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Over 200 days into the COVID-19 pandemic, people around the country and the world are, at the very least, becoming normalized to the new normal. Kids are back in school, sports have returned and, depending on where you live, some restrictions may have been relaxed.

This more relaxed approach to life possibly in combination with the cooler weather is resulting in a third surge in the number of COVID-19 cases in the United States. According to John Hopkins data, the U.S. one-weekly daily average of new cases is 101.8K as of Nov. 8, which is an increase of +114% from Oct. 8. This uptick prompts the obvious question of how will patient traffic within the doctor’s office be impacted?

Contrary to some expectations, the data suggest patient traffic is not affected by increasing incidence of COVID. Except for the late-March / mid-April timeframe, patient traffic and COVID numbers have moved independently of each other, as can be seen by the graph below. Patient traffic has steadily increased since mid-April even as the number of new COVID cases have fluctuated. People are again comfortable going about their lives and taking care of their daily needs.

Based on the data trend and the positive news regarding the success of vaccine trials, the outlook for patient traffic and treatment going into 2021 is positive. We can expect patient office traffic across most specialties and disease states to remain within normal seasonal levels. The possible exception to this will be with acute illnesses primarily within primary care and pediatrics as masks and social distancing may result in a milder cold and flu season.

For marketers, this means as much as things have changed, the future is looking very similar to what it did pre-COVID. As we are still seeing signs that practices are catching up on some of the delayed care from earlier this year, it is probably more important than ever that marketing plans are being made at scale.

At PatientPoint, we are continuing to work with our clients to access our market insights based on our data assets and analytical capabilities. Using these insights, we are able to better help brands plan, execute, and optimize in order to maximize the impact of their point-of-care campaigns.

In mid-October, the latest wave of research tracking COVID’s impact on outpatient visits was published by Commonwealth Fund, Harvard, and Phreesia. The latest data found that overall outpatient care visits in the prior month have finally returned to prepandemic levels, after dropping nearly 60% during the spring. (This fifth wave data set tracked trends through October 10th.) Not only did overall visit counts per week return to normal levels, but they even “slightly exceed” pre-COVID counts. But, as researchers noted, “there is considerable variation by patient age, geographic area, clinical specialty, and insurance coverage.”

While all age groups are on an upward trajectory again since the spring weeks, “visits for younger children remain substantially below the prepandemic baseline,” noted the report. Those aged 6 years or older all exceed prepandemic levels (6% above baseline for ages 6-17; 4% for ages 18-64; 5% for ages 65-74; 4% for ages 75+). Children ages 0-2 years are recording at 18% below baseline and ages 3-5 are coming in at 10% below baseline.

Weekly visits to dermatologist offices and adult primary care appointments are showing the highest level of rebounds, coming in at 17% and 13% above baseline, respectively. Areas such as OBGYN and Oncology are even with baseline. While pulmonology, otolaryngology, and behavioral health visits each track well below baseline at -20%, -17%, and -14%, respectively.

The researchers also detailed that while “telemedicine use has slowly but steadily declined” after peaking in April, its usage is still “well above the prepandemic baseline of very few telemedicine visits.” The use of telehealth varies depending on the medical specialties: areas such as surgical record low level usage (2% of total visits), but behavioral health outpaces other areas significantly (41% of total visits). Telemedicine’s implementation does vary by provider organization as well. For example, “organizations of six or more clinicians use more telemedicine than practices of one to five.” Additionally, the report finds that approximately 32% of organizations “never adopted [it] at all”. Those that did, however, have seen their use of it decrease to Minimal usage in the fall after Heavy or Moderate usage in the spring.

As a marketing channel, the pharmacy turned challenges into opportunities for Rx brands

Pharmacies stepped up to help consumers through the public health crisis. And consumers responded by stepping into pharmacies. That dynamic has been an important part of getting many communities through an unprecedented challenge. And it has also helped pharma marketers reach patients in healthcare settings and generate positive ROI in several therapeutic categories at a time when few other businesses could operate in near-normal conditions.

Pharmacy in 2020: reliable, essential, more valuable than ever

The stay-at-home orders from COVID-19 response nationwide interrupted many typical doctor-patient relationships as access to clinics and hospitals was curtailed or discouraged for non-emergency, nonessential concerns and public transportation was interrupted. So pharmacies became an even more natural and logical healthcare destination.

And pharmacies leaned into that responsibility. As CVS CEO Larry Merlo said in the company’s second quarter earnings report, “The environment surrounding COVID-19 is accelerating our transformation, giving us new opportunities to demonstrate the power of our integrated offerings and the ability to deliver care to consumers in the community, in the home and in the palm of their hand which has never been more important.”

Pharmacies opened thousands of on-site COVID-19 testing centers and became de facto leaders in transmission reduction for retail stores. In concert with the Department of Health and Human Services, pharmacies expanded vaccine services by broadening the range of vaccinations approved for administration by a trained pharmacist. In hard-hit communities, pharmacies stepped up their telemedicine and delivery options, even launching drone services to minimize contact and spread. Some locations even opened customers’ eyes for the first time to the full scope of services when they applied their compounding skills to make hand sanitizer during shortages.

Stay-at-home’s impact on the pharmacy channel

Look past the headline items when evaluating the story of patient outreach in the pharmacy channel. Visits to pharmacies were undeniably down at the peak of stay-at-home orders. That resulted in a short term impediment to campaign lift and ROI.

Doing well in a tough time

Yet even during the periods of curtailed movement, pharma marketers were reaching patients in a relevant setting and an appropriate mindset. InStep Health’s media programs in 2Q 2020 operated mostly on-plan and on-schedule, even as stay-home orders were in their fullest force in most markets. Consumers still saw appropriate messaging in categories including eczema, type 2 diabetes, dry eye, and HIV. And despite the challenging operating environment, those messages were seen and acted on.

Over this period, our Media Display program continued to deliver positive results, with an average lift in total prescriptions of over 5%1 and ROIs greater than 4:12 across several therapeutic categories. Those results reinforce the pharmacy’s strength and viability as a marketing channel, even at a time when people are focused on the barest essentials.

A resilient rebound

Many of the effects of stay-at-home on pharmacy performance were short lived. Even when overall visits to pharmacies and general outlets were flat or trending down, visits relevant to pharma marketers were outperforming industry averages. As measured by IRI reporting3, while total non-edible (CPG) trips decreased to an index of 84 at their lowest point over the course of the stay-at-home period, trips for non-edible items, including health products, trended 11% higher during the same timeframe.

Basket sizes have climbed as well. So although hard-hit areas did show a drop in visits and for pharma marketing program performance, we also saw compelling data showing that consumers have pent-up demands and look for opportunities to return and shop.

New prescription volumes declined significantly, and the so-far lower propensity for telehealth visits to generate new prescriptions has slowed recovery in new scripts. But volumes have been steadily climbing since late spring 2020. At the same time, patient confidence as measured by HealthVerity quickly neared pre-pandemic levels in summer after bottoming out in late April.

Industry data analysis published on drugchannels.net found that in-store visits for refills, which account for the vast majority of visits, have nearly rebounded to pre-pandemic levels after spiking early in the stay-at-home order period and remaining depressed in spring. And concerns that the pandemic would send more customers to mail-order remain unfounded, as dispensing growth through both mail and retail channels is virtually identical year-to-date through mid-August.

What hasn’t changed

The key strengths of the pharmacy channel remain intact. So do the fundamental principles of a strong in-pharmacy marketing program.

Measurement needs to be governed by consistent standards, including the use of test and control groups for matched panel analysis. Campaign performance should also take into account when the program ran: pre-COVID-19, during stay-at-home, or post-restriction periods. Understanding differences in performance between geographies will also be more relevant than ever.

Partnerships already guided by sound measurement and long-term analysis will find it easier to incorporate COVID-19 adjustments into both evaluating campaign performance and future campaign planning. COVID-19 and related responses will undoubtedly continue to affect consumer behavior, pharmacy visits, and doctor access for a period of time. Sticking with careful, detailed analysis will reduce risk for future campaigns by providing a solid base for planning and decision making.

Most of all, what hasn’t changed is that the pharmacy is solidly positioned at the front line of community healthcare. Even as pharmacies adapt to changing needs by expanding delivery services and promoting telehealth options, the local pharmacy remains a pillar of in-person healthcare delivery. As healthcare services return to normal capacity and delivery channels continue to evolve, the pharmacy will be more relevant than ever.

Instead of speaking for the pharmacy, we’ll leave the last word to Walgreens Boots Alliance co-COO Alex Gourlay. “We’ll be relied upon in this new world to get medications and products to customers faster because of the proximity of our brick-and-mortar locations. Flexibility in supply chains and among wholesalers and delivery partners will become critical,“ he wrote in Chain Drug Review. “What won’t change? The heart of the retail pharmacy.”

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InStep Health is a continuum of connections. We place Rx, OTC, and CPG brands at the center of care, wherever consumers go. Designed for the individual experience (iX), our platform reaches patients when they interact with healthcare providers or pharmacists, reaches healthcare providers and pharmacists so they’re up to date on the best possible solutions for their patients, and uses best-in-class data insights and technology to focus when and where your messages will have the most impact.

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Sources:

1. Matched-panel research conducted by Retail Intelligence Inc. for InStep Health Media Display programs executed April – June 2020

2. Patient Value ROI calculated using script lift and client-supplied or RED BOOK™ pricing data

3. IRI Consumer Network™ Panel All Outlets (CSIA) Data for weeks ending 04/12/20 – 06/28/20 instephealthmedia.com

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In this interview, DTC Perspectives’ Chairman, Bob Ehrlich, and Phreesia’s SVP of Life Sciences, David Linetsky, discuss how the patient experience has evolved rapidly during the COVID-19 pandemic, particularly as providers leverage digital patient intake solutions to enable safer contactless workflows. They will also explore the importance of aligning with platforms that are flexible, adaptive, and meet patients where they are, given that these changes are likely here to stay.

Bob Ehrlich: As many are aware, the outbreak of the COVID-19 pandemic resulted in steep declines in office visit volumes in the Spring. Phreesia has since published multiple studies on outpatient visit volumes with Harvard University and the Commonwealth Fund, using Phreesia’s network data. Can you provide some insight into where these visit trends now stand?  

David Linetsky: Bob, I am happy to report that overall, patients have returned to seeking care. Most practices within the Phreesia network appear to have adapted to the pandemic and stabilized their operations. Visit volumes have remained relatively stable since June and in many cases have returned to pre-pandemic levels. In some cases, visit volumes have even exceeded their pre-pandemic levels, as many practices do active outreach to their patient populations to bring them in to catch up on deferred care.

Phreesia continues to publish this data in partnership with researchers from Harvard and the Commonwealth Fund. Our reports are released monthly and can be found on the Commonwealth Fund’s website.

Bob: I am glad to hear that levels are approaching normal. Phreesia has released several applications as a response to the pandemic across its provider network. As medical offices adjust to the “new normal”, how have these digital intake solutions helped practices get their visit volumes back to pre-pandemic levels?

David: Practices are implementing contactless workflows that help minimize exposure between patients and staff. Phreesia’s Zero-Contact Intake offering allows practices to set up alternative workflows, such as patients checking in from their cars or drive-through testing sites. In addition, practices are removing unnecessary shared spaces and assigning many of their non-provider staff members to remote work. Our COVID-19 Screening Module also automatically screens patients for self-reported COVID-19 risk factors before their visits and is continually updated based on evolving CDC guidance.

Telehealth visits have been proven to be an essential solution for patients, allowing those who don’t need to be seen in person to continue to receive care. Phreesia’s Intake for Telehealth workflow captures important intake information ahead of the visit and facilitates the start of the virtual session.

We recognized the urgent need for intake products that could support telehealth visits, screen for COVID-19 risks and minimize contact during in-person visits, and we shifted our efforts to help medical groups stay safe, stay open and continue to see patients.

Bob: Telemedicine seems to have been breaking new ground in providing a safe and efficient alternative for patients. How do you view this solution long-term?

David: We’ve heard from many of our practices that their priority is to adapt to COVID-19 by putting the safety of providers, medical staff and patients first. Prior to COVID-19, the telehealth market was dominated by specialty services offered through employee benefits plans. With the expansion of visit types qualifying for telehealth reimbursement and Medicare copays waived for telehealth visits, many of the barriers that have traditionally prevented practices from embracing virtual visits have been removed.

Data from our most recent Commonwealth Fund report show that while telehealth adoption varies significantly depending on the specialty, telehealth utilization has been relatively stable since June, at a level many times higher than pre-pandemic.

While the future of reimbursement changes—and therefore of telehealth—remains uncertain, many providers are looking towards telehealth as a creative, long-term solution to deliver patient care. From portable EKG machines to at-home ultrasounds to cancer screenings, physicians are looking for effective alternatives to traditional in-person services.

Bob: Do you see COVID-19 as the initial cause of these changes to the patient experience, or do you think some of these changes were already underway prior to the pandemic?

David: That’s a great question. While the COVID-19 outbreak accelerated the adoption of these tools among providers, it was not the initial catalyst. Prior to the pandemic, many healthcare providers had already begun to adopt digital engagement tools to manage operational, clinical and financial processes. This is a change that has been happening for many years in other industries, with consumers having come to expect the convenience of digital solutions broadly. So, safety concerns have greatly accelerated these changes in healthcare, but those changes were already underway and they will persist because consumers expect effective and convenient options.

Phreesia’s patient intake platform was designed to support these trends, which has allowed us to thrive in the current industry environment and to deliver valuable applications to our provider network and the broader market. As we navigate a new normal in a post-COVID-19 world, we believe digital engagement tools will become even more critical to ensuring that the POC stays relevant to Life Sciences manufacturers and healthcare marketers. 

Bob: With all these changes in the patient experience rapidly occurring, do you think Point of Care is still an effective channel to engage with patients?

David: Absolutely. Point of care remains a critical and incredibly valuable channel. However, to be successful, healthcare marketers must adapt to the long-term changes to the patient experience. They must understand that the point of care continues to become more ephemeral and less tied to physical locations; it’s now wherever patients choose to engage with their providers and seek care. In addition, one-to-one engagement tactics are increasingly more valuable as in-person visit volumes fluctuate because of COVID-19. Marketers should not have to worry about audience volume or quality. They should focus on tactics that ensure both of those important factors.

Some traditional tactics are quickly becoming obsolete due to providers’ concerns about shared surfaces. As technology enables patients to take an even more active role in their care, patients are increasingly receptive to personalized content tailored to their individual health needs, that can be accessed on their own devices.

Lastly, COVID-19 has caused a tremendous disruption to patients’ access to care, creating a greater need for support programs. The point of care has moved beyond the walls of the physician’s office, and I believe that the POC marketing industry must adapt.

Bob: Are there specific strategies you suggest for the Point of Care marketing industry to adapt to the increasingly digital environment?

David: I believe it is critical for healthcare marketers and life sciences manufacturers to have strategic insight into how the POC can become an integral part of their digital and mobile strategy. Patient utilization data demonstrate the value of mobile and how it enables providers to deliver care safely through contactless and virtual workflows. Personalized content and directed, one-to-one engagements cut through the noise and influx of health information and address patients’ specific needs and priorities.

Finally, incorporating disease education and patient support programs into digital engagement campaigns to ultimately improve health outcomes for target patient populations will be critical for long-term success in the changing healthcare landscape. As the patient experience becomes increasingly mediated by the converging forces of digital adaptation, patient centricity and pandemic response, we must find a way to align our digital engagement strategies at the point of care to every patient’s needs.

About David Linetsky
SVP, Life Sciences, Phreesia

David Linetsky is responsible for cultivating Phreesia’s partnerships with Life Sciences companies, supporting them in the development of healthcare products that deliver value and engage patients in their care. He has worked at Phreesia for more than a decade and held key leadership roles, including Vice President of Analytics and Insights, and Vice President of Finance.

Prior to joining Phreesia, David worked in academia as a researcher and instructor in the fields of biotechnology, mathematics and philosophy. David holds a BS in mathematics from the University of Alberta. He also earned a master’s degree and was a PhD candidate in mathematics and logic at the City University of New York.

To learn more about Phreesia, please click here or visit them on:

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After consistently seeing an underrepresentation of non-white patients in clinical research, Genentech decided to dig deeper as to why there is such enrollment inequity. According to an announcement from their website, the pharmaceutical manufacturer “undertook a landmark study to elevate the perspectives of these medically disenfranchised individuals and reveal how this long-standing inequity impacts their relationships with the healthcare system as a whole.”

Interviews with 2,207 patients were conducted to learn about their direct experiences with the healthcare system. Of the research participants, “1,001 [were] from the general population and 1,206 [were those] who qualified as ‘medically disenfranchised’ from four communities: Black, Latinx, LGBTQ+, and low socioeconomic status (Low SES).” Research findings unveiled a significant lack of trust, with patients often feeling that they had been treated unequally and unfairly – or worse yet, that the system was working against them.

Genentech revealed that approximately just one-quarter to one-third of medically disenfranchised patients agree that all patients are treated fairly and equally (27% Black, 27% Latinx, 34% LGBTQ+, 23% low SES). Meanwhile, nearly half (49%) of the general population agree with that statement. Furthermore, “52% of medically disenfranchised patients believe that the healthcare system is rigged against them.”

As a result of these experiences, medically disenfranchised populations often delay, interrupt, or discontinue seeking care – often “for fear that they were not understood.” Additionally, the lack of trust has also translated to as many as one-in-three medically disenfranchised patients opting to not participate in clinical trials, vaccinations, and testing for medical conditions.

Genentech plans to continue investigating this situation further and progress their program efforts to help combat this issue. The study’s announcement concluded with an inspirational message for the healthcare industry’s growth and improvement by stating:

“[T]o address healthcare disparity, we must address issues of trust in the healthcare system. We must build bridges to medically disenfranchised patients to make them feel valued, respected, and understood. We must give them reasons to believe in the healthcare system.

“We know we cannot do this alone. Only through a broad coalition of industry, government, NGO, and community stakeholders will we make the changes necessary to ensure the healthcare system works for everyone. This research is the latest step in our efforts toward that goal, and we hope it serves as a call-to-action for candid discussion, proactive collaboration, and meaningful action.”

Her current work has her continuing to lead the New York medical team, managing the EU medical strategists, and also “developing solutions to address the disparity in recruitment of people of color into clinical trials.” The medical team supports both DTC and HCP new business opportunities.

“I’m thrilled to take on this new role, as this is an opportunity to elevate our diverse, best-in-class medical talent even further,” Dr. Bazuro said in the news announcement. “I look forward to ensuring best practices are uniformly implemented across all of our offices in support of our amazing clients, as they continue to bring life-changing therapies to patients in desperate need.”

Dr. Bazuro “holds a PhD in Cell and Molecular Biology from the University of Pennsylvania Medical School, a BS-Research Intensive in Cell and Molecular Biology from Yale University, and she conducted her postdoctoral research fellowship at Memorial Sloan Kettering Cancer Center.”

A record low price increase on branded drugs and changes in health insurance benefit design are just a few of the reasons that patients in the US are experiencing improved affordability for their medications, according to a new report from The IQVIA™ Institute for Human Data Science. Their research found that 71% of branded prescriptions have a final out-of-pocket cost of below $20, while just 3.6% of branded prescriptions have a cost above $125. The report, Medicine Spending and Affordability in the U.S.: Understanding Patient Costs for Medicines, discovered that “[a] rising number of prescriptions are now dispensed with a $0 payment by the patient, and now amount to 44% of all branded prescriptions in 2019, up from 36% in 2015.”

Additionally, the data found that branded prescriptions costing more than $125 largely affects those with commercial plans (44% of high-cost claims) or Medicare coverage (35% of high-cost claims). IQVIA did also find that “abandonment is higher at higher prescription cost levels, and those prescriptions may be underrepresented as those prescriptions might have been abandoned due to cost.” Of the 9% of branded and generic prescriptions that are abandoned: 5% are for medications of no cost, but 60% are when the medicine costs more than $500.

“Lower drug price growth and improvements in affordability to patients is a testament to the positive market dynamics of the American pricing system and the fact that manufacturers, health insurers and the intermediaries, such as wholesalers and benefits managers, have taken actions to reduce the burden of drug costs to patients,” said Murray Aitken, IQVIA senior vice president and executive director of the IQVIA Institute for Human Data Science, in the news release. The report examined the complexities of our current pricing system, hoping to “contribute to more transparency and understanding of the different levels of cost,” Aitken added.

“Visits to physician offices and other health care practices, which had fallen 60 percent by early April, have now rebounded and plateaued at 10 percent below prepandemic levels,” found the latest wave of research from the Harvard University, Phreesia, and the Commonwealth Fund. In-office visits are still showing a decline, even among those states which saw a surge in cases during the June and July months. However, these declines are still smaller than that of the early days of the pandemic.

Several hot spots states – including early-opening ones such as Arizona, Florida, and Texas – recorded an increase in telemedicine visits, but only a slight decrease in overall visits. “Practices in these states appear to have maintained most of their visit volume by increasing telemedicine visits and creating new safety protocols for in-person visits.”

Telemedicine use peaked in mid-April. While it has shown a decline and its current adoption has plateaued, it is still being used at a “substantially higher rate than prior to the pandemic” the report notes.

The research continued to find a large difference in visit patterns between adults and children, with adults still outpacing children. Those aged 18-64 years old showed a -4% change in visits (the smallest percent change for the week starting 7/26/2020), while children ages 3-5 represented the largest percent change at -36%. Children ages 0-2 were tracked at -32%; ages 6-17 recorded a -17%; and those aged 65-74 and 75+ both came in with a -9% each in visits.

Initial data findings were published in April 2020, with this research partnership team providing monthly updates to track trends in outpatient office visits. Click here to view more of the findings – including what impacts insurance type has had on visit rebounds and the adoption of telemedicine by Federally Qualified Health Centers (FQHC) and non-FQHC.