acceleration Point

That readiness meeting, a short structured conversation to align on principles before committing real resources, is often the difference between a TPO initiative that sticks and one that stalls a few months in.

Frequently Asked Questions

What is Target Population Output (TPO) in Medical Affairs?

Target Population Output (TPO) is a measurement framework that expresses the proportion of patients at a specific stage of their care journey as a percentage. It gives Medical Affairs teams a shared, trackable metric for defining and closing care gaps, and it enables cross-functional alignment without crossing into commercial territory.

How is a care gap different from an unmet medical need?

An unmet medical need describes what is missing in scientific or clinical terms. A care gap is more specific: a quantified measure of how many patients are not progressing through their care journey as expected at a defined stage. TPO methodology defines care gaps by patient movement, which makes them actionable across the organization.

Do you need complete data to start a TPO program?

No. The recommendation is to start with whatever credible signal is available, including survey data in markets without claims data, and use it to set a reasonable baseline. The goal is enough data to prioritize and begin, not a statistically perfect dataset. Teams can refine their measurement approach as evidence accumulates.

How does TPO methodology affect MSL accountability?

TPO methodology reframes MSL accountability away from generic activity metrics and toward patient movement in a defined territory. MSLs become accountable owners of their territory’s patient journey rather than activity executors. This shift requires psychological safety: missed targets should prompt inquiry into why, not blame.

Where does compliance fit in a TPO framework?

The earlier in the patient journey a TPO sits, the easier the compliance conversation becomes. Legal and compliance teams should be brought in early, not as a final checkpoint. The guiding principle is that Medical Affairs demonstrates contribution toward a shared health-system goal, not sole attribution for patient outcomes.

Ready to go deeper?

Watch the full webinar recording for the complete Q&A, including implementation lessons, edge cases, and how to structure a readiness meeting before rolling this out with your team.

You may also find these resources useful:

• Unlocking the Impact of Medical Affairs: Overcoming Challenges in Defining and Measuring Success
• Medical Affairs Consulting Services at Acceleration Point