Targeting, step by step	August 2008

Catalina Health Resource clinical director Mike Skovira spoke with Med Ad News about how the company develops and targets its messages to patients, and his role in the process.

Med Ad News: When you are with your peers, your friends, and they ask you, what do you do, what do you tell them?

Mike Skovira: As a clinical director, we get involved in almost every aspect of our business. We don’t get involved with billing on the back end, but from the point of time when one of our sales reps contacts a brand, engages with a brand to talk about what Catalina Health Resource does, a clinical resource is there to help guide them in the discussion about what might be of interest to this brand, what types of patients we might be able to provide them access to.

We work a lot with helping to determine, in the sales process, appropriate targeting for that brand. Let’s say it’s a cholesterol brand, a statin brand. If there is a unique clinical benefit to their statin or to their brand, if we just use it generically … if there’s a unique clinical benefit, they may want to talk to persons on a competitive drug. We wouldn’t do that as a matter of course if there wasn’t a unique clinical benefit, but where one exists, and there are cases where they do exist, that may be a pool of patients that they’re interested in talking to. For cholesterol, for example, they may want to talk to persons who have confirmed diabetes and also may have hypertension.

We can look at the history of patients, their fill patterns for certain classes of drugs, and we might know that a large group of persons have diabetes, have hypertension, and have never filled a cholesterol med. And that, indeed, is a really ripe population to add in a cholesterol medication. It’s good from a clinical perspective because patients with diabetes and hypertension should be watching their blood lipids or their cholesterol, and that may be a very appealing population for the brand to target with a message about what cholesterol is, what it does, why it’s important to check it, and then of course what their product does and has been proven to do.

In the sales process, we support the efforts of our sales team in targeting and in also helping to define the message in copy. Our creative services staff does the physical manipulation and will do research around what this brand is and what the message might be, or works with the brand’s agency, but we also have a look at that too, because clinical balance, our business model relies on the fact that we have, on one side, these brands that want to talk to patients, and on the other side we have this vast retail network of pharmacies that these patients come to and visit, that we have an opportunity to then promote.

One of the key roles of clinical is to find the right balance between a message that the brand may want to project to a group of patients, and to make sure that that message is structured in a way so that it gets the broadest reach in the retail network. A very simple example: for retailers, generic drugs typically have a higher margin and, from a business perspective, they would much rather dispense a generic drug than a brand counterpart. They’re less expensive for the patient, a little higher margin for the retailers, better from their business perspective. So if we have that statin company that said, “I want to go out there and target generic simvastatin patients,” our retailers would likely refuse to run that message.

As part of my role in clinical, I’ll give guidance to the brand, the teams that are working with the brand, and I’ll also give guidance if the retailers come back and say, “I’m not sure I understand what this program is doing, why is it working this way, who are we trying to talk to specifically.” We’ll sit in between the brand and the retailer to try and pave the way for a program that is good for the brand and is good for the patient and is good for the retailer. That’s the triangle we try to satisfy for every program. The brand is on one point of the triangle, the retailer is on the other point, and the patient is at the third point of the triangle. We own that from a Catalina Health Resource perspective, as a clinical department.

Med Ad News: So you are in charge of the balancing act, if you will – satisfying all of these three constituencies.

Mike Skovira: Yes. That is certainly one of the main aspects of our job in clinical. We’re a vehicle for patient education. We focus on a couple of different areas. One of our primaries is medication therapy adherence; we’re a great vehicle for supporting adherence. We can also go out there with educating patients about alternative therapies, where a clear clinical benefit exists, if there are alternate therapies, we’ll do programs like that. I can’t separate out the patient’s perspective from my own; that’s part of my job, to look at this as, if I’m a patient receiving this, is that program appropriate for me, am I the right patient to receive that? You certainly would never want any program copy to be offensive in any way; we talk about sensitive disease states, if somebody does have HIV, how are we going to message them? It’s one thing to receive a message if you have HIV and you’re picking up an HIV therapy. If you’re in there picking up something else, is it still appropriate to give an HIV message off-cycle? It may not be. So we want to look at the sensitivity of disease states, whether it’s something like erectile dysfunction or HIV or psychological disorders. We balance the perspective between the brand and the retailer and the patient. That’s the crux of what we do, if you boil it down.

Med Ad News: What is the process of developing these messages?

Mike Skovira: Our messages will arise typically from two sources. When we work with larger brands, those brands generally have an agency and an associated campaign with that brand, so we’ll just tie into that campaign. Our creative staff would let them know the specifications for the message, how big it is, what font types we can support, and things like that. The agency would put the message together. It would come back through creative services. Then they would always run that past their clinical resource, whether that’s me or one of my peers, for that balance that we talked about between the patient and the brand and the retailer.
But, really, the agency carries the brunt of the load in creating that message copy and providing it to us. We also deal with a lot of smaller brands that don’t have the luxury of an agency for whom we provide those services as a part of what we do at Catalina Health Resource. So the creative team actually can create message copy for a brand. Typically, there will be some discussion between the sales person for that brand, somebody who is responsible at that company, about this brand, and somebody from our creative services, potentially somebody from clinical as well. And we’ll either go to that brand with some ideas, or we’ll work with them to understand their ideas about what types of messages and who to reach.

There will be some meeting of the minds along that route; our creative team will put something together, using the techniques they have available, the artwork we use, the graphics we use. Maybe we’ll get some artwork from the brand that is consistent with what they’ve published on their Website, and then we’ll come back to them with copy and they’ll approve it and eventually take it through their med legal review process to get final approval before that message is run at any retail stores.

Med Ad News: What is the process of figuring out targeting?

Mike Skovira: Personally, this is something I believe Catalina Health Resource does better than anyone. In the plan to targeting, we’re looking at, let’s say for a specific brand, we want to understand what that brand does, what’s unique about that brand. What we’ll do is, first, we’ll research the brand, to make sure we understand the strong points and any potential vulnerabilities of that brand in the marketplace.

If there’s a dosing advantage or there’s a side effect profile advantage or something like that, we want to understand that – that will help us in targeting. The second thing that will help us in targeting is looking at history. We have an analytical services department that will help us look at history. Where do these patients come from? What drugs were they on before? Were they on competitive drugs? Do we see patterns in the way that people on board to this brand? And if so, does that seem to fit with what this brand does, and is it appropriate, and is there an opportunity to target those patients who have not moved to the brand? Sometimes you’ll see, just through looking at the history, a nice opportunity to target a certain group of patients.

Obviously we want to look at the disease state too. We will look at available guidelines for treatment. There are some diseases where you have well-established step therapies. You’ll find, in diabetes for example, typically, patients will start in type 2 diabetes on a drug called metformin. Well, there are other brands that, their strategies are to be the first thing added after metformin. Since we have full patient history, we can now segue into the technological part of targeting, and we can find patients who meet very well established criteria for historical prescription filling. We can find those patients who have only ever filled metformin and have not filled other medications to treat diabetes.

Sometimes we look at the data, and the data shows us that it’s typical that a time period elapses before a person switches from one therapy to another or adds a therapy on, for something like hypertension. So we can also target based on time. We can look for somebody on an initial step therapy in hypertension, and somebody that’s been on that therapy for a period of time; let’s say, for example, 9 to 12 months, and then start to message them. So not only are they the right patient that the next logical step for their therapy could be the brand’s drug; it may also be, from a timing perspective, about the time from historical analysis that we would expect somebody to have a higher likelihood of moving to or needing another therapy.

Of course, for the brand, this all takes place behind the scenes when we’ve engaged a brand, or even before we’ve gone out to engage a brand. We’ll start churning through some of the numbers and trying to look for what is an appropriate target here. Oftentimes we’ll find that the brand teams, especially in the smaller companies but also in some of the larger pharmas, don’t have access to or have not done the types of analysis that we typically do when we try to target. What we want to do is get to the right patient at the right time with the right message. That’s exactly what we’re trying to do, because every message that you give to somebody where it doesn’t really matter, then that’s just a wasted print. You want to target thoughtfully, and look at not only history and understand the category of drugs that are out there, you want to understand the disease state as well, and then create the targets based on a combination of those.