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DTC in FocusGuest Columnist

Why Pharma Patient Adherence Programs Fail

April 15, 2015

In last month’s edition of the DTC Perspectives’ DTC in Focus newsletter, we discussed patient engagement and provided prescriptive thoughts on maintaining and even increasing patient commitment. This month, we take that thought one-step further (as well as, adhere to this month’s theme) and focus on patient adherence. The discussion includes whether the emphasis of such programs should be on both long and short-term medication adherence particularly in how they are resourced and measured.

A situational review

  • Current support programs typically devote a large amount of time and money ensuring patients initiate therapy. However, these programs never allocate time or funding to safeguard that the patient maintains adherence after that time period.
    • Studies indicate that patients with chronic diseases may not either grasp the severity of their condition; understand the literature they receive about their condition; or require multifaceted efforts to achieve adherence.[1]
    • Current support programs operate in silos. While these programs are typically mapped out strategically, they are not executed in a coordinated fashion.
      • These silos execute patient adherence programs:
        • Ad agency
        • PAP vendor
        • Co-pay card company
        • Reimbursement and benefits investigation vendor
        • Specialty pharmacy
        • Technology companies
        • Consumers, patients, and caregivers often are not satisfied with the content and creative contained in patient adherence programs
          • These targets at some point in the treatment process stop at Brand.com. All find the information initially helpful, but tend to look somewhere else for information because the information they want or need is not in the adherence program.
          • Patient adherence programs today are like an inverted hourglass. The strategy is thin at the top, disparate and expansive in the middle due to the silo construct, and then the program strategy attempts to narrow again. Yet, often this does not occur.
          • While all pharma brands say they have patient adherence programs, the reality is – and I am basing this information on my 20 years of experience – very few deeply engage and build a relationship with the patient; maybe 10% to 15% really execute this well. These programs work because senior leadership is committed to them for the long term, both in human and financial capital. (See last month’s column re: Biogen Idec.)

Operational issues still exist today

Along with the barriers already mentioned to pharma’s delivering quality adherence programs, there are two more barriers, and they are formidable.

First, product managers are no longer brand champions. Their roles now resemble those of purchasing procurement agents who buy a single program; their sole hope is to get noticed by senior leaders.

The second, arguably more significant complication is the FDA, namely its regulations. Companies have allowed their legal and regulatory teams to make business decisions regarding programs that minimize risk in terms of providing the evidence and content that patients and healthcare professionals want. The pejorative natures of today’s drug marketing regulations are designed to educate, not inform. Grant Corbett, a psychologist we have worked with says pharma produces content from the perspective that patients and others affected by disease are not competent to understand the information so brand programs need to “educate them.”[2] He asserts companies should make the opposite assumption and assume the patient, caregiver and consumer understand their condition and work to provide information that fills in the knowledge gaps. This is where great programs in the marketplace are focusing their efforts today.

Answers exist today

The short-term lead generation and conversion marketing strategies of patient adherence programs are no longer viable. The key to winning at the ground level is to have the program’s patient advocate be part of the solution that has been prescribed. It is paramount to ground a multi-channeled adherence program in a scientifically validated model to instill confidence in patient and caregiver. Patients and their care team need to believe they have the complete and long-term support needed to overcome their disease. Moreover, to accomplish this, the program needs resource and execution in a coordinated fashion. These are the factors creating a real competitive advantage in adherence programs today!

While industry spends $10s of millions on various aspects of the entire effort, that resource is cut up into smaller chunks or pools of money. This causes all parties to fight for their chunk of the pie and to lose interest with the whole strategy. Senior leaders, in this age of consolidation of resources, must consider these programs at a total cost level and ensure they all are driving value. That is why we advocate bringing back the role of a Brand Champion, an individual or set of individuals who commit to a longer-term career path with the brand, who can oversee the convergence and collapse of the silos – and decide how to spend the money.

Finally, we are big proponents of the net promoter score construct. Two or three simple questions added to any program to assess the patient’s willingness to recommend a product to a family member or friend. This simple measure helps leadership teams stay focused on the end goal of customer satisfaction, regardless of the program’s timeframe.

References:

  1. http://www.uspharmacist.com/content/s/200/c/33457/; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/; http://www.ncbi.nlm.nih.gov/pubmed/12472330
  2. Grant Corbett, Behavior Change Solutions.

Robert Nauman

DTC in FocusGuest Columnist

Get Hooked – Making Engagement a Habit

April 15, 2015

We know that the formation of healthy lifestyle habits is critical to overall health. However, adherence to exercise programs, medication regimens, or dietary changes can be challenging. So how do we help patients develop habits to improve their overall health?

Habits are defined actions employed without conscious thought.1 Habit forming potential of any behavior is often driven by two factors: frequency and perceived utility. The more frequently a new behavior occurs, especially within a short period of time, the stronger the habit becomes. Likewise, the more rewarding the behavior is perceived to be (its utility), the greater the chance for habit formation. The “Hook Model” is one method that we use at Health Union to build value and encourage habit-forming behaviors within our communities. Four key components converge in the hook model – a trigger, an action, a reward, and an investment2 – to create ecosystems that cultivate engagement habits and motivate people to live better with their health conditions.

Triggers

Health Union communities use both internal and external triggers to encourage patient engagement. External triggers may include advertisements or comments from doctors, family, and friends; while internal triggers are leveraged when an action becomes strongly tied to a thought, emotion or preexisting routine, like checking email every morning. While we utilize some paid external triggers, like Facebook advertising, we’ve found that relationship triggers (social media sharing/word of mouth) and owned triggers (opting into a weekly newsletter) are most effective for long-term engagement. Owned triggers are most likely to prompt repeat engagement until a habit is formed, and relationship triggers support continuous community growth.

Action

The more people interact with your product, the more likely they are to keep doing it. Our community engagement strategy creates a “funnel” approach to increase the level of participation over time, knowing that simple actions can lead to big changes in future behavior.3 For instance, our members may start as site visitors, then progress to following us on social media and engage in passive activities like anonymous polls. Passive participation may lead to newsletter registration and eventually active engagement by posting comments or personal stories. It’s important to make it easy for even the most passive patients to engage while still providing outlets for the most active members.

Reward

Provide a real benefit to action – with variability – and do it quickly! Show people that taking action results in a clear benefit. Of course, keep in mind that the preferred benefits vary from one person to the next. Make sure to clearly communicate what the reward is – whether that is answers to basic questions, immediate poll results upon voting, published results from surveys, or community support. Don’t assume the reward is obvious and communicate the benefit gained by others as well as that of the individual. Variability can multiply the natural effects of a reward and keep people coming back for more. All Health Union communities provide daily content that is relevant and useful, but the type of content, topics, and authors are varied to create novelty.

Investment

Encourage people to make an investment, beyond just lurking or passively clicking. This may be an emotional investment, an investment of time, or a contribution of personal information. Investment implies action that will improve the service for the next visit. And, the greater the investment, the more likely they are to continue engaging over time, thereby increasing the value of the product. For example, the simplest investment is to follow one of our social media accounts. However, we also invite members to “own” part of the site by participating in surveys and publishing personal stories.

What else can we do?

In addition to the four elements of the Hook Model, don’t forget to …

  • Remove barriers and provide support. Be aware of both perceived and actual barriers. For example, in response to a perceived barrier that weight loss is dependent on foregoing all desserts, provide recipes for healthier dessert options.
  • Strengthen self-efficacy, the belief in one's own ability to complete tasks and reach goals. Since many people are uncomfortable asking their doctors questions, provide discussion guides to encourage dialogue focusing on areas where the patient is the expert – like how a condition affects day-to-day life.
  • Find what people are doing already, and make it easier for them by linking habits to daily routines.4 Our content strategy focuses heavily on giving people the information we know they are seeking, where they are already seeking it (with social media and search).

The ultimate goal is to create a cycle of interaction where the investment itself becomes an internal trigger. Members seek responses to topics discussed within the community – that desire for shared experience is the trigger to continue engaging. And then, they’re hooked!

References:

  1. E. Morsella, J.A. Bargh, P.M. Gollwitzer, eds., Oxford Handbook of Human Action (New York: Oxford University Press, 2008).
  2. Eyal, Nir. Hooked: How to Build Habit-Forming Products.
  3. J.L. Freedman and S.C. Fraser, “Compliance Without Pressure: The Foot-in-the-door Technique.” Journal of Personality and Social Psychology 4, no. 2 (1966) 196-202.
  4. Bas Verplanken and Wendy Wood, “Interventions to Break and Create Consumer Habits, Journal of Public Policy & Marketing 25, no. 1 (March 2006): 90-103, doi: 10.1509/jppm.25.1.90.

 

Amrita Bhowmick

DTC in FocusGuest Columnist

Adherence and the Authentic Truth

April 15, 2015

After a patient initiates treatment, the real selling-process begins. More than ever, patients are approaching Rx-trialing with a heavy dose of skepticism. It’s understandable. Oftentimes, long-term treatment is thrust upon patients without time to get comfortable. And sometimes, those patients have healthy fears over side effects. On the other side of the coin, many patients expect treatment to fix everything fast or they diminish the value of Rx treatment altogether (before giving it a real chance).

This net skepticism has fueled – no, skyrocketed – a behavior patients hold dear when trialing treatment. And that is finding the authentic truth – conducting their own in-depth exploratory research into Rx treatment expectations, outside of brand communications. Outside of the brand context is where patients perceive to find this authentic truth and the optimal basis for their own opinions and behaviors toward Rx treatment.

Here, I’ll explore this rising phenomenon a bit more and then present an opportunity for brand adherence communications. Essentially, I’ll show you how to guide patients toward external content, in order to help them find their own, preferred version of the truth. In the end, they want to put the “authentic” puzzle pieces together. If we can help them do that, we can help them feel more comfortable with treatment early on and more receptive to the rewarding possibilities of long-term treatment.

Origins of the truth

A year or so ago, I spent time reflecting on the success of online services such as Angie’s List, Yelp, and others, with large investments into customer review networks. I came to one conclusion: in the digital age, the truth comes from strangers.

My hope is that this speaks to you, as both logically flawed and intuitively accurate. Let me explain. Logically speaking, we put our trust in people/entities we know, or in some cases, those we think we know. In this case, the ol’ saying “never trust a stranger” holds true. But today, we live in a hyper-consumerized world where we have many “long-term relationships” with an array of organizations and companies we really “know” little about (e.g., mobile phone, streaming, cable, grocery delivery, etc.). We expect those companies to meet our expectations or, in other words, be trustworthy.

In many cases, the results have been less than stellar. However, there are exceptions. Brands like Zappos and Wayfair have elevated the benchmark of customer service to a religion – but again, these are exceptions. And, the fault cannot be placed entirely on either side – it’s a combination of consumers and companies. Consumers can exaggerate or even create the problems, yet companies (or brands) aren’t exactly model citizens, when the almighty dollar rules the day.

Regardless of who’s right and who’s wrong, the net result has been a heightened mistrust among consumers. You could even say it’s already hit the boiling point with persistent steam ahead. Who can we trust these days?

The person/entity we often trust is the person/entity with no vested interest in us: the stranger. They don’t want our money, our commitment, or a relationship. They do have opinions, though – invaluable ones about the subjects that matter most to us. And they like to voice these opinions. It’s these anonymous voices we seek in order to find the authentic truth and, as a result, make better decisions.

The patient “truth-seeking” journey

This is the kind of approach patients take when trialing Rx treatment. They get the doctor’s version of the story, they get the brand version (e.g., brochure, site), and then they go looking for the outsider context: the anonymous opinion, the unknown academic perspective, the clinical trial data, the virtuous community site, and even sponsored content, but on a trusted site.

Now, let’s bring these learnings back to the question at hand: how can Rx brands become an integral part of the content system patients tap into when finding their authentic truth?

First, I have to acknowledge that this is not a one-stop shopping experience for patients. They will leverage this behavior at multiple points during treatment. In my experience, the best way to manage this is to glean the most important barriers to short-term, intermediate, and long-term adherence. Typically, short-term issues surround potential side effects, whereas intermediate and long-term issues usually surround side effect experiences, efficacy, and cost.

On the subject of cost, we often think of cost-saving programs benefitting patients just starting treatment. What I’ve learned is that most patients wrestle with treatment value relative to cost, once they’ve come to the conclusion that they’ve experienced said treatment’s full potential. For the commercially insured, if their treatment co-pay is negligible (through a branded support program), they will likely accept average efficacy, for example, and stay on treatment longer.

So, how do we use branded content to encourage adherence, while embracing a patient’s journey to find the authentic truth? Below are five recommendations to help you, and your patients, succeed:

  1. Use a trustworthy environment to evolve your brand marketing into brand truth.
  2. Market clinical studies without feeling like your marketing clinical studies.
  3. Gain their trust by setting them free.
  4. Let patients – even help them – find the good and bad about your brand.
  5. Lastly, recognize how search can unearth issues patients were never searching for.

Patients hold all the power these days. Let’s help them realize that dream… and get rewarded for it.

EDITOR’S NOTE: This is a condensed version of John’s article. To read the full-length feature and learn more about the five recommendations for the authentic truth, check out his upcoming article in the 2015 annual issue of DTC Perspectives Magazine out next month.

About the Author:
John Nelson has spent over 13 years in advertising, working with some of the most iconic health brands of our time. In his role as VP, Strategic Planning at Evoke Health New York, John is responsible for inspiring strategy that creates big ideas and big connections between brands and people – connections that drive behavior change and deliver tangible results for clients. He can be reached at john.nelson@evokehealth.com.

John Nelson

DTC in FocusGuest Columnist

How Contact Centers Leverage Live Patient Interactions to Drive Adherence

April 15, 2015

As the new model of healthcare delivery takes shape, the spending burden for care continues to shift to the patient, giving them more control over their care. As a result, patients are more informed and have access to more healthcare decision-making tools than ever before.

However, it needs to be relevant to them. Recent research commissioned by McKesson shows that patients are less interested in general information about their condition and more interested in personal communications and support in the form of missed prescription reminders (89%), refill reminders (87%), live phone support (86%), and pharmacist coaching (83%).

Evolution of relationship marketing

In the past, one size-fits-all-messaging followed by content delivered through traditional communication channels such as e-mail or print, enabled brands to deliver consistent and controlled messages to the patient. However, this model did not enable dynamic two-way communication, where questions can be asked of the patient, responses captured, and then messaging and actions tailored accordingly. As a result, the ability to create lasting behavioral changes was limited.

Driven, in part, by more engaged and empowered patients, new technologies now enable brands to perform more targeted outreach to patients with specific medical conditions, on particular medications, who have opted in to receive information. While this improves patient targeting and personalization of the message, this evolution of relationship marketing in healthcare is not just about pushing a brand message, but about creating greater patient engagement and opening the door for two-way conversations designed to improve adherence and outcomes. Ultimately, this support helps to differentiate the brand from its competition, driving adoption and adherence.

Delivering personalized support

There is no silver bullet for impacting adherence as every patient is diverse and every patient situation is different. Complexities that can impact a patient’s likelihood to remain adherent include the length of time since diagnosis, brand challenges and attributes, cost barriers often outside the patient’s control, and the nature of the diagnosis itself.

The ability to uncover what behavioral barriers can be modified and to recognize what factors cannot be changed (e.g., doctor’s choice to discontinue the medication), is one of the benefits of dynamic live patient interactions. While each patient’s individual situation may be unique, our experience in behavioral coaching reveals that there are similarities across therapeutic conditions which can be used to infer best practices in addressing patient challenges across brands and patient populations. For example, sensitive conditions (HIV, Hepatitis C) have social implications that require more empathetic messaging than more mainstream chronic conditions, such as Diabetes or Hypertension. Patients with a visible dermatological condition (psoriasis, onychomycosis) often face quality of life issues that physicians may not fully embrace and will need significantly different support.

Recognizing that adherence barriers change over time, as well as patients’ information and education needs, brands can integrate out-bound support and multi-channel communications to maintain that personalized support for patients throughout their brand journey. In this scenario, delivering smarter dynamic communications can help connect patients to support driving brand loyalty and program success.

Consider a program that helps patients navigate their own healthcare decisions, supporting adherence, sharing information, addressing barriers along the way and deploying proven behavioral-based techniques. One example is McKesson's Behavioral Call Campaigns (BCCs), which use live agent support to identify adherence barriers and provide targeted messaging to help overcome those barriers, connecting with patients using proven health behavior change tools and techniques to build programs that allow patients to opt in to allow them to be more engaged in their healthcare decision-making, while aligning personalized messaging with a patient’s intended utilization activity. These campaigns can be used as stand-alone solutions or integrated into broader marketing campaigns by pairing them with financial assistance or educational support programs.

Engaging live interactions

Successfully tackling adherence requires a comprehensive strategy that includes multiple communication channels to support patients towards positive behavioral outcomes. Coupling in-bound and out-bound support, live patient conversations can transform static traditional relationship marketing programs and allow live agents to uncover patient needs over time and use behavioral coaching techniques to address those needs. Pharma brands are increasingly leveraging live support, the insightful data provided through their co-pay programs, and segmentation tools to help predict a patient’s level of engagement or likelihood of being non-adherent, then allocating the investment accordingly.

Brands using these tools at enrollment can segment patients in order to provide additional support only to patient segments which need it. The interesting brand question then becomes which segment should you invest in: the group that you predict will be adherent and most engaged; the group you predict will not be adherent; or the group in the middle that could go either way?

This is a great conversation to have with your contact center strategist.

Amanda Rhodes

DTC in FocusGuest Columnist

Adherence: It Takes a Village

April 14, 2015

How do we keep patients adherent? It’s the billion-dollar question in the healthcare industry. And the truth of the matter is there isn’t one simple answer.

In the past year alone, nearly 75% of adults age 40 and older with a chronic condition admit to not adhering to their prescription medication treatment. As healthcare marketers, we focus our efforts on getting patients to the doctor. We’re hoping to motivate them to make an appointment. We provide tools and information to talk to their doctor about medication. We encourage them to ask for a particular brand by name. We push the HCPs to prescribe it. And finally, we hope that patients fill it and actually take the medications as prescribed. It’s a significant investment – time and money. Yet, after all of these efforts, only 25% of these patients are taking that medication as directed. It’s apparent; we have some work to do.

So, what do we do? Often I hear healthcare marketers telling me they are focused on driving adherence through a particular tactic. “We’re

going to invest in our CRM database” or “We’re using text message reminders” or “We’re utilizing SEO to keep our brand top of mind”. Good! These are great tactics. But by merely implementing a tactic, you’re checking a box to say you’re driving adherence. Is that enough?

We need to be better and smarter about how we are keeping patients adherent (remember only 25% of patients are adherent). We cannot only be thinking tactics. The reality is, keeping a patient adherent requires much, much more. To keep a patient adherent to their treatment, we need to be their partner and support them, and also look at the key motivators in a patient’s life: spouse, parent, child, sibling, boss, friend, HCP, and many more. And who is their biggest personal motivator? It is their spouse or partner as shown a recent study conducted by Remedy Health Media with Princeton Survey Research Associates International (PSRAI). (See related pie chart.) When it comes to healthcare, we rely on the people we are closest to, our support systems, and the people we trust. It truly takes a village to motivate a patient to stay adherent and committed to their health.

My personal story
10 years ago my husband complained that he had terrible heartburn. It was a daily battle. He attributed it to too much eating and too much drinking (at 25 years old, I’m sure that was the case). But then I explained, although it felt like a daily discomfort, heartburn/GERD can have long lasting and damaging effects. I urged him to see a doctor. After he reluctantly made an appointment, to be supportive, I printed out 10 questions for him to ask his doctor, along with a medication to request. At the time, I’m sure he thought I was slightly annoying with my persistence and I am certain there was some eye rolling when I handed him the printouts… but he took them. Then after a productive and successful doctor visit, he was given a prescription, and he’s been taking the same medication ever since. Even today, to keep him adherent, I ask, “Did you take your pill today?” Although it’s his health, I’m a part of it, I’m connected, I’m supportive. I feel responsible.

We are responsible for our own health, and we also feel responsible for somebody else. It’s what connects us. It relates us. We rely on each other. Health is incredibly emotional. It’s happy, it’s sad, it’s scary, it’s confused, and it’s triumphant. It is real. We’re an industry dedicated to helping people live better, healthier lives – yet we get bogged down in the tactical solutions rather than the big idea of how we can create change and embrace patients. I challenge you to put down your excel spreadsheet. Look beyond the media spheres of TV, print, digital, mobile/tablet, etc. Stop for a minute. Take a step back. Be human and put a relatable, personal approach to adherence. Challenge yourself to inspire millions of people. It takes a village. But we will get there.

Alison Sheerin

DTC in FocusGuest Columnist

Does the Rise of Payer Power Mean the End of Patient Empowerment?

March 18, 2015

At a recent pharmaceutical marketing conference in New York, speakers and attendees were focused on – and visibly concerned about – a massive sea change happening in healthcare. The concern went well beyond “the best way to implement wearables into pharma programs,” or “how pharma can get involved in social media.” This wasn’t about shiny objects. This was about business. The theme? The impact of the Affordable Care Act is here. And increasing scrutiny on costs and outcomes is having an unprecedented impact on our industry.

The conference-opening panel, titled “How Will Marketing Innovation Help Pharma Adapt to the Massive Changes in Healthcare?” highlighted this conundrum well. Monique Levy, Vice President of Research, Manhattan Research, may have sent a bit of a panic throughout the room with her provocative point that “it’s time to face the music: treatment decisions are not happening the way they used to be.” Levy cited Manhattan Research findings that the real treatment decisions are happening elsewhere, and, in her opinion, “the glory days of patient empowerment are over.”

It’s no secret that, thanks to the Affordable Care Act and a variety of other factors, more and more treatment decisions are being made by payers – not providers, and – to Levy’s point – not patients. Levy maintained that patients may have preferred choices – they may even ask their doctors about them – but the payers are in control. For an industry that, for decades, has viewed its primary audiences and critical decision-makers as physicians and consumers, this represents a fundamental shift. Craig Kemp of Merck Vaccines, who also spoke on the panel, agreed. “There are fewer options now to promote pharmaceutical brands, and there will be even less in the future … Things are changing fast.”

So does the rise of payer power mean the end of patient empowerment? A recent study published in Health Affairs provides an alternative viewpoint. In the two-year study, researchers analyzed patient “activation” levels for more than 32,000 adult patients at Fairview Health Services in Minnesota. For the study, activation was defined as a “metric used to quantify a person’s knowledge, skills and confidence in managing one’s own health and healthcare.” (Some might call that empowerment.) To summarize the findings, patients with higher levels of activation demonstrated more improved healthcare outcomes and lower healthcare costs. In contrast, those with lower activation levels experienced significantly reduced chances of positive outcomes and their healthcare costs were higher. Researchers saw costs increase or decrease as patients’ activation levels changed. In other words, empowered patients had healthier outcomes and cost the healthcare system less than their less-empowered counterparts.

This study proves ending patient empowerment may not be the best option after all. In fact, it provides an important link from patient empowerment to the two things that matter most to payers: costs and outcomes.

While there’s no doubt we are experiencing a massive shift in the way healthcare is “consumed” and decisions are made, it’s important to not lose sight of the big picture. Imagine a world, for example, where pharmaceutical companies adopted a model of only “selling to” and speaking with payers, leaving the HCP and consumer completely out of the discussion. Of all of the stakeholders in this decision-making mix, isn’t it the patient who has the most at stake?

Yes, there are more challenges and barriers than ever before. Yes, there are many unknowns about the future. But that doesn’t mean the industry must choose one audience over the other, or shift its focus completely from one realm to the next.

Think about the outcomes that matter to payers and how you can measure and report your products’ impact on those outcomes. Encourage ties between empowerment, education, outcomes, and cost. Prove the worth of your products. And if those products work better with adjunct services and tools, prove the worth of those, too, and they will be reimbursed.

And yes – still – think about what patients want and need, and serve that up. Empower them with knowledge, skills, confidence, and choices. Because it’s the patient – the true “end user” – that is the greatest reminder of why we are in this business to begin with.

Wendy Blackburn

DTC in FocusGuest Columnist

To Segment or Not to Segment? That is the Question in Pharma Marketing.

March 18, 2015

Having split my career neatly into two halves – first non-pharma, then pharma – I feel I have a good sense of what best practices can, and should, be lifted from the regular world into pharma marketing. In my experience, attitudinal segmentation by disease area isn’t one of them. In the non-pharma world, a segmentation study can be extremely helpful, and can help you narrow your gaze to a laser focus on the unmet needs of the most valuable target audience.

To clarify, I’m talking about good old-fashioned customized attitudinal segmentation studies. The ones that start with a foundation of qualitative research to uncover the range of attitudes, perceptions, and needs that exist in your category, and then plug those dimensions into a quantitative survey – culminating in a neatly segmented pie of a condition-specific universe. Each of those slices represents a target that is more or less valuable to your brand, based on unique mindset and demographics. These segments go on to inform creative development and help you make sense of future tracking studies and copy testing.

In the non-pharma world, a segmentation study can be extremely helpful, and can help you narrow your gaze to a laser focus on the unmet needs of the most valuable target audience. For example, I imagine that, years ago, Volvo figured out that among the car-buying public, there were people with deep pockets whose greatest concern was keeping their kids safe. They then developed deep equity in owning safety –  literally – and in their communications, based on the understanding that this segment was real, and its needs unmet. Similarly, Dove was successful in the consumer packaged goods (CPG) world by segmenting the market and figuring out that an opportunity existed to serve the needs of women who rejected popular notions of beauty.

Why does this custom attitudinal segmentation fall short in pharma? Because there is a profound difference between pharma and non-pharma that reduces the value of segmentation. Primarily, there is a fundamental difference in how consumers enter the category in each world. In the consumer world of goods and services, people choose to be in the buying universe. One chooses to identify as a Volvo person vs. a Subaru person vs. an Audi person. One nominates oneself into that universe. One chooses to buy into Dove’s brand image vs. Chanel.

In pharma, the rules are starkly different; no one chooses to be in the diabetes club, or the psoriasis club. You enter these clubs kicking and screaming, and if you had your way, medicine would not be in your life at all. Yes, if you have a condition that is profoundly impactful, such as arthritis vs. an asymptomatic condition such as high blood pressure, you will enter the club sooner rather than later, but ultimately, regardless of the condition, pharma is the only category where the primary end users want little to do with it (which is why caregivers are such an attractive target… but that’s a whole other article).

So, how do you profile your best opportunity?

The fact remains that to anchor great communications and build a brand, it’s critical to understand what portion of the disease universe represents the best opportunity. The good news is that a different type of segmentation can play a role here; specifically, a segmentation of overall healthcare attitudes (as opposed to a segmentation of patients diagnosed with a particular condition). Everyone has healthcare attitudes, and everyone who consumes healthcare (that is, the entire human population) can be divided into recognizable healthcare attitude segments.

If you work in healthcare marketing, you have seen these segments under various names. There is the Proactive Health Preserver – the person who takes charge of their health, has a strong sense of identity, does not allow themselves to be defined by their condition, and plays a strong role in their own treatment decisions. At the other end of the spectrum, there is the Disengaged and Uninvolved. That nomenclature speaks for itself. And in between, there are another two or three segments that represent people you would recognize at a backyard barbeque.

The reason that general healthcare attitudinal segmentation is more valuable than a condition-specific one is that healthcare attitudes remain fixed across conditions, and often across time. A Proactive Health Preserver (or a Solution Seeker or an Uninvolved) with diabetes represents essentially the same type of opportunity as a Proactive Health Preserver with psoriasis. The condition-specific study does not need to be fielded, because you can predict in advance what the segments will look like and who will be deemed valuable in DTC terms. Spoiler alert: it’s nearly always the Proactive Health Preserver/Solution Seeker (or whatever he/she is called in your study), because they are the ones who are most open to medication and most influential in their treatment decisions.

Further, over time, attitudinal segments tend to remain stable, because they tap into profound perceptions about sense of self and authority that are central to who we are as people. For example, people with a strong internalized identity who are not defined by external circumstances (such as their diabetes) are likely to retain this mindset over the long term. They will see medication as a tool in their arsenal and will not avoid treatment because they don’t want to be “that guy with diabetes.” They will research treatment options and partner in their treatment plans.

Similarly, those who are unable to extricate their identity from their condition are not likely to change this attitude over the long term, and those who leave it all to the doctor are likely to continue doing so over time. This is opposed to other types of segmentation (such as patient-journey based), which, because they are rooted in an external temporal structure rather than an internal mindset, are not truly segmentations. Those segmentations map a patient population as it moves along a disease path. This information may be useful when developing a CRM program, but again, that’s another article.

What can a pharma company (and its agency) do to bring segments to life?

Rather than spend several hundred thousand dollars on segmentation studies that continue to reveal the same segments when the dust clears, a pharma brand team would be better off using existing data to bring their core segments to life. For example, by using the healthcare segmentation already provided by syndicated studies from Kantar Media (MARS) or The Futures Group, and then layering your disease state over that segmentation, we can then profile these augmented segments to determine where your best opportunity lies. The result is a detailed view of attitudes, demographics, and actual media consumption that is actionable. This profile can be cross-referenced with other sources such as qualitative research to flesh out the richness and detail of your target and bring them to life.

What can I do with my de facto segments? The segmentation keys (provided by the vendor) can overlay your de facto segments on to your customer database, so you can create customized messaging for priority segments. You can fold them into your tracking study, so you can track the impact of communications against the patients who are most valuable for your brand. And you can use the segment screening criteria to recruit patients into qualitative research. To learn how to do this, all you have to do is call whatever syndicated vendor makes the most sense for your brand.

So, I still need to do qualitative research? Yes! Leveraging off-the-shelf segmentation with an overlay of disease state does not negate the need for in-depth qualitative research among patients. Understanding how your patients think and feel at every step of the journey – the obstacles and opportunities at key touchpoints – is crucial. The research is also critical to bringing your segments to life in the rich and nuanced way that is necessary to anchor great briefs, and great work.

However, to ensure that your qualitative insights are reflective of your key segments, it’s important to put thought into recruiting these segments for qualitative, which can be done, again, by leveraging the segment tools that can be provided by the vendor. If that’s not possible, the next best approach is to apply a proxy for the segmentation key, ensuring all recruits are proactive about their health and influential in their own treatment decisions – attitudes that, when it comes down to it, are really the key criteria for evaluating the value of one segment versus another.

Deb Silverman

DTC in FocusGuest Columnist

How to Better Connect & Engage with Patients?

March 18, 2015

The goal of any support program should answer this question: What factors must we use in the program that will instill patient confidence in our product – and by default our company? Trust is built by a series of actions and those actions speak volumes more than any words or discount prices ever can! A recent article in eMarketer reported seniors do not trust pharmaceutical company sites and prefer WebMD more.  In this work, companies need to be brave and work harder to deliver a better “patient experience,” while a patient is “on the product.”

A situational review

  • Patients do not want a relationship with a product; they want an “experience.”
  • Federal regulations tend to inhibit innovation in these pharmaceutical support programs.
  • The pharma industry’s patient support programs, in terms of the information they provide, are not valued as they once were. So many other avenues are available, and considered more trustworthy, to patients to get information, including the Internet and patient advocate groups. Maybe it is time to give Regulatory and the other legal protectors some new assignments.
  • Competitive pricing could force excellent programs to be marginalized and undifferentiated (i.e. Gilead and Abbvie in hepatitis C).
  • Patient Engagement is the hot new topic. Not only is pharma trying to come up with a viable, profitable formula for PE, but the Accountable Care Act is forcing many ACOs, integrated delivery networks, and other health care delivery system to tackle this issue as well. With so many different health care systems putting their unique spin to the issue, other questions arise: what works, what does not, how to separate the good from the bad? Think mobile app development.
  • The industry has examples of good and bad pilots. When programs scale to larger patient populations, they lose their patient focus. Outside of specialty drugs, physicians will choose DTC efforts over patient support programs as a factor influencing prescription recommendations.

The first problem is inherent in the program itself: Not all are ground in proven theoretical based methodologies that assist with a patient’s needs. In our opinion, the way to connect and engage is remove the current program silos. Commercial organizations need to consolidate approaches, converge vendors, look to execute more than innovate, and, most importantly, measure and value engagement as much as they do reach and lead generation efforts. Senior leadership should consider looking at the total spend as many fail to ask if all those dollars being spent can be focused more effectively to deliver better program execution.

It has been done before

We frequently mention the work! Biogen Idec demonstrated this with its MS drugs (Avonex & Tysabri) in the in the late 90’s to early 2000’s. Its focus was execution excellence and customer support. The call center and customer relationship management approach acted as the quarterback of its patient focused efforts. Its current website says it handles 800,000 calls a year.

Patients wanted to know about what to expect on therapy, they wanted to know what side effects they would experience, especially with Tysbari’s known side effect, Progressive Multifocal Leukoencephalopathy ( PML). Because of the regulatory requirements, the company embraced this as an opportunity, not a burden, to disclose potential side effects. Moreover, in 2002, Biogen had to take these issues head on because of other products in the market and the high visible media reports on PML.

Back then, management felt it important to have an employee assigned to each patient or caregiver as the single point of contact and relationship steward. This required consolidation and coordination with the ad agency, PAP, HUB, Co-Pay Card, Reimbursement and Benefits investigation, specialty pharmacy and technology.

It’s not a stretch to say that, 13 years later, this plan is still literally paying off: To quote a recent Motley Fool: “Biogen Idec's MS drugs include the billion-dollar blockbuster drugs Avonex, Tysabri, and Tecfidera, as well as the company's newly launched Plegridy … Sales of Biogen Idec's MS drugs increased 47% to $7.93 billion, and its total sales increased 40% to $9.7 billion last year.”

In conclusion, keep in mind these points:

  • Doing this right with patients will produce the brand’s best product advocates.
  • Switch the metric quantified! Measure and reward commercial and medical teams on the number of patients who get better on the therapy as a result of the product and support; not on how many new patient starts were achieved in the past week. Measure engagement, get engagement is what produces real results!
  • “What have you done to help a patient on our product today?” should be stuck on a post-it on every employee’s computer, laptop and iPad.

If the product works, produces outcomes, and patients can easily access information they want, this will help them. They will get started on therapy and realize the value of staying on therapy for the long term. Consider who saved Tysabri from a market recall.

Robert Nauman

DTC in FocusGuest Columnist

Digital Health and Pharma: Leveraging Healthcare Delivery Models to Engage Patients in New Ways

March 18, 2015

In such a strongly regulated industry where it is most important to avoid a downslide, pharma is falling behind in digital health. Risk taking and innovation suggests being open-minded for failure. As Robert F. Kennedy said, “Only those who dare to fail greatly can ever achieve greatly.” The path to success is filled with risk taking: adventurously shifting the predictive and precise, sustainability, quality-based and patient-centric healthcare delivery models away from the reliance on profitable drugs and moving towards resource allocation in digital health to engage patients in new ways.

Predictive and Precise Healthcare Delivery Model with Data Analytics: Real-world evidence and outcome research not only identifies high risk patients but also anticipates medical issues to create customized care plans for individuals as well as improves patient population health through data analytics in the predictive and precise model. Digitally leveraging this model with telehealth efforts, such as wearable devices, can result in pharma partnering with equipment manufacturers to deliver patient adherence information. Headsets which track brain activity and sleep patterns, and sensored “esmart” clothing which monitors blood pressure and heart rate can allow for medication content to be analyzed and then used to form clinical decisions. mPharma and smart devices can digitally leverage this model with real-time, self-tracking, and progress feedback devices and apps, such as 1) food and movement tracking apps; 2) compliance apps with automatic prescription refills; and 3) sensor supported diabetes apps that create a new demand for test strips.

Sustainability Healthcare Delivery Model with Community and Personalized Content: Fostering digital patient-to-patient interaction instead of information exchange exclusively between patient and physician is a key factor in the sustainability model. Online patient communities, such as PatientsLikeMe, digitally leverage this model by allowing for patient reciprocation of objective medical information that results in resourceful discussions about a patient’s personal experiences with different medications that have proven efficacy. Physician communities such as KevinMD and Sermo also can digitally leverage this model with physicians acquiring value through sharing online information with other medical experts about new and successful drugs. Both communities not only promote certain medications but also create pharma brand loyalty.

Quality-Based Healthcare Delivery Model with Physician Tools: Reimbursement depends on measures which promote clinical expertise in the quality-based model. Physician tools support the diagnosis and selection treatment, increase the efficiency of the care process and improve the rapport between the physician and patient. Digitally leveraging this model with IBM’s Watson shows that physicians are on the forefront of technological care access with virtual assistants to facilitate physician referencing and decision making and also improve patient confidence in the progressive capabilities of their physicians who they believe will prescribe the newest and most effective drugs on the market. Electronic Health Records (EHRs) are utilized as cloud-based solutions that integrate data resulting in research and clinical trials that lead to faster results. Patients are engaged via recruitment for clinical trials and the post-market monitoring of safety and efficacy with prescription medication.

Patient-Centric Healthcare Delivery Model with Patient Tools: Consumer experience and understanding patients in their daily lives to achieve patient adherence is the main emphasis of the patient-centric model. Patient tools such as Quick Response (QR) codes that allow patients to interact with chosen information at their own pace can digitally leverage this model. Specific QR codes for each product can be imprinted on prescription bottles and boxes leading patients directly to the online product website. Patient education explaining use, dosage, and safety information can be highlighted through animations, interactivity, and videos from medical practitioners. Remote monitoring support programs can provide information about a patient’s surgically-implanted device that allows constant observation of functioning organs and the skills patients need to manage them. Monitored results can be programmed to text patients’ phones to remind them about upcoming medication doses. The information can be collected and returned to the physician in real-time which would allow for any necessary intervention to be delivered immediately.

In summary, technologically leveraging the predictive and precise, sustainability, quality-based and patient-centric healthcare delivery models with data analytics, community and personalized content, physician tools, and patient tools, respectively, will bring pharma up to speed with current digital health efforts resulting in improved outcomes. Pharma will always invest money where it believes it can secure the highest return, but risk is of utmost concern. At the moment, pharma envisions the highest gain and lowest risk opportunity in developing drugs and not in developing ways of digital patient engagement. By pharma taking a riskier, spirited leap of faith and engaging patients through digital health, greater progress will be achieved.

References:
Gupta, Anu, Schumacher, Jeff and Sinha, Saptarshi. “Digital Health:  A Way for Pharma Companies to be More Relevant in Healthcare.” Booz & Company. (2013)
“Healthcare Delivery of the Future:  How Digital Technology Can Bridge Time and Distance Between Clinicians and Consumers.” EHealth Research Institute. (2014)
“Wearable Tech Regulated as Medical Devices Can Revolutionize Healthcare.” MDDI Medical Device and Diagnostic Industry News Online. (2014)
Palgon, Gary. “Secondary Use of Healthcare Data. and Health:  Use the Cloud to Harness Mainstream Patient Data for Valuable Research.” Contract Pharma. (2013) Brueggeman, Jessica. “Managed Markets:  Operation Patient-Centricity.” Medical Marketing & Media. (2014)

admin

DTC in FocusGuest Columnist

At the Center of Industry’s ‘Solar System’: Five Strategies to Connect with Patients

March 17, 2015

Children and fools speak the truth, they say. When Galileo first said that the Earth travels around the Sun, he was held for a fool. When industry pundits say that patients are at the center of the life science Solar System, they, too, are sometimes accused of throwing around mere buzzwords. But that doesn’t make it any less true. Patient centricity matters for the sake of patients as much as for the sake of business. So how can it be done well?

1. Prioritize face-to-face encounters
Of course, we do market research, social listening, and a myriad of other activities to gain insights and improve business strategies. Those things are needed and necessary. However, how many of us are actually engaging patients personally? While words can convey a great deal of information, but visuals, the voice, the face, and body language all provide relevant context to what is said. Nothing shows greater respect and a higher level of interest than taking the time to be physically present and interact personally with someone. When was the last time you actually had a conversation with someone who had the condition you are working on? If that was not recent, perhaps that’s the place to start.

2. Be human
If you ask patients what’s most important to them when they choose a healthcare provider, overwhelmingly, they’re looking for someone who cares how they’re doing. For a number of reasons, pharmaceutical brands can be perceived as lifeless, cold, necessary evils. They are viewed as merely pills, injections, or infusions, and their benefits sometimes get lost in the commercial mandatories for people to only find that they can’t remember why this brand was a good idea in the first place. We shouldn’t be content with just being “necessary.” Successful brands have a human face, because they work with real people living with the disease, and they offer real support rather than just marketing messages.

3. Include care partners
A large body of literature points to the importance of close family and friends to help patients adhere to their treatment regimen and to provide for the right care at home. In some disease categories, reaching care partners is arguably more important and more appropriate than reaching the patients themselves; think of Alzheimer’s, autism, or any kind of pediatric disease, where it’s mostly physicians and care partners making the most important decisions on the patient’s behalf. A parent caring for a child with a disease will struggle with a different set of worries than someone caring for a spouse, so customization is vital. Care partners often end up being just an afterthought, but in our experience the best patient communication programs have always taken loved-ones into account early in the process. Being mindful of how an illness affects not only the person, but also those around them, is a critical consideration in the communication strategy.

4. Be relevant – tell stories
Research points to three main drivers of medical adherence: patient comprehension, recall, and motivation. Only one messaging format can address all three supporting factors to improve behavioral outcomes: stories. As studies at the University of Princeton have shown, storytelling can lead to neural coupling, where the brains of listeners essentially mirror activities happening in the brain of the storyteller. What this means is that if you hear a story, your brain comes close to actually experiencing the story. Stories get our attention, so our brains are switched on, which helps us understand and remember what we’re being told. And since stories also stimulate us emotionally, we are more open to messages that encourage certain behaviors.

5. Choose peers as messengers
The most credible messenger for any target group is a peer. Testimonials and personal recommendations by people in our inner circle have always had the strongest influence on our most important life decisions. We trust people who are just like ourselves more than total and utter strangers. Storytelling is good, but it has to be culturally appropriate; i.e. your messengers should have a similar demographical background as the target group. Don’t speak through “the average person on the street,” but through “the average person living with the condition,” or a person just like the ones you’re trying to reach.

Bottom line: Engaging with patients takes commitment and preparation. Yet, regardless of brand, it needs to be done – it’s about accepting the facts surrounding the entire healthcare universe. It’s about listening to “fools” like Galileo.

Chemelle Evans

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