When Biogen Canada needed to move a fragmented, underprepared healthcare system toward readiness for the first-ever disease-modifying Alzheimer's therapy, it faced two problems at once: a structural one and a logistical one. The structural problem was that no single actor controlled the solution — neurologists, patient advocates, health administrators, and provincial policy actors each held a piece of it, and they had never been asked to solve it together. The logistical problem was the calendar. It was November 2020. Bringing 27 people into a room was not an option, and making 27 people do real collaborative work online — not listen to presentations, but build something together — was a different challenge altogether.
The workshop convened around a single, deliberately constrained question:
The “no new resources” constraint was the point. It forced the room to redesign how the existing system worked rather than wait for funding that would not arrive in time.
The Canadian healthcare system was unprepared, and the timing could not have been worse. Eight months into the pandemic, dementia care was being deferred across the country, memory clinics had shifted to virtual models never designed for this population, and governments at every level were consumed with COVID-19 response. Layered on top was a structural problem that predated the pandemic entirely: no standardized diagnostic pathway, insufficient PET and MRI imaging capacity, and deep stigma around dementia that suppressed early help-seeking even in normal times.
Biogen could not mandate any of this to change. It is a pharmaceutical company — it cannot compel provinces to fund PET scans, direct physicians to adopt new protocols, or set the priorities of patient advocacy groups. And yet neurologists, patient advocates, homecare providers, health administrators, and provincial policy actors would all need to move together, in the same direction. They had never been in the same room.
The readiness problem was not one obstacle but several interlocking ones, each owned by a different part of the system. None could be solved by Biogen, or by any single actor, alone.
| Dimension | Why it could not be solved alone |
|---|---|
| Public and physician awareness | Early treatment depends on early presentation, but families discounted symptoms as normal aging and primary-care physicians received only weeks of neurology training. Raising awareness requires patient advocacy groups, primary care, and specialists to align on the same message — none of them controls the others' channels. |
| Diagnostic and referral pathway | There was no standardized Canadian pathway from first concern to confirmed diagnosis, and rules on who can refer, diagnose, order lumbar punctures, or read an MRI varied by province. Building a coherent pathway requires provincial health authorities, memory clinics, and specialists to agree on a model no one of them can mandate. |
| Biomarker and imaging capacity | Confirming eligibility and monitoring safety requires PET, MRI, and emerging blood tests that were not uniformly approved, reimbursed, or available — and a disease-modifying therapy would add a new MRI burden to a system already at capacity. Capacity sits with provincial payers, hospitals, and radiology, not with the manufacturer. |
| Treatment delivery and infusion logistics | A monitored infusion therapy needs local delivery sites, trained staff, and safety monitoring protocols. Leveraging existing local assets (e.g., nurse-led infusion) requires clinics, provincial funders, and professional bodies to define who can do what — a multi-party design problem. |
| Patient and caregiver experience | Stigma, fear of losing a driver's licence, and the absence of post-diagnosis navigation kept patients away even when families knew something was wrong. Fixing the lived experience requires advocates, clinicians, and homecare providers — the people who touch the patient journey at different points — to co-design it. |
| Funding, policy, and the “burning platform” | Sustained change depended on persuading provincial governments that earlier diagnosis and care would reduce overall system burden. Making that case credibly requires clinicians, advocates, and former system leaders to advocate together — a manufacturer advocating alone has limited standing. |
The Mind Meeting convened 27 participants — 9 from Biogen and 18 external stakeholders, including neurologists, memory-clinic founders, an Alzheimer Society network, a homecare provider, a former Ontario Health CEO, and a patient. Each held a piece of the problem that the others could not solve without them.
| Stakeholder | Role in the problem | Why their absence would have stalled the solution |
|---|---|---|
| Specialist neurologists (memory and dementia) | Diagnose and manage Alzheimer's, interpret biomarkers, and set the clinical standard of care. | Any pathway or treatment-readiness plan designed without the diagnosing specialists would miss the real clinical bottlenecks and fail to earn the credibility needed for other clinicians to adopt it. |
| Primary-care and nurse-practitioner representatives | The first point of contact, responsible for recognizing early signs and initiating referral. | If the front door of the system is not represented, the earliest and largest point of failure — missed or dismissed early symptoms — goes unaddressed. |
| Memory-clinic founders and models of care (e.g., MINT) | Run the interprofessional clinics that already diagnose efficiently at scale. | The fastest path to capacity was scaling models that already worked; without their operators in the room, those models could not be turned into a national recommendation. |
| Alzheimer Society (national and provincial) | Hold the public-awareness channels, patient navigation, and post-diagnosis support. | Awareness and navigation recommendations would be unworkable without the organization that actually delivers them, and the “with, not for” principle would be hollow. |
| Homecare and seniors-care providers | Support patients and caregivers in the community, where most of the disease course is lived. | A plan built only around clinics and hospitals would ignore where care actually happens, producing recommendations that break down in the home setting. |
| Former health-system leadership and policy advisors | Understand provincial funding levers and how to build a case governments will act on. | Without insider knowledge of how funding decisions are really made, the advocacy recommendations would be naive and the “burning platform” case would not land with payers. |
| A person living with dementia (patient voice) | Carries the lived reality of diagnosis, stigma, and navigating the system. | Every recommendation about patient experience risked optimizing for the system's convenience rather than the patient's reality; the patient's presence kept the work honest. |
| Biogen cross-functional team (9 roles) | Hold the therapy, the evidence, and the resources to convene and help execute. | The convener and eventual coordinating partner had to hear the constraints first-hand to build a plan it could actually support — not a plan handed to it second-hand. |
The conventional pharma response is the advisory board: invite a handful of experts, brief them on the therapy, gather input, and synthesize it internally. Biogen had done this, and had commissioned a substantial body of research on Canada's readiness for Alzheimer's disease-modifying therapies. The team understood the problem in detail. But data and advisory input hit the same ceiling. Advisory boards put the company at the centre and ask external stakeholders to react to the company's framing, one at a time, in separate conversations. They generate opinions, not ownership — a report, not a coalition.
Biogen needed to know how to move a fragmented, underprepared Canadian healthcare system toward readiness for a new class of Alzheimer's therapies — in the middle of a pandemic, without the authority to mandate any of it, and assuming no new system resources. The neurologists, patient advocates, health administrators, and provincial policy actors who each held a piece of the solution had never been asked to solve the problem together.
The workshop ran each of its six topics through the same three-stage discipline. In Analyze, small cross-functional teams surfaced the real constraints and disagreements — what each actor controlled and where they were stuck. In Diverge, they generated a wide range of options across organizational boundaries, before committing to any. In Converge, each team built the recommendations it would own, and the full room voted to prioritize them. What follows is how that played out, topic by topic. The mechanics were identical; the content differed.
Analyze. The team established a sharp distinction the system kept blurring: mass screening of the well had been formally advised against, but early diagnosis of people with real symptoms was being missed. The binding constraints were that families discounted symptoms as aging, patients resisted coming in, and physicians outside neurology lacked training to act — with biomarker access (PET, LP, blood tests) uneven and largely unreimbursed.
Diverge. Options ranged widely: at-home self-assessment tools and a digital MoCA to lower the threshold; specialist “spokespeople” in each discipline because doctors listen to doctors; CME programs to teach non-neurologists when and how to test; community partners (pharmacists, even banks and police) as screening touchpoints; and reusing proven public campaigns such as the Heart & Stroke anti-smoking model.
Converge. The team committed to four recommendations under culturally appropriate, “with not for” principles: ensure early intervention by health professionals; build capacity by funding and scaling models that already work (GAIN, MINT, rural memory clinics); advocate for increased access to biomarker technology; and run a targeted public awareness and activation campaign.
Analyze. The room mapped how fragmented the route to diagnosis was: no standardized Canadian pathway, province-by-province variation in who could refer, diagnose, perform lumbar punctures, or read an MRI, and no shared baseline data on diagnostic rates. Natural resistance in the system and missing post-diagnosis navigation compounded the delay.
Diverge. Options included an expert advisory panel linking primary-care, hospital, and specialist data; an environmental scan aligning provincial dementia strategies; serious data-mining with each jurisdiction to find gaps; modelling the ALS edaravone pathway; and national PR built on acceptance, modelled on the Bell Let's Talk campaign.
Converge. Three recommendations carried: build a patient-and-caregiver pathway from pre-diagnosis to end-of-life with clear inclusion criteria and a navigator for each person; build capacity for screening, diagnosis, and care (funded PET/MRI access, defined scopes of practice, adequate HCP compensation); and develop prevention and risk-mitigation messaging with measurable national campaigns.
Analyze. The team confronted the capacity reality: a disease-modifying therapy would require MRI before and during treatment to monitor safety, adding load to a system already at its limit, with infusion delivery, monitoring, and provincial approval all unresolved. Coverage thresholds (e.g., MMSE cut-offs) risked excluding exactly the early patients who would benefit.
Diverge. Options spanned delivering MRIs locally with centralized remote expert interpretation to relieve bottlenecks; leveraging local assets such as nurse-led infusion; and a coordinated advocacy push for provincial approval and funding of both the therapy and amyloid PET.
Converge. The team committed to leveraging local assets for infusions, delivering MRIs locally with remote interpretation, and advocating for government approval and funding for the therapy and amyloid PET in each province — the last of which the full room ranked among its highest priorities.
Analyze. The patient voice in the room reframed the problem: stigma, fear of consequences such as losing a driver's licence, and the absence of navigation support kept people away even when families knew something was wrong. The team surfaced how often the system optimized for its own convenience rather than the patient's reality.
Diverge. Options included empowering and incentivizing HCPs to advocate for patients, expanding access to current and future diagnostic technology, and codifying patient rights and expectations across the journey.
Converge. The team's signature recommendation — advocate for a patient bill of rights — was joined by incentivizing HCPs to advocate for patients and expanding access to diagnostic technology. The bill-of-rights recommendation drew strong cross-stakeholder support in the vote.
Analyze. This team's job was to make the case for urgency that would move provincial governments. The constraint was that a manufacturer advocating alone has limited standing; the system needed a credible, coalition-backed argument that earlier diagnosis and care reduce overall burden and cost.
Diverge. Options centred on building an evidence-backed case for patient success in the home setting, quantifying the societal and caregiver savings of early intervention, and refreshing the public/government-relations campaign to prioritize early detection.
Converge. The team committed to building the case for patient success in the home setting and developing a refreshed PR/GR campaign to drive early detection — both of which the full room ranked among the very highest priorities, signalling shared conviction that the case for change had to be made to government, together.
Analyze. Held in the eighth month of the pandemic, this topic stress-tested every other recommendation against the disruption underway: deferred dementia care, virtual memory clinics not built for this population, and a possible launch into a system in crisis.
Diverge. Options examined how to proactively find higher-risk seniors who had fallen out of contact, how to harden the new pathway against future scenarios, and how to use virtual care without losing the in-person assessment that diagnosis still required.
Converge. The team committed to proactively finding higher-risk seniors and building scenario resilience into the broader plan, ensuring the recommendations from the other five topics would hold even under pandemic conditions.
Across the six topics, the room produced a single coherent strategy rather than six disconnected wish-lists. When the recommendations were prioritized by vote, the system-level moves clustered at the top — building capacity for diagnosis and care, making the case for home-setting success, scaling existing models, and refreshing the early-detection campaign — and these consolidated into three themes: redesign the dementia care model, build capacity to implement it, and advocate for it to be implemented and sustained.
Biogen Canada left the workshop with three things a pharmaceutical company cannot buy or commission:
Advisory boards put the pharma company at the centre and ask external stakeholders to react to the company's framing, one at a time, in separate conversations. They generate opinions, not ownership. What Biogen needed wasn't more input — it was a coalition of neurologists, patient advocates, administrators, and policy actors who had built a strategy together and left with a shared stake in executing it.
You design for it from the start rather than adapting an in-person format. MMG used Zoom breakout rooms for structured small-group work and MURAL to replicate the synthesis that would normally happen around a physical wall — clustering ideas, surfacing patterns, building toward shared conclusions. The distributed format was new; the rigor wasn't.
Because the 18 commitments weren't Biogen's recommendations handed to stakeholders — they were built by the stakeholders themselves and prioritized by the room. When the people who will have to execute each part of a strategy are the ones who built it, the ownership question largely answers itself.
Yes. The underlying challenge — getting a fragmented group of actors, none of whom controls the full solution, to build and commit to a shared strategy — appears across sectors. MMG has run similar engagements for government agencies, not-for-profits, and commercial organizations facing the same structural dynamic.