A whole new ballgame
February 2015, Marketing & AdvertisingTo an industry insider who magically fell asleep in 2010 and woke up as the ball dropped in Times Square to ring in 2015, the pharmaceutical industry might be nearly unrecognizable. Five years ago the Affordable Care Act had just been passed and signed by the president; today its consequences have flowed out in all directions, transforming the way healthcare is provided and paid for. Five years ago mobile web was just catching on; today it accounts for more than 60 percent of web traffic. The pharmaceutical executive of five years ago would be overwhelmed by all the new audiences, new decision makers, new expectations, new media, new data and sources of information of today; even for those of us who have not been napping for the past five years, it can all be a little overwhelming. For this year’s Agenda overview, Med Ad News spoke with a long list of industry insiders, the people who have to deal with this sort of tranformational change every day. Here are the trends that they told us would be most important for pharma marketers in 2015.
The changing marketplace
Topping the list of crucial developments for pharma marketers in 2015 is the continuing transition in how health services are provided and paid for. Today’s brand manager is faced with a bewildering array of acronyms – the Accountable Care Organization (ACO) and the Integrated Delivery Network (IDN) are the two most prominent of many – and each of these has its own unique decision making processes and value definitions. Pharma companies are having to learn on the fly how to deal with all these new decision makers, a process that is causing perhaps the largest single shift in selling strategy in the entire history of the industry.
From the perspective of the healthcare consultants at PwC, the changes wrought in the marketplace by ACA and the rise of new provider and payer entities will drive nothing less than a change in the real meaning of value for pharmaceutical companies and their constituencies, leading to a greater focus on real outcomes accompanied by real data.
“The shift of risk in selection and payment for therapeutic treatment to various provider entities introduces new variables that the pharmaceutical product industry will need to orient towards, namely quality and total cost of care,” says Warren Skea, principal, PwC. “No longer will pharmaceutical product companies’ strategy that focuses on physician directed therapy based on their clinical knowledge and payors processing claims based on their approved cost of treatment analysis, define and determine their success.”
Nothing less than a new definition of value through outcomes-based evidence that proves such value is what stands between success and failure for pharma companies now, Skea suggests. The very definition of payer has begun to radically shift to a variety of new models that are both consolidating and adopting risk for cost (bundles, capitation) and care (quality, outcomes), to say nothing of employers and consumers who are the primary funding sources. And this shift is driving a corresponding change in payer expectations.
The payer as provider is looking for materially different shifts in clinical quality impact and the total cost of care.
“The payer as provider is looking for materially different shifts in clinical quality impact and the total cost of care, both upstream and downstream, as related to any product therapy,” Skea says. “Providers also want to know which patient cohorts will receive the greatest impact from the day a therapy is authorized, not after months or years. Determining the holistic, incremental, and/or avoidable costs of care, across a broad range of actual operating costs incurred by delivery systems outweighs the incremental discount that typifies the current state.”
So outcome study proof and the documentation of cost and quality differences is going to have to take place in the laboratory of every day clinical delivery where the variables of real life impact therapeutic performance. “The validity of value measured is best spoken for by provider industry leaders that have the trust and stature of peers across their community,” Skea says. “This has become necessary to avoid the skepticism that can often accompany product company-led studies. This shift to provider system definitions for outcome value has put a premium upon the product industry’s need to abandon the vertically integrated model that was committed to a pre-determined value definition over to a highly collaborative outcome model that is intent upon discovering value as an ongoing journey. In this way product companies can more responsibly convert to risk based contract agreements where outcomes and the data to support them can be trusted and operationalized across the provider community.”
In addition to the consolidation of provider networks into ACO/IDN models and rollout of the federal and state-level exchanges, experiments with outcomes-based reimbursement and the muscle-flexing of the leading pharmacy benefits managers to negotiate exclusive deals with pharma is continuing to put general downward pressure on healthcare costs. This, says CEO David Ormesher of closerlook inc., presents both challenges and opportunities for pharma to assert its role and value.
“At this point, most pharma companies continue to play the role of vendor,” Ormesher told Med Ad News. “Most contracts are priced on volume-discounts, not on outcomes or value. In an environment that is aligned around cost-reduction and fee-for-value, winning on price leads directly to commoditization. For brands that are competing with an effective generic, there are fewer options to avoid this margin squeeze, but for many, the path forward looks like a business partner model. As healthcare in the United States moves away from fee-for-service, pharma will need to move towards more partnership approaches to disease prevention, management and cure.”
Taking a similar position, Patrick Jordan, chief administrative officer of Encore, a Quintiles company, believes that the shift in the marketplace commands a different operating model among individual stakeholders and a far more interdependent relationship between them. “Mergers provide scale and access to capital to enable stakeholders to compete today. Partnerships, alliances, and shared-risk agreements will be the vehicles for tomorrow’s success. Healthcare industry executives spoke to these trends in a recent survey Quintiles conducted; seventy-nine percent of biopharma executives anticipated being involved in significant joint initiatives with payers and providers over the next three to five years, and each of these stakeholders expected improved health outcomes and innovation to be among the greatest benefits of working together.”
While the benefits of all this partnering may be clear, achieving real alignment between partners is and remains a challenge. “Incentives and data are at once the tools for competition that divide value in healthcare and the tools for collaboration that increase it,” Jordan told Med Ad News. “The healthcare stakeholders that succeed in the future will align their incentives and use of data around achieving superior health outcomes at the best cost, a determination that can only be achieved through contributions from each stakeholder. Through these contributions come significant returns – biopharma’s innovation rewarded in market share, providers’ expert delivery earning recognition for differentiated care, and payers’ insight on patient-level treatment options resulting in stronger member loyalty.”
On ground, providers are already encountering a number of reactions by pharma companies to the rise of organized payer groups and their corresponding impact on communications with HCPs.
“We are starting to see several responses to this trend,” says Michelle Keefe, president, Publicis Touchpoint Solutions. “These include the use of key account managers who engage these groups directly to communicate important health information and who work toward increasing access to HCPs; greater use of field-based clinical nurse educators who are focused on helping HCPs and their patients achieve improved health outcomes; and the augmentation of field sales teams with virtual teams of all types. There are times when a healthcare system’s restrictions may impact access for field teams while a virtual representative (e.g., via live video or phone) can often get through. We see health information engagement via contact center teams continuing to grow.”
Finding new ways to interface with the provider obviously is not enough, though; marketers will also have to keep a close eye on the exact needs and requirements flowing out of all those new payer and customer organizations.
“While there appears to be a strong certainty among bio/pharma leaders that organized customer groups and payers will demand evidence of better value, understanding how the requirements emerge will be critical,” says Joe Falcon, senior VP, managed markets, TGaS Advisors. “Building a strong Health Economics and Outcomes Research (HEOR) competency, combined with a single point of contact in the account management realm, will be a minimum core capability for companies.”
In continuing to respond to all these tectonic shifts, most industry watchers seem to agree that pharma needs to broaden service offerings to both patients and providers. “In an outcomes-focused environment, service offerings that focus narrowly on a product (access, reimbursement support, et cetera) will do little to differentiate brands or provide true value to providers and patients,” says Alyson Connor, president/partner, Micro-Mass Communications. “Services need to focus on helping patients and providers address the real-world challenges to optimal clinical outcomes – many of which are related to patient choices and behavior and not to product efficacy, safety or administration. Ultimately, to deliver on these services in a commercially viable manner, pharma companies may need to adapt their business models to monetize both products and services.”
To that end, Connor believes that the capabilities of pharmaceutical representatives must evolve. The demands on rep-provider interaction will be higher. To be a valued partner in a population health model, pharma reps not only need to have a deep understanding of disease and products, but also of key factors that drive outcomes outside of prescription treatment.
“This evolution of marketing approaches in a regulated environment may be daunting for pharma,” Connor toldMed Ad News. “The industry will need to be brave and deliberate about stepping away from traditional product-centric marketing tactics. This may involve proactively consulting with Regulatory and taking calculated risks. Ultimately, to approach brand marketing differently, pharma will need to develop champions and new best practices within the organization – case studies that demonstrate how these services are a more effective and efficient way of connecting with customers and delivering better outcomes.”
Looking at these market trends from pharma’s point of view, it may no longer be possible to neatly separate company strategy and operations between payers, healthcare centers, and physicians since they are all inextricably intertwined. Instead of creating a separate strategy for different market stakeholders, they need to formulate an end-to-end value proposition for their products that addresses cost effectiveness of overall treatment, superiority of outcomes, and ease of use by patients. This will require a significant rethinking of the internal structure and processes of pharma companies, suggests Angeliki Cooney, director, thought leadership, U.S., IMS Health.
“At the same time, pharma companies need to rethink how they engage with this constantly evolving ecosystem of market stakeholders,” Cooney says. “A rebate for a payer will do nothing to convince IDNs to include a drug in their formulary and treatment algorithms if they don’t lead to lower total cost of care and improved outcomes at the patient level.”
External stakeholders … all have Amazon-size expectations.
IMS’ own research indicates that IDNs and ACOs can have double digit impact in percentage terms in the sales volume of a drug. Likewise, a very effective drug will not be adopted if it breaks the bank. Even outright cures nowadays do not necessarily maintain market dominance for too long, as the evolving battle between Gilead and AbbVie shows in the hep C space, and Zaltrap’s launch was hampered due to non-adoption by provider groups.
“Going forward, engaging with market players can no longer be safely compartmentalized between sales, marketing, and managed markets,” Cooney says. “Pharma companies need to look at all their customers as partners in a longterm relationship. In this relationship, it may be necessary to contribute in a myriad of ways like offering patient awareness programs, coupons/vouchers for patients going through financial hardship, volume discounts to a hospital, a risk sharing agreement with an insurer and so on and so forth. Zeroing in on a geographic cluster surrounding each influential IDN or ACO system and offering what each one specifically needs is imperative for pharma companies to successfully participate in this evolving market.”
But if said evolving market could be boiled down to a single word, that word would no doubt be “efficacy.”
“The marketplace is moving to accountability, and pharma will someday be forced into efficacy-based reimbursement,” says David Kopp, executive VP and general manager of media group, Healthline. “In 2015, I expect to see the more innovative marketers begin to experiment with consumer marketing campaigns designed more to impact efficacy than acquisition – campaigns which effectively educate consumers on adherence, compliance and lifestyle counterparts to therapy (such as diet and exercise) can and will impact a drug’s efficacy, and ultimately, bottom lines.”
Raised expectations
The man on the street of 2015 is consuming information at a dramatically more sophisticated level than ever before. When shopping online, for example, consumers expect retailers to instantly provide relevant product recommendations (you purchased brown loafers last year, so here are this year’s styles in your price range), and follow up logically in synchronized ways (enjoy this 20 percent off coupon at checkout) and through preferred channels like mobile and email (come back next month to find out how to weather-proof your new pair of shoes). Further, there’s little distinction between the expectations of consumers at home versus consumers at work.
“So when it comes to the life sciences industry, external stakeholders – particularly HCPs and patients, but also payers and investors, and internal stakeholders, all have Amazon-size expectations,” says Paul Shawah, VP of product strategy, Veeva Systems. “Case in point: multichannel, which was a castle in the air five years ago, is now table stakes for success. Indeed, the bar has been raised.”
The problem, and the difference between life sciences and many other industries, Shawah points out, is that pharma marketers only have partial and disparate view of customers.
“To meet the expectations of all stakeholders, marketers must demand a complete picture of the customer – including all non-personal communications and personal interactions between field reps and physicians,” he says. “Today, in contrast, most marketers only have bits and pieces of information, seeing just the interactions from those marketing-led campaigns that have been tracked. Worse still, this data is typically compiled ad hoc by each external partner who executed the campaign, so marketers don’t have the advantage of a holistic understanding of customers, their preferences, their motivators. Without an integrated look at all customer interactions, it’s difficult to meet the ballooned expectations for personalized, well-orchestrated customer experiences. It’s time to demand as much from our technologies as we do from marketing.”
Magnifying the impact of growing consumer expectations based on interactions with other industries is the increasing participation of patients in their own health. With copays on the rise and health-related information continuing to proliferate on the Internet and elsewhere, the patient who simply thinks, “I’ll ask the doctor” is becoming a rare breed.
“Patients are seeking more information to get more deeply involved in their treatment, as an addition, not as a replacement to the expertise of their HCP,” says Dan Stone, CEO of AccentHealth and co-chairman of the board of the Point of Care Communication Council. “Patients do on-line research before they enter the waiting room where they receive additional, relevant information in the waiting room and exam rooms – and right before they talk to their doctor. Like never before, patients are able to engage as their own advocate – ready, for example, with a series of questions and knowledge of specific treatments, drugs and brand attributes. Furthermore, patients of all ages are increasingly entering the doctor’s office with their smartphone or tablet in hand. Increasingly, in-office media interact with these devices for a truly interactive, real-time information-gathering and knowledge-building experience.”
And docs are expecting more too. “Physicians have less time and tools to engage with patients,” says Amy Parke, VP integrated marketing communications, Ashfield Healthcare Communications. “No longer can they just write a script and send patients on their way. Instead, they are looking to the industry to support them in their decision-making, so when they write a script, they can also provide the resources, direction and education their patients need to understand the effects of their treatment and why adherence is important to improve their outcome.”
According to Parke, these changes have created a significant challenge and a gap in the conversation, which in turn has presented an opportunity for the pharmaceutical industry to look at interactions from a holistic approach. “To do this, our focus has been on helping our pharmaceutical clients find ways to change the conversation to ensure a successful collaboration between them and their physician and patient targets. In addition, this holistic approach has created a new opportunity for sales reps who are now able to hold a new conversation with physicians about the resources the pharmaceutical company offers their patients. These resources that aid the patient journey will ultimately help physicians streamline their dialogue with patients, and also provide the education and engagement the patients seek.”
The results of Publicis Touchpoint Solutions’ most recent “What Physicians Want!” survey suggest some possible solutions to the challenge of raised expectations on the provider side. The survey found that docs are definitely demanding more value from the life sciences industry, with interest in seeing representatives actually increasing. But they don’t want their time wasted; physicians expect real value in their engagement with representatives. According to Keefe of PTS, survey respondents identified three important value measures: field sales representatives who are highly trained and who know more than “just their product” (i.e., the market, disease state, reimbursement issues, other products, and the physicians’ practice); representatives’ knowledge and use of clinical studies and evidence-based medicine; and increasing access to non-traditional teams, such as field customer service representatives, clinical nurse educators, and virtual (or contact center) teams of all types.
Moving to the consumer side, Bill Coyle, principal at ZS Associates, has three suggestions. “First, develop deeper insights into the wants, needs, and expectations of consumers all along their healthcare experiences – not just in the moment where they are making an Rx-specific decision. This requires improving research and analytics approaches to understand the rational and non-rational drivers of health behavior and decision-making.
“Second, expanding and enhancing the use of personalized messages and interactive channels in consumer promotion. Some pharma brands are starting to leverage social media, mobile, and other technologies to create more engaging experiences and interactions with consumers, but there is a lot of room for growth and innovation here. And third, deliver significant value-added services to patients to support better treatment outcomes, including high-touch services such as personalized support. Specialty brands in particular are starting to experiment with new service models to support patients in new ways. All three of these will require the pharmaceutical industry to think creatively about how to achieve these goals within regulatory and legal guidelines and communicate appropriate disclaimers in more consumer-friendly ways.”
Looking more widely, one critical part of the solution comes in two overused but underapplied words: comparative effectiveness.
“At a minimum, companies should be able to provide comparative evidence of the effectiveness of their products against not only competing drugs but also combination drug therapies as well as alternative therapies that may not be drug-centered,” Cooney says. “This evidence should not only cover the clinical trial stage but continue throughout the in-market lifecycle of the drug.”
Such ongoing patient outcomes studies, Cooney suggests, should be transparent and conducted in collaboration with customers such as IDNs, ACOs, and payers. They should be used not only to continuously reaffirm the effectiveness of the drug to maintain market advantage but also to provide early warning systems for side effects as well as patients at-risk of relapse or adverse outcomes. “Such treatment and population management offerings are essential to compete going forward in the drug market,” Cooney says.
The marketing tapestry
As both the number of media and the level of consumer expectations proliferate, marketers in 2015 and beyond are going to have to reach their audience through an ever-growing and changing number of touchpoints and locations, traditional, digital, mobile, and otherwise. Once upon a time the creation of a brand could grow out of a single campaign in a single medium – but no more. Today’s brand manager, responsible for a whole tapestry of campaign touchpoints, is going to have to start thinking in terms of reaching each customer at the just-right time, in the just-right place, and with the just-right message.
Transmedia storytelling is a new form of narration characterized by the combined use of several different media platforms to develop a story world.
“The best way to do marketing planning across a large tapestry of media touch points and interactions is to re-frame the role of the marketer as a portfolio manager who is responsible for asset allocation,” Ormesher says. “Just like a financial advisor who monitors investment returns of various asset classes and makes investment recommendations based on risk and return, so the marketer can look at the marketing landscape as a portfolio of options, each with their own risk and return profile.”
And just like the financial advisor, the marketer should be basing his decision on real data, which for pharma brand managers is becoming increasingly available in both quantity and level of granularity. “With access to data that can also show return at the individual physician level, the marketer can take portfolio management to a new level,” Ormesher says. “Rather than just managing budget allocation across media assets, she can use targeting and segmentation techniques to allocate types of interactions based on both customer preference and customer behavior. As a portfolio manager, the marketer has the confidence that she has balanced risk and return in her marketing investments, and senior management will see that budget planning is based on data and not just intuition.”
Another phrase for this “tapestry” approach is “transmedia storytelling.”
“Transmedia storytelling is a new form of narration characterized by the combined use of several different media platforms to develop a story world,” says Mark Finn, VP, account director, AbelsonTaylor. “With transmedia storytelling, we can optimize the brand experience across multiple channels, far exceeding the sum of the one or two traditional channel choices. Of course, modern marketers applying transmedia storytelling would need to know how to present a brand’s unique story in different layers based on the utility of a given device, the HCPs, and even their behaviors at that given moment. And because transmedia storytelling is such an effective byproduct of today’s complex, modern world, it can easily be tailored to any new channel that HCPs adopt, such as wearables, or “binge watch,” such as subscription-service channels Hulu, Netflix, Amazon, or Vudu.
Behind this strategy – whatever it might be called – is the need to reach the target in her natural habitat, at the moment of maximum impact. And those habitats and moments go far beyond what most pharma marketers have ever attempted.
“That includes embracing the pharmacy channel, which has become the de facto around-the-corner ‘health and wellness destination,’” says Mindy Price, head of planning, Ogilvy Healthworld. “Brands must ensure that when they develop their HCP communications plans, the target definition is broadened to include pharmacists, pharmacy assistants, and nurses, so that they are armed with valuable brand information.”
Additionally, given the growing body of evidence about the value of community and spirituality in healing, patients and caregivers are rallying in the social media space to build emotional motivation events. “These programs are going viral worldwide overnight and gaining more share of mind than any print ad can generate in that period of time,” Price says. “For example, ‘Photo Doggies for Anthony’ is a Facebook page created to help heal a 16-year-old stricken with cancer. Dog lovers virtually share their pets’ love and prayers via photos to cheer up the patient as he goes through his chemotherapy regimen. The brands who figure out how to support and incorporate more of these kinds of efforts in their plans will win.”
The bottom line is that in order to be successful, marketers will have to activate multiple levers to reach the right audiences. Traditional marketing channels like TV, digital, and print will certainly play a role, but they cast a wide net and need to be supplemented with tools for communicating a refined message to target consumers – the 1 percent of the population taking biologics, for example. “Marketers will find greater return on communication channels that reach the patient when they are most engaged and thinking about their health,” says Tom McGuinness, CEO, PatientPoint and co-chairman of the board of the Point of Care Communication Council.
For this reason, McGuinness suggests, investments in communication at the point of care will grow in the new year. “While messaging at the point of care is certainly not new, using the channel effectively for communicating with patients – and providers, by extension – is evolving rapidly and producing compelling returns. The realities of the information overload experienced by many HCP specialties and the challenges of delivering changing behavior is obvious. Further, 2015 is the year to move from science experiment to scale in those areas traditionally considered ‘new’ such as EHR, eRx and point-of-dispensing. Likewise, choosing those solutions that allow marketers to adapt information delivery based on short- and long-term behavior patterns is also ready to move from pilot to prime time.”
New connections
A handful of years ago, “big data” was a fancy buzz-concept that technology prognosticators were using to paint their pictures of the future. Now? Big data is becoming a real part of any marketing discussion of significance. But despite all the salivating over opportunities to know the customer better than ever, pharma has not quite figured out all the headaches inherent in big data. Pulling a needle of insight out of a Mount Everest-size haystack, after all, is a great deal more difficult than pulling it out of one of more traditional size.
“The challenge of ‘big data’ is one of maximizing signal to noise,” Jordan says. “Multiple sources of data can yield powerful insights about the biology of disease and best methods for treatment, but these insights are often faint signals against a complex background. We know that amplifying these signals requires an ability to isolate the data of interest, whether they are related to efficacy, outcomes, meaningful use, or inpatient utilization. Yet making value from big data requires more than isolating signals but connecting insights. What is this treatment’s impact on length of stay or risk of readmission? Even more, insights from big data need to reflect insights on patient behaviors, the role of community and environmental factors, and genetic predisposition for disease, all of which are thought to be greater contributors to health than what occurs in the clinical setting.”
To be successful in this data-rich era of healthcare, Jordan believes that biopharma brand managers will need to be as expert in data analytics as in detailing message. However, the industry still has gaps in its readiness to integrate signals and insights.
In a recent Quintiles’ industry survey, nearly three-quarters of biopharma executives, payers, and providers expected information-sharing to be key to their success in the future, but more than half feel they have neither the tools nor the expertise to integrate, optimize and develop insights from healthcare’s breadth of available data.
So what’s a brand manager to do? According to Mike Zubey, managing director, pharmaceutical life sciences advisory, PwC, the key to mulling through all of the “big data” sources such as social, mobile, electronic health records, and traditional third party data sets is focusing on the questions that are most critical to the new brand manager’s role.
“How are patients moving through the clinical pathways of the episodes of care that my products and services support?” he says. “How can the real world outcomes help me guide the expansion of my product label? Who decides how my product will be prescribed and administered/dispensed to which patients? How are my largest Integrated Health Systems customers changing their business model and how are my products and services a part of that change? And how are the patients that could potentially use my products and services making decisions about healthcare options now that they have greater financial responsibility or for the first time have healthcare insurance?”
Refocusing on key brand management questions like these, Zubey says, is the critical first step in making modifications to brand analytics and marketing operations functions. These brand management questions change by therapeutic class and overall company strategy. The required data sources to effectively answer these questions should be vetted and then the proper marketing operations functions should enable the market insights.
Also, somewhere along the line each brand manager will have to make a balancing choice between finding that dream insight and the resources on hand to do so. “‘Real world’ data – almost by definition – is messy,” says Sean Walter, principal, ZS Associates. “Combining fragmented EMR data and physician notes with other emerging, unstructured sources of insight – such as social media feeds, clinical trial records, and call center recordings – makes the data management requirements skyrocket. Companies will have to decide whether to implement new data management technologies or to compromise and take a more limited view of ‘big’ and ‘real world’ data and focus on a single data set at a time, which may provide more limited insights.” challenges are significant, the payoffs can be significant as well. With ready access to big data through an integrated data management platform, Walter says, marketers can develop insights across EMR data sets – and overcome the historical limitations on the “reach” of EMR data without sacrificing its “richness.” For example, “An orphan drug marketer could identify providers who have undiagnosed patients and ensure they are referred for the right treatment,” Walter says. “In high-prevalence diseases, marketers could readily segment providers based on treatment paths – as well as attitudinal information captured in EMR notes. This could be further complemented with sentiment analysis captured from patients through social media to understand interplay between patient attitudes, M.D. assessments and treatment decisions.”
In 2015 and years to come, PAs and NPs will become a very important target within office accounts as they take on the responsibility of training the clinical staff within the office on the use of new products and educating patients,
Outside of its potential impact on direct patient communications, big data is already offering brand managers vastly increased predictive powers. For example, marketers and brand managers will be able to use the signals from big data to predict product switchovers, patient journey, KOL networks, and the impact of large medical conferences on product launches.
“Brand managers can now predict product switchovers much earlier by analyzing and cross referencing online search, Wikipedia and social media conversations,” says Siva Nadarajah, general manager of social media, IMS Health. “Also, mapping patient journey by analyzing social media conversations is much more cost effective compared to the traditional field-based approach. Given there were close to 50,000 tweets during ASCO 2014, and the use of Twitter by KOLs is increasing at a rapid pace, traditional KOL networks no longer represent reality. Input from big data analytics into marketing operations to trigger HCP and patient campaigns will become absolutely necessary in 2015.”
Even so, it will be critical for marketers to keep the human element in mind. After all, no one is going to win any awards for having the largest database; real people are going to have to find and exploit real insights no matter how big the database gets.
“As long as big data are seen as a data acquisition project, they will have limited value and provide maximum frustration,” Ormesher says. “In the holy trinity of people, process and technology, technology is an enabler, not the answer, and mountains of data are just that.”
Beginning with the end in mind, Ormesher suggests that marketers within pharma companies should build their data model based on their marketing goals and the readiness of their organization to actually share and coordinate based on what they discover. “It’s expensive and tedious to build the real-time data feeds from the various marketing agencies necessary to generate proprietary insight, and it helps to be able to explain to senior management precisely what the business goal is before making the investment.”
Once the data are being captured and normalized, then the real work of people and process takes over. “There are real opportunities to look at segmentation and targeting differently, understand message and channel engagement at the physician level, integrate sales and marketing to an extent it has never experienced before, and introduce significant promotional efficiencies that can be replicated across the enterprise,” Ormesher says. “The goal of better customer insight is deeper customer access. The measure of better customer insight is whether we are making smarter marketing decisions that are leading to better financial outcomes.”
Physician extenders
HCP communications are not just for doctors any more. As physicians grow busier they are increasingly being supported by extenders of various kinds –nurse practitioners and physician assistants, most notably – and these extenders are taking on larger responsibilities for healthcare decision making. That being the case, any intelligent brand strategy for communicating with HCPs in 2015 and beyond has to take into account the unique wants and needs of physician extenders.
“Nurse practitioners and physicians’ assistants are critical members of the healthcare delivery team,” says Mark Heinold, CEO of PDR Network. “They will increasingly drive patient care decisions in both private practice settings as well as in newer sites of care such as chain pharmacies, infusion centers, mobile care, et cetera. Understanding and delivering information to these professionals based on traditional profiling such as specialty is an important foundation.”
Aside from their increasing numbers, two other circumstances are driving the importance of physician extenders in the eyes of brand marketers. First, access to PAs and NPs is often greater than what is seen with physicians. And second, in many cases the PA or NP in a practice is responsible for initiating the use of new therapies and operationalizing the process around these new therapies.
“In 2015 and years to come, PAs and NPs will become a very important target within office accounts as they take on the responsibility of training the clinical staff within the office on the use of new products and educating patients,” says Nareda Mills, VP of nursing services for Ashfield Clinical Services. “Strategies to communicate with this audience include the standard lunch and learn in-service by either a sales representative or increasingly by an industry-sponsored Nurse Educator. Nurse Educators often build a strong rapport with this audience as they are seen as a peer with real world experience managing their patient population.”
Mills believes that extenders are well-suited for digital media, as many of them have “grown up” in the digital world and prefer web-based research and text or email communication with peers or advisors.
“On demand ‘web-Ex informational sessions via industry portals or ‘Skypelike’ face-to-face interactions with reps or Nurse Educators at a time that is convenient to the PA or NP are also emerging,” Mills says. “The pharmaceutical industry has a unique opportunity that should not be overlooked to partner with these physician extenders in order to provide education and support of the patient population cared for in the practice. It will also be vital to ensure these extenders are reached so that they may carry these messages back to their attending physicians who are increasingly difficult to access in today’s market.”
One concept that some sales teams are already trying in the marketplace is the “total office call,” in which the representative actively seeks out and interacts with every member of a practice – physicians, physician extenders, medical technicians, practice managers, reimbursement administrators, et cetera. But simply interacting with everyone is not enough; sales reps need to be armed with the appropriate message for each different constituency, and so some hard research into the specific needs of each type of extender is in order for any brand that plans to make them a part of its HCP strategy.
“These customer segments will likely become a greater focus in market research as customized programs and content are developed to align to their specific practice needs,” says Darlene Dobry, managing partner, Ogilvy CommonHealth Worldwide. “This could even potentially include customer segmentation analysis to better define their attitudinal and behavioral attributes in prescribing, and increased participation in advisory boards, consensus roundtables, and guideline initiatives.”
Nurse practitioners and physician assistants also play an important role in educating new patients entering the healthcare system, and companies would be wise to engage them in innovative educational outreach, counseling, and medication adherence programs.
“We will also see increased support and sponsorships of educational sessions at their annual/regional chapter meetings and specific program partnerships with the industry,” Dobry says. “Although many of these practitioners are reached through independent practices or through physician practices, we will see a continuing proliferation of urgent care centers, ‘minute clinics,’ and pharmacy care clinics, all of which will largely be staffed by nurse practitioners and physician assistants. These channels will open up additional opportunities for both personal and non-personal efforts. In this new healthcare environment, we will see a renewed interest and increased investment in developing stronger partnerships with these providers to ensure access to valuable healthcare information and enhanced patient care.”
Wearables
Perhaps the most prominent bit of geek chic in pharma marketing right now are wearables – personal pieces of technology worn on the body that can measure and track a variety of health-related variables. The most prominent example is the still-to-be-launched Apple Watch – the latest reports suggest it’s coming in March – but the consumer marketplace is filling up with hundreds of other examples, stoking the fantasies of virtually everyone who deals in digital healthcare matters.
So far, though, the reality of wearables has not quite lived up to the hype just yet. “It is still early days for wearables,” says Will Falk, North and South America healthcare leader, PwC. “The market has developed a lot in the past 24 months, there is significant consumer demand for these products, but clinical applicability remains very limited.”
The market (for wearables) has developed a lot in the past 24 months … but clinical applicability remains very limited.
PwC’s survey of consumer attitudes towards wearables (“HRI Health wearables: Early days”) showed that 21 percent of Americans own one and 10 percent use them every day. A much higher number has interest in the technology – nearly one in two consumers said they were “very” or “somewhat” likely to buy a wearable device during the next year. The leading companies in the space each have major product launches coming this winter/spring that will further enhance the usability and functionality of wearables.
“However, the question still remains as to how they will be integrated into care practices,” Falk says. “Self-care, fitness, prevention, and exercise monitoring are all worthwhile in principle. Our study shows that many consumers perceive real value and that is why a market has developed. Understandably, the healthcare system will need to run its own clinical trials to understand how these new tools can be used and how and whether they can be incorporated into medical practice. Patient demand suggests that there will be an ongoing tension around this.”
So who will win at wearables? The key word here seems to be “integration.” According to Brian Williams, PwC’s director of global healthcare strategy, the leaders and potential winners in the wearable marketplace have rightly identified that certain biometric measures – blood pressure, heart rate, oxygen saturation, respiratory rate, temperature – are fundamental data points across multiple conditions and that by capturing these key biometric measures through their devices, they can serve as a health platform upon which manufacturers of disease specific applications and peripherals can integrate. “In addition, these new wearable platforms will be able integrate across the broader healthcare value chain, providing consumers, pharmaceutical life sciences and healthcare practitioners with a holistic view into patient specific indicators delivering on the promise of personalized and precision medicine with better outcomes at a lower cost,” Williams says.
Before this magical world of integration is born, though, a number of hurdles will have to be overcome – the most prominent being regulatory.
“As wearable devices made by Nike, Fitbit, Jawbone, and Apple have become increasingly popular, data that’s currently being collected can only be viewed for the individual’s personal us,” says Matthew Richards, creative director, eMed Fusion, an Ashfield Healthcare Communications agency. “He/She may be assessing and reacting to this data without the benefit of their HCP’s perspective. We haven’t yet seen where the pharmaceutical industry and caregivers fit into this equation. There are compliance barriers that need to be overcome to feed patient data back to the physician and pharmaceutical company so that meaningful analyses and subsequent recommendations on treatment can occur.”
Clearly, the pharmaceutical industry will have to jump through a few hoops with HIPAA and FDA’s regulatory requirements to tap the potential of wearables. But in order for wearables to be truly successful, Richards believes they need to make themselves relevant on a daily basis to the patient and caregiver, and to connect the patient, caregiver, and HCP. Programs that can collect metrics from patients, that feed back to the HCP to effectively treat and monitor outcomes of the patient’s overall health, should be near the top of the pharmaceutical industry’s objectives.
“There have been many apps developed thus far for notebooks and the Internet to help patients monitor their health and treatment regimens, but they currently rely on the patient to upload data regularly – an activity where patients often fall short, thereby minimizing the ability to collect meaningful information,” Richards says. “Wearables, on the other hand, have the potential to make significant inroads in understanding patient behavior and outcomes by automating this accumulation of data. This data can then be cross referenced with data from other channels creating a holistic picture of the disease which can be used to create programs for the individual patient. Pharma-sponsored pilot programs that combine the use of a device with customized reporting functionality, along with a prescribed treatment, may better define how this trend could be adopted by HCPs.”
The consensus among industry watchers seems to be that wearables are bound to play a significant role in the industry’s marketing efforts at some point – but how far we are from that day remains an open question. The first step, of course, is actual marketplace uptake – and the more forward-thinking agency folk are already thinking of ways their brands can catch hold once that uptake gets rolling.
“Watch the Apple iWatch frenzy unfold and you’ll see perhaps two types of wearable users emerge,” says Scott Hansen, VP, executive director digital creative, AbelsonTaylor. “The first is the group we call the ‘health adopters.’ These are the people who jump in before the bandwagon even begins moving. The second group is the ‘reluctants.’ This group is generally reluctant to try wearables, or to manage their healthcare in any fashion. Think of reluctants as the ones who fast one week prior to their cholesterol test, or cut out sugars temporarily to show improved test results.”
Adoption of wearables, Hansen believes, will be swift among those who are already accustomed to tracking some form of health data, like miles run, steps taken, or foods eaten. Collecting additional data like cholesterol, glucose, or blood pressure would be seamless for such users. In fact, they may even use these data as baseline measurements to help build their goals. Reluctants, on the other hand, may adopt wearables perhaps only at the behest of their physician and/or their loved ones. These individuals may be afraid of the “truth” because data does not lie.
“Pharma is in a great position to help both of these groups of patients,” Hansen says. “For health adopters, pharma’s marketing partners can support them by offering apps to download complementary information (e.g., healthy heart recipes) or tips to improve their numbers. For reluctants, we can develop tools that can help hold their hands as they navigate through the device, provide encouragement when they reach certain milestones, or even given them a reward or incentive (e.g., discount cards) if they refill their prescriptions.”
Pharma additionally must begin thinking about promoting brands differently in the approaching world of wearables. “Previously, features and benefits were the primary access point for brands,” Hansen states. “With the advent of wearables, it behooves the industry to elevate the concept of patient support to equal footing with brand attributes. When both are aligned, the magic of data – and great brand marketing – can begin.”medadnews
The brand of a product needs to build both a clinical system outcome experience as well as consumer-patient impact. There are a broad range of mobile, social, clinical, non-traditional sites and other aspects of branding that contemporarily enable outcome optimization and decreased costs for total care. Moving away from basic demand generation through DTC over to clinical and cost impacting experiences endears the product brand to both the risk holder and to the consumer-patient investing in a therapeutic outcome expectation. Consumer out of pocket growth has exploded and introduced the concept of consumer price elasticity to an industry that has traditionally never had to consider this lever of access, beyond OTC products. Consumer information empowerment and the cost shift to them with high deductible health plans as well as co-insurance rates that can range from 10 percent to 35 percent of a product is a seismic shift for which product companies in healthcare will need to be better prepared. Provider and consumer cost attitudes and expectations of value will reshape the go to market model in fundamental ways that haven’t been seen since the days of our house calls. Like it or not, the setting of care is gravitating to the home or retail health locale, while the new access issue is all about consumer perceptions of value and the will to pay a growing HDHP and OOP cost. Is the product industry ready to convert clinical value to the patient over to economic value justification in order to earn access to the consumer?
Joe Albian, principal, PwC
IDNs and ACOs are one of the primary vehicles in the execution of ACA in the delivery of patient care. They provide the economies of scale needed to rein in costs. For example, they own more than 80 percent of hospitals and 60 percent of physician group practices. More than 60 percent of physicians are affiliated with them with the majority directly employed by IDNs and ACOs. At the same time, up to 80 percent of drug volume is prescribed through them depending on geographic location and therapy area. More interestingly however, IDNs and ACOs have also been expanding vertically by entering the insurance business. ACOs by definition offer insurance coverage to their patients and at least half of IDNs offer their own insurance plans on top of accepting other insurance. From a strategic standpoint, this trend makes perfect sense. Since IDNs and ACOs are responsible for care costs, they have to own the cost side of patient care too. Prime examples of this trend are Aetna with 200 ACO deals in the pipeline and Ascension Health with a stated objective to acquire a payer business.
Angeliki Cooney, director, thought leadership, U.S., IMS H
With the digitization of media, there are now many different tactics that a marketer can use to reach the customer, and it seems as if new tactics are being developed almost daily! This raises three questions:
1. Which tactics should a pharma company invest in?
2. Which new tactics are ready to emerge?
3. How much should be spent in each tactic to maximize promotion ROI?
A fourth question may be even more important:
4. How should these marketing tactics be deployed – for this individual?
Traditionally, marketing tactics have been deployed in silos and targeted to a broad audience. However, the digitization of media provides marketers with a new opportunity – to create and deliver a personalized customer experience based upon customer preferences and their ongoing response. Doing this well by matching to that customer’s journey is the key play, as opposed to looking for a new shiny channel. Accomplishing this goal requires two steps:
Step 1: Build Tactics and Content Most pharmaceutical marketers have already invested in a number of marketing tactics, including email, mobile, direct mail, portals, etc. Newer tactics, such as social media, will continue to become a more prominent part of pharmaceutical marketing. Additionally, new customer metrics – such as tracking customer engagement over time and across tactics and measuring ROI for a campaign, not individual tactics – will become more common. These new metrics will guide marketers to determine the optimal mix of tactics for specific customers. To enable these new metrics, it is critically important that tactics and content are “connected” and not siloed, meaning that it is possible to follow customers as they engage across tactics. From this foundation, the customer journey can be developed.
Step 2: Delivering the Customer Journey Customer journeys are a series of linked tactics and messages tailored to the customer’s preferences and delivered over a 6-to-12 month period. Brands will begin to focus on these journeys, which are not the same for each customer. They will also need a way to predict the customer’s preference (for channels and offers), and a way to dynamically alter how to engage the customer depending on where the customer is on that journey. Leveraging data and analytics will provide the right sequences in the tapestry that lead to good outcomes. This will then need to be combined with the automation of campaign management, so as to achieve scale.
Pete Mehr, principal, ZS Associates
Big data is the fundamental consequence of living in the digital world. But having big data doesn’t necessarily lead to better marketing. It’s what we do with data that brings opportunity knocking. The opportunity occurs when pharma is able to dissect big data into new environments that turn them into small data, making them more accessible, more relevant, and more flexible.
Thanks to technology, we now live in a digital world where every interaction, reaction, and response is captured as a data point—and because we’re constantly innovating, we “ain’t seen nothing yet.” As wearables become ubiquitous, the inclusion of physiological data (e.g., blood pressure, EKG, EEG, oxygen levels) will only add to the throngs of data we’ll have to cull. The opportunity lies in our ability to dissect big data into “digestible” and categorical buckets that can then be generated into reports and populated into dashboards to give us a better picture of what story the data are actually telling us. The good news is that as devices become more advanced, pharma’s ability to cull data gets easier because devices are creating centralized data repositories. The Apple HealthKit is an example. All that physiological data Apple will be able to collect becomes fodder for marketers.
It won’t be long before pharma begins relying on its agencies to not just develop the brand messaging for their products, but also to collect, analyze and disseminate data reports to enhance their brand marketing. The future is rosy for agencies with strong expertise in making sense of big data.
Jose Andrade, VP, director of interactive technology, AbelsonTaylor