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Hispanics account for 1 out of every 5 adults who suffer from diabetes. Although it’s a major health concern for Hispanics (68% of Hispanics who have diabetes say they worry about someone in their family developing the disease vs. 52% of non-Hispanics), studies show that there is still a lack of education on the risks and management of this disease.

With this issue in mind, Univision Communications Inc. (UCI) wanted to find a way to better inform the Hispanic community about this disease, but it couldn’t be done alone. In an extraordinary moment of collaboration not often seen in the healthcare industry, Univision Farmacia, a service of UCI that offers discount prescription cards to Hispanics, partnered with Novo Nordisk, Montefiore, and seven leading healthcare organizations. These industry leaders, which included Inquisit Health, Nestle Health Science, The YMCA, Bayer Healthcare, The American Diabetes Association, CVS Health and Morris Heights Health Center, came together to create a patient program aimed at helping Hispanic diabetics live healthier lives.

Through a 360-degree promotional campaign across UCI’s properties, including digital, social, local TV and radio, the collaboration came to life in November of 2014 with a local community event at Hostos Community College in the Bronx. The event ended up falling on one of the rainiest and coldest days of the year, but spirits remained high among all who were helping to make it happen. Despite the weather, over 500 attendees showed up with one purpose, and that was to learn about diabetes, its symptoms, and treatment options.

Throughout the event, participants received health screenings, face-to-face counseling, panel discussions with experts, and more. In addition, we administered hemoglobin A1C tests to close to 300 attendees. Depending on the level of their hemoglobin A1C score, patients who signed up for the program were each placed into one of three groups and matched with the most appropriate treatment plan in accordance with their diabetes needs.

The first group was the pre-diabetics or those who were at risk for developing the disease (A1C score= 5.7-6.4%). These individuals were placed in The Diabetes Prevention Program, offered by Montefiore and the YMCA, and were provided with Nestle Boost Glucose Control products which they picked-up free of charge at CVS.

Next are the diabetics (A1C score= 6.5 and 8.9%). These patients were given almost the same treatment as the pre-diabetics, but they were also provided with a chronic condition management course at Montefiore Hospital and free glucose test meters provided by Bayer.

Lastly, our third group consisted of patients who had uncontrolled diabetes (A1C score=> 9). These individuals received the chronic condition management course at Montefiore Hospital, free meters and testing supplies from Bayer, nutritional products from Nestle, and they were assigned a peer mentor who provided healthy coaching advice in relation to their condition.

The three groups were monitored over a six month period, and then brought in for testing. Although we have yet to learn the results of this collaboration, which will be revealed in a white paper developed by Montefiore and Inquisit Health, what’s unique was the ability to bring together ten different organizations, each with the common goal of educating Hispanic diabetics and their families on how to make lasting changes that will help them live healthier lives.

Dennis O’Leary will delve further into this case study as he moderates a panel discussion, Novo Nordisk, Montefiore and UCI: Connecting the Hispanic Community with the Diabetes Care they Need, at the MCH National Conference. Discover how these companies worked together to find the common ground and help an underserved population manage this disease. Learn from Dennis, as well as the rest of our esteemed speaking faculty, at the 2015 MCH National Conference, held Oct 12-13 at The Westin in Fort Lauderdale. Register today!

By 2050, the United States population will include almost 30% Hispanics/Latin-Americans, 13% African-Americans, and 9% Asian-Americans, with less than half of the population being Caucasian. Multicultural marketing is described as targeting and communicating to ethnic segments on their diverse cultural framework. Pain management is a universal dynamic among all cultures. The pharma marketing of pain medication to a culturally varied audience will be successful by understanding the Anderson Conceptual Framework and developing specific targeted strategies.

Anderson Conceptual Framework  

Predisposing Factors

Health beliefs are predisposing characteristics that are not easily changed.

• In the African-American culture, pain medications may be passed over due to the fear of addiction. Patient education should be incorporated into a strategy which not only teaches the facts about addiction but also allows individuals to accept medication while foregoing the use of folk healers, prayers, laying of hands and speaking in tongues.
• In the Japanese-American culture, patients may believe that it is honorable to suffer silently through pain. A successful marketing strategy for this particular culture should include a clinical environment where the patient is comfortable expressing his feelings about drug acceptance while incorporating acupuncture, herbs and other natural remedies which are aligned with their culture.
• In the Mexican-American culture, pain may be viewed as penance for sinful behavior or a poor life style while the machismo(a) attitude acknowledges they are courageous without medication. Once again, patient education should be part of the strategy to explain pain can be controlled with medication and also the negative impact when pain remains uncontrolled.

Enabling or Impeding Factors

Family support, access to medicine, and individual community are the enabling or impeding factors with pain medication supported by high, medium, and low degrees of ethnicity.

• A high degree of ethnicity is found in patients who are first generation immigrants strongly affiliated with their culture, raised outside of the United States but now live in areas with a high ethnic concentration, not fluent in English and speak mostly their ethnic language in heavy accents.
• A medium degree of ethnicity is found in patients who are second generation or acculturated first generation belonging to both worlds, have spent up to half of their lives in the United States but now live in areas with moderate ethnic concentration and are proficient in both their native language and English while speaking in light accents.
• A low degree of ethnicity is found in patients who are second generation and onwards, less affiliated with their original culture, born and raised in the United States but now live in areas with low ethic concentration and bilingual but prefer speaking English in a neutral accent.

Perceived and Actual Need Factors

Pain medication is based on the perceived and actual necessity of drugs. Some cultures show a “nocebo” effect where individuals who do not believe in medication experience deteriorating symptoms due to pessimism about becoming healed. The opposite end of the spectrum is a placebo effect where medication is more beneficial if it is more intrusive. The Asian-American culture may view pain as a sign of weakness, believe that medication is inadequate without an injection and prefer an intravenous medication rather than highly effective analgesic tablets. The Mexican-American culture may view medication as unnecessary since they believe they are strong enough to endure the suffering naturally, and believe that a larger pill or bitter medicine are more effective than a smaller pill or medicine that has a pleasant taste. The African-American culture may perceive pain toleration without medication as heroic with past generations in slavery and reject medication entirely out of fear of a detrimental impact.

Developing Specific Targeted Strategies

In a study conducted by Experian Simmons, almost 10 million Hispanics between the ages of 35 and 64 did not use a prescription drug during the past year with 61% spending up to 40 hours of their time each week watching Spanish language television, surfing the web, and visiting social media sites. In terms of context, behavior, and demographics, specific targeted digital and media marketing strategies will increase pharma revenue in pain medication by 50%. Also, strong brand affinity by a culturally diverse population encourages pharma to create direct relationships with target markets that are growing exponentially.

In conclusion, under the medical ethics tenet of beneficence, it is the duty of the physician to intervene with pain medication for the comfort and well-being of the patient with the goal of alleviating distress. Pain is applicable to all cultures. Different cultures create the formation of certain values and then these particular values create perceptions that motivate behaviors. Understanding the Anderson Conceptual Framework with unique cultural insights allows pharma to formulate successful specific targeted multicultural marketing strategies for pain medication.

References:

Alvarado, Anthony J. “Cultural Diversity: Pain Beliefs and Treatment among Mexican-Americans, African-Americans, Chinese-Americans and Japanese-Americans.” (2008). Senior Honors Theses. Paper 127.

McDonald. K.M., Sundaram, B., et al. “Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies.” Agency for Healthcare Research and Quality. (2007)

Guion, Lisa A. and  Kent, Heather. “Ethnic Marketing:  A Strategy for Marketing Programs to Diverse Audience.”  Allied Media Corp. Multicultural Communication. (2014)

Young Entrepreneur Council. “5 Tips to Refresh Your Multicultural Marketing Strategy.” Forbes. (2013)

Millerman, Steve. “Multiethnic Marketing:  The Billion Dollar Upside.”  PharmaExec. (2015)

A Santiago Solutions Group (SSG) in-depth analysis of the most recent enrollment data into ACA exchanges from 38 reporting states revealed that multicultural segments continue to lag way behind the enrollment rate of White Non-Hispanic segment. Less than 100 days away from the third Open Enrollment period, the trends are concerning because so much additional effort was put behind Hispanic, African American and Millennial efforts this past period and the results are marginal at best.

The 38 states in the analysis represent 80% of the country’s population and many of the largest multicultural states in the country such as Arizona, California, Florida, Georgia, Illinois, Nevada, New Jersey, North Carolina, Pennsylvania, Texas, and Virginia were among the 38 states which have broken down the ethnicity of those newly enrolled and renewed in exchange Qualified Health Plans. Included amongst these are all of the Federally-facilitated marketplaces and state-partnership and most of the state-based marketplaces, with notable exceptions like New York, Connecticut, and District of Columbia.

On the surface, the multicultural enrollment rate seems adequate at a 91 index, only 9% below its fair share when considering that 39% of those enrolled at the end of Open Enrollment 2 were from multicultural segments compared to 43% of those eligible in these states. In comparison, 61% of those enrolled have been White Non-Hispanics while 57% of those eligible were of that race, for an index of 108, meaning it is 8% above its fair proportion of eligibles – the segment is enrolling exceedingly well.

Nevertheless, a deeper analysis into each race reveals a much more concerning reality. Hispanics are trailing much further behind than any other group despite all the additional resources that went specifically behind that group in the last open enrollment. While Hispanics make about 15% of those enrolled, they are about a quarter of those eligible, net of undocumented in FPL 139-400 – an index of only 63, that is equivalent to 37% below where the segment should be given its proportion of exchange eligibles. Similarly, the African American segment shows an index of 84, or 16 below where it should be. It is the Asian/Other segment that skews the Multicultural trends with an index of 241, or 141% above where it should be, given that it only represents 5% of eligibles versus 11% of those enrolled so far.

On the eve of the third open enrollment period, the national trends clearly suggest that there are major barriers still standing in front of Hispanic and African American eligibles. There are five major factors at play:

• Lack of Trust in the Government – Mixed status families don’t want to risk exposing immigration status of certain members to official entities and prefer to remain without insurance.
• Poor Value – Deductibles for current plans under the affordable care are far from affordable for many. The plans are still above what many middle-income families can afford relative to their income and other living expenses. Many of them choose to continue to pay-as-they go using urgent care/community clinics and gladly pay the tax penalty. Cheaper plans are critical.
• Ineffective Messaging – On one hand, the plans’ mass media messaging is overly-promising and, on the other hand, the fine print is overly-complex to clearly evaluate.  As a result, negative word-of-mouth prevails and a huge portion of the segments are not even seeking official information in-person or digitally.
• Poor Culture & Language Relevancy – While the messages have improved, they are mostly translations or adaptations of communications intended for audiences with high levels of health care and health literacy. For the most part, Hispanic nuances addressing specific barriers and the most effective triggers to adoption have not been brought to the forefront. Exchange communications from the government and insurers are still in cultural diapers.
• Lackluster Customer Experience – The customer experience of those newly enrolled is rampant with stories of poor on-boarding, repeated incorrect bills, systems that don’t reflect conversations with customer service, physicians not in the promised network, communications that are very difficult to understand, inconsistency of in-language communications, and very mixed experiences with call-centers. These unsatisfactory experiences are drowning the exceedingly good ones in physical and digital circles of influence, keeping the undecided eligibles at bay.

At the end of the day, half of the remaining exchange eligibles in these states are Multicultural and 1 in 3 of the overall remaining eligibles (net of undocumented) are Hispanic. The source of growth for ACA is adding critical pressure to getting multicultural engagement, acquisitions, and retention properly focused on the needs of this vast potential. The time for blanket strategies versus dedicated segmentation has passed us. Health insurers which can effectively figure out the nuances of educating, influencing, signing up, and serving multicultural customers are poised to accelerate their growth and win significant share.

Carlos Santiago will delve further into this topic during his presentation, The State of Multicultural ACA Marketing: Hurdles, Opportunities & Return, at the MCH National Conference. His presentation examines the relationship between Hispanic dedicated efforts and overall revenue acceleration, the so called ACA feasible/eligible opportunity gap for Open Enrollment 3 and beyond, as well as the Multicultural opportunity coming from this next Open Enrollment. Learn from Carlos, as well as the rest of our esteemed speaking faculty, at the 2015 MCH National Conference, held Oct 12-13 at The Westin in Fort Lauderdale. Register today!

As a gay man and a supporter of LGBT equality, 2015 has been a momentous year because of the Supreme Court’s decision to extend marriage equality to the entire nation. On the evening of the decision, my husband and I made our way to The Stonewall Inn in New York City – the birthplace of the modern gay rights movement – to celebrate this historic event. As a healthcare advertising professional, I wondered how this watershed moment would impact the way health and wellness is marketed in the United States. As I reflected on this, several key issues and opportunities rose to the top.

LGBTs are becoming increasingly more accepted by mainstream US culture, and brands are taking note. Over time, as LGBT visibility has increased both in the mainstream media and in people’s personal lives through the coming out of friends and loved ones, acceptance of LGBTs and LGBT relationships has grown. We are now at a point in our history where the majority of Americans support LGBTs. According to Gallup, 58% of Americans say that same-sex marriages should be recognized by the law as valid, with the same rights as heterosexual marriages. This increased acceptance has not gone unnoticed by brands looking to attract a customer segment they haven’t specifically targeted in the past. In 2012, Oreos – the epitome of Americana – posted a rainbow-filled Oreo on its Facebook page. In 2014, CVS Health included LGBT characters in its rebranding TV ad as one of the many diverse customers that the company serves (or wants to serve). And this year, Dove included a gay couple as a part of a Father’s Day ad celebrating all kinds of Dads. Marketshare is not easy to win, and more and more brands are adding LGBTs to their target segments.

Taking an inclusive stance toward LGBT consumers can influence non-LGBTs, especially Millennials. Most of us are aware of the fact that Millennials are the most diverse consumer segment we’ve ever seen. And Millennial culture includes respect for and appreciation of diversity, including LGBT. According to Pew, 70% of Millennials support LGBT marriage equality – the highest of any generation. Brands today are taking note of this cultural value and using it as a way to gain sales and share among Millennials. This works particularly well for established brands that are trying to shed an image of being “dated” or not relevant to today’s consumer. Two brands using this approach are Coca Cola, who ran an ad during the Olympics that was a celebration of diversity, including LGBT, and Honey Maid’s This is Wholesome campaign featuring tattooed, interracial, and gay parents in their modern take on the American family. Healthcare could benefit from this more modern image, courtesy of a supportive take on LGBTs.

The definitions of relationships, parents, and families are changing. Are your communications keeping up? Providing culturally competent care is an important objective for hospitals, health plans, and other healthcare providers. Patients seeking healthcare are often in a vulnerable state as they grapple with the myriad issues that come with dealing with a health condition. Having care delivered in a way that is sensitive to one’s culture helps to reduce emotional anxiety and increase outcomes for patients. If all of your communications speak to “husband” and “wife,” then you are completely missing LGBT couples who may be seeking a healthcare solution that you can provide.

Gay marriage will also likely lead to more children in LGBT households. As LGBT couples take the traditional relationship path to marriage, children are the next logical step. This means that your target may not be just “Mom”; it may be “Dad” or “Mom and Mom” or “Dad and Papa.” We are at the point in marketing where acknowledging and celebrating LGBT families is differentiating. Now is an ideal time to jump in and capture this opportunity. At some point, most brands will be speaking directly to LGBT families; those that do not will stand out… for all the wrong reasons.

The LGBT segment has been an opportunity for brand influence and growth for decades. Healthcare marketers – along with travel, financial services, consumer packaged goods, and many others – have been successfully reaching and influencing this segment. The shift in societal attitudes toward LGBTs has now opened up this opportunity to “mainstream” brands and not just those on the “cutting edge.” In addition, the state of the American healthcare consumer has changed forever. Individuals, couples, and families represent a diversity that includes LGBTs. Therefore, our communications must keep up with this new reality if we are to remain relevant in today’s consumer/patient landscape. The upside: this is one of those moments where doing the right thing socially is also the right thing for business. Let’s get started!

Andy Bagnall will delve further into this topic as he moderates a panel discussion, Taste the Rainbow: Best Practices in LGBT Healthcare Marketing, at the MCH National Conference. He will lead a panel of LGBT experts, sharing trade secrets and tips on how to tap into LGBT media and culture to drive business results. Learn from Andy, as well as the rest of our esteemed speaking faculty, at the 2015 MCH National Conference, held Oct 12-13 at The Westin in Fort Lauderdale. Register today!

For years, pharmaceutical marketers have tried to convince themselves that the FDA accepted a standard under which risk information could be presented separately from benefit information via a hyperlink in online communications (the so-called one click rule). And for just as long, the Food and Drug Administration kept taking enforcement actions making clear that it did not accept that position.

Indeed, some people began to referring to one click as the rule that isn’t. But that didn’t stop marketers from dreaming of a world in which they could use social media and other online platforms to communicate benefit information while limiting the presentation of risks to a destination in a link.

Apparently, some members of Congress agree. For the past year and a half, the House of Representatives has been engaged in a bipartisan effort to radically transform healthcare and the approval process for new drugs. That effort is known as the 21st Century Cures Act. The first draft legislation released in January of this year included a provision about social media that would essentially have written into a law a version of the one click rule.

Just last week, on Friday, July 10, the House of Representatives passed the 21st Century Cures in an overwhelming vote (344-77). 21st Century Cures now moves to the Senate, where its future is far from certain. Unfortunately for advocates of the one click rule, that provision wasn’t in the version of the legislation that received the vote; however, that isn’t the end of the road for this item.

The one click provision is now a standalone bill that Representative Billy Long from Missouri is sponsoring. That legislation could either be part of a revised version of 21st Century Cures (for example as part of the Senate bill), or it could pass as a separate item.

In addition, the Prescription Drug User Fee Act (PDUFA), which comes up for renewal every five years, is again being updated. The last time PDUFA was updated in 2012, the bill was called the Food and Drug Administration Safety and Innovation Act (FDASIA). Pharmaceutical marketers might recall that FDASIA mandated FDA release social media guidance by July of 2014. Some people credit that legislation for the three draft guidances on social media that FDA released last year.

So there is extremely recent precedent for Congress to use this vital must-pass legislation to prod the agency about its direction on advertising and promotion of prescription drugs, specifically regarding new and emerging platforms and technologies.

And of course, FDA is itself reviewing the comments received on those draft guidances, and several comments endorsed some version of a one click rule and encouraged the FDA to accept such a provision.

Marketers of pharmaceutical products will need to pay attention in the next few months as all of these pieces fall into place. For now, one click remains the rule that isn’t, but marketers are born dreamers, and this is a dream that clearly won’t die easily.

We’ve all heard about “Meaningful Use,” but where did it come from, what does it mean, and how might healthcare consumers ultimately benefit? Let’s find out!

Back in 2008 the National Quality Forum (NQF) issued a report identifying opportunities for improving public health, efficiency, safety, privacy, and patient engagement, among other areas. The recommendations became the foundation for the “Meaningful Use” of electronic medical and health records (EMR/EHRs), which gained momentum a year later when the American Recovery and Reinvestment Act (ARRA) formalized the need for preserving and improving healthcare affordability.

The HITECH Act soon followed, designed to help meet those goals through Health Information Technology (HIT). Monetary incentives through Medicaid and Medicare were offered to eligible healthcare professionals and hospitals to adopt certified EMR/EHR technology and use it “meaningfully” to improve healthcare. The goal is to ultimately create better clinical outcomes, increased transparency and efficiency, boost individual empowerment, and produce more robust research data.

In July 2010, the Centers of Medicare & Medicaid Services (CMS) established three phases of the EHR Incentive Program applicable over five years, whereby eligible physicians and hospitals would meet meaningful use criteria and gain incentives by adopting certified EHR technology, and use it to achieve specific objectives:

• Stage 1: Data Capture and Sharing (2011-2012)
  The nuts and bolts of EHR integration, including capture and standardization, tracking, internal communication, reporting of quality measures, engaging patients and their families through data.
• Stage 2: Advance Clinical Processes (2014)
  Integration with the Health Information Exchange (HIE) of e-prescriptions and lab results, electronic transmission of patient care summaries, and increasingly utilized patient-controlled data.
• Stage 3: Improved Outcomes (2016)
  Achieving top line benefits, including improved quality, safety, and efficiency, and healthcare outcomes; decision-support; patient access to self-management tools; HIE-based access to patient data.

Implications & Opportunities

Up to now, the integration and adoption of health information technology, especially EHRs, have often been problematic. Whereas most professionals and even patients agree that technology can improve outcomes, the disruptive nature of digital often precludes utilization, and typically spawns fragmentation and interoperability nightmares. Meaningful Use combats these obstacles with genuine incentives, physicians qualifying for as much as $63,750, and hospitals for $2 million or more.

• 88% of providers report that their EHR produces clinical benefits for the practice
• 75% of providers report that their EHR allows them to deliver better patient care

Such an unprecedented synergy between government, healthcare providers, and technology has already created powerful opportunities, especially in EHRs and digital health. Focused on realizing the looming goals of Meaningful Use, technologists are getting closer to the Holy Grail of platform agnosticism, device interoperability, and data universality. The central tenet of patient empowerment – making the healthcare system less paternalistic – is a core objective of Stage 2.

As such, the ACA and Meaningful Use hold tremendous promise for patients and patient-centric communications. Despite many challenges and the ongoing need for caution, unique and compelling opportunities abound for closing the loop between patient data and their physicians through EHRs at the point of care. Additional opportunities for integrating patient data into decision-making tools such as @Point of Care powered by IBM Watson are taking hold, further expanding the vision.

Summary & Key Takeaways

The future of health information technology, especially EHRs, points to a “Coke vs Pepsi” future competitive landscape, where thousands of fragmented vendors eventually coalesce into three, most likely just two, main platforms. Until the inevitable happens Meaningful Use has helped drive adoption, utilization, and innovation. The benefit to the patient is realized not only in terms of reduced costs and heightened efficiencies, but in exciting new opportunities for engagement:

• Patients will gain ever-increasing control of their own data
• Patients will communicate more directly and transparently with their physicians beyond the point of care
• Patients will integrate their EMR/EHR platform with wearables and other biosensors to make biometric data input and sharing seamless
• Patients will share biometric data between appointments, giving their physicians an unprecedented view into their overall health
• Patients will make their data responsive, with alerts and other feedback loops to help heighten adherence and other forms of behavioral modification

So pay close attention to the evolving digital health landscape, where science, communications, and technology merge – sometimes even with helpful impetus from the government – for the benefit of patients and the healthcare systems that serve them.