Latest News

Here’s the big question: How does an industry with regulatory constraints around how it communicates with the public successfully engage on social media through robust, timely, and helpful interactions?

There’s not a simple answer, but creating clear and consistent “rules of engagement” can make for a good first step forward.

As a digital and social media strategist for C3i Healthcare Connections, I help pharma clients build out their social presence and extract meaningful information that can be gleaned from social media. While ongoing monitoring of conversations is a key component of any pharmaceutical brand’s social strategy (see my previous article here), companies need to be well-equipped to participate in those conversations, too. Five broad steps can help you get started.

1. Develop engagement strategies

Take the time to outline your plan of attack, along with the ways your team can apply these principles to their everyday interactions. Doing so will benefit everyone involved by making operations more efficient and streamlined, your customers more satisfied, and your brand more favorable.

Start by assessing the engagement opportunities available to non-regulated industries and rule out those activities which regulations prohibit, such as providing off-label information, soliciting or prompting users to share content that might lead to off-label questions, and recommending or directly promoting the use of a product to a user. After implementing compliance safeguards for handling Adverse Events (AEs), Product Quality Complaints (PQCs), and Privacy Violations (see this article), you can begin to develop your own engagement strategies and practices.

As part of this process, you should:

• Work with key stakeholders — including marketing and branding, public relations, medical information, and pharmacovigilance — to identify the objectives of engagement
• Be prepared to identify and report any AEs and PQCs on owned properties (e.g., branded or unbranded Facebook Pages) and any properties over which the pharma company has control or influence
• Evaluate the current social media space and your role in it
• Develop workflows and escalation guidelines, perhaps considering third-party technologies that help streamline workflows and support operational evaluation
• Establish community guidelines — besides guidelines for posting and commenting, this may include a statement that explains the purpose of the property, links, and contact information

2. Be consistent … but human and flexible, too

After you’ve decided to move beyond monitoring and begin engaging on social media, many companies often start with a simple first-step strategy of responding to AEs and PQCs with a “contact-us reply.” For example: “Hi Sarah. Thank you for bringing this to our attention. We take product safety seriously and are interested in learning more about your experience. Please call us at 800-555-5555.”

A standardized “contact-us reply” can sometimes feel robotic. While remaining consistent is important, it’s equally necessary for brands to consider how to bring the human element to their interactions. Beyond AEs/PQCs replies, teams can add a personal touch by taking the initiative to respond to on-label inquiries or consumer sharing of experiences: “Thank you for sharing, John. We’re glad that you’re taking steps to manage your health.”

Being more human means listening carefully to what is being asked and acknowledging what has been stated. Text can be difficult to interpret sometimes, but you can take cues from emojis, emoticons, and images. While providing accurate on-label information is critical, so too is the emotional tone of an interaction, especially in the sensitive area of health.

3. Establish KPIs

If something can be observed, it can be measured. Two kinds of key performance indicators (KPIs) help assess the performance of your interactions and resource needs of your initiatives. They are productivity KPIs and volumetric KPIs.

Productivity KPIs include metrics such as:

• First Response Time — the time between the consumer’s first contact and the company’s first response for all engagements over a period of time
• Response Time — the total time from the consumer’s first contact and the company’s last response
• Handle Time — the time from the consumer’s first engagement and the completion of all tasks required to process a case
• Resolution Rate — the ratio of the number of resolved posts to the number of those that needed resolution

In today’s world, consumers expect swift responses. In an ideal world with infinite resources, response times on social media could be less than a minute. In reality, however, resources can limit optimal response times. Establish your initial KPI standards based on the number of people on your staff, hours of labor, and average number of posts per hour they can handle. Often vendors can assist in the heavy load of supporting customer care in cooperation with your company.

Volumetric KPIs might include the total of all posts in a given period for a given property (e.g., total Facebook posts in May), or the volume of posts for which the company responded, which can be further organized by type of post (AEs, PQCs, product inquiries, etc.). Third-party technologies can assist with these KPI measurements, although some are better suited for monitoring and reporting, while others are built to support consumer care and interaction. Your technology selection depends on the objectives of your engagement strategy.

Besides supporting the initial stages of your engagement efforts, tracking KPIs after they have been established helps to identify areas of improvement and opportunities within your operations.

4. Prepare for the unexpected

No matter how refined your social strategy, there are always surprises. While you can’t control unexpected events, you can prepare for them.

Before launching your social media initiative, carefully document the process for escalating an issue depending on the situation presented. Establish escalation criteria and communication protocols to avoid last-minute panic. Be transparent, and continually monitor the situation until it resolves.

Keep in mind that a response isn’t necessarily an answer. Make sure your teams can distinguish legitimate consumer concerns from spam content. If a consumer posts an inquiry and an immediate answer is not available, it’s OK to acknowledge the question and inform the consumer that he or she will receive a follow-up response. Suggesting a private message can be another effective way to handle, or public responses that benefit the community.

5. Evaluate performance, apply insights, and adjust practices

In social media, as in any initiative, there is always room for improvement, refinement, and course-correction. For example, if average response and handle time goals are not being met, is it due to a lack of staffing (a volume issue), or a need to coach your representatives? On the flip side, if response times are quicker than anticipated, are there other activities that can be added to the initiative, such as improving the quality of responses?

A big advantage social media has over traditional media is the ability to more immediately measure and evaluate the performance of content. As experience is gained and insights are gleaned, proceed to evolve from a passive/reactive model to an active approach that seeks out opportunities for engagement.

Consumers are eager to receive information and support from all parties in the healthcare system. Those pharma companies or brands that have established the foundations for social media processes and, ultimately, build up to higher tiers of engagement, not only have a greater opportunity to meet or exceed patient expectations — they’re also able to earn long-term trust and favorability among patients.

While the primary focus of patient adherence programs today has shifted from the product to the patient, the communication barriers that hinder patient interaction and engagement are still common. Many of these barriers can be overcome by investigating and addressing the root causes of issues, which often occur in either the basic program design and/or within technology systems.

This article looks at three common obstacles and how they can be addressed in order to improve communications, and as a result, improve the adherence rates and outcomes of your programs.

The Obstacle: Patients lack interest in participating, or the program does not allow for patient interaction.
The Solution: Design a program that emphasizes empowerment and two-way communication.

A basic principle to keep in mind when considering the communications modes of your programs is that patients do not want to be “compliant,” they want to be empowered. The more that patients understand why they need to take a specific medication in a timely and consistent manner, or how they will benefit from participating in a treatment regimen, the more likely they will become fully invested in the process to reach a desired end goal. Poor communication often results in patients who don’t feel that they program reflects their needs, concerns, and interests. Enabling for two-way communication is crucial — that means allowing ample opportunities and channels for feedback, and tailored resources to be shared at the right time throughout the entire course of the program.

The Obstacle: Communication with the patient is “one size fits all.”
The Solution: Allow for interactions that are flexible and relevant.

Many factors come into play in the communications of adherence programs: the channel (phone call, text, online chat, etc.), the frequency, the topics discussed. But all too often these communications are designed with solely the general group patient profile in mind. While overarching information about the patient profile is important, it needs to be married with the flexibility of individual experiences and preferences. There are many factors that influence patient behavior — age, gender, family, socio-economic, financial, and logistical — and each of these adapts the patient journey. For example, a more responsive model could mean stratifying patients by level of risk and adjusting the information provided, and the frequency of contact, depending on the needs of the patient at that particular moment. Interactions need to adapt to the patient, not just the patient population.

The Obstacle: Communication systems are siloed — they inaccurately portray a straight narrative, and lack the necessary insight into the entire patient journey.
The Solution: Leverage new technology to assist in program coordination and tracking.

Technology is critical in adopting an adaptive approach to patient communications, but it needs to be orchestrated and adaptive. Taking advantage of a system that synchronizes with the ups and downs of a patient’s journey can help manage variation and provide guidance and insights through intelligence and integrated analytics. Far too long, systems have been focused on single business models or functional areas. This hinders patient communications by creating a fragmented customer journey. As programs become patient-centric and holistic, the technology should follow suit. A platform that allows for evolving interactions with a patient can present a big-picture perspective, and through continuous sensing and orchestration, offer real-time insights and assist with decision-making.

While it’s true that the most effective patient adherence programs keep patient engagement at the heart of their programs, that’s no longer sufficient as a stand-alone element. Considering what patient-centricity really means in terms of communications — and how technology can make a difference — will allow for adherence programs to adapt and improve in real-time, and help further their goal of improving patient outcomes.

Diagram, courtesy of Pegasystems, illustrates how patient communications across all channels meet in one hub, combined with the ongoing communications with healthcare providers. In this article, the challenges to patient communications are in focus.

ABOUT THE AUTHORS

Ed Chase is the director of Life Sciences Solutions at Pegasystems, where he manages the strategy, design, development and marketing of enterprise software products and solutions. He has spent more than 20 years in the software industry, with the majority of those in life sciences, covering both R&D and Commercial solutions. Ed brings a deep technology background that includes product management and development for enterprise applications, business process automation, imaging and electronic documents, and information assurance and authentication. Currently he leads the Patient-Centric strategy, marketing and product development for Pega’s life sciences applications. He can be contacted via email at Ed.Chase@pega.com.

Susan Mattson has more than 25 years of management experience in the pharmaceutical, healthcare and education industries. She has owned her own business development and marketing firm and has served as the director of public relations for a major hospital, with responsibility for marketing, public affairs, community health and development.  She was also previously the assistant vice president of public relations and marketing for a major university. She began her career as a U.S. Naval Officer in public affairs. Susan currently serves as a senior director in account management for programs at C3i Healthcare Connections, with oversight of several patient engagement, access and reimbursement programs and business process outsourcing programs. She can be contacted via email at Susan.Mattson@Telerx.com.

For more about these companies, follow C3i Healthcare Connectionson on Twitter @C3iHC, or follow Pega @pega.

Should Pharma Site Metadata Play by the Same Rules as Paid Search Ads?

This is the second entry in the series about “promotional peccadilloes” available on Convergence Point Media’s Insights blog – topics that often trigger a perceived conflict between good regulatory compliance and effective marketing, and our perspectives on best practices to address them. 

The SERP (Search Engine Results Page) has become the primary gateway for patients seeking health information. As people research a condition or its treatment options, search results often serve as a brand’s first impression, playing a critical role in the split-second decision to click and engage, or move on to other results. While organic search results are controlled by proprietary search engine algorithms, site owners are responsible for the meta tags placed on their pages.

A brand’s decisions about SEO meta tags can have very real implications on organic (non-paid) site traffic and engagement, so hitting the mark on both compliance and effectiveness is a significant competitive advantage. To be blunt, it’s easy to be compliant by erring on the side of extreme caution – but the concerns of both marketers and reviewers are best address holistically, giving rise to informed decision-making with sensible safeguards resulting in better digital outcomes. SEO metadata is a shining example of how this can play out.

A little refresher may help put this in perspective. Meta tags play an important role in a website’s discoverability via organic search results – or, as described by Google, a “way for webmasters to provide search engines with information about their sites”.  They are strings of HTML code that provide descriptive information about the content of the web pages they are placed on, meant to help search engine’s automated crawlers accurately formulate relevant search results and appropriate rankings. Here, we will focus on the two types of meta tags found on web pages that are available to search engine algorithms in generating organic listings.

• Title Tag:
  • Function: accurately and concisely describes the page’s thematic topic
  • Appears in page source code as: <title>Page title here</title>
• Meta Description Tag:
  • Function: provides a short description of the page’s content
  • Appears in page source code as: <meta name=“description” content=”Page description here” />

While the organic listings users see on the SERP may include the provided meta tags, Google’s generation of organic results “is completely automated and takes into account both the content of a page as well as references to it that appear on the web.” Importantly, even if site owners omit meta descriptions altogether, the engines crawl the page content and other sources to determine what will be displayed in the search result. With respect to best practices for their intended use, Google states that “the goal of the snippet and title is to best represent and describe each result and explain how it relates to the user’s query. The more information you give us, the better your search result snippet can be.”

Since title and description tags are often pulled by the engine crawlers into the results users see on the SERP, this sets up what may be perceived by brands as a conflict between best practice website development and promotional compliance. The simple question we address today is “should branded pharma web sites restrict their meta data to conform to compliance standards used for paid search ads?”

State of the industry – Who’s doing what?

Within the Rx pharmaceutical industry, where promotional practices are often consistent across major manufacturers, brands appear split into two groups with respect to their approach to website title and description tags.  One group conforms with the intended purpose of the metadata elements, using the available space to fully summarize the site or page content for the benefit of the search engine algorithms, typically including prominent naming of the disease state the product is approved to treat. Others, however, restrict meta tags on branded sites to conform with the “reminder and  “reminder-like” ad format for compliant branded paid search ads (as defined by Dale Cooke on the Regulatory Rx Blog). These include the brand and generic names and may contain dosage form, quantitative ingredient statements and other descriptive information provided they make “no representation or suggestion” about the product use.

Examples of brands not restricting metadata:

Examples of brands restricting metadata (using “reminder” or “reminder-like” format):

Below we summarize key considerations with respect to both common approaches:

Reasons to restrict metadata:

• Applying the principles of the “reminder format” essentially treats meta data as equivalent to direct brand communications and increases the probability that an organic search result will be constructed by the search engine without implying a claim
• This is arguably the most conservative and risk-averse approach from a regulatory perspective as it removes fair balance from the equation altogether

Reasons not to restrict metadata:

• Irrespective of the presence of meta data, search engine algorithms ultimately determine what shows as copy in organic listings; website owners do not.
• There has yet to be any specific direction from FDA on metadata and no rules requiring their adherence to the “reminder” format in place for paid search ads – specifically:
  • In sending 14 enforcement letters pertaining to paid search (SEM) campaigns to pharmaceutical companies in 2009, FDA weighed in forcefully against the practice of limited space ad copy making brand claims without meeting all of the requirements for a full product promotion. The absence of any corresponding direction explicitly addressing metadata and organic listings in 2009 and for the 7 years since suggests that meta data is seen in a different light.
  • The industry has taken the cue, with many pharma brands using meta titles and descriptions that include brand names and claims that correspond with the contents of their respective web pages, much like the algorithms themselves might generate in the absence of site-provided metadata.
• In the absence of formal rules preventing their use, fully transparent meta data offers search engines more accurate and transparent descriptions of a drug than can be deduced by an algorithm. The result is an arguably superior user experience for patients and HCPs, as metadata can more accurately represent page content. The core goal of search engines is to communicate to the searcher the contents of the indexed pages, and titles and descriptions help the engines maximize accuracy to users when includes condition information. As we argued in our previous post in defense of controversial paid search keywords, given the abundance of incomplete and inaccurate information about drugs online, it serves the public interest for consumers to have unfettered visibility to the drug information provided by an FDA-regulated information source. Uncensored meta data makes that possible.

As implied above, a third option that pharma website owners have is to omit title and/or description tags altogether, leaving search engines to select content from the indexed webpage that it deems most relevant for inclusion in the organic result. We do not recommend this option as it introduces a greater degree of uncertainty to the process, leaving it entirely to the engines as to how to describe the page, site and/or product.

When a brand chooses not to restrict its meta tag content to conform with the “reminder ad” format, we recommend applying best practice guidelines:

• In meta descriptions, include language encouraging searchers to read the brand’s important safety/risk info, and ensure that the full ISI is included on the linked page

• Use copy consistent with drug’s approved indication and avoid being misleading
• Include brand name and generic name
• Indicate the intended target audience (Patient/HCP/Caregivers)

Branded Website Meta tags – The Good, the Conservative and the Ugly

Example condition: Pediatric Relapsing MS

This article has been reposted with permission from Convergence Point Media. Click here to read the original posting.

As pharma marketers continue to expand their footprint in the point of care (POC) channel – a channel where spending is growing at eight-times the rate of television spending – they are realizing not only its potential but the importance of ensuring their messaging mirrors their brand essentials as much as possible. For pharmaceutical brands, the moment of truth happens in the exam room, the “magic moment” when the physician is discussing treatment options with the patient and the prescription is being written.

We encourage pharma partners to view point-of-care as an extension of, not adjunct to, their overall marketing campaign. That’s the mindset needed to unlock the full potential of a pharma brand in the POC channel – and this channel offers lots of opportunities to do just that. First, though, consider POC’s uniqueness and develop strategies and tactics accordingly. Tried and true branding and marketing philosophies are a good place to start.

Consider the setting

We are not the same person when we are watching a television commercial in our basement during a football game as we are sitting in a waiting room in a doctor’s office or wearing a gown in the exam room. We are no longer a consumer of mass media but rather a patient thinking about our personal health. Your creative should capitalize on this environment and mindset.

Let’s look at Crohn’s disease as an example. According to the Crohn’s & Colitis Foundation of America, approximately 780,000 Americans have Crohn’s disease. TV as a medium for advertising Crohn’s treatments has become quite prevalent as of late. While this raises awareness of the condition, or can generate website traffic, given the millions of people watching television, it can be like finding a needle in haystack to reach the target patient suffering from Crohn’s disease. However, consider if that campaign had a strong pull through in physicians’ offices, and not just any physician, but IBD gastroenterologists. Brands could go much deeper with education and dialogue starters to address flare ups, treatments, compliance, etc. This setting encourages meaningful conversations between patients and physicians, and results in a direct correlation to an increase in new prescriptions.

Innovate

As marketers, we strive for a multi-channel marketing plan in which both print and digital play a vital role. The same holds true in the doctor’s office. While the educational brochure is and will remain an influential POC execution, brands have the opportunity to innovate and engage tech-savvy patients who expect innovation in the healthcare arena.

Take the use of interactive 3D anatomical models as an example. With print and TV advertising, patients are pushed a message and but aren’t really interacting with the brand. PatientPoint technology in the exam room is designed to foster interaction with touchscreens and explorations with 3D models that show inside of their body. This accessible interactive tool, also available on mobile for physicians, is unlike anything that has been offered before. Brands can extend their creative to sponsor this content, building innovative brand associations not possible through pushed mass market content.

Be helpful

Patients crave information like never before. 80% of internet users look for health information online, making medical inquiries the third most popular web-based pursuit, following only email and search engine use. Physicians, too, crave information; indeed, it is integral to providing up-to-date meaningful information. They require an endless stream of information to keep up on the latest research and treatment options. In POC, we have the ability to target and validate helpfulness and credibility, which is important since trusting content found on the web is often challenging.

Pharma can be helpful by strengthening the patient-provider relationship through its sponsorship of tools and information that help make complex medical issues easier to explain and understand (especially now that you can’t sponsor pens or hand sanitizers!).

Remember your message

Your brand need not be left at the waiting or exam room door. Pulling through your brand message to a POC execution does not need to be challenging. Assessing creative thoughtfully will help determine if it is a direct pull through or if custom content should be created. We guide our pharma partners through those decisions, helping them see how to create advertising that positions their brands while adhering to established branding guidelines. Bringing that same expertise to the POC channel will ensure the right brand message resonates with patients and physicians.

Be creative

Like other health care touchpoints, POC offers a wide variety of opportunities for creative execution. The National Health Information Awards (NHIA) program, for example, honors leading organizations in the consumer health field. The NHIA program – the most comprehensive competition of its kind – sets the standard for the industry’s educational collateral. Honorees include prestigious organizations like the American Heart Association, Mayo Clinic, March of Dimes, and Parents magazine. At PatientPoint, we’re proud that, over the past 12 years, our point-of-care programs have been recognized by the NHIA with a total of 431 awards, a great honor that brings credibility for our sponsor brands to medical professionals. Your brand can win awards here, too.

Pharma marketers who apply their marketing prowess to POC will reap the full rewards of a channel that offers unparalleled opportunities for deepening relationships with patients and providers, and for delivering the right message at the right time. The best POC program is seamless with TV, print, sponsorships, detailing, and other pharma marketing tools, and takes into account the touchpoint’s unique needs and opportunities.

The Point of Care Communications Council (POC3), an industry association dedicated to advocating for the effective use of the point of care (POC) channel to advance health and healthcare outcomes, recently held its annual meeting in New York to discuss how to elevate healthcare at the POC. Whether we come from clinical, marketing, patient education, or analytics disciplines, we all have the same concern: How to better engage patients using their physical presence at the POC as a core part of their patient journey. Healthcare providers and marketers must “compete” for patients’ attention as digital technology envelops their lives. And, while pharma in general has been conservative about employing new innovations, we understand the need to be part of this (r)evolution and are actively working to adopt new technologies in order to better engage patients both at the POC as well as at other points across their patient journey.

Marketers can target patients along the patient journey, from pre-visit symptom inquiry to post-visit condition research, including those moments of truth in the physician’s office, engaging with them at each critical decision point. POC marketers are leveraging digital technologies to match the individual preferences of their schedules, lifestyles, and preferences for consuming information.

2016 saw a breakthrough of healthcare-compliant technologies. Geo-fencing, with ads and patient education being sent to mobile devices within a highly defined geographic area in and around physician offices, gained traction. Studies show that 50% of patients in the physician’s waiting room use mobile devices[1] and 18% are accessing healthcare information[1], underscoring the value of this immersive moment. Highly specific condition- and/or specialty-related information is often targeted within the office, while geo-fences are extended to broader geographic areas for the delivery of information around conditions affecting larger patient populations.

Targeting messages to desktop and mobile devices complements marketing at the POC by enabling more touchpoints along the patient journey. In particular, contextual, page-level programmatic targeting enables marketers to provide patients with educational content or advertising that is contextually relevant, regardless of whether the information appears on a dedicated health website or via another premium site, including online newspapers and other information sources. This contextual marketing enables marketers to expand their reach and provide patients valuable information whether the patient is in the initial stages of researching symptoms or is educating themselves about a specific condition post-diagnosis.

As we move into 2017, we can expect that healthcare marketers will be designing marketing plans which employ a more comprehensive multichannel approach – evolving from planning models that can often be outdated. This includes relevant and engaging waiting room television programming, interactive exam room tablets, and mobile marketing which combine to mobilize the patient from disease awareness to treatment. Surveys have shown that patients wish to manage their healthcare online[2], enabling the opportunity to engage them more often in-between physician visits. The trend spans all age groups, including 53% of seniors, age 65 or older, who note that they use health technology “at least a few times a month” to manage their health[3].

We anticipate that telehealth will gain prominence as a POC channel. Telehealth is currently poised to realize exponential growth, with a projected jump from 800,000 virtual consults in 2015 to 7 million by 2018[4], reaching a market size of $38B[5]. Supported by changes in legislation and Medicare billing, physicians will use telehealth platforms to see more patients. At the same time, patients appear ready for virtual consults, with recent data showing 80% of patients are open to telemedicine[6]. Marketers will leverage virtual waiting rooms and virtual exam rooms to enrich the patient experience with patient education, brand information and other health-related content.

Innovative virtual reality (VR) applications will continue to develop to both promote patient education and as a clinical tool. While VR is in its initial stage, data show 96% of physicians expressing an opinion that VR engagement can be more valuable than websites and other clinical tools. Other experts forecast VR to be a $150 billion industry by 2020[7]. The VR opportunity to explore patient and provider education through richly immersive therapeutic and behavioral visualizations and enhanced anatomical modeling further supports the trend toward increasingly meaningful and deeply relevant education for patients.

Overall,the POC segment continues to grow at a faster pace than overall DTC spending[8], which itself is firmly back on the rise supporting a steady flow of major drug introductions[9]. The customizable power of POC advertising addresses the trend toward personalized medicine, resulting in more customized communications to targeted patient populations. At the same time, more patients are engaging in healthcare due to an increased prevalence of chronic conditions, an aging population, and greater access to care, placing health and wellness at the top of mind.

As it continues to evolve and expand, the POC channel will remain a highly effective and measurable tool for pharma brand marketers. The return on marketing investment at the POC, whether measuring new prescriptions, conversions, or adherence rates, continues to perform exceptionally well relative to other forms of promotion[9] and with digital innovation, the ability to impact the broader patient journey is greater than ever.

Editor’s Note: On Nov. 16, 2016, ContextMedia, the leading healthcare decision platform, announced that it will acquire AccentHealth, which provides best-in-class patient education at the point of care. Click here to read the full news release.

References

1 Accent Health Consumer Connections Panel, 2013

2 https://newsroom.accenture.com/industries/health-public-service/most-patients-want-to-self-manage-healthcare-online-accenture-survey-finds.htm

3 https://www.accenture.com/t20160829T222305__w__/us-en/_acnmedia/PDF-29/Accenture-Silver-Surfers-Continue-to-Make-Waves.pdf

4 http://blog.evisit.com/36-telemedicine-statistics-know

5 http://www.theihcc.com/en/communities/health_access_alternatives/2015-another-unstoppable-year-for-telehealth_i7gjbohl.html

6 http://www.healthitoutcomes.com/doc/of-patients-open-to-telemedicine-0001

7 http://www.aha.org/research/reports/tw/15jan-tw-telehealth.pdf

8 Digi-Capital Forecast, 2015, Confideo Labs Survey 2014 (AH presentation)

9 http://www.zsassociates.com/~/media/files/publications/public/zs-point-of-care-research-executive-summary.ashx

10 http://www.fiercepharma.com/dtc-advertising/pharma-s-dtc-ad-spending-soars-past-5b-2015

The patient as the consumer. You’ve heard this one before. Additionally, you’ve probably read about how you, as a healthcare marketer, need to view patients through that lens from now on. But how do you actually turn that insight into action? Before answering that question, we should be asking ourselves how accurate the “consumer” label is.

Why consumer?

Tremendous improvements are changing the healthcare landscape to make it more consumer-driven. Since 1990, average life expectancy in this country has increased from 71.8 to 76.4 years for men, and 77.8 to 81.2 years for women. Meanwhile, the uninsured rate in that same period has dropped from 13.9% to 9.1%. The number of physician visits is increasing at a rate faster than the increase in the population of the US.

As a result, patients are spending more than ever, which is one of the primary reasons we, as healthcare marketers, now call them “consumers.” This trend will likely continue: health spending in 1990 accounted for 12.2% of our GDP; today, it accounts for 17.5% of our GDP, and this is expected to grow to 34% by 2040.

Is the label ‘consumer’ accurate?

The physician/patient relationship has also changed dramatically, as has the manner in which patients seek information. Calling them “consumers” makes marketers feel they have a handle on delivering this information. However, patients now seek to share in the decision-making around treatment options, and are no longer just taking orders in the exam room. We cannot underestimate the importance of the physician in these decisions. Removing “patient” from our language can do that, because it takes the physician out of the equation.

Additionally, the “consumer” label oversimplifies the complexity of decision-making for patients, and the extent to which they seek input. Patients want to know more than they find in the retail emails they receive. Today, 72% of patients seek information about their healthcare online, 60% turn to friends and family, and 24% get support from others with the same condition. Yes, patients want to make informed decisions, but demand more than a web search or advertising message.

In the past, I’ve promoted the use of the term “Well-Connected Doctor.” As a counterpoint, I’d like to propose that we also adopt the term “Engaged Patient”. Health decisions require more input than almost any other decision we make, and we should treat the individuals who we hope to reach with respect.

How to reach the ‘Engaged Patient’

Back to the original questions: How do we as healthcare marketers, best approach the needs of the Engaged Patient?

1. Offer Authentic Value to the Patient. The Engaged Patient reads about conditions, seeks communities for support, and has conversations at the dinner table about their health. More than any other group, the Engaged Patient doesn’t want to be sold to. To deliver on the unprecedented desire to present the Engaged Patient with reliable information, we need to accept that there is no easy route to build this trust, and find creative ways to include them in all the relevant inputs.
2. Leverage Technology. It is our job to understand the complexity with which they seek information, and present it in a meaningful way to patients and physicians. From point-of-care platforms that place us in the exam room during the consultation to online support groups to shared experiences, it is critical to align on messaging across channels, and generate relevant content on a consistent basis.
3. Address the Rising Health Care Costs by Investing in Outcomes. As marketers, reaching the Engaged Patient is different from reaching other consumers, because patients are subject to a system that does not make it easy to understand pricing, or why costs continue to rise. For healthcare marketers, by identifying health outcomes as a KPI, this means a greater life-time value for each of the patients we can impact.

Republished with permission. Click here to read the original posting on MediaPost.

Editor’s Note: On Nov. 16, 2016, ContextMedia, the leading healthcare decision platform, announced that it will acquire AccentHealth, which provides best-in-class patient education at the point of care. Click here to read the full news release.

In the past year, news stories have featured multiple outsider challenges to “the Establishment.” Traditional authority faces threats of being upended. Moreover, the challengers seem to have emerged with tsunami-like force, seemingly out of nowhere. Technology makes it easier for like-minded individuals to find each other and collectively demand changes that may shake up the status quo. Since branding uses messaging to reinforce an organization’s or product’s “reason for being,” it is worth looking at what potential shake-ups could mean for the industry.

This is particularly important for advertising agencies serving healthcare and pharma, sectors that have recently faced their own heightened public scrutiny. Turing Pharmaceuticals’ Martin Shkreli became the poster boy for corporate greed. Mylan’s EpiPen price increase owned the headlines this summer, and renewed focus on perception of co-pay programs across patients, payers, and physicians. The US Treasury Department blocked Pfizer’s plans to buy Allergan, an acquisition that would have drastically reduced Pfizer’s American tax exposure. And despite the fact that Bill Gates calls the US’s drug-pricing system “better than most,” there is a growing narrative that suggests companies are putting their money into communications to push profits over patient-saving innovations. But do these discussions truly challenge the $21 billion-plus advertising spend of America’s pharma industry?

The conversation may be intensifying due to societal changes, but there have been periodic calls to ban pharmaceutical advertising since Merck ran the first DTC ad in 1981. (A ban would likely be unconstitutional under the First Amendment.) Calls for increased regulations have been considered, as well. The Responsibility in Drug Advertising Act, introduced in February 2016 by Connecticut Congresswoman Rosa DeLauro and Comptroller Kevin Lembo, would place a three-year moratorium on any ads for newly approved prescription drugs. Minnesota Senator Al Franken introduced similar legislation, the Protecting Americans from Drug Marketing Act, which would lead the IRS to stop drug companies from deducting marketing costs of direct-to-consumer (DTC) advertising.

So what’s really going on? Reinhard Angelmar, emeritus professor at INSEAD and an expert on pharma marketing, says criticisms of pharmaceutical advertising are misplaced. “The call for a DTC advertising ban is a desperate attempt to slow down the erosion of organized medicine by tackling the pharmaceutical industry,” Professor Angelmar told Havas Tonic. “The timing is well chosen. It fits the current debate around high drug prices, while diverting attention away from the high price of healthcare.”

Angelmar sees multiple factors eroding the traditional sources of physician power. Web and mobile technologies have increased consumer access to medical information through online sites and digital apps. In addition, Angelmar points to ACA-related price pressures on both patients and doctors, which have led to consumers demanding a greater say in medical decisions. Finally, Angelmar focuses on the expanding sector of nontraditional healthcare providers, including pharmacy-based clinics and nurses, as well as “third-party payers who convert independent physician-entrepreneurs to contracted agents and salaried employees.”

Where does that leave Big Pharma? Or the advertising agencies that service it? Or the media that carry the communications? From Professor Angelmar’s perspective, pharma brands and their marketing partners need to be more proactive in reaching out to multiple constituents. Angelmar believes that doctors and payers, as well as patients, can (and should) be courted as natural allies of DTC: “Develop a plan to improve the perceived value of DTC among physicians,” he says. “What do third-party payers think about DTC? Ensure that they perceive the value of DTC.”

These are good points, and there is evidence that DTC has a real value. For instance, health economist Austin Frakt, in a March 2016 New York Times The Upshot Blog, pointed to multiple studies that demonstrate positive healthcare outcomes generated directly by DTC, ranging from better-informed consumers to better patient care. One study about DTC antidepressants showed that when patients “requested a specific drug, 90% received appropriate care, but not all of it involved drugs.”

Havas Tonic’s learning from a multi-month healthcare panel it ran in 2015 supports these points. Paul Klein, Managing Director of Havas Tonic, says, “Polling consumers about their attitudes toward DTC advertising, we found the most receptive audiences for such marketing were more – not less – informed about healthcare, media, and marketing. The study seems to negate the assertion that advertising exploits vulnerable consumers.”

In fact, the poll suggests that the most engaged audience for such messaging (i.e., “Requestors”) is a sophisticated group. And compared to those polled who feel negatively about DTC (i.e., “Non-Requestors”), this group expressed a sense of empowerment around their healthcare decisions. Take their relationships with doctors. Says Klein, “Compared to Non-Requestors, Requestors expressed feeling far more engaged with their physicians and were conscious about maintaining a patient-doctor dialogue.” This makes sense: The Requestor, after all, is bringing an informed request to their doctor. It is up to the doctor whether or not to grant it.

A compelling aspect of Requestors is their attention to societal values. Pharma brands should take note: Their most engaged customers prioritize companies with a social conscience. For Requestors, this means demonstrating a propensity for innovation. For instance, a company might stress the research as well as the innovation behind the treatments it brings to market. Pfizer’s “Before It Became a Medicine” is one such effort. Consumers care about a brand’s overall societal imprint, and will lean in to companies that work to establish that they are truly keeping the patient top of mind in their efforts. But pharma needs to be careful – if every pharma company comes out with a personal story about why they pursued innovation, the messages will quickly become duplicative and dissonant. We’re already seeing this in consumer perception of patient-assistance programs – if the drugs weren’t so expensive, then there wouldn’t need to be financial assistance.

There are challenges to DTC advertising that need to be taken seriously. Addressing them starts with recognizing that today’s DTC advertising audiences are not mindlessly consuming products. They are thinking carefully about what they purchase, and from which companies they purchase. The most powerful branding for them will acknowledge their hunger for innovation, as well as social consciousness. Equally important, pharma brands (and their marketing partners) have to be more imaginative in thinking about allies, from patients to doctors to payers.

Part 3: The Medications

A few months ago, I went for a blood test and found out my A1C was over 10%. This, combined with an unexplained weight loss of about 30 pounds, lead doctors to the obvious conclusion that I had joined the ranks of about 30 million Americans who had diabetes. At this point, the two major questions were which type of diabetes, and how can I treat it? Because it came on suddenly and quite severely, my doctors suspected type 1. I, knowing my diet and physical activity regime over the last 30 years, suspected type 2.

As diabetes is very complex, it’s more than just taking medication every day to treat this disease. There is a great deal a patient has to know about diet, exercise, devices, drug interactions, dosing, and testing. As there was so much to take in, I decided to detail my experience as a newly diagnosed diabetic and the challenges I have faced, having spent so much of my time on the marketing side, to now be on the patient side. In this article, I detail my experience with diabetes medications and why I chose the ones I did. My final article in this series will deal with the overall consumer experience.

Upon getting my diagnosis, my doctor prescribed me two things, insulin shots 3 times a day, with meals, and Glimepiride (Amaryl). I was surprised not to receive Metformin, as I heard this was usually a first line treatment, but was told that Glimepiride was secondary to Metformin in history and lack of side effects. For my other prescription, I was given Humalog quick acting insulin, along with a very quick primer on how to use it and instructions on self-dosing.

For reference, my numbers at this meeting were awful. My A1C was around 12%, which equates to a blood sugar around 300 mg/dL. My cholesterol was also awful, with a total of 327 mg/dL. My LDL was 228 mg/dL and my triglycerides were 206 mg/dL. Other endocrine numbers were also terrible but those were the most alarming to me, especially since all of these readings were normal at a physical almost a year earlier.

My instructions were to take the Glimepiride twice a day and take the Humalog twice a day, with 1 unit of insulin for every 40 points of blood sugar over 140 I was getting. Early on, most of my readings were in the 240 range, which equated to 3 units of insulin 3 times per day. The Glimepiride was easy, just a small pill, twice a day, no side-effects. My endocrinologist told me I’d see results pretty quickly if it worked, but I saw almost nothing from the pill alone. A few days later, once I mustered up the nerve to do the injections, I added the insulin to my regimen.

This immediately started to bear fruit, not only reducing my average blood sugar to the low 200s over the next few weeks but controlling my spikes. After a high carb meal, I could hit over 300; but now my spike would usually stay down in the 250 or less range. While this was an improvement, it was still way too high for me.

As far as taking the insulin, the hardest part was doing the injection. My instructions weren’t great and sticking a needle in your own stomach goes against every instinct you have, so it was a hard mental barrier to overcome. The Humalog pen, however, made it much easier than this otherwise would have been. Choosing an insulin dose was incredibly simple, physically injecting and administering the medication was quite simple, and with the insulin not needing refrigeration, it was a matter of keeping it out of heat and direct light, as well as making sure I had the proper equipment.

The needles given to me were Becton Dickinson ultra-thin micro-needles. Supposedly, they are some of the smallest needles on the market and, as my nurse told me, were lubricated to make injection/removal simple and painless. For the most part, this was true. If I could muster up the nerve, the injections were pretty easy, removal was always quick, and there was only occasional some redness or marks at the injection site.

I never really noticed many side effects from either medication or the physical injections, except for an occasional sting when the medicine was being administered. There occasionally may be some small bleeding if I came in at the wrong angle or a sting like getting pricked at the wrong spot if I hit a nerve, but the mental part was much harder than the physical part. I attribute that a lot to the quality of the penlike injection device and the quality of the needles as I don’t know how I could make it through this if I needed individual needles, syringes, and vials as previous diabetics would.

Adding an additional treatment option

While this was starting to move my numbers, I still wasn’t happy with the progress I was making so I requested my doctor add Metformin to my treatment plan. I was told that it could cause stomach discomfort but discounted that as I rarely experience digestive side effects from medication that is prone to cause those, but I erred significantly here. Firstly, I was prescribed 4 XR 500mg pills, 2 each twice a day. The pills are massive horse pills, so they physically aren’t the easiest to take. But the side effects made the experience much worse. At two a day, I experienced mild and occasional discomfort, but three (taken two in the morning and one at night) made things much worse. Frequent diarrhea, stomach pains, and overall discomfort became fairly common. Once I increased to four, it became almost unbearable as it went from an inconvenience to a real impediment in living my daily life.

If I was seeing major results, it would have made the effects more palatable, but I only saw maybe a 20-30 point drop in my already high blood sugar range during this time, to the 180s to low 200s on average. Because the side effect risk with Metformin, other than the stomach issues, was very low, as was the cost, I elected to remain on the medication but wanted to find an additional treatment option to hopefully reduce or replace my reliance on these medications.

I examined many type 1 medications, which are few and far between, as I was told it was likely type 1 early in my journey. Upon finding out a few weeks later that it was type 2, that opened up my world of medication options. I was looking at several, including Actos, Januvia, and Invokana, as I was adamant that I did not want to take any more injections. However, the potential side effects I read on many of these medications was enough to frighten me off, as was the cost on several of them. After further research and seeing that by body did react to insulin, I decided to go with a long-term insulin. I felt it would be the most effective, have the least side effects, and possibly replace one of my other injections so it wouldn’t really be adding to my troubles.

After examining my options, I tried to decide between Toujeo and Tresiba, the two newest on the market. Toujeo had a long-history as a somewhat newer version of Lantus. However, you needed a fairly strict dosing schedule on this insulin. Secondly, the discount program was less than stellar (more on this in my next article). Lastly, the patient reviews I read on Drugs.com for it were really poor, with lots of adverse reactions. While I know that people who have bad experiences are much more likely to post than those with good, I found there to be enough ratings to be of significance and they rated poorly compared to similar products.

I found this not to be the case for Tresiba. The fact that it would work for almost two days gave me some comfort as I was still figuring out my dosing and medication needs so that flexibility was something I valued. I could get it at a very reasonable cost while I tried it out so the financial investment wasn’t terrible. Lastly, the user experiences and clinical trial results for it were very favorable. Therefore, I had no problem anxiously asking my doctor to try Tresiba.

Upon starting Tresiba, about a month after my initial diagnosis, the hardest thing I found about it was the actual purchase (more on this next article). Taking the medication was very similar to the Humalog, with a similar device. However, I found, for whatever reason, it was even easier to take. The injections were simpler and less painful, the needle went in more easily (despite it being the same needle), and the medication caused less of a reaction. The pens also kept a long time, for about 45 days rather than the 30 days as with other pens. For someone like myself, who was put on a very low dose (8 units, even lower than the recommended 10 unit start dose), this allowed me to use the entire pen before expiration, saving me both inconvenience and money.

I was told the Tresiba could take nearly a week to work but within 3 days, my numbers fell substantially. I was getting my first readings in the normal range at that point, well enough that I could both dial back on the Metformin and no longer needed the quick-acting Humalog. Instead of getting in the upper 180s as I was prior to this prescription, I was getting most of my pre-meal readings around 120, with my spikes only going up to around 170 or so. For medical purposes, within a week of Tresiba, I was getting readings akin to what a healthy person would get.

All that was left was to fine tune my medicinal treatment and diet plan. Shortly after starting Tresiba, I spent ten days in Germany on a long-planned vacation. With a diet heavy on beer and pretzels, I was quite nervous what would happen to me, yet I only spiked to over 200 if I was REALLY bad with my diet. I would also come down to normal readings by the next morning and almost never experienced low blood sugar.

Long-term planning

Once I returned home, I was able to normalize my schedule and found even better results. I switched to taking my Metformin to one pill in the morning and two in the evening, from two pills twice a day. Suddenly the unbearable stomach issues I had from taking four pills were nullified almost that day. Furthermore, my waking blood sugar was down from its prior readings of 120-140 to around 90-110. I was so pleased with these results that I quit the Glimepiride entirely without any adverse results about a month later.

Keeping myself only on the 8 units of Tresiba for about two months and 1500 mg of Metformin XR for about a month, I went in for a followup blood test. I figured my A1C would be way down, based on my blood sugar monitor readings and that my diet was better so my cholesterol would be down. However, I was shocked when my results came in. My A1C, which was measured in late July at around 12%, was down all the way to 6.6%, which was pretty much within normal range. I expected improvement, but not that much.

Even more shocking was what happened to my cholesterol. When I took my initial test, my doctor wanted to put me on a statin immediately but I wanted to see what treating the diabetes would do. He approved this line of treatment but said not to expect a significant improvement. Therefore, he was shocked to see most of my numbers were cut nearly in half. Total cholesterol down to 167 mg/dL. Triglycerides down to 113 mg/dL. LDL down to 88 mg/dL. All of these numbers were improvements beyond my best hopes, despite mediocre commitment to diet and exercise. Furthermore, the significant 30 pound weight loss I obtained from diabetes has been maintained.

For now, I am maintaining my treatment of 8 units of Tresiba every morning and 1500 mgs XR of Metformin. I am thrilled with the results and finding that, thanks to the medications I am on, just three months after a terrible diagnosis, I am able to live my life much as before while keeping my numbers in a normal range. Other than annoying side effects from the Metformin, I have very little issues from my treatments. I don’t workout nearly enough and I am not strict about my diet, although I try to avoid high carb sides and desserts, as well as eat smaller portions than before, yet I have still achieved and maintained successful numbers with very few troublesome spikes. I have kept my weight lower; my vitals and cardiovascular numbers have improved considerably. While injecting myself every day is an annoyance, it’s not a major problem. I am still hoping for a longer-lasting insulin so I can cut my dosing, but I am comfortable that maintaining this treatment plan and nothing else can lead me to a long, healthy life – something I never thought I’d be able to write a few months back.