Advertising agency roundtable responses	December 2008

Get the full text from our panel of healthcare communications agency executives.

The Med Ad News editorial staff presented eight questions to executives representing this year’s Manny Award winners and finalists. The questions focus on varying topics relevant to the healthcare industry: the global financial crisis, cost-saving strategies, technological development/advancements, obsolete business strategies/structures, consumer advertising and research strategies, packaging vendors, managed-care communications, and science.

1: Is the current worldwide financial crisis affecting agency/network and client conditions? Are future plans affected?

Bruce Medd, managing partner, Revolution Health LLC: Having our agency located in the shadow of New York, there is not a day that goes by when I am not asked this question. To say that today’s zeitgeist is economy-focused is a gross understatement as we experience dynamics the likes of which my generation has never seen before. Luckily, as we weathered 9/11 and the crash of ’87 and suffered through the paranoia of universal healthcare coverage in the early 1990s, the healthcare industry has repeatedly demonstrated that it marches to the beat of its own drummer. Unfortunately, the prevailing pharma cadence is not as upbeat as it once was, irrespective of what is going on with the mainstream economy. The ever-changing rules of the FDA, third-tier co-pays, and a dearth of innovative compounds are the real contributors to the crisis affecting the pharmaceutical industry. Yes, we have smaller clients that have been significantly hampered by the contracting capital markets, but by and large, the worldwide financial crisis is not the chief culprit for the conditions we now operate under with our clients.

Our plans in the future have not been affected because our focus still remains on providing clients maximum value. Being an independent agency, we are able to maximize our investment in our employees and in return, they provide superior service to our clients. An example of this investment is the fact that our “junior” level employees are Pharm Ds from prestigious pharmacy schools who can provide extraordinary value to our clients the minute they start their professional careers. The primary result of this current financial crisis will most likely be a flight to value as investors gain greater appreciation for companies built on strong and credible business foundations. We have confidence that current and future clients of ours will continue the flight to value and we will be rewarded for the investments that we have made in our employees.

Ryan Abbate, president, Pacific Communications: Absolutely. Our clients are smartly recalibrating the expected demand for their products in the current economic crisis. This is especially true for cash pay procedures/products where patients will carry the burden for payment. Less disposable income will presumably mean less spending. It’s really no different than the traditional demand curve for any non-essential consumable during an economic downturn. A decrease in sales will impact promotional spend and ultimately agency billings. The exception to this rule would be agencies that are lucky enough to have product launches. Launches by their very nature need to be fully funded to be effective. You cannot half-launch a product.

Bruce Lehman, CEO, LehmanMillet Inc.: We are seeing every company we work with pay closer attention to cash, to investment spending, and to the P&L. The lack of consumer confidence is increasing the wariness of our clients and sharpening their focus on today. Although we are not seeing dramatic reductions (or increases) in spending plans, we are seeing a heightened sense of caution, and a lowering of tolerance for risk.

Phil Deschamps, CEO, GSW Worldwide: Our business has been affected more by the restrictive regulatory environment than the overall financial conditions. One of the tangible effects of the financial condition is that we have less visibility and reliability in the flow of revenue from client to client. This forces our model to become more nimble and flexible to respond to this volatile environment. On the positive side we find our clients looking to us for broader, more streamlined solutions. Everyone is conscious of the fact that major pharmaceutical companies are looking to consolidate their roster of agencies to extract cost reductions and synergy. For the major agencies, this creates an opportunity to build their internal systems to provide truly integrated solutions for their clients.

Lynn O’Connor Vos, president and CEO, Grey Healthcare Group Inc.: I do not think that the worldwide financial crisis is affecting us as directly as the crisis within the pharmaceutical industry. The pipelines are somewhat less productive, and the FDA being risk-averse so there are many more FDA denials and fewer products approved. The trust in the pharmaceutical industry, companies as well as products, is at an all-time low. Many products in big categories are going generic. You really have an industry that is absolutely in need of change.

In fact, we have spent a lot of time talking about the “prescription for change” that is necessary now as we move forward. The last piece that is impacting the pharmaceutical industry is the election, and certainly healthcare reform has been discussed tremendously. The impact of the financial crisis may in fact be such a distraction to the new administration that healthcare reform will not happen for a few years. So, that might be a positive note. In essence it will give us a chance as an industry to get ourselves more organized around improving the trust in the meantime.

Charlene Prounis and Risa Bernstein, managing partners, Flashpoint Medica LLC: Notwithstanding the current financial crisis, the pharma industry is already facing cost-conscious times because of the lack of innovation, more expensive and lengthier clinical trials, and then still slow drug approvals at FDA, limited access to physicians and the big cuts in the sales force, the rise of managed care in formulary preference driven by price, cost-shifting to consumer, the emergence of biotech and the need to make often expensive deals to lock desirable companies in. All this is taking a toll on big pharma and companies that are not doing well, will have budget cuts across the board to make up for it.

However, the pharma industry is not as affected as other industries, and I am almost afraid to say it, but is generally recession-proof. That said, the immediate crisis had some implications for lower consumer medication compliance, as many looked to cut back, and eventually this will make its way in lower sales to the pharma industry, and thus reduced agency budgets.

What is surprising is that it is hard to generalize about the entire industry, as there are several biotech and big pharma companies that are doing very well. Third-quarter earnings reports were robust for Genentech, Genzyme, J&J and Lilly to name a few. It’s companies that do not have innovative products, or run into approval delays, that weaken them more than the financial crisis.

For us, we work with Genentech, Genzyme and J&J among others, and have not noticed impact into promotional budgets for 2009.

Sheri Rosenblatt, executive VP, managing director, Draftfcb Healthcare: We are already seeing an impact in the way we do business due to the current financial crisis. Within the past few months, many companies have already begun to downsize their sales forces in an effort to reign in costs and more companies are poised to follow suit. Brand teams are expected to “do more with less,” and this is passed on directly to their agency teams who need to increase the effectiveness of their marketing dollars. When new client and agency teams begin working together, there is an expectation for the agency to hit the ground running. Marketers and agency teams alike are moving at the speed of light managing to the bottom-line.

There is an ever-growing scrutiny of marketing plans and a “no-risk” attitude. Where once marketers were willing to try new ideas and engage in trial and error, now many clients have become risk-averse under the pressure from senior management. It’s almost impossible to sell-in new ideas without showing a demonstrated ROI. Because of this, many clients are faced with doing what they have always done and not embracing some of the newer technologies that are available.

That said, clients expect their agencies to be providing digital recommendations to increase brand awareness and usage. Even with the current financial woes, online advertising is expected to grow in 2009.

With terms like “integration” and “consolidation” at the forefront, we should expect to see more clients looking for integrated solutions in order to reduce the number of agency partners and ultimately, reduce costs and marketing expenses. Additionally, we are seeing clients move to non-personal initiatives to compensate for their reduced field forces. But, in general, even though there is much greater emphasis on cost efficiency, we are somewhat insulated because no company can afford not to invest in a launch brand or jeopardize sales of an in-line brand.

Richard T. Minoff, president and CEO, Dorland Global Corp.: Clearly the global financial crisis has and will continue to affect virtually all businesses to some degree. And this will likely be further impacted by the new Washington political situation, which will not be kind to the industry. With continued profit pressure (despite high cash reserves in many cases), enhanced generic encroachment and weaker new product launch prospects, a once supposedly “recession proof” industry is struggling regardless of whether we, as agencies, or our clients openly admit it. And the future course of agencies is becoming much clearer as those who are willing to take moderate risk, assess their real value/expertise and look through a new lens of reality will be the long-term winners. This applies to our many monolithic thinking clients who need to adapt to the changes to thrive as well.

David Kramer, CEO, Digitas Health: Effect thus far has been minimal, as budgets are largely locked in. In short term, we expect to see some cutbacks in marketing budgets — but since the major opportunity to cut costs lies in downsizing of pharma’s sales forces, much of the burden of communicating with HCPs will shift to marketing, and some agencies may actually see an increase in billings. The more serious, longer-term risk will be the potential negative impact on pipelines of cuts being made now in R&D budgets. A scenario of fewer new-product launches and a higher proportion of mature brands in the product mix will inevitably mean lower marketing budgets.

Consolidation within Big Pharma, and Big Pharma M&A activity with biotech will also shift the landscape and make conflict management more challenging for the large agency networks, as well as making it harder for the remaining independent agencies to compete.

Pharmaceutical companies as a whole are realizing that digital offers more bang for the buck. We do not expect to be hit as hard as traditional advertising agencies, because we lead with digital campaigns and build print and broadcast media around it.

Scott D. Cotherman, CEO, Corbett Accel Healthcare Group: Yes, but not nearly as much as is the fundamental restructuring of the pharmaceutical marketplace and the possibility of sweeping healthcare reform under Democratic Party rule in the U.S. Not since the early years of the Clinton administration has the prospect for healthcare reform been so strong; this will likely bring further downward pressure on the pricing of pharmaceuticals while extending insurance coverage to millions of Americans now without it.

However, there are a few bright spots for the worldwide healthcare marketplace that are uniquely possible under the new administration - most importantly, support for advanced R&D efforts, such as expanded stem cell research funding, and the coming era of personalized medicine supported by genomic research plus drug discovery and repurposing efforts. Whether this is viewed as a glass half-empty or a glass half-full, it represents a time of great change for the healthcare industry. At Corbett Accel we have always viewed change as more of an opportunity than a threat.

Future plans are affected only if one is paralyzed by the coming changes. Although typically moving more slowly than other industries, the pharmaceutical clients that we know are restructuring their organizations for greater efficiency and effectiveness. And they are exploring new opportunities and structures to capitalize on the new era of R&D. At our shop, we are continuing to invest at an unprecedented rate in things that we believe will pay off handsomely in the future: staff learning and development, new business models that drive global campaign management efficiencies, select acquisitions to fill service area gaps, and genomics and personalized medicine.

We believe that the time to move forward is now, so we are seeking out and maximizing opportunities that will allow Corbett Accel and its business units – Corbett, Surge, Kinect, Iris, and Accel Health – to provide greater value for our clients and a secure future for our employees.

Concentric Pharma Advertising: There is no question that we are feeling the effects of the worldwide financial crisis. We have several start-up companies on our client roster, companies that are launching their first products. These clients are under significant financial pressure at a time when investors are cautious and the FDA seems unable to review NDAs in a timely fashion. As a result, good companies working on valuable medicines have trouble finding financing, which puts their futures in question.

Established companies are becoming more fiscally conservative too. Although they are less directly impacted by the financial crisis, uncertainty about the future is a big issue. Budgets are more closely scrutinized and brand teams are getting more pressure from management to increased return on investment or reduce spending. It’s not, “business as usual.” No longer can marketing plans include a litany of standard, uninspired tactics. Instead, plans must comprise a few programs that can measurably propel business. This shift may be painful, but it is necessary to trim the waste and focus the industries resources on what is required to help pharmaceutical brands reach their clinical and commercial potential. In the long run, this challenge will inspire innovation and proper alignment between industry and its customers.

Ed Wise, CEO, Cline Davis & Mann LLC: Financial issues had been affecting client behavior long before the worldwide financial crisis was clearly identified and I can imagine it will continue for many years to come. As far as a direct effect of a decline in consumer confidence, there are reports in the news media that consumers are viewing medications as much more discretionary than they have in the past. This could have a real impact on pharmaceutical sales, and may ultimately impact the health of the American consumer. I think at this point there is a general cautiousness about the future, and that clearly affects the predictability of long-term planning.

Susan Miller, partner, The CementBloc: The short answer is “Yes.” As a New York-based independent agency with a global client base and talent numbering over 150, we are at the epicenter of the financial crisis.

When our clients catch a cold, we catch pneumonia. All the symptoms are there. Not a week goes by without front-page news of pharma slashing its workforce and sales force, FDA issuing non-approval letters, the decreasing number of drugs in development, client-cutting budgets and restructuring rates, the advertising sector forecasting poor prospects in 2009, IMS reporting a drop in unit sales for the first time in a decade, and 11% of Americans saying they have cut back on the number of prescriptions they take.

Our vision remains the same: to be the most creative group of healthcare communications agencies. Our growth strategy has always been focused on the long-term and takes into account downturns that we expect to see in 2009: invest in talent, diversify our healthcare creative services, and enter into value-based long-term agreements with our clients.

Kathy Magnuson, executive VP, managing director, Brand Pharm: General financial conditions have certainly taken a toll on the overall industry, and many companies are cutting back on discretionary/non-essential spending where possible. Travel budgets, for example, are being scrutinized for any unnecessary spends, non-essential projects are being cut, and the financial metrics being demanded by management are more stringent. Many agencies have taken the opportunity over the past several months to “right-size” against current and projected revenue and many are strengthening their value proposition for their clients to ensure ongoing work flow.

On the client side, there are – and will continue to be – deep cuts in many sales forces. In terms of promotional budgets, most marketing budgets have been set for a while as it is important to continue to promote existing products. Equally important is to give full attention to new brands being launched so they can gain the market share they need as well as the many well-publicized acquisitions that continue to move forward. The impact will be most strongly felt in 2009 plans as marketing budgets are pared down by reducing investment spending or more closely reflect brand sales.

Michael Schreiber, managing partner, creative director, AgencyRx LLC: There is no question clients are factoring economic pessimism into their future plans. We have already seen sales forces and marketing budgets slashed. For the most part, however, pharmaceutical companies are generally well-capitalized and they do not seem to be as dependent as other industries on the liquidity of capital markets.

Still, there is no doubt everyone is trying to get more with less. That is actually an exciting opportunity for marketers and agencies. There are unique ways to work within and around shrinking sales forces and budgets. In fact, we consider that the ultimate creative challenge.

Blue Diesel LLC: Everyone is being affected by the financial market. Our clients are clearly looking for ways to reduce costs, but maintain market penetration and continue to innovate. With that being said, clients are reducing costs where the services are being seen as a “commodity-based” service. As a result, we have worked very hard to continue to innovate our offering to stay ahead of that curve. Our clients have reacted positively to ways of innovating while leveraging learnings, assets and insights across multiple channels to meet their customer needs. Ultimately, we have not seen a reduction in spend, but more of an increase in spend, based on our ability to leverage alternate channels to continue to deliver meaningful experiences.

Dudnyk: No doubt everyone is hurting. The effect of the crisis on us so far is probably a lot like its effect on others – we have become more cautious about cash flow, expansion, acquisitions, and capital expenditures. But going forward, the most encouraging thing is there seems to be tremendous opportunities for agencies flexible enough to operate in the new pharmaceutical economy. Having to answer to stockholders and the Street may make this kind of flexibility increasingly difficult in the future.

As far as a client effect, our clients are dealing with the crisis in a variety of ways. Of course, big pharma is cutting back and, unfortunately, marketing is one of the places that is hardest hit. In some cases, the cutbacks have brought about the end of certain projects. However, agencies that can move nimbly, provide quality work and dedicated, cost-effective service may find increasing opportunities in this environment. Why? Because the poor souls in product management – who are already overworked – are being asked to take on more, consolidate efforts, make less go farther; they need agency partners more than ever to help. Budgets may not be what they once were, but the need is still there. Clients need us more than ever to help find solutions.

Giant Creative Strategy LLC: Giant has continued to grow during this period of economic uncertainty. Sure, we have seen some tightening of budgets with some of our clients, and a little more propensity to keep some of the work “in house,” but the overall direction of the business has been up. In terms of future plans, we are continuing to look for opportunities to grow our business with existing and new clients, and have found that, despite the economic outlook, these opportunities definitely exist. We are aware of the realities of how current and future economic conditions can impact our business, but as an efficiently staffed, independent agency, we are able to be more agile in both planning for and reacting to outside forces.

2: What cost-saving strategies does your agency/network provide to assist clients struggling to make financial ends meet?

Ryan Abbate: For us, it’s all about essential work and efficiency. In better times, agencies are able to provide many bells and whistles that, while they may make clients feel good, are really not essential to the ultimate marketing communications deliverable. Secondarily, clients should expect efficiency. Flatter organizational structures/senior staff models, for example, are far more efficient and, therefore, cost-effective than bloated organizations.

Bruce Lehman: Reducing waste is not the sole domain of the green movement. Any step you can take to make the client’s dollar work harder helps to make financial ends meet. So we are seeing more attention at the client level paid to surgical strikes and targeted media as a replacement rather than a supplement for more mass-marketing initiatives. Clients, of course, want quantity and quality. But at the end of the day, quality matters most because it creates the strongest ROI. With certain clients, we’ve been able to accurately identify the audience(s) that we feel will be most responsive to the offering and develop communication tools to reach them — with little spoilage. We used social networks, consumer shows, online contests and other tactics that did not generate huge quantities, but did generate significant conversions to the key actions being measured.

Phil Deschamps: The most effective strategy is one that requires the agency and client to completely change their paradigms of what it means to work together. Our agency’s internal six sigma research has demonstrated that 20%-40% of the cost of working with an agency is related to having an accountable manager on both sides of the relationship. By making one side or the other 100% accountable for the delivery of a service, you remove most of that churn. In turn, this raises satisfaction on both ends, including the effectiveness of the service or product being delivered, while greatly reducing cycle time to produce the idea or solution.

The other cost-saving strategy is more intuitive. Traditionally, our clients have focused on having a stable group of dedicated professionals on their agency team. By allowing agencies to reduce the size of the core, client-facing team and allow more variable cost resources, it would allow agencies to appropriately reduce the number of high-salaried employees and pass on the savings to our customers.

Steve Viviano, president and CEO, ICC: We are utilizing online strategies using virtual events like trade shows as a way to cut costs or add value. They cost less and many times result in more targeted leads. One of the biggest advantages of a virtual trade show is that you can track what people at your event do and what they are most interested in. Attendees are free to interface with the “exhibitor” as much or as little as they choose. Viewers can speak with booth representatives, view demos and attend sessions. Plus, the event is accessible for a few weeks to a few months. Virtual detailing is another cost-effective channel that can not only improve a client’s bottom line, but provide a less intrusive tactic in disseminating product information in a peer-to-peer environment.

Lynn O’Connor Vos: We are all being as flexible as possible in this situation. Very recently one of the clients felt in the fourth quarter they could not continue doing the full marketing effort on their brand. What we did is we came back with the recommendation of must haves and a team that could deliver those in a project basis. They were very receptive with the idea that in 2009, we could probably go back to our original retainer relationship. So, we did see some cutbacks in the fourth quarter, and it really encouraged us to be creative in delivering what was needed in order to finish the year for that brand.

Bruce Medd: Our principal strategy to assist clients struggling to make financial ends meet is to invest in a senior staff. The primary driver of agency budgets is hours needed to complete a job. By having an agency team comprising senior members, we are much more efficient than typical agencies because our experience mitigates the hours spent getting things wrong. As I have said countless times to clients, we would rather complete two jobs to help you drive revenue than complete one bloated job filled with wasteful hours.

Charlene Prounis and Risa Bernstein: This is the time for creative thinking on both the client and agency part. One example is to assign preferred agencies business, rather than make them pitch, and the cost savings of a pitch can be applied directly back to the client. If a client is working with an agency, and likes them, thinks their work if of high quality, why do a pitch? The answer is often, “because that is how we have always done it and we need to see who is the best.” Rewarding good work, with more work, is more of a motivator to the current agency to work out an arrangement that can be mutually satisfying and at the same time cost-effective for the client. This is particularly true when dealing with products in the same category. The agency is highly experienced and can make a difference from day one.

Sheri Rosenblatt: Many clients have turned to “in-house” agencies to reduce costs and the number of projects an agency handles. We have recognized the need to develop our own version of delivering materials cost-effectively through highly specialized express studios. Staffed with CAD operators, these express studios have the capacity to generate a full range of promotional materials – once a campaign has been finalized. As a result, we are able to provide our clients with many of their promotional selling tools and ancillary tactics in an expedited time frame and at a fraction of the cost.

We have also engaged in compensation models, with some of our clients that have an incorporated “incentive” portion based on both team performance and brand performance.

Rich Minoff: As an agency with many long-term partnerships, we have been willing to “hold” our current financial structure despite rising costs to recruit, train, motivate and retain the company’s “intellectual capital.” As we solidify this coming year, and given that in some cases our clients have had final budget presentations/agreements moved, we anticipate we will be asked to do more with less. We will work with our clients to work towards an equitable solution and we in the past taken kindly to appropriate risk-reward contracts.

David Kramer: Our fundamental cost-saving strategy is the intrinsic cost-efficiency, accountability, and optimizability of digital programs and digital media.

As mentioned above, the shift from personal to non-personal promotion to HCPs, through advanced eDetailing, physician RM, and next-generation service portals enables order-of-magnitude reductions in professional promotion costs … while improving HCP access, engagement, and customer satisfaction.

We have also developed proprietary predictive analytics and consumer RM programs that enable marketers to maximize adherence while minimizing the cost of incentivizing that adherence.

Scott Cotherman: Corbett Accel Healthcare Group and its network of marketing communications companies are committed to a process of continuous improvement based in Six Sigma methodology. By focusing on improving processes and creating tools designed to provide “Flawless Execution,” we are able to increase efficiency, which provides our clients superior cost effectiveness and real cost savings. Because this commitment is constant and ongoing, these savings are generated and shared with our clients in both good and difficult times.

In addition, our firm is committed to providing its staff with learning and development programs designed to elevate the level of business acumen across all levels of our company. Through these programs, our staff gains significant insights into business philosophies, approaches, and the realities of budgets, budget management, and cost efficiencies. As a result, we are able to drive optimal budget utilization for our clients and the brands they entrust to us.

Beyond the core services we provide our clients and our commitment to continuous improvement, we have been developing innovative approaches for the implementation of global marketing campaigns. These innovative approaches and tools will streamline these campaigns and generate significant cost savings and efficiencies through the elimination of duplicative efforts and reduced manpower costs worldwide.

Finally, as a wholly owned subsidiary of Omnicom Group, Corbett Accel is able to use the full buying power of the world’s largest communications holding company to negotiate preferred prices for a wide variety of services and resources consumed as part of the work we do on behalf of our clients. This generates direct cost savings that are passed along to our clients.

Concentric: We are doing three things to help clients financially. First, we staff our accounts with very senior-level, experienced people. This is counter-intuitive because it makes the hourly rate go up, but in actuality, it has a very positive impact on the bottom line for the client and the agency. Simply put, experienced people do better work faster and the experience is a more pleasant one. Second, we try to get our clients to reduce the number of projects they develop and execute. Doctors barely want to see representatives any more because the industry has inundated them with frequent visits by multiple representatives selling the same product. Although this trend is being reversed, the damage to the doctor/representative relationship will be on the mend for years to come. We encourage our clients to focus on tactics that are engaging and valued by the customer, the kind of things that can help revitalize the doctor/representative relationship. Third, we are also using several compensation methods that reward the client and agency for efficiencies. These are proprietary.

Ed Wise: The first place everybody seems to look for cost savings is toward the absolute reduction of hours, but we have found that some additional time spent up front in planning can reduce overall costs in the long term.

One example of this comes out of our initiative to reduce out-of-pocket-costs for our clients. For example, through effective up-front planning, we are able to conduct a single photo shoot for professional and consumer communications. Likewise, we are piggybacking our relationship-marketing video shoots with the consumer television production shoots. In both cases we are significantly reducing costs. We also have increased our focus on interactive media and print-on-demand to reduce the number of items printed and stored in warehouses. And we have reduced travel dollars for meetings and research by using digital resources for virtual attendance.

We have also looked at our creative process and taken steps to ensure we are being cost-efficient. This includes spending more time with our client during the development of the creative brief, which helps ensure on-target creative delivery, thereby reducing rounds of revisions. In creative presentations, we now focus on the overall idea versus the elaborate execution of the idea. Additionally, we have created an on-site photography studio that allows us to utilize internal resources to create art instead of regularly outsourcing this process.

Additionally, all of the agencies in The SSCG Group of companies utilize shared services, such as facilities, finance, IT, and human resources. This has allowed us to have several independent agencies with more efficient cost structures.

Kathy Magnuson: Brand Pharm is working to ensure we provide the most effective solutions efficiently and with little waste. We have looked closely at staffing the brands we manage to keep our rates affordable, and we try to provide implementation of projects through our studio to keep hours and costs down. We have partnered with a Publicis agency, Mundocom, to provide low-cost implementation of ancillary pieces on a global basis. We have redoubled our efforts to keep travel to a minimum, through videoconferencing, and webexes, and only have essential personnel traveling. In addition, we have focused our marketing recommendations to those tactics essential to brand success, and incorporate alternative channel recommendations to help keep clients’ media and delivery costs low.

Blue Diesel: We have been working with our clients to not think in terms of cost savings, but efficiencies. Over the last several years, we have refined our methodology to more fully embrace all client stakeholders. We have welcomed Medical, Regulatory and IT into the equation at earlier points in the process. With this broader group of individuals participating throughout the process versus coming in at the end of the process, we find the review points are quicker and much more effective. As a result, we have driven efficiencies into the process and reduced the “churn.” Ultimately, it saves our clients money, but more importantly, we are able to move the brand forward in a much more cohesive and innovative manner.

In addition to reducing “churn,” we are constantly challenging ourselves to find points of leverage. In many interactive tactics, we capture wonderful and very meaningful data. This data fuels our understanding of the needs of our various audiences. As a result, we leverage these key materials in other channels to reach more deeply and in a more targeted fashion. Again, this results in cost savings, but more importantly, we are fueling the brand based on data-driven, evidence-based decisions that apply to multiple touch points.

Giant: Beyond the obvious things we do tactically and through production and media strategies, it’s ultimately how we work that has had the greatest impact. Our agency model was designed around helping our clients’ meet their business and financial ends – whether their budgets are healthy or weakened. We have found that top-level management working day-to-day on the front lines is the most efficient, and cost-efficient model for our clients. Our clients’ dollars go further. We also have a high level of flexibility in defining the terms of a particular scope of work or contract.

3: Social networking sites and Web 2.0 have grown in popularity among healthcare communications agencies that are monitoring users and conversations on the net. What other up-and-coming technological development/advancements are marketers exploring?

Robert Palmer, managing partner, S&H Digital: The “influence mapping” technologies that monitor where conversations are taking place on the Web and what is being discussed have uncovered some surprising trends: health content has rapidly become less site-centric and dependent on “traditional” venues such as message boards. The research indicates that healthcare information seekers want to gather and spread information on portable, flexible platforms such as text messaging on mobile phones or passing along e-mail strings. From a marketing point of view, these portable pipelines live largely outside of traditional online search; optimizing the growing volume of content that is being generated and consumed outside of the PC environment is a challenge.

To meet that challenge, a plethora of widgets have been developed (e.g., Wego Health’s “personal blog” widget; iMedix’s Buddy, which encourages communication through MSN Messenger). These applications can offer the best of both worlds: vast communities that attract large audiences yet facilitate one-on-one conversation. To counteract credibility issues within user-generated content, health Websites such as WebMD have developed technologies that serve up relevant editorial content (articles, newsletters, videos) that can be accessed and interjected into “private” peer-to-peer conversations. The algorithms for these applications are tricky, but if done correctly they offer non-intrusive segues from intimate information-sharing to the broader information highway.

Some marketing advancements are being driven by technology, while others simply leverage long-existing technologies. For example, cross-platform development technologies can simultaneously spread content that is developed for the Web across a number of mobile platforms, from iPhones to Blackberrys. Less sophisticated but equally powerful, landing pages that link to Websites can contain blogs to encourage user-generated content within the landing page itself. This generates highly focused search activity; since user-generated content is viewed as more trusted, it ranks higher on search engines. With the explosion of video content, marketers are increasingly embedding search-optimized tags that drive not only to Websites where the video is featured, but to blogs where the videos are passed among peers.

Healthcare communications have moved far beyond the Facebook and MySpace experience as the seamless integration of technology and marketing will continue to accelerate the new user experience in health-related social networking.

Steve Viviano: In addition to utilizing social network sites like Facebook and You Tube, marketers are also beginning to leverage mobile technology in innovative ways. With the focus on personalized medicine, the need to reach the patient on a one-to-one, individual basis with messages specific to their individual needs is key in today’s competitive healthcare arena. Basically, if it has a screen on which digital messages can be shown, it will be used. From medication reminders to information seeking while out-of-home, mobile platforms are becoming increasingly viable as web enabled smartphones are becoming more prevalent. Importantly, given variability in computer ownership/broadband access, mobile can become the communication platform of choice for certain demographic groups (e.g. Hispanic’s overall have lower access to broadband, but far broader utilization of cell phones). Also, because as much as 80% of all health-related inquiries on the web begin with a search engine, search-engine optimization (both organic and paid) should become the first place to invest marketing funding.

On the physician side podcasting, customer-generated content, virtual meetings, and iPhone applications are just a few of the newer technologies that are continuing to find their way into the pharmaceutical marketing landscape. E-learning platforms are growing in sophistication and design, facilitated by technology that allows the physician to learn on their time while providing them the ability to navigate the information at the pace they choose, and with the flexibility to select the areas that are most important to them.

Marketers can use the cell to communicate product benefits, demo equipment, provide late breaking news, send out invitations and links to online events — without breaking up a physician’s daily routine. In addition, iPods can now be used to upload radiographic images for review, view webinars — all without the physician being in front of a computer screen.

Lynn O’Connor Vos: I would just challenge your point that social networking and Web 2.0 have grown in popularity among healthcare communications agencies. I think that we are still as an industry in Web 1.5 at best. Most of the time what we are doing is talking about digital strategy and what it should be and taking our clients from a Website to a mind-set where everything starts with search. Search needs to be iterative. Not just a finite, “done it one time,” but needs to continue for a long time.

We also are looking to help our clients understand how to evaluate what is going on in the blogosphere. One can understand what is going on by using tools like visible technologies tools to go in and analyze the blogs, understand the sentiments that are on there between physicians and consumers, and maybe even more information on reputation of the clients as well as the products.

And then we want to move at some point to optimizing those conversations by providing more detailed information about the subject matter, but I think we are all working toward that goal. We have not actually accomplished that yet.

As far as social networking goes I would say that one of the things we are doing here is we are launching bewell.com. It is an expert-guided social-networking site. The host of the site is Nancy Schneiderman from the Today Show. And our view on social networking is the opportunity is out there to introduce experts into the conversation. There is a tremendous amount of unbridled conversations among consumers out there on health, and the opportunity if you can add expert guidance would be to actually see a day where perhaps some of these networking opportunities will turn into better health outcomes. It happens offline with weightwatchers, etc. Why not make it happen online. So we are in the forefront with launching bewell.com that was going to launch by the first week in December.

Charlene Prounis and Risa Bernstein: Many of us believe that the advent of new digital media is the future of our business. Ideas and platforms are proliferating, and target a number of different constituents from thought leaders to doctors and other healthcare providers … to patients. Among the many ideas that abound, there are a few that we feel are particularly worth mentioning.

First is the impact of video on the web that You Tube has driven to a whole new level. Gone is the perception that we need high-quality/high-priced production value to develop any and every web video, so the barrier to entry has been removed. People just do not like to read volumes, and “lazy learners” enjoy the convenience and dimensionality of video-based learning. Docs and patients alike appreciate viewing procedures and instructions in video, versus print/diagrams … and they appreciate being “spoken to” by experts/colleagues on any array of topics and science. Embedding video creatively throughout existing web platforms is clearly a trend to watch.

Additionally, the popularity of the iPhone with doctors (and consumers) is a potentially “game changing” trend in healthcare marketing. We attended a recent conference where it was projected that approximately 25% of physicians will have iPhones by the end of 2009, a number which greatly illustrates the promise of that particular PDA platform to deliver point-of-care information on drugs, guidelines, studies, interventions, lab results, medical imaging and a host of other relevant communications.

Finally, “gaming” as a means of education for all key constituents in healthcare from doctors, to patients, to sales people, holds a great deal of promise. Many people respond to visual learning techniques that are fun, engaging, interactive and customized to personal needs from speed to interests. The advent of creativity in gaming platforms is infinite in its possibilities and iterations. The use of gaming for virtual learning has only just begun to scratch the surface in our industry.

Donna Murphy and Doug Burcin, worldwide managing partners, Euro RSCG Life: Marketers continue to utilize social networking sites to target their audiences. The future for digital is limitless as new applications, unique interactive media and other technological developments create exciting opportunities for healthcare companies. Currently, social networking sites are a popular method of communicating to consumers as well as a source of insight for marketers. For example, the Centers for Disease Control used Second Life to create a virtual health fair. The site is also used for patient focus groups.

The use of video advertising online will grow significantly and become more interactive. “Interest profiles” will become more portable and will be utilized across multiple Web sites to personalize content. For example, LinkedIn profiles can already be used to personalize content on NYtimes.com, and Google health profiles are being used to personalize content on Livestrong.com general health portal. Search is becoming more beneficial to consumers as well, through “Micro-verticalization.” This is the usage of specialized search engines that limit results to highly trusted sources.

The medium on which we will be receiving these messages will not only be the computer screen, but the screens of Smartphones as well. Mobile communication will gain broader adoption and will become more interactive as well as continue to penetrate all demographics. For example, Apple’s iPhone already has hundreds of free applications such as “RMD-Remote Desktop for Mobile,” “IQ-Smart Mobile Search,” and “Friendsync” (contact information is uploaded from Facebook onto the iPhone).

Looking ahead three to five years, medical records will continue to migrate online and become accessible and manageable via mobile technology. Mobile devices will evolve to interact with print. eBooks are expected to gain a large market share. These devices should create new media opportunities to sponsor content and functionality that is thematically related to the eBook. RSS will gain adoption as a means of creating more personalized Web sites among all demographics. Personalization of audio content will evolve as well.

All media will continue to blur into one; the distinction between Internet, computer and television will decline and the opportunity to use the Web to deliver content and functionality to the television will arise. Today we are able to see the beginnings of this. TiVo can be used to access Web content directly onto a television and movies can be sent directly to TiVo from Amazon.com.

Outside of the home, the growth of interactive kiosks in out-of-home/retail will be apparent, allowing marketers to use digital technology to reach their targets at unique locations.

Sheri Rosenblatt: Requests to develop e-strategies are becoming a common part of our agencies scope of work. Everyone is looking for ways to interact with their customers in an engaging manner. More and more of the business is becoming digital — we like to say “if you aren’t bringing digital ideas to the table, don’t bother coming to the party”. However, we do not “do” digital for the sake of digital. It has to fit the overall strategy and needs of the brand. Certainly we know things such as social media and the capabilities of Web 2.0 are important, but they are a means to the end.

Our strategic planning group now employs the use of social media tracking software. This gives them the ability to better understand the e-conversation that is taking place on the tens of thousands of blogs and within social networks about topics of interest to us. We, however, do not stop there. We go from tech to touch and our planners evaluate and analyze the information and make recommendations that have a practical application for our clients.

Everything we do is grounded in the fact that we need to engineer a different dialogue with our customers — and do it on their terms. The iPhone and other mobile devices are changing the way we communicate and changing the content of the dialogue. It’s all about improving the customer’s experience throughout all the touch points with the brand.

Sophisticated marketers are using technology to better target their customers more precisely — taking advantage of their online behaviors. This type of advertising better links advertising messages to customers and allows for a richer, more relevant dialogue. There are more and more opportunities to engage our customers in a more enriching experience as brands deliver their messages in this format.

A step into the not-so-distant future (actually we use now) is the incorporation of neuromarketing technologies into our research for message and creative development. By using well-founded and scientifically sound applications of brain activity scanning, we get true unfiltered data on a persons’ response to creative stimuli.

Rich Minoff: Quite frankly, our industry is still in the very nescient stages of social networking and Web 2.0 applications so we have advised our clients to get more acclimated to this environment and look to become more proactive in this space as opposed to trying new advancements. That said, the word is interconnectivity, so the holistic application of this concept into several channels (e.g., web, mobile technology, etc.,) is upon us more and more. The key is to determine what the applications can do, whether they are right for your stakeholders/audiences and will they really affect the right change in behavior. Or will it be a costly experiment?

David Kramer: Mobile – especially in categories such as virology, where marketing to millennials and younger African-American and Latino males – is important.

Cross-channel and online/offline integration – e.g., QR codes in retail, convention, or doctor’s office; Internet Broadcasting.

Remote sensing and device/therapy interaction – e.g., continuous glucose monitoring that drives an insulin pump and uploads data to physician via Bluetooth.

Finally, we remind all our clients that the most valuable way to gain business value from social media is not to create it … but to listen to it, extract insights from it, and feed those insights back into business strategies that serve customers better.

Scott Cotherman: Our clients’ use of online eDetailing continues to expand as it replaces the loss of more traditional “face time” interaction between sales reps and physicians in office and clinical settings. Both live and self-guided eDetails are rapidly growing in popularity among physicians as this group becomes more comfortable with the Web and experiences the convenient advantages of navigating information on their own time. Additionally, the use of PDAs among physicians continues to grow, with increased relevance as the handheld devices add new functions to support daily practice needs. Patient records, drug and dosing information, clinical data, and treatment protocols are just a few areas where physicians can access content in real time through these handheld devices.

Delivering content through electronic channels provides healthcare marketers with the ability to present relevant communications to physicians while exchanging intelligence and information that is beneficial to both parties. The value of the content encourages physicians to participate in an ongoing dialogue that provides our clients a way to better acquaint themselves with their customers. An understanding is gained as to the physicians’ preferences and needs in terms of what information and channels they prefer. These insights are then applied toward future delivery of more focused content that the physicians find more relevant to their practices and specialties, ultimately resulting in long-term relationships and valued engagements.

Ed Wise: We see several developments on the horizon. The first is what we are calling “Tablet 2.0.” When tablet-based detailing started emerging several years ago, the early platforms were a little bit clunky, and the way they tied back into our clients’ data-analytics systems was not fully sorted out. But now we are seeing a real move into more sophisticated closed-loop marketing potential with Tablet PCs. There is greater ease in getting content into the systems quickly and efficiently, and a greater ability to analyze and interpret metrics so we can adapt content to be relevant and meaningful to different customers.

And then there are the benefits of wireless connectivity coupled with stronger nationwide technology infrastructure, allowing reps who have wirelessly enabled Tablet PCs the ability to access resources, which in the past would have required additional follow-ups.

We also see mobile technologies really penetrating the physician space. More than half of U.S. physicians currently use a mobile device in their practice, either a personal digital assistant (PDA) or smart phone. With this growing trend of mobile content-consumption by HCPs, we are exploring the creation of mobile content such as Podcasts or iPhone applications, and looking at partnership opportunities with mobile content providers such as ePocrates and QuantiaMD.

The still-unexplored frontier for medical marketers is Virtual Worlds. We have been absorbing and monitoring this virtual space, and as more and more people (including our own employees) seem to be living a “Second Life” online, we see this as a potential area to deliver healthcare information or content. The Obama campaign has been running geotargeted online ads on XBox360 games. How will our healthcare communications world mesh with this virtual world? We are not sure, but we are excited and starting to think of ways to explore the channel.

Overall, we know that there will always be new and emerging technological advancements that marketers can explore and adopt. But what may be most exciting to us is finding ways to take existing and emerging channels and truly integrate them with each other. It will not be enough to focus on disseminating messages through new and sexy technology channels; we have to think about how these channels work with each other to create an efficient entirely customer-focused experience.

Jennifer Matthews, partner, The CementBond: 1) Mobile platform initiative. We have seen rapid growth of smartphone-based technologies designed to facilitate communication of information to and encourage networking among physicians. Smartphones allow for rich media experiences, rapid delivery, and instant feedback mechanisms. We are also exploring the development of full-service relationship-marketing programs for HCPs that either complement or replace the sales force. With the number of reps shrinking, companies will need to leverage the Web to stay connected to physicians and allow them to access medical information, patient education, and samples.

With the introduction of the iPhone apps store, the upcoming Blackberry apps store, and Google’s Android Platform, this is definitely an area that medical professionals are starting to use due to the amount of specialized content being developed on these platforms. The mobile applications and platforms reach an audience, medical community, and education markets that are worldwide, so the opportunities are vast.

2) Customized Portals and RSS feeds. In addition to the mobile platforms, another opportunity for marketers is portals. Portals are customized information repositories such as iGoogle that allows users to tailor their own content and receive relevant information based on their interests. This also gives them an avenue to subscribe to certain newsfeeds and other information.

Web 2.0 is paving an easier way to subscribe to specific information feeds based on certain criteria. For example, a user can subscribe to a medical research feed, and receive specific alerts in real time. The transport mechanisms and the information sources for these feeds can be subsidized with ad revenue.

3) The Intelligent Web. The internet feels more “alive” than ever. We are seeing many applications emerge that take advantage of that. Sites that leverage aggregate data in compelling ways are also booming.

4) Social Retailing. The Social Retailing concept is another idea that might have applications in hospitals, spas, wellness centers, and perhaps doctors’ offices. The idea behind Social Retailing is to bring social networks (ie, your MySpace or Facebook friends) into the store. You can try on articles of clothing, let your friends vote or comment on them, and let them recommend alternatives. Thinking of this in the health care context, your personal health network (nutritionist, yoga teacher, personal trainer, nurse, doctor, insurance agent, etc.) could be available to you while you are in the hospital or at a wellness center.

5) The Semantic Web. The next wave of technology innovation, now being called Web 3.0, or the Semantic Web, has a large group of people believing there is significant opportunity for health and life sciences. Today’s savvy marketers are beginning to use technology to target messaging even more based on real-time behavior. This includes Live Help (often triggered on ecommerce sites when a user lingers for too long), and code like using Ajax to change the page dynamically based on user interaction/selection, etc.

Kathy Magnuson: Many companies are looking at incorporating gaming technology into their communications and sales-force training to make the interaction between brand and customer a more integrated experience. Use of PSP’s is increasing as we try to capture physician attention, and provide greater detail on brands in a shorter amount of time. SMS, text messaging, podcasting, and providing brand and disease-care information through PDAs are other ways to reach customers and patients,

Michael Schreiber: It’s not enough to just monitor conversations. You have to influence them. So while digital user behaviors continue to evolve, our approach to successful interactive communications remains consistent — engagement. With the goal of user engagement in mind, the next digital horizon is highly focused on mobile technology. We find that HCPs are an increasingly mobile-friendly audience because of economic enablement. The higher-than-average use of smart phones by HCPs enables embedding of brand-related devices by marketers into smart phones.

With regard to Web-based communications, the next technological advancement will be the inclusion of OpenID. OpenID technology will provide unique identifiers that allow all Internet users to carry profile information to each site they visit, thus enabling advertisers to target users (both HCPs and consumers) on the basis of professional specialty, disease state, and even browsing history. The eventual adoption of such technology will ensure higher ROIs and 100% target acquisition by eliminating the exposure of advertisements to non-targets.

Blue Diesel: Beyond social networking and Web 2.0, our clients are very interested in mobile technologies, compliance, and evidence-based marketing. We saw interest in all three areas in 2008. I believe 2009 will be the year where our clients put these technologies and innovations to the test. We are excited about these new developments and believe each of them will have great returns and impact on the brands that utilize them.

Giant: As with most other industries, one area that our clients and us are looking at is mobile and hand-held communications. We are constantly competing for our customers’ attention at virtually every communication touch point in their lives. And with the time we spend in our cars and with our PDAs and iPhones — it’s an obvious place where we can do more to exploit the power of technology.

4: What do you view as outdated healthcare communications business strategies/structures?

Lisa Ebert, managing director, Medicus Life Brands: Business strategies and structures that foster an environment where various marketing function teams work in silos will be at a competitive disadvantage, and therefore outdated. As advances in technology continue to bring us more options related to where, when, how and to whom we can communicate, we are at ever increasing risk of brand message fragmentation. The competitive advantage belongs to those who promote and facilitate cross-pollination between groups that have an opportunity to achieve cohesion and synergy in communication strategies. This applies not only to teams across communication disciplines, channels and audiences, but also across different brand teams within a category franchise.

Rob Rogers, co-CEO, The Americas, Sudler & Hennessey: One outdated healthcare communications business strategy/structure is the separation of digital from other forms of communication. With most of the new and exciting ideas in communication occurring at the intersections of media, it’s become clear that separation by discipline does not allow companies to take advantage of the benefits and opportunities available from combining the offline and digital world. Beyond creating territorial challenges and unseemly turf wars, the real cost of this separation is that a marketing discipline usually remains in the center of the discussion instead of a client brand.

Another outdated healthcare communications business strategy/structure is data dependence. Einstein said not everything that matters can be measured, and perhaps his is a useful axiom to consider when contemplating our reliance on metrics. That data are required to support communication claims is undeniable, whether this data is suitable for use as actual communication is arguable. The best examples of communication reach beyond the data to find higher order benefits and create richer more compelling ideas.

A third outdated healthcare communications business strategy/structure is follower mentality: They have done it, we should too! Following the actions of a competitor is like a permission slip for some companies, but for those employing strategies of copying there will be no first mover advantages, only a reliance on another’s ideas. No doubt there are risks associated with being first, but taking a track proved by another is a track to diminishing returns. As marketers better understand the financial value of differentiation, it is clear that finding a new path can be highly rewarding.

Bruce Lehman: Today’s healthcare products marketer is an orchestrator and integrator, generalist and specialist, diagnostician and surgeon, collaborator and leader. What is no longer viable is any strategy that depends solely or predominantly on only one or two tactical supports. Orchestrating multiple touch points that both sequence messaging and deliver on the singularity of the brand is key.

Phil Deschamps: It is striking how brand management still is structured around channels rather than customers. Marketers or brand managers who do not look at the web of communication that their customers are exposed to tend to work in a siloed environment. Most brand teams still have a manager for professional communications, consumer, digital and payers — and the teams are not set up to cooperate and collaborate. By reversing that cycle we can look at the customer though the lens of how they are influenced by the sum total of channels which is key to creating a connected message. Without this we are left with channel communications that are no more than the sum of their parts.

Steve Viviano: While TV and print remain critical media to broaden awareness, it is now vital for those media to be viewed as merely the catalysts to further information seeking. Websites (brand.com and health sites) are becoming the preferred source of information for patients and caregivers, and therefore far more attention needs to be paid on these sites to ensure that the target has a full understanding of why their physician recommended a certain drug

Lynn O’Connor Vos: Any communications strategies or structures that are one-dimensional or static are outdated. To stay competitive in today’s healthcare field, a company must be fully integrated and use a multichannel approach that includes a combination of both traditional and online media.

This evolution to a multichannel business model has been coming for a while, and we have seen other industries embrace it; however, healthcare as a whole has been slow to adopt online strategies with good reason, at first. Due to the strict legal and regulatory guidelines that our industry must adhere to, pharma companies have only recently started to venture into online media with Facebook and YouTube, for example. And with almost half of consumers getting their health information online, compared to 23% asking a healthcare professional, the future of healthcare is happening now. Companies need to be ready to become a part of this new landscape and prepare their clients for the changes that are yet to come.

Bruce Medd: As my partner Brian Wheeler emphatically states, “Everything that is not customizable.” Tactics that drive brand messages on an individual level have the most impact. Messages need to be consistent and focused on a macro level, but customizable by target on a micro level. As our clients become more customer-centric, it is imperative that we provide solutions that can address the needs of individual customers without breaking budgets or deviating from the brand platform. As physicians and consumers continue to rely on electronic media, this can be readily achieved through a little foresight and creativity. More traditional promotional vehicles can also be adapted to meet this raised threshold of personalization. At Revolution Health, we have created a company called First Amendment that is dedicated to professional promotion. As pharma guidelines addressing CME become more restrictive, First Amendment provides professional promotion on a one-on-one basis through various turnkey programs. The outcome is that our clients get a personal message delivered through peer-to-peer selling in a very cost-effective way.

Ryan Abbate: The idea of consolidating content is something I believe clients are figuring out. The idea that you would separate content development from your primary content provider (your AOR) is problematic, especially when your products are highly technical and regulated. That may work for Levi’s, but it will not work for medical products and procedures. Future agency-of-record structures will need to be fully integrated so that the AOR becomes the true keeper of all content and the brand steward across all tactics including digital and traditional. Right now you often have a bifurcation of content development between separate groups based on tactics or technology. I think this will change in the future.

Charlene Prounis and Risa Bernstein: Big sales forces and promotional dinner meetings top everyone’s list right now. Communicating 30 second messages via a sales rep is going away, and instead, higher scientific reps or MSLs are increasingly being brought on to develop more meaningful relationships based on disease and drug knowledge along with a contextual understanding of the doctor’s practice. The rep must be able to dialogue about the issues the doctor faces on a daily basis when dealing with the conditions that the pharma product treats.

The second thing is the promotional dinner meeting with a regional thought leader, slide kit and restaurant dinner. Doctors have voted with their feet, they do not want a “sell” lecture on a particular drug. They do want to be educated and do see the expertise that the pharma industry has. Pharma/Biotech need to provide more interesting forums, from on-line interactive cases, “You-Tube” style tall hall webcasts, to cross-disciplinary lectures and more.

Sheri Rosenblatt: Although the day of the “one size fits all” marketing campaign is over and is no longer a relevant healthcare communication strategy, we believe solid marketing and selling principles can be updated. A good example would be journal advertising. Because it competes with more interactive media we are working on a system that will use image recognition and allows a reader to take a digital picture of the ad with almost any cell phone and send simple text message to instantly receive more detailed information such as a full clinical study. The objective today is to reach out and touch our customers one by one, with a targeted, relevant message. Now it’s about keeping up with the changing media landscape.

Segmentation has been a part of most marketing strategies for some time. In the past it often relied upon call data, syndicated behavioral data, and general psychographic information about our customers and did not allow for the precise message and delivery we have today.

New technologies and an individual’s willingness to share personal data in return for information and/or services they consider to be of value has given us the opportunity to better engage our customers.

Our agency understands the importance of being media agnostic and because our parent organization, Draftfcb, has its roots in direct marketing and CRM, we have begun to incorporate the well proven strategies, methodologies and systems of CRM to professional audiences utilizing a multi-channeled approach specific to the situation and need.

Information has shifted from a push model to a pull model.

Consider the traditional role of the sales representative. He walks in with his 16-page detail aid and expects to be able to go through the brand story from start to finish – just like he was trained to do.

Now presentations have moved from a product-centric to a physician-centric approach. In an environment where they can pull brand information from various sources when they need it or when it is convenient for their schedules – day or night or weekend they expect the representative to give them information more suited to their needs. This has led to sales forces being equipped with tools that can go broad, deep and quickly to only the information the physician needs to make up his mind about a product. Seeing this, our agency has built a division that develops, designs and builds content solely for this technology. It has completely changed the rep/physician dialogue.

The traditional agency model is rapidly changing and entering a transformation. Many agencies still fit the model that says, “sell what you have.” Other agencies of the future will help clients “sell what the customer wants.” Our agency takes it to the next step and looks to create what customers will want. The newer model requires constant investment and innovation in order to stay ahead of the competition. We have formalized, through our Innovation Council, a process that transforms ideas into innovations. But, at the heart of it, it’s about providing our clients better ways for customers to connect with their brands. It’s no longer about “pushing” out messages to customers, but relying more on the “pull” and learning what your customers want.

Rich Minoff: Clearly the overuse of the sales force, once and still in many cases an industry staple, has and will continue to undergo significant change. Step one was the needed downsizing and better alignment of often multiple sales teams from one company looking to dominate the office. This was needed as it became ridiculous and so many physicians and other stakeholders rebelled and became “no-sees or hard-to-sees.” Another outdated communications strategy is an over-reliance on journal advertising, which has a place but is no longer the best way to necessarily gain top-of-mind awareness. From a client viewpoint, building a marketing or communications strategy with the physician as the centerpiece is also growing quite outdated as more and more responsibility and authority is being taken away from them by payers and consumers.

David Kramer: 1) The clinging, on the part of some brands, to consumer marketing strategies based on low-accountability.

2) The continued belief, by some brands and some companies, that the field sales force remains the most effective tool for driving HCP mind- and market-share … when the data clearly shows that 75% of all sales calls today receive no physician face time at all and most of the remainder achieve less than two minutes.

3) The continued belief, on the part of some agencies, that the most important element in marketing prescription medications is branding … rather than what both consumer and HCP research make abundantly clear is the most important business driver – service.

Carleen Kelly, president, Surge Worldwide Healthcare Communications: The pharmaceutical companies are reinventing the way they have approached their business over the decades. Our clients recognize that change is needed. Our clients are moving into a new commercial model that is leaving behind the previous model of the “one size fits all” marketing approach. As a result the three areas that our clients are focusing on are: Sales Force Optimization Strategies, Integration and Collaboration, and Customer-Centric and Solution Selling.

There continues to be extensive industry dialogue regarding strategies for optimizing sales-force effectiveness. Previous sales optimization strategies focused on three major tenets: the right message (what), the right customer (who), and the right frequency (when).

The new strategy that needs to be considered is the right channel (how), and the maximization of said channel. The new strategy of considering the right channel and the maximization of the channel will allow us to address all healthcare professional’s needs in the marketplace. This is exciting because with new channels, we will also be able to address the marketplace needs with greater urgency when required.

Marketing of Brands has become more complex. The strategies of Brands must remain single-minded but now must be layered with cross-functional nuances to enable them to be executed for maximal efforts. In addition, many of our clients are migrating toward customer-centric selling models. The sales-force selling paradigm shifts from product-selling to one of solution-selling.

The marketing silos have now been replaced with greater collaboration and integration. As a result, our client meetings now include team members from interactive, managed care, public relations, and promotional medical educational teams.

Discussions around integrated channel strategies and optimization of said channel mix have come to the forefront – challenging communication agencies to rethink their approach to strategic solutions and tactical support, which was heretofore traditionally aligned with a single channel of communication. The cross-functional approach is quickly becoming elemental to addressing communications efforts among clients welcoming “non-traditional” forms of media.

We can all expect changes in terms of the way we approach business. Gone are the days where traditional agencies provide offline support, interactive agencies provide online support, and so forth; forward-thinking strategic partners have assumed more holistic views of promotional support and can provide channel integration strategies (and metrics therein) as stewards of their respective brands. More aggressive agencies have made structural/organizational changes to keep in-step with this emerging trend. By proactively addressing some outdated business practices within the agency world, we might just come upon the perfect mix—efficient, engaging, and impactful communications that meet the needs of both pharmaceutical companies and their customers.

Concentric: Sales representatives are not an effective reach and frequency medium. The dramatic rise in sales-force size and the importance of call frequency diluted the quality of the sales representative/doctor relationship. The sales-force “arms race” passed the point of diminishing returns quite a while ago. Personal representation is imperative and needs to be preserved, but it has to be integrated with targeted marketing strategies that employ effective new communications channels. The role of the representative needs to be restored that of product and therapeutic category consultant. This has been recognized, but it will take time before sales representatives have been adequately trained to fill this role and drug makers have developed appropriate support services for their brands. This is not a threat to the sales force, but an opportunity to be more of a clinical resource and less of a promotional megaphone.

Ed Wise: The siloed approach to marketing is quickly becoming outdated. The inefficiencies of that approach, whereby we have wholly independent strategies and communication efforts dedicated to physicians, patients and payers, is no longer practical. At the very least, collaboration and coordination is currently required to maximize the effort to our various customers.

Ed Cowen, partner, The IronWorks: In many ways outdated business strategies/structures in healthcare communications reflect shifts within the larger marketing landscape. A crisis of corporate trust, rapid fragmentation of the media marketplace, and introduction of consumer-generated content has driven new models across the board. As a result, the following strategies, for example, have become outdated:

Siloed Approach to Planning and Execution. Gone are the days of siloed initiatives — professional versus consumer, brand building versus relationship marketing, digital versus offline. Marketers have realized that all efforts are focused on the same end goals – to drive a dialogue that results in a written prescription that is filled and taken as directed. The alternative to the siloed approach is convergence – convergence of patient and professional and the convergence of channels.

Professional/patient convergence: While the industry was once 100% professionally driven, the sheer investment in mass DTC marketing between 1998 and 2007 has actually set the stage for a more balanced approach. It’s not about one or the other in isolation. The holy grail of affecting what occurs in the office between patient and doctor is best addressed by balancing the clinical story with patient priorities. In execution, this translates into close coordination of strategy and messaging: the right message to the right person at the right time. More and more, brand teams are tightly coordinating professional and consumer efforts to maximize overall brand impact.

Channel convergence: Healthcare marketers are continuing to embrace integration of channels – mass, targeted, digital – but are now moving beyond to strategically link marketing strategies from awareness through CRM activity. The ability to drive patients to a more customized conversation, using permission-based data which recognizes unique individual needs, is an increasing trend. Delivered through personalized offline as well as digital channels, this “microsegmentation” engagement is working and consumers are responding. But integration goes beyond weaving marketing strategies to maximize consumer engagement. The ultimate goal of DTC is drive dialogue between physicians and patients and, as a result, we are seeing more and more integration between professional and consumer strategies and campaigns.

The need for DTC marketers to shift their media mix and employ a broader range of “push” and “pull” channels to engage with highly savvy consumers is a well established trend. The days of “mass media” are largely over. Now even traditionally mass reach channels offer substantive opportunities to target finite patient populations. While much discussed, social networks, viral and mobile marketing, exploding in the broader consumer landscape, have been slow to catch on in pharma. We see this as less of a current trend and more of a near future untapped opportunity.

DTC = TV alone. Let’s face it, management of the top and bottom line is a priority for every marketer. In pharma, the days of blockbusters and huge budgets are waning with the advent of specialty treatments for targeted populations. Investment decisions are based on the ability to driving qualified leads and sales. In an environment where actual sales impact can only be derived from blinded pharmacy match back data, we see the import of the CRM approach described above on the rise. Simply delivering audience reach and impacting attitudinal tracking studies does not cut it. Metrics such as qualified leads, effective conversion, brand-engagement measures, NRx, TRx and ROI are now foundational components to planning before the decision to even embark on a consumer effort is made. Those marketers who plan their marketing campaigns with a solid approach to accountability are better able to optimize their investment and prove to management the worth of the investment.

Kathy Magnuson: It is rapidly becoming outdated to consider “digital” as a separate strategy or destination and having separate digital teams implement tactics that are not integrated with brand strategy. Today, digital media must be considered as a media output option for communicating brand strategy. Every communications touch point with customers must relay the same, integrated brand message so we can capitalize on multiple interactions with our customers and build the emotional connection critical to strengthening brand loyalty.

Michael Schreiber: I believe there is nothing more antiquated than the door-to-door salesman, dropping doughnuts at the reception desk and pitching the physician off a paper detail aid. There is clearly a place in pharmaceutical marketing, indeed all marketing, for personal relationships and selling. But that has got to become a part of a bigger more well-rounded communications plan.

In lieu of pens and paperweights, sales reps need to brand themselves. They need to embody the brands they sell. I think that is an interesting canvas for marketers to play with – the actual man or woman who is walking into the doctor’s office and speaking face-to-face with the HCP. But to think that a handsome man or woman with a rep tie and an eight-page visual aid retreading the same old data to a busy, business-conscious physician will be successful is delusional. Reps, like most advertising, are an unwanted interruption. They have to offer something new, exciting, and thought-provoking. And they have to do it quickly. Tablet PCs and closed-loop marketing are a good way to jump start that success.

Blue Diesel: As an agency, “making the donuts” is outdated and will not be a successful agency model in 2009. The agencies that continue to develop the same old scopes with the same old tactics will be outdated in 2009.

In today’s environment, it is critical to think beyond the current or traditional tactics and start to think about our customer audience as just that – customers. They want to be engaged with the brand, they want to learn more about the tools and services the brand has to offer. But we need to allow them to do so on their terms, in ways and at times that are valuable to them, as individually as possible. Our healthcare system is getting more challenging every day. We have to think of our HCPs as customers, and we need to look at the model as a service-based model, not a product-based model. We need to develop services to support an HCP’s practice and ultimately their patients. We need to create experiences for them that are consistent and connected over time, as they interact with a brand or a company. These interactions need to build on each other in order to create value and build loyalty.

It’s not about sales aids anymore; it’s about creating an engaging and useful experience for our customers. We need to understand how our patients are feeling and how we can bridge the gap between the patient and the HCP. We need to leverage all of the channels, office settings, technology and tools available to support these customers in their everyday lives.

Giant: The hierarchical vertical organizational models that apply too many layers of mid-level staff on client business. Some agencies sell this structure as an advantage, but having worked in many of them, we have found them to be cumbersome, expensive, and inefficient. They can stifle the development of the agency’s creative and strategic product, and needlessly waste a significant amount of the client’s budget. “Billable time” may be the holy grail for the accounting department, but we believe that “Quality time” is of more value for profitable agency/client relationships that last.

5: Many healthcare communications tactics/strategies, such as ethnographic research, can be attributed to the consumer advertising industry. What consumer advertising and research strategies can benefit the future of the healthcare communications industry?

Leslie Rabin, director of account planning, AbelsonTaylor Inc.: Regardless of strategy, what consumer marketers really did right was to learn to step into the shoes of their consumers. Not just by surface listening in a sterile focus group facility or by looking at demographics and sales data, but by truly living in the world of their consumers. Ethnography allowed them to sit across the dinner table from their consumer, shoot the breeze with them in a bar or follow them through a grocery store where actual decisions and behavior take place. They were able to see things first hand rather than rely on consumers trying to recall behaviors that they may not actually have been aware they were doing. Healthcare marketers are slowly following suit, but they need to take it to an even deeper level. Every strategy, every tactic and every piece of communication should be anchored in a deep understanding of the customer, their needs and how they relate to the world they live in.

Healthcare agencies need to be just as creative with the ways they learn about their customers as they are when creating communications. While it may not be as easy in the pharmaceutical world with all of its legalities, there are still many ways to get deep and personal with your customer. Equally important is to understand the equation from both ends – what the physician deals with day-to-day, how the patient’s world is impacted by their condition … AND how the dialogue flows (or does not) when both come together.

Patient-physician interaction research – which gives you a peek into real-life dialogues — has been incredibly enlightening for some of our brands. Where we assumed physicians were discussing treatment options with their patients, we learned that they were only broaching the subject when patients brought it up. At the same time, patients were assuming nothing further could be done for their condition so they remained silent. Traditional research rarely yields these types of insights. We often hear from surveys that physicians are anti DTC advertising, yet in this research we heard them referring to our commercial to help educate patients on treatment.

For years, consumer marketers have understood the incredible power of emotion. Yet only recently have healthcare marketers acknowledged that physicians are people too. People whose emotions impact each and every decision they make – even on the job. Most physicians will not admit this, so very few thought to appeal to them on this level. “Right-brain” research is a very in-depth exploration of the deep emotions that drive decisions, create barriers or cause someone to take action. This is often done with people specially trained who know how to make even the most uptight respondents divulge their true feelings. Insights from this research have helped us to appeal well beyond the traditional promise of QOL to a level of emotion that really hits a sweet spot.

Creating a truly useful patient support tool takes more than asking them where they need help. Follow them around for a day and experience their true challenges. Understand what it’s like to eat-on-the-run with severe dietary restrictions or to have to test your blood glucose in the middle of an all day meeting. You may now realize what seemed helpful initially, adds yet another challenge to their day. Experiencing their lives first hand often sparks truly innovative tactical ideas.

Reach out to customers in new ways … ways that better reflect their active lifestyle today. How often do you hear physicians say they only have time to flip through their journals? How many people do you know that spend the majority of their free time perched in front of a TV? Yet, many people (including doctors) are reading their Blackberry or listening to their iPod while commuting to work and surfing the Internet after paying their bills online. Learn how they live their lives and you will discover touch points that allow you to communicate with them in unexpected yet relevant ways.

Like the consumer world, we need to learn everything we can about our customers’ lives. What seems irrelevant or mundane at first glance, may actually be the secret door into their hearts and minds.

Deborah Stymest, senior VP, strategic planning/patient and consumer, Sudler & Hennessey: Brand relevance and distinction are even more important in healthcare than in most other industries because of the complexity of the purchase process – not to mention those less-than-friendly brand names that we try to warm our audiences up to! Paradoxically, though, we face some of the greatest challenges to brand integration within our own walls. The siloed organizational structure of most healthcare companies can actively work against achieving a singular brand voice. Both basic principles of consumer advertising and research, as well as some more emerging techniques, can benefit us as we strive to develop impactful and singular voices for our brands.

Back to basics and identifying the unmet need: While many of us do explore the unmet needs of our audiences during the early stages of building our brands, the process is almost always done through the lens of our product’s clinical profile. In so doing, we may be limiting the discussion, and ultimately the power of our brands.

Consumer products makers are known to lean heavily on unmet need to drive innovation in product development. Despite that healthcare products are developed years before they see the light of a marketing team, it is well worth considering an open-ended exploration of what the customers want. Short of a cure, what would be the patient’s ideal for treating a condition? How about the healthcare providers? We marketers are well schooled in creating need where none had existed previously. But our art can also encompass refining and defining a product and its marketing materials to deliver what the audience wants most – and in so doing, extend and improve the brand’s performance.

Standing out in a crowd: Today, as media fragmentation reaches new heights, and consumers have ever-greater freedom in deciding whether and how they engage with marketing messages, the need for content that our audiences will choose to participate with is paramount. How can we do a better job of captivating viewers? How can we do this within bounds of regulatory guidelines? How can we then leverage this content across multiple facets of the marketing mix to inspire healthy behavior, and include consideration of our brand? Most profoundly, how can we expand our focus beyond current year sales toward the consumer marketing objectives of brand equity and loyalty (as these no doubt influence sales for years to come)?

Beyond bricks and mortar: As consumer goods have moved a greater share of their distribution from bricks and mortar points of purchase to online channels, they have worked to leverage opportunities inherent in them. The advantageous cost of distribution and increased self-sufficiency were obvious to consumer marketers early on. The chance to learn from the more comprehensive and quantified understanding of behavior as their consumers browse, consider, and make purchase decisions was discovered along the way.

Our sales and distribution model in healthcare is changing as well, from primary utilization of direct sales forces to parapersonal channels, including tele- and e-detailing. What opportunities exist in this paradigm shift that the healthcare industry can capitalize on? Rather than quake in the face of this change, how can we exploit the benefits that these new channels offer?

Uncovering the decision path: Viral marketing, online communities, virtual browsing and buying — none of these existed a mere 20 years ago, and yet today exert unimaginable influence over the consumer’s purchase decision. For health care providers, webinars, targeted health portals, and e-detailing are providing new ways to learn – and creating new opportunities for our industry to employ – as we educate and build preference for our brands.

The traditional consumer goods assessment of brand awareness and purchase intent to estimate the role of advertising in the purchase decision is being necessarily replaced by ever more sophisticated media mix models. These tools attempt to measure the impact of the myriad influences on the purchase decision in order to help us optimize our media investment. They also seek to unravel the hierarchy of those influences, so that messaging can become increasingly tailored and impactful.

How can we adapt these tools to assess all of the points of influence on our prospective patients and healthcare professionals so that our communications are more timely, helpful, and persuasive? How should we speak, and what communication vehicles should we employ, at each point in the awareness, need, consideration and decision continuum?

We are facing an increasingly intricate puzzle in healthcare marketing. Communication and distribution channels are multiplying rapidly, technology is expanding control for our HCPs and patients, and the regulatory environment is becoming more conservative every day. The good news is that opportunities are born of these challenges, and the lessons that are being learned by consumer brands can help to inspire solutions in our new world of healthcare marketing.

Bruce Rooke, chief creative officer, GSW Worldwide: While not everything from the consumer world is automatically translatable to the healthcare space, due to both the obvious regulatory environment and, more importantly, the different buying process of pharmaceuticals and devices, there is plenty of inspiration to go around.

The first one is not even a communications technique, it’s a truism: Professionals are consumers, too. Once you accept the fact that the physicians we market to are wearing Hugo Boss and Polo beneath their white coats, driving BMWs and Priuses rather than ambulances, and, yes, listening to iPods and not just sales reps, it opens up a world of possibilities. They make intelligent, expensive decisions based on emotion and the power of brands — not just data.

Next, the entire world of brand entertainment has barely been breached by healthcare clients, and yet there are no more powerful stories being told than the human ones we face around our health. Taking advantage of that fact, and meaningfully integrating our brand story into a bigger human story that people want to drop everything and watch, can increase relevance and urgency for that brand. And, guess what? Consumer brands can learn something from healthcare marketers, too. As they venture into positioning their products and services as “health and wellness,” no one knows how the emotional/rational decisions around healthcare get made better than us. So we will be glad to trade a few of our secrets for a few of theirs.

Steve Viviano: New methodologies we have developed break down silos between HCP and patient research, by conducting research with both audiences simultaneously. We are creating research and communications tools geared towards “closing the loop” in the doctor’s office research – creating a common verbal and visual language linking medical and consumer insights to drive brand positioning and messaging.

Projective Techniques play a crucial role – a range of visual techniques that let HCPs and patients express rational and subconscious thoughts and associations with their disease state, brand experience, physician interactions, etc.

Leveraging digital technology is a must in today’s world, including research. We use a variety of digital techniques to get 3 dimensional pictures of patients, their relationship with HCPs and an ongoing view into the world of patients living with a range of disease states.

Tools include Social Network Analysis and Observational Interviews. For Social Network Analysis, we analyze the conversations taking place on blogs, disease communities and wellness sites to understand how consumer word of mouth influences treatment and brand decision making.

Observational Interviews are an ethnographic approach to understanding how patients are actually consuming products and services­— from how and when they take medicine, use health and wellness products and services, shopping at pharmacies and grocery stores­— providing a realistic picture of how they are consuming that provide insights into their choices.

Lynn O’Connor Vos: We are advantaged by the fact that the Kantar Group is part of WPP so we have access to all kinds of research techniques. One of the ones that I think relates back to ethnographic, well I guess the sweet spot we believe is to create research programs and platforms that will really understand the intersection between doctors and patients and again I point to the internet. I think you are going to see a lot of innovation and research as it relates to analyzing what is going on on social-networking sites and blogs and see how that information and the way people describe their conditions can then be related back to how physicians are conversing with those patients. One of our companies, sister companies, Yankelovich, has a fascinating new study called Living Well that is really gets inside the heads of a lot of consumers to understand how they view healthcare and how likely they would be to change their behavior. So I think you are going to see many more behavior-based research platforms out there as well and again given the digital, given the faster than the speed of light, you have the opportunity with internet-based research to get information very quickly. Lightspeed is one of the groups that we work with, having panels of doctors and consumers available to test and retest is also very exciting.

Bruce Medd: To fully develop a brand, one must appeal to customers on both a rational and emotional level. While we would like to think that physicians make decisions objectively, physicians’ emotions can be a significant influence on prescribing. Although emotions never outweigh data, when two options are clinically viable, it is a significant advantage when your brand appeals to physicians on an emotional level. Traditional market research in the healthcare communications industry is rarely designed to uncover the emotions that may be relevant to prescribing and therefore brand communications.

Deep introspective research is often employed in the consumer world to identify relevant customer emotions. When conducted properly, this technique can be very fruitful despite the unique challenges of our customer base. On numerous occasions, we have employed the services of a trained psychologist who is able to break through the barriers instilled in physicians through many years of medical school, to uncover underlying emotions. Through exercises that include role playing and metaphorical visualization, the moderator is able to establish a dialogue with physicians that elucidates feelings that may otherwise have gone undiscovered. After identifying these emotions, a brand platform can be produced that emphasizes not only key features and benefits, but appeals to the emotions gleaned from deep introspective research.

Donna Murphy and Doug Burcin: Historically, the approach in pharmaceutical healthcare communications was to primarily concentrate on prescriptive, more transactional data, such as TRx and NRx to garner key market insights, and focused on important facts and figures connected to a category in order to drive action among our healthcare professional targets.

But, the world of marketing communications has become more complex and fragmented. Additionally, an increasingly competitive healthcare marketplace for share of mind demands evolution. Healthcare professionals, like the rest of the human race, are bombarded by media, and while the prescriptive approach of the past is still of fundamental importance, our approach must keep up with a constantly and dramatically evolving communications marketplace.

As such, we are evolving at Euro RSCG Life. StratStar, our strategic planning and consulting services practice, within Euro has expanded our toolbox to include ethnographic and semiotic tools more commonly used in consumer advertising. These tools seek to uncover not only the clinical and practical drivers, but also the emotional and behavioral drivers of healthcare professionals; enabling us to better understand and leverage the way that physicians and healthcare providers think and behave. Decipher™, Euro’s proprietary semiotics tool, draws analyses from advertising, media, print, and other cultural phenomena to give us a rich understanding of our clients’ brands, and the visual and textual codes that surround them. These codes are used to establish deeper connections through the accurate and timely use of communications strategies. Our ethnographic tools allow us to delve deeply into our target audiences’ hearts and minds. What qualities characterize dermatologists as a group? What do they talk about with each other? Who do they admire, and why? Thick descriptions of our targets, their cultures and concerns allow us to further sharpen and enhance our communications strategies, building our competitive edge by offering our clients unique and cutting-edge services.

Rich Minoff: Many clients and their agencies are still learning from their CPG counterparts and so we remain years behind in many areas. How many clients really know about ethnographic research? How many have used it? Again, it’s a tremendous opportunity for the right brand at the right time. What I am really astonished about is the lack of psychographic research and application to better inform everything we do from segmentation to positioning to developing the campaign and finally to determining the best way to deliver the message. This applies to virtually every stakeholder encountered along the buying process.

David Kramer: Social-media surveillance and analysis, which delivers deeper, more fine-grained, and most importantly, longitudinal insight into the attitudes, beliefs, and behaviors both of consumers and of healthcare professionals. The key difference, however, between the requirements for general-market SMS and that in healthcare, is in the need for depth, rather than breadth of analysis. In contrast to consumer brands, social-media activity relevant to a pharmaceutical brand tends to be concentrated in a relatively small cohort of social-media venues. So quantitative roll-up of data like share-of-voice and sentiment index are less important … and analysis by SMEs with deep knowledge and experience in science, medicine, and healthcare marketing is essential.

Search-engine optimization is critical for any marketing campaign, perhaps even more so for healthcare than for other industries. Just imagine the newly diagnosed patient Googling their condition, then multiply by thousands. These people are already out there looking for your brand, you just need to make it easier to find you.

A deeper understanding of the behavioral science of adherence will become increasingly essential, as effective programs to keep patients on therapy become more vital to maintaining TRx volume for pharma brands.

It’s anecdotally clear that the physician-patient dialogue is frequently fraught with miscommunication and mutual misunderstanding. Sociolinguistic research can help clarify the dynamics of these interactions and help both physicians and patients to interact more productively and constructively.

Elaine Eisen, president, Corbett Worldwide Healthcare Communications: Many of our Corbett clients have begun to truly understand the power (and potential efficiency) of Customer Relationship Marketing — a discipline well-embraced and executed by our consumer advertising colleagues. Just as technology has undermined the 30-second spot as the centerpiece of the consumer advertising industry, so has it forever changed the manner in which our physician customers seek information about our clients’ brands.

There is certainly widespread agreement that the role of the pharmaceutical sales force will be reduced. However, the truly enlightened pharmaceutical marketers are moving far beyond simple cost-cutting measures. They are taking a page from their consumer counterparts by focusing on a goal of full engagement with their customers. This is neither a simple nor a quick-fix solution, but for those who persevere the rewards will be substantial. The loyalty (and, frankly, even evangelism) of a fully engaged customer who has a true relationship with your brand will serve as a sustainable and powerful force in driving sales and market share.

Concentric: We need to apply the principles of customer relationship marketing and behavioral change to all of our marketing tactics. I am not talking about the typical direct marketing communications streams, but real insight-driven marketing programs that take into consideration ethnicity, media preferences, readiness to change, and myriad other factors that, over time, can inform a dialogue between the marketer and customer. There are many methods for collecting the information that we need to execute at this level of customer specificity, not the least of which in-market testing – something that we do not do enough of in Pharma, but is commonplace in the consumer world.

Ed Wise: Getting into physician’s offices and patient’s homes through ethnography was a great step forward. But it offers only a glimpse at a point in time. The idea of real customer engagement needs to be applied to everyday practice rather than just periodic research. We are currently exploring ways to accomplish this.

Looking forward, healthcare brands could benefit from segmentation work that transcends basic attitudes and behaviors, target profiles that go beyond basic demographics, media that engages more than interrupts and, most important, cultivation of true brand ideas that can stand the test of time.

Another area to reconsider is how we go about building and evaluating strategic ideas. The typical whitepaper brandcept focus group whereby we look for customers to give us a thumbs-up or -down is usually unproductive. Looking for opportunities to “co-create” with our customers around specific ideas often provides more insight, meaning, and inspiration. Essentially, image- and language-based co-creation work allows customers a real chance to express and project themselves into an idea rather than just react to it.

Jennifer Matthews: The healthcare industry has certainly benefitted from the deep and long experience of consumer marketers, particularly in the realms of strategy and research. A few opportunities that can benefit us going forward:

Point-of-Sale/Point-of-Care Dialogue Monitoring. The consumer industry has gone to great lengths to understand what occurs at the point of sale – what drives the decision to pick one brand over another when a consumer is faced with a choice of product. Much of this is focused on the retail environment (whether online or in-store). Translating this to the healthcare space requires a finer understanding of what is happening at the point of care – both in the office and in the pharmacy. Currently, much effort is spent understanding general attitudes and perceptions of disease states and branded alternatives, but not enough on understanding how the literal interaction between prescriber and patient actually results in a prescription and, once at the point of care, how is this affected. Through HIPAA-compliant quantitative research techniques, marketers can match actual recordings from patient visits with chart data to better understand why behaviors occur, rather than relying on recall. Not surprisingly, much of the learning helps inform language choices so that more commonly used language can be deployed in marketing materials.

Microtrend Analysis: A trend in the consumer marketing space is not just to look at the large trends, but also to identify the smaller ones — often called microtrends — that are often overlooked. The basis for this trend comes largely from the political arena, where microsegments, once aggregated, are often responsible for the election of candidates (think “soccer moms” in 1992). By understanding that not-so-obvious social and political forces can help to shape attitudes and behaviors, marketers can identify new markets and new ways of selling.

Kathy Magnuson: Consumer advertising is ahead of the pharmaceutical industry in making their brand experiences all about a positive customer outcome. While there is greater emphasis now on patient-centric marketing, it has not dominated current activities as customer-centric marketing has dominated consumer goods. Allowing product users to determine how, when and with what level of interaction will take greater hold in the pharmaceutical industry in the near future.

Michael Schreiber: I think pharma has inherited some bad habits from the world of consumer advertising. Not all techniques successfully employed by packaged goods can be cut and pasted into the clinically regulated, budget-constrained world of healthcare.

Having said that, I see the possibility of guerilla marketing tactics currently in vogue in the consumer world easily employed on the healthcare convention floor. Especially in light of the economic realties, subversive, under-the-radar communications may have more impact for the clients’ money.

6: Will healthcare communications agencies and packaging vendors work more directly with each other in the future to improve patient compliance?

Louisa Holland, co-CEO, the Americas, Sudler & Hennessey: Following tougher guidelines from the FDA in 2006, there has been a big push in the pharmaceutical packaging industry to promote packaging solutions that improve patient compliance and increase safety. Packaging industry trade groups have been pushing compliance issues to the forefront. The Healthcare Packaging Compliance Council, for example, runs annual competitions among packagers, and takes a very specific approach to the problem: “Improving patient outcomes with unit dose packaging” is the HPCC’s mission. There is little dispute that packaging innovations can improve outcomes; The National Academy of Sciences reports that “the strategy of using calendar blister packs could help large numbers of patients take their medications more reliably and safely, and enhance their treatment outcomes.”

However, packaging innovations alone are not the answer, and this is where the healthcare communications agency can and should partner with package designers to help pharmaceutical companies with their compliance strategies. Even though “easy-dosing” blister packaging is used more than 80% of the time in Europe – far more than in the U.S. – compliance is lower in Europe than in the U.S., according to a report on PharmaLive.com. This may be attributable to cultural factors or differences in physician access, in some cases, but the discrepancy suggests that packaging alone is not the solution to compliance. We believe that patient and physician education can play a large roll in supplementing package innovation, and enhancing adherence.

The most important message the communications agency can give to the pharmaceutical client is that packaging alone is not the answer, and that compliance alone should not be the goal of effective packaging and dosing; greater compliance cannot be separated from increased adherence, which inevitably leads to increased persistency.

How often do seniors or patients with functional or physical disabilities struggle to read the impossibly small print on package inserts and on the package itself? The push has been to comply with the FDA regarding the ever-growing volume of required information and how it can fit on or in the package. But innovative packaging design has not made its way to these crucial sources of information as it relates to compliance issues; even with a blister pack, does the patient take one pill or two at a time (read the fine print to find out)? The proactive healthcare agency can provide several solutions: converting package inserts from fine print to universally understood graphic images; instructing the patient or caregiver to go online for a step-by-step tutorial on dosing and compliance; providing 30-day or weekly dosing kits to the patient in a Welcome Kit at the doctor’s office, along with step-by-step instructions that promote compliance; setting up a telephone “help line” specifically for dosing instructions.

It can easily be argued that any of these tactics will more than pay for themselves with increased compliance and the resulting rise in adherence and persistency.

Phil Deschamps: My belief is that this dynamic will have a positive impact on our industry more than any other when it comes to best practice tactics for improving compliance. It is not just about creating better compliance packaging, but rethinking the value proposition that a product delivers. Right now the clinical trials measure the effectiveness of a product based on its sole contribution to reducing symptoms or curing a given condition. For instance, in the case of statins we know that when a patient takes that statin they will benefit from a 25% reduction in heart attack among other benefits. We also know that a patient who is prescribed a statin does not fill the third refill over 50% of the time. So, the healthcare system really does not benefit from these products in reducing morbidity and thus cost. Let’s imagine a world where drug manufacturers built compliance programs inextricably tied to the performance of the brands in clinical trials. The whole healthcare system would benefit.

For patients it would allow them the ability to stay on their medication and receive the full benefits of the therapy; for manufacturers by achieving more sales; and for physicians and payers by benefiting from huge cost reduction. Through these types of compliance programs, manufacturers would raise their profile in the eyes of patients, caregivers and payers to become welcome participants on how to effect a significant cost reduction for our healthcare system. Tying that strategy into well-documented compliance packaging tactics would only serve to enhance the effectiveness of the programs. Again it would be interesting to see how we could bring the packaging component alive by documenting the effect through the clinical-trial development program.

Steve Viviano: As compliance levels remain stubbornly low, pharmaceutical marketers need to utilize media where patients/caregivers can understand the importance of remaining on their drug regardless of the reasons why they have decided to discontinue. In addition, packaging innovations can certainly play a role in ensuring that patients remain compliant with their medications. Clearly, improving compliance is a win-win-win for patients, health-care providers and the pharma industry.

Lynn O’Connor Vos: Absolutely. The innovation in our space is going to come in two places. At the very early part of the continuum we need to figure out how to get patients to identify themselves faster through more self diagnosis, particularly when you are talking primary care. You are going to see more relationships with Walgreens and Walmart, where there are these doc-in-a-box and nursing clinics where people might come in and get diagnosed faster on some of these lighter conditions so that we can get them into the system faster. Then at the far end what we need to do after they have been diagnosed is figure out how to get them to stay on the product longer. A few companies that I am aware of are really looking at the product plus solutions.

Traditionally when you look at how we have launched products, it was very much a discovery model. So in the laboratory we came up with a molecule that looked like it had promise, it went into clinical research, we continued down the path and if it was effective, we assumed that we could market it.

There have been several products that this and last year, Exubera would be one at the top of the list, where we actually found out that once it got out into the marketplace we could not sell it. So, I think we are going to move towards a needs-based approach to developing drugs. When you really think about a needs-based approach and you use some of the tools and some of the information that are online due to the mass consumerization of healthcare you are going to find that when you look for a need you are probably going to find that you need a product plus an intervention. So, I would say that yes, not tomorrow but certainly in the future, we are probably going to see many more combined solutions that will actually impact health.

Bruce Medd: Hopefully! I feel that the utilization of packaging has been a big failure within the healthcare marketing world. Whether it is having your brand neutered by the little brown pharmacy bottle or producing samples that lack any connectivity mechanisms targeting patients, there are countless examples where the power of good packaging is not fully realized in the healthcare industry. While our consumer brethren treat packaging as a vital component of the marketing four Ps and thus integrate packaging into the core brand team, pharmaceutical packaging, with the exception of logos and colors, tends to be separated almost entirely from the marketing process.

Increasing compliance and strengthening brand equity with patients are two key benefits that should catalyze the integration of communications agencies and packaging vendors. Starting with samples, patients should be driven into communications programs that are designed to reinforce the benefits of disease management achieved through compliance while at the same time, strengthening the bond between brand and consumer. This bond should be strengthened with every prescription refill through dose packs or other promotional vehicles.

Donna Murphy and Doug Burcin: In the healthcare communications industry, packaging is a highly underutilized vehicle to communicate directly with customers, improve patient compliance, and extend the overall brand experience.

Currently, the scope of healthcare communications includes the following channels: general advertising, conventions, sales force, medical education, digital, direct marketing, and public relations. These are the current means of creating the brand experience for customers. However, at the end of the day, the point-of-sale purchase is delivered in a generic package, like a prescription pill bottle, with very little information and a lot left in the hands of the patient to ensure that he or she is taking the proper medication in accordance with the prescribed treatment regimen.

Point-of-sale packaging offers a great opportunity to extend the brand, differentiate the product, and potentially improve patient compliance. We have seen innovative examples of this in the OC market, in which daily-dose blister packaging plays a great role in ensuring compliance. The Zithromax Z-Pak is another example of how packaging has helped not only to elevate the importance of completing the entire cycle of therapy but also to clarify to patients how to properly take their medicine.

In the future, packaging will be considered an instrumental part of the marketing mix. And healthcare communications agencies, packaging vendors, and pharmaceutical companies will work together to develop innovative packaging ideas to solve compliance issues and create continuity of brand communications.

Sheri Rosenblatt: Because compliance is such an important part of the communication that brands need to deliver to their customers, the integration of healthcare communications agencies and packaging vendors is a must. We cannot rely on healthcare professionals to have the time to educate patients and reinforce why a medication is being prescribed and for how long it needs to be taken. So, it is up to us to help facilitate this process. If we believe that the first experience a consumer has with a brand determines its success or failure, then starting off with better patient starter kits and sampling packages is our best weapon. The package, the messages, the educational information can all be utilized more effectively to help foster better compliance. We know from research with patients themselves that the sample package is not fully leveraged, and yet, it has so much potential. We need to partner more closely and work harder to ensure that the packaging and the messaging are aligned to support better compliance.

Rich Minoff: Most likely this will occur, but it will depend on the specific needs of the market and situation, since the ongoing compliance and persistency issues we often may have more to do with other aspects such as medication cost, dosing issues (e.g., difficult titration), and patient mind-sets rather than packaging. However, in some cases, a much more collegial and open relationship could create a unique, highly differentiated brand that does drive increased compliance and persistency.

David Kramer: Except in a few categories, such as oral contraceptives and devices for delivering inhaled steroids to asthma patients – where the packaging serves an important function in reinforcing proper use of a complicated regimen or device – packaging decisions have tended to be aligned much more closely with the manufacturing function than with marketing and to be driven by factors such as shipping volume and shelf-stocking space. While packaging ideas borrowed from consumer marketing as a reinforcer of brand value or a driver of compliance with more ordinary regimens seem to float perennially in the industry, the evidence for a positive impact of packaging on compliance remains too slight – and the potential benefits of packaging on “brand equity” too soft – to dislodge packaging decisions from their traditional locus.

Elaine Eisen: As competition among agencies continues to escalate, the winners will be those who embrace any and every opportunity to bring business-building ideas to their clients. Improving patient compliance/persistency rates has proven to be a very elusive (but highly-pursued) goal among most clients—particularly those marketing medications for chronic conditions. Although very few of these efforts have actually resulted in demonstrable improvements in compliance or persistency, the upside (for clients, physicians, payers, and patients) of actually cracking this code ensures that the challenge remains front and center.

The opportunity to partner with packaging experts is certainly one avenue worth exploring. However, it is our belief that no single package design – regardless of how clever it might be – will be sufficient to cause a significant and lasting behavioral change on the part of patients. For that kind of change to take place, there will need to be a well-orchestrated set of positive reinforcements directed at the patients, their caregivers, and their families.

Concentric: You only get one chance to make a good first impression. For most industries, the package is that first impression. But, in the pharmaceutical industry, we are handicapped. Repackaging at the pharmacy interrupts the connection between the customer and the brand. Essentially, gaining patient acceptance and commitment is difficult to achieve if the only thing they see is an amber vial. This is where starter packages given out by the physician can fill the gap. Sample packages with patient information, etc. can be quite helpful. The retail pharmacist can also help fill this gap by distributing literature to patients when they fill prescriptions, literature that contains helpful information or connects them with services patients can access online, through the mail or at live events. This takes collaboration between Pharma and retail chains and managed care plans.

Ed Wise: Good agencies have been recommending packaging ideas to clients for many years and will continue to do so. Packaging is a critical “point of use” opportunity for communication, simplification, and as a way to guide patient expectations. We once had the challenge of marketing a single-dose cure for an acute infection. The packaging allowed us to communicate critical information that helped maximize success, including when the pill should be taken, and when cure could be expected. Information such as this is most effectively delivered at the moment of use, and only packaging can deliver on that.

Lori O’Neill, senior VP and director of access, The CementWorks LLC: I am not sure if communication agencies and packaging vendors will work more closely together in the future but they should. While communications and packaging decisions are made by marketing teams, the vendors who deliver these services are not aligned And this lack of alignment can delay coordination of communication and resources. Furthermore, many packaging decisions (e.g., delivery format and dosing) are made long before a communications agency is engaged, making collaboration difficult.

The packaging is the patient’s first personal experience of the brand. Packaging must evolve to include tailored compliance messages. It’s time to evolve the technology required to segment end users by reorder rates (a proxy for compliance), develop appropriate user messages, and customize compliance messages.

Additionally, as the healthcare market continues to consolidate and marketing budgets to shrink, greater pressure will force innovation, efficiency, and evolution. That said, value innovations will emerge as a differentiator, especially for brands that are not well defined. What is a value innovation? Think insulin. Novo Nordisk repackaged insulin into prefilled syringes and revolutionized care for people with diabetes worldwide. Rethinking innovative packaging with the end user in mind can eliminated costly and unnecessary steps in an already overburdened healthcare delivery system by allowing self administration and greater independence. Prefilled insulin syringes not only cut down on dosing irregularities, but the clicking function on the syringe allows those with visual impairments to remain independent.

Using packaging to enhance a compliance message, such as with birth-control pills, makes logical sense. The packaging acts as a built-in reminder. When the oral tyrosine-kinase inhibitor Sutent launched with a 4-weeks-on, 2-weeks-off dosing schedule, compliance was an immediate worry. As a result, packaging similar to that for birth-control pills was designed and utilized.

With the development of smart chips embedded in bottle caps, telemedicine providers can record medication compliance remotely. As this technology becomes less expensive, it can be included in more brands. Such technology can allow older people to remain independent longer, putting off the need for assisted living, an important consideration as the majority of baby boomers reach retirement age.

Kathy Magnuson: There already is greater emphasis on integrated marketing approaches for brands, so if agencies and packaging vendors can partner to improve compliance and demonstrate strong results, this will definitely happen.

Michael Schreiber: That would be ideal. The earlier agencies can get involved in a brand’s development, the better. Whether it’s naming, color choice, pill shape, or packaging, all are reflective of the brand. That should be done with as much research and creativity as the launch ad.

When you consider the cost of drugs, there is something infuriatingly unsatisfying about receiving your medicine in a generic amber vial. For a patient, it raises questions as to whether the medicine is worth the expense and leaves one feeling cold and irrelevant. For a healthcare provider, it’s a missed opportunity to deliver value, let alone instructions, to patients. And for a marketer, it reflects poorly on the drug and cheapens the entire brand experience.

Better packaging will not just improve patient compliance, it will build better relationships.

Blue Diesel: Integration is essential in any effective communication strategy. With the evolution of technology, identifying and leveraging points of integration are necessary in order to impact the overall HCP or patient outcome. As we strategize about our clients’ brands, we are also working with our agency partners to combine knowledge and practices to move the brand exponentially. We are combining the rep-physician relationship with the physician-patient relationship, fueled by the pharmacy-patient relationship. Driving connectivity across these audiences brings credibility to each of the players, therefore all are focusing on improving patient outcomes. We believe it is important to think “above the brand” and look beyond one point of communication – but to think how these pieces of communication can work together to drive more value. It’s the “sum of the parts” methodology.

Giant: We hope so. All too often, we have seen packaging go down a road that seems to be out of line with, and sometimes diametrically opposed to the goals and objectives of brand marketers. We have had some very successful collaborations with packaging vendors that have resulted in more cohesive brands, clearer messaging, and improved compliance. Generally speaking, success begins with clients who have a collaborative culture where marketing works closely with their other departments, and with their agency, earlier on in the process of developing the marketing vision for the brand.

7: The significance of managed markets to pharmaceutical companies’ bottom line is growing, but oftentimes the managed-care aspect of developing communications is handed off to healthcare agencies as project work. How can agencies/networks help clients place the appropriate emphasis on managed-care communications?

Phil Deschamps: In principal, this scenario has occurred because the service side of the equation is lacking. We are caught in the vortex of clients having low expectations so agencies do not invest in talent and therefore neither group can be effective. Access is one of the most important issues related to the performance of the whole healthcare system. As an industry we need to bring the payer on board as a key stakeholder in the web of communication that supports the marketing of a brand. Most often, on the manufacturer’s side, the B2B group sits apart from the brand team and develops their own strategy. They often hire their own agency independent of the core agency, and set up communications that work against the core strategy of the brand. Agencies find themselves responding to this kind of fragmented approach by forming different divisions that do the B2B work, but they are usually not staffed appropriately to pull through the production of the suggested programs. The time has come to integrate access strategy in the core brands strategy so that the brand story holds up for all stakeholders.

Thomas J. Kempisty, executive VP, managing director, Sentrix Health Communications: Pharmaceutical manufacturers generally assign the development of Managed Care communications in the form of project work for two reasons: One, managed-care marketing is often viewed as less important than traditional brand marketing efforts; and two, managed-care marketing is more complicated and highly specialized However, as the role of third-party payers becomes more important and integral to core brand marketing efforts, the desire for truly integrated brand AOR partners that provide top-to-bottom offerings gains momentum.

Madison Avenue agencies largely built their competencies around brand-building and creating promotional communications targeted at physicians and consumers. They understand the interaction between sales reps and doctors and the increasing influence that patients exert on prescribing behavior. When it comes to account managers and their interactions with pharmacy and medical directors, however, traditional agencies are considerably less comfortable. Further, expertise in areas like disease-state management, health economics and outcomes research, long-term care, Medicare and Medicaid, and trade marketing is even rarer. Until now, these assignments have been the domain of managed-care consulting firms, boutique agencies, and occasionally as one-off projects for brand AORs.

In order to meet the needs of these progressive, new-age brands, traditional advertising agencies must evolve their service offerings, providing sophisticated competencies specific to managed care and integrating brand-wide approaches that serve multiple audiences across all media. Now more than ever, multi-message platforms that speak to drug access, Medicare coverage, patient assistance, and disease-based selling models are necessary in creating differentiation and driving sales pull-through efforts. Leveraging the influence and impact that payers, employers, and trade partners have on providers and patients is now vital to core brand strategies.

In the end, those agencies best positioned to compete in this era will be those that have more to offer than just a managed care-specific group or some payer marketing experience. Those that succeed will demonstrate a clear understanding of the new marketplace, have command of truly integrated strategies and executions, and provide innovative solutions that leverage the power, influence, and importance of third-party payers throughout the sales continuum.

Craig Sullivan, executive VP, management director, Pacific Communications: The industry has come a long way in a very short period of time; however, the manner in which companies manage this division is still varied, ranging from brand team off-shoots to separate and fully funded divisions. No matter the structure, regional and national account managers are on the front line and often initiate and drive activities; as a result, there is a risk of becoming reactive and hyper-focused on immediate access issues. This live-time activity is important, but can distract from the need to have a longer-term strategic plan in place, not only for the products they support, but also the division itself. Agencies can work with the Managed-Care team to determine how they are viewed in the eyes of the managed markets customer, how they want to be viewed and how they will get there. In many ways, this is similar to basic brand planning, however, in this case, the brand is the division. This macro approach can help when shaping what brands to prioritize and allows the team to look for ways to move the needle beyond product support services or messages.

Lynn O’Connor Vos: A fundamental problem that we have if you look for a prescription for change in our industry is we have not addressed the value of our products early enough in product development. So, when we go to our clients now, we need to ask ourselves the question right from the day we think about launching, starting the prelaunch program for the product, what is the value to the stakeholders, what is the value proposition to consumers, payers, and doctors, and is there enough value there that we can launch this product and believe that we are not just going to survive, but will actually thrive.

So the earlier that we start thinking about value in the early product phases, the more likely we are to develop studies that are more meaningful in terms of access and the more likely that we will have managed care and access fully integrated into the marketing plan. That is what will change this paradigm, because right now the concept that you can just develop brochures or even quite exciting programs post launch without having done that kind of heavy lifting early, is probably not going to be as effective.

We are already seeing the change. We are seeing that many of the clients are starting to recognize that they want to think about value early. They want to engage with us early. We have a company in the UK called WG Consulting, and that is all they do. It is interesting that our experience over there is becoming very relevant over here because they have gone to school on access with NICE in the UK and some of the other regulatory bodies in Europe. And, of course many of those same approaches and many of the things that go along with NICE are happening over here. So, we are going to see, particularly in 2009, that managed-care strategy is more ubiquitous in the plan and is not isolated in silos.

Charlene Prounis and Risa Bernstein: It is an interesting observation that so much of pharma’s managed-care work has been done as “one offs,” as opposed to part of true branded tactical plans. This phenomenon probably started with good reason, and then became a bit of a self-fulfilling prophecy. Typically, I think the managed-care marketing teams at pharma companies began a bit as silos. They tended to be populated with people who came out of “payor” versus marketing backgrounds. They spoke the language of the managed-care arena, were comfortable with the jargon and the acronyms, and they became quickly frustrated with agency teams who did not “talk their talk.” In that environment, we saw that frustration drive the advent of the “managed care agency,” which typically grew through project work, and never expected full “agency of record” status or contracts … they grew revenue by identifying need and inventing/selling individual projects to address it. But they typically functioned outside the core brand team promotion.

As the importance of managed care has grown, particularly in its ability to be the gatekeeper of access to complex biologic and specialty drugs, agencies have come to realize more and more that the understanding of managed-care issues and customers are an integral part of successful drug marketing. As a result, we believe that visionary agencies are ensuring more managed market expertise among their core account and creative teams. They are spearheading more positioning and messaging research among payor audiences, and ensuring that key members of account teams are listening and learning. Agencies that understand the burgeoning importance of third-party payors are doing a better job of modifying promotional pieces for these audiences, while keeping them within a recognizable branded approach.

They are recognizing the need for new kinds of materials that help practices streamline reimbursement and patients ensure access, and again, the power of these pieces lay in their strong branded association that lets customers immediately know that a given company/product is delivering value beyond the brand.

Sheri Rosenblatt: It all starts with how the team is structured and organized. All too often we see the managed-markets team sit on the other side of the building or on another floor — not fully integrated with the brand team. They do not always have a role on the product launch team. And on the team agenda, they are usually last “if time permits.”

Once the brand launches we hear from the field that a brand is losing its Tier 2 status with a significant plan and everyone is calling on his or her managed markets partners to figure out why. Suddenly, the managed-markets team is critical to the future of the brand!

Clients do not always believe that agencies understand the managed-care aspect of the business and are surprised to learn that this is a service, via a specialized department staffed with individuals WITH managed-markets expertise that we provide — and we consider it equally important to the brand positioning. As we are building brand plans and developing communications to engage customers at every touch point, it’s critical to have your managed-markets plan integrated at every level, from the beginning and most essentially, PRELAUNCH!

Rich Minoff: The question you have to ask first is why does this occur? Is it because the client is unsure what to do or how to do it? Or is because the agency does not have a core competency in managed markets/payors so “sells” what it knows and is most comfortable with? Agencies need to change, see themselves as “solutions-providers” and gain increased comfort/expertise with managed-market issues to change this. Alternatively, clients need to better recognize that a one-stop shop such as their current agency with one or two people in this area, might not have the ability and time to really help them so they should partner with a boutique agency and task their AOR with managing the relationship.

David Kramer: The industry learned pretty thoroughly in the mid-1990s that managed-care access is driven by two factors: 1) the product profile (i.e., clinical benefits and safety) and 2) contracting (i.e., rebating). Value-added programs, customized pull-through programs, disease-management programs, outcomes data, and all the other tactics the industry experimented with as alternatives to aggressive rebating failed to make any measurable impact on the rebates that companies ultimately had to give to gain access and only increased the cost of sales. This picture has not changed appreciably in the last decade — except for the increasing difficulty of identifying formulary decision-makers to target them for communication.

Some brands, however, are beginning to do scenario-based planning in which the net present value of aggressive contracting for preferred formulary status is compared with that of accepting non-preferred (i.e., high-copay) status and offering co-pay offsets (i.e., rebates) directly to consumers. If the latter scenario is chosen, communication obviously becomes critical to driving desired script volume … but it is, of course, consumer communication, not managed-care communication per se.

Carleen Kelly: Product promotion (professional and consumer) has been the traditional focus of pharmaceutical companies, but the growing influence of managed markets and the importance of product formulary acceptance and placement are rapidly changing that parameter. The best promotion will not work if a product is not on formulary. Just as a brand promotional agency is important in bringing the appropriate product message to providers on a consistent basis, a managed-markets agency should bring the relevant larger messages to payers on the same consistent basis. Effective managed-markets communications – before and after a product is launched – can help to make a difference in product uptake. A committed and full partnership with a managed-markets agency is vital in helping clients realize product goals and profitability. Importantly, managed-markets agencies should have access to the client’s other agencies, working together and sharing materials to support a comprehensive effort for product success. A strong managed-markets team, dedicated to an ongoing client relationship as agency of record, has the experience, expertise, and connections with a variety of groups to enhance client objectives at all levels. Project assignments, with short-term involvement and short-term thinking, do not allow for achieving that degree of success.

Managed-markets agencies have opportunities to support clients in several ways. 1) Helping to develop a value proposition before launch. Beginning a relationship as early as possible (Phase 2 studies) is integral to developing a strong value proposition for managed markets that demonstrate the clinical and economic rationale for a product. A managed-markets agency can develop strategies based on the disease state, the competitive market, and payer concerns. Working in conjunction with the client and other agencies (medical education, publications) affords access to data and direction that can help to shape presentation of information and favorable perception. Early use of advertorials and articles in managed-markets journals can help develop the value proposition.

2) Raising awareness of the specific disease state to prime the market. Disease-state awareness can make a difference with plans, providers, members, and advocacy groups. One successful example is the increased awareness of COPD, the fourth-leading cause of death in the United States yet, until just a few years ago, relatively unknown by a large part of the population. Materials developed by the managed-markets agency to educate these different groups and help in directing priorities made a big difference for the pharmaceutical company with a product for COPD. In therapeutic categories where there is greater awareness, targeted messages to payers, providers, and patients can make a difference in bringing new information to a wider audience.

3) Supporting pull-through with programs and materials to aid uptake. Critical to uptake at launch or at formulary win is a concerted sales effort to support uptake. Development of a new, or enhancement of an existing, pull-through program offers strategic direction, targeted and customizable tactics, client communications, and other materials to support this aggressive effort. Review of results as part of a continuous quality improvement effort enables fine-tuning and communication of best practices to elevate performance.

4) Developing value-added materials that support product use. MCOs face the same financial challenges that other groups do. Nonbranded educational and other communications materials support MCO initiatives for providers and members and are considered an important part of doing business beyond pricing and contracting. Desirable materials cited by MCOs include patient educational pieces at appropriate literacy levels and in languages relevant to member populations, explanation and support for HEDIS initiatives, and educational toolkits for providers that adhere to accepted guidelines. A managed-markets agency that understands the relevance of superior value-added materials helps the pharmaceutical company be seen as a good collaborator and elevates its perception as a supporter of customer needs.

[Yet another way is] enhancing perception of the pharmaceutical company as a valued supporter of managed care. An important role of a managed-markets agency is to elevate the perception of the client. This can be done in a variety of ways that have meaning to MCOs. Relationship building, through ongoing industry and KOL working groups, generates ideas for tools and services that customers really want. Additionally, materials that help to broaden and deepen relationships at customer organizations enhance the perception of the pharmaceutical company as a dedicated supporter and partner in addressing disease management. Providing avenues for organizational support also helps to elevate the client’s leadership position in the industry. If done correctly, the improvement in how the client is perceived as a result of these strategies is clearly measurable through a variety of industry mechanisms (HIRC, etc.)

Therefore, a dedicated managed-markets agency, appointed as agency of record, is a valued partner that is instrumental in achieving client brand goals, specifically resulting in favorable formulary status for enhanced uptake throughout the product’s life cycle.

Concentric: The pharmaceutical sale is complex. Despite our marketing emphasis on patients and physicians, a successful sale requires a three-way customer conversation centered on the brand value. Increasingly, managed care is becoming the dominant customer in this conversation and must be considered early in the process.

We help our clients address this reality using of our CustomerCentric™ analytical model. This process helps marketers identify the dominant customer, align strategies, and prioritize resources. It is most successful prior to brand commercialization. For brands that fail to develop and communicate a strong value proposition, reimbursement often comes at a high cost in the form of significant rebates or disadvantaged formulary status. Neutralizing or gaining an advantage in managed care could be the most critical component of any brand plan. Before you drive demand through promotion, we must ensure the prescription written will be filled. At Concentric, we believe the best way to accomplish this is to build a single brand proposition that considers all customers, build informative relationships with key decision makers and continuously bolster the services offered with each prescription.

Ed Wise: Today the tide has turned as we see the majority of our clients being as invested in managed-markets communications as they are in healthcare professional (HCP) and direct-to-patient or DTC work. Certainly, many of the large manufacturers (pharmaceutical and biotech) have divisions or business units devoted to the managed markets. But virtually each one is devoted to the larger enterprise of their company, which is improving patient outcomes with a direct line of site to the products themselves.

We are seeing more client FTEs devoted to managed-markets marketing than ever before. And we are seeing more of these clients coming from true marketing backgrounds. All of our clients seem to have greater support from their upper management. Top corporate strategies and initiatives generally revolve around patient access to products.

Perhaps our greatest successes come from knowing that managed-markets marketing is, simply, healthcare marketing. So never forget the basics: know your audience better than anyone else. Speak to them in their language. And deliver compelling, single-minded work.

Lori O’Neill: Uncovering payer insights and then developing a brand-value proposition that focuses on the payer is necessary. Payers impact every audience: prescribers, patients, and consumers alike. Identifying and championing the payer value story will result in consistent message delivery across all audiences and products. Most product managers have a terrific understanding of how prescribers think, but know little about how payers manage population health. Considering payer acceptance early in product development will help marketers better understand how payers make decisions, develop more accurate product financial forecasting, encounter fewer access barriers, and realize greater product utilization once on the market.

Agencies are in the position of advising marketing teams on their strategies early on. Developing market shaping and launch strategies and tactics that include the population impact, geographic dispersion, treatment environment, and impact the disease or condition has on payers, employers, governments, and specialized channel segments (LTC, VA/DoD, PBM) will, in turn, help your clients develop more robust strategies that include these segments in their forecast and in their market plans.

Agency partners must elevate the clients’ understanding of payer issues and the impact payers have on a brand. By communicating payer points of interest, how/where drugs are delivered, and the payer mix in a given category, agency partners can assist brand managers. Agencies are also in a position to help expand understanding and prioritization of customer key accounts, based on the account’s contribution to the brand and the level of exposure by book of business (commercial, Medicaid, Medicare spend).

While formulary decisions will continue to be made based on the traditional formulary hierarchy (effectiveness, cost, safety, documented persistency, convenience, me too, no additive value), as creative partners with a deep understanding of healthcare decision makers, agencies are in a unique position to expand the conversation and offer creative insights, solutions, and value innovations.

Kathy Magnuson: It always goes back to what is the brand strategy and how each customer touch point is able to reflect that brand strategy for an integrated brand experience. Managed markets will continue to dominate discussions as new healthcare strategies dominate the social discourse. Importantly, it is essential that agencies, along with brand teams, become more involved in the conversation around this issue so they are better able to reflect that expertise in brand strategies. While the managed-markets departments will continue to own the specialized information on the subject, brand managers and their agency counterparts must become more invested in the area to develop fully integrated programs that will drive brand sales. “Pull through” tactics are no longer sufficient in today’s environment nor will they work in the future.

Blue Diesel: As an interactive agency, we have had the opportunity to work with brands in a much more holistic manner. For example, when we are deploying closed-loop marketing (CLM), we look at the brand challenges from every aspect to enable the representative to handle and overcome any challenge presented. As a result, we think about the overall strategy for the brand, whether that involves managed care, patient compliance, brand objections, etc. To that end, we have been able to work with our bands to include managed care as part of the equation and the conversation, not just a topic for a rep to cover off on. As a result, the rep becomes much more knowledgeable and empowered to engage with the physician on managed care. We see this as both a core tool for the reps in the field and a differentiator. We see this trend continuing. The more integrated and connected the brand is, the better the relationships the brand has with all of its customers, and the more value both personal and non-personal promotion are able to deliver.

Dudnyk: Managed-care organizations provide services other than just formulary selection and management; but pharmaceutical companies often focus only on the Medical and Pharmacy Directors involved with the P&T committees. By establishing relationships with other areas within a managed-care organization, and by developing a partnership with the whole company, a pharmaceutical company can encourage an MCO to reach out to its key audiences of healthcare professionals and consumers.

For example, Disease Management personnel within an MCO have regular contact with healthcare professionals and consumers, and require a deep understanding of products, disease states and treatment protocols. This group would greatly benefit from educational activities provided by pharmaceutical companies. These activities would influence not only formulary decisions as well as product usage.

Most managed-care organizations are directly involved in consumer education not only in terms of providing formulary information, but also in providing health education. The education activities conducted by managed-care organizations provide effective avenues for pharmaceutical companies to provide disease and treatment information that can eventually lead to a pharma company’s targeted consumers receiving their branded product information. The benefit of providing consumers unbranded, general disease-state information is often overlooked by pharmaceutical companies, who deal so extensively in the “branded” world.

Managed-care organizations maintain close ties with physicians and pharmacists in their networks through regular communication and network development activities. Pharmaceutical companies can leverage these outreach efforts to communicate about particular disease states, treatment options, and even product information.

Community outreach is another area where pharmaceutical companies can benefit from a partnership with managed-care organizations. Local organizations provide access to consumers, many of whom trust grass-roots organizations much more than big corporations. When consumers see the positive impact that public/private collaborations can have in their neighborhoods, they are more likely to support these companies. This dynamic is key with so many product choices on the shelves and behind the pharmacy counter.

Though pharmaceutical companies, managed-care organizations, physicians, pharmacists, and consumers can be at odds when it comes to determining which treatment option is best, all of these groups strive to provide and receive the best healthcare possible. If pharmaceutical companies extend their reach into managed-care organizations beyond the members of the P&T committee, the goal of both parties — in addition to the goals of consumers and healthcare professionals — can be attained.

Giant: Appropriate emphasis on managed-care communication occurs when a system of checks and balances are put into place to ensure that managed-care promotion and product promotion become symbiotic. A team approach to promotional program development is critical to ensure that all work created for managed markets support the overall brand positioning while reinforcing core promotional messaging. And of course, all promotion must be consistent with established local and global brand guidelines.

8: As pharmaceutical science becomes more complex (i.e. biotechnology and drug/device combos), is the science of healthcare communications becoming more complex as well? What are the challenges with meeting clients’ expectations in this evolving environment and how can they be addressed?

Debbie Fletcher, managing director, IntraMed West: The rate of information exchange in biotechnology and drug/device combination environments is high. Data will continue to evolve at a rapid pace. Technology advances through research are creating exciting new opportunities to expand this complexity. For example, research in the oncology category has yielded significant new discoveries such as the new biologic targets that have led to the explosion of targeted product candidates. As each new discovery leads to another pipeline addition, the market environment heats up challenging us to create viable communications that survive the crowded fields.

There are many needs we must meet in order to maintain relevancy for our client’s business and each pose new challenges. These include:

1) Clients in these areas need to be able to differentiate their product. The traditional safety and efficacy differentiators are not the complete communication story. More than ever, the differentiators are complex properties or deliveries that require our deep scientific understanding. Our challenge is to develop a unique positioning for the product as a particular nuance might be the distinguishing factor.

2) Clients will demand more of thorough understanding of the entire aspect of the product and the company, including the ever-changing regulatory environment as a compound makes its way through development. Our challenge is to build solid teams with strategic insight to very specific technology and drug platforms who maintain regular relevancy in respective areas. Keeping pace with the client and the product’s progression through development is key.

3) Clients in these exciting new areas have a greater need to coordinate more with multiple disciplines within their company. Our challenge is to establish access both internally and externally. Internally, there is a rapid transfer of information that if lost or slowed loses significance to the communication required. Externally, access to engaged investigators and key opinion leaders allow the communication to be tested and filtered if necessary.

4) To break through the market noise, clients need their products to achieve audience reach and clarity of product messaging. Broad exposure in focused communication with respect for limited resources and novel communication approaches can mean success or failure for these companies. Our challenge is to create multi-vehicle approaches across multiple audiences with the integration of appropriate technology solutions. Of course this is not an exhaustive list of needs or challenges!

How? The Three T’s: Talent, Translation & Technology. First, talent is critical. Healthcare communications teams need to have knowledgeable talent leading within to provide insights to clients. Recruiting for these lead strategic positions looks different than those traditionally used. Candidates from traditional and nontraditional backgrounds with strong science may trump those with history in agency communication positions. Demonstrated success combined with proven skills of leadership and a strong understanding of our client’s environment have high value.

Talent will be tested in their ability to translate the science into simple, meaningful communication. There is not a simple formula for this translation process. When done, however, it can yield powerful outcomes. Teams working in a well-aligned client/agency relationship with a knowledge or information based foundation will be the winners.

Finally, matching technology solutions with strategic insights is a must. Combined with talent, appropriately placed solutions can fuel tremendous success. Not all clients are seeing technology as the opportunity and it is our job to show them the way. A holistic approach is needed to manage their business is an important, up-front planning consideration. Technology integrated into thoughtful plans will provide the best solutions.

Bruce Rooke: The demonstration of more complex science actually gives us a chance to rethink the model of conventional healthcare advertising. Tracing back our roots, we discover we were sired by the consumer approach to advertising: that one big idea to grab attention that then works as a portal you have to go through in order to get more decision-making information. So the classic icon or photo with headline approaches dominate, simplifying both the story and the science down to a 2.5 second read. But jump off the printed page for a moment and observe how people are getting more of their desired information: the Webpage. Viewers have multiple stories to choose from, click what interests them most. Now why have we not translated that style of information design into print, so that our audience sees all the stories a brand has to tell and gets to browse versus being told where to go and what is important to them? Your brand earns instant trust through transparency, the customer feels good about being in control versus sold to, and your communication does not end up looking like everyone else’s. So maybe complex science can save healthcare advertising while it is also saving lives.

Steve Viviano: The more complex pharmaceutical science becomes, the more things remain the same. Because regardless of the degree of scientific nuance needed to communicate the value and utility of a new therapy, the things that are important to the end users – physicians and their patients – remain unchanged. They want science that results in ease of use, sustained or increased quality of life, and greater efficacy. These brand promises will always be at the center of sound strategies in scientific communications.

Clients are focused on breaking down complex data into discrete, easy-to-understand messages – and communicating them to the right audiences on a regular basis. The role of the agency or partner in this will continue to be to 1) identify the messages that are most important and 2) make them simple, and 3) identify the target and the time line for reaching that target.

The science of healthcare communications is, however, becoming more convergent. There are more constituents involved in the purchase of novel technologies. And where these professionals get their information is constantly evolving – plus, they get to choose which communication they want to receive. The ability to address their particular needs is critical to successful adoption. Game-changing product technology may be extremely innovative, but if it does not have the proper coding, if it does not have the support of the governing societies, if physicians do not have the credentialing requirements, and it is not going to be reimbursed appropriately, it very well may be an uphill battle. So, it is imperative for the agency to provide insightful counsel and value on the use of the most cost-effective channels of communication, including leveraging new media to do things that have not been done before; finding better, faster, more efficient ways of communicating at multiple “touch points.” Clients are demanding more accountability, more measurement of ROI and a broader range of services.

Ryan Abbate: I do not believe the science of healthcare communications needs to become more complex, but the tactical technology does. Classic full-service agencies are already well positioned and structured to accommodate the needs of complex categories. If anything, marketing communications is now easier than it used to be due to the technological advances we now have to deliver content. Historically, delivering complex, content-heavy messages was extremely challenging given the limited tactical options available to us. In the digital age, anything, no matter how technical or complex, can be effectively and creatively delivered.

Lynn O’Connor Vos: The science has been complex for quite awhile. We have a scientific visualization group that dives into the pharmacokinetics of the brand and comes up with a way to visualize the mode of action. That is a very effective way of helping physicians understand how this product works and also how the physiology is in the body with certain conditions.

That, plus working with key thought leaders and developing better ways of publishing more interactive campaigns or programs where more physicians can speak to other physicians online. We have developed several peer-to-peer Web programs that have helped to introduce some of the newer vaccines, which is pretty complicated. A lot of those things are great tools.

This moment does not feel like it is any more complicated than it was. Certainly we have had about five years or 10 years with working in the biotech field where we have used a lot of these techniques. The thing that is most exciting right now in terms of biotechnology or just the whole way we are going to look at diseases is the introduction of biomarkers. We can actually understand which products will work in which populations. It’s quite exciting, and that is going to in some ways make the job more challenging for the pharmaceutical industry because it might be a narrower group of patients who will be affected by these brands. On the other hand, they will be on these brands for a much longer time and will have better outcomes.

And, so the challenge for us as a communications firm is double in the sense that first we are going to have to understand and describe the impact of the biomarker and then also the science as it relates to it. This is why we are going to call this next phase the niche-buster phase because we will find these niches through biomarkers and they will be fantastic products that will help, particularly in oncology, save lives.

Bruce Medd: The simple answer to the first part of this complicated question is “yes and no.” Clearly, many of the products that are marketed today are more complex than ever before, but that does not mean the brand’s message needs to be just as complex. Even when the average pharmaceutical product was more basic, marketers had a tendency to fall in love with all the features it possessed and as a result, the message suffered from “and the kitchen sink syndrome.” With complex products, there are even more features to fall in love with and that can have a disastrous impact on effective messaging. To further complicate matters, the high-science nature of today’s products puts an increased burden on the agency team to truly understand the science behind the product because unless this is achieved, you can not be a true strategic partner in the marketing process.

The two aforementioned challenges of a more complex pharmaceutical industry can be addressed by enacting a branding process that seeks to achieve a focused outcome regardless of the product’s complexity and by hiring the right employees. Revolution Health uses a process called the Brand Wheel™ that is designed to “center” the creative on the most compelling message possible. As messaging becomes more complex, we have partnered with trained psychologists to help us uncover the fundamental drivers that still exist with high-science products and then, through prioritization exercises, focus on the single message that has the biggest marketing impact. However, what makes our process strong is the fact that all of our employees have the experience and aptitude to process today’s complexities and deliver simple solutions.

Bruce Lehman: Of course everything is becoming more complex. And today’s healthcare agency has to be generalist and specialist, orchestrator and player. Products are being approved as drugs but are being marketed as devices, for example. Drugs are being approved with labels that require tailored diagnostics to be run before they are prescribed. The list goes on. What does remain simple, however, is the critical nature of the agency’s need to understand the mind-set of the customer. The complexity of the offering and the resulting complexity of the clinical adoption journey have to be viewed through this lens. If we understand the customer’s needs and wants, and drive messaging, branding, strategies and tactics from that point, the rest will fall into place.

Charlene Prounis and Risa Bernstein: Biotechnology is complex and because this is our future, the science of healthcare communications is growing in complexity. But, all good communication is simple. The point is to get the reader/listener to understand what is been said, and even many specialists have forgotten the MOA and molecular basis of the disease. So, for us in the communication business, we cannot forget that. KISS. We have all got to challenge ourselves to keep it simple and speak about the clinical and emotional benefit to physicians and patients. It’s what everyone can understand, and makes a difference.

That being said, it is also interesting to note that the level of scientific complexity is simultaneously driving a need for a higher level of scientific understanding, and staffing challenges, on the agency side. There is a greater associated need for medical and scientific direction, writers who are facile with the more complicated science, and account people who can go “toe to toe” with the scientific and regulatory bodies on the client side. To some degree, it has made for an interesting change in the staffing mix within agencies.

Donna Murphy and Doug Burcin: The scientific, clinical, and social environment in which pharmaceutical and device products are marketed has changed considerably over the last decade. The science behind treatments has become more complex. The clinical reality is heavily influenced by economics. Patients are more actively seeking healthcare information. Society in general has become more skeptical when evaluating company-sponsored medical communications. While this complicates healthcare marketing, the main objectives of medical communications have not changed: 1) Introduce the product by showing how it works differently from other products available; 2) Emphasize clinical benefits/advantages and, when possible, link them to the mode of action; and 3) Remain credible.

Clients today realize the impact of a concerted effort across communications channels. As a result, they expect from their agency/agencies to drive product differentiation for all product stakeholders including managed markets and patients. Product differentiation of biologics and biosimilars can be challenging, but that was also true in the past, e.g., for ARBs and SSRIs. But it is now imperative to find a simple convincing way to describe the product not only for healthcare professionals, but also for consumers. Close collaboration between medical and creative is critical to ensure a convincing and aligned product description.

Because of increased safety concerns, being different in itself is not enough of a motivator anymore to use a certain product. With many products working in similar ways, it becomes even more important to link the clinical benefits to the product. Managed markets and their demand of outcomes data have contributed to this. But, prescribers and patients have become more skeptical after the experience with the COX-2 inhibitors and apply heightened scrutiny to such claims. To develop the strongest supportable clinical claim for our clients we need to work closely as a unified team. Business, medical, and creative strategies together develop the meaningful description that is also grounded in reality.

The biggest change for the science of healthcare communications is not the more complex product science, but rather increased patient involvement and heightened scrutiny. Medical and scientific rigor must be applied consistently across all communications in order to remain unified, convincing, and honest.

Sheri Rosenblatt: The challenge is really in distilling all of the complexities into simple messages that customers want and need to hear. Although the science is complex, the reality is that our customers, physicians, HCPs and medical/pharmacy directors want help in managing the information. We have to translate the salient points of a brand into more manageable and memorable sounds bites that can be delivered and interpreted quickly. Time is money! Physicians (if they will see reps) have virtually no time to spend with them. That is why we have recently merged our strategic planning and scientific services groups. We used to believe that only our high-science brands – oncology and virology – needed scientific services (our M.D.s and Ph.D.s) assigned to them. Now we recognize how essential it is to have these scientific resources (in addition to strategic planning) applied to all of our brands, even primary-care brands. Differentiation, often through a scientific nuance is essential to brand success.

Rich Minoff: The art and science of healthcare communications as a process might not change or become more complex as we move towards a new environment with the likes of personalized medicine, biopharmaceuticals, higher science/technological solutions and other possibilities. That said, I do believe that the message will become much more complex and more layered. As such we will need to educate more/better and have a much greater understanding of the manner in which people learn (e.g., an auditory versus visual learner). How do you break the message down into the right bites? How can you get healthcare professionals to communicate these “bites” to his/her patient given the time they have allotted? Not easy things to achieve but the clients (and their agencies) who understand and perfect this process will be way ahead of the curve. Personally, I think that clients will need to become educated about basic communications theory and different “learning” models that engage people so they will be able to understand that these complex messages and how they are delivered will be much different from today. For example, if you have a 15-25 year old, does he or she read a printed newspapers or read online these days?

David Kramer: The science of healthcare communications is advancing in three important areas: 1) in our ability to derive deeper, more actionable customer insights from new research modalities, such as social media surveillance, sociolinguistic research, dynamic surveying, and user-centered ethnography; 2) in our ability to predictively model the business impact of alternative marketing-program scenarios and make more informed decisions with a higher degree of confidence in the business outcome; and 3) in our ability to measure with a high degree of precision what really matters in how customers interact with our clients’ businesses through digital channels – dimensions such as engagement, satisfaction, advocacy, and conversion to purchase behavior – rather than what is merely easily measurable through conventional weblog data.

The medium is increasingly important, as most people turn online for their healthcare information – consumers and physicians alike. It’s critical for brand managers to consider this when they are designing their marketing plans, rather than letting digital be an afterthought.

Scott Cotherman: Yes, the science of healthcare communications is evolving and becoming more complex as biotech and drug/device combos continue to fuel pharmaceutical growth, replacing the blockbuster model of past decades. This evolution poses sales and marketing challenges, impacting the who, what, where, when, and how our clients market and promote these products.

New, innovative specialty products require a scientific sell, delivered by a knowledgeable specialty sales force. A recent survey by a health professional social networking site found that physicians want “smarter” reps, well-steeped in the disease state and utilizing clinical studies and evidence-based medicine in their sales interactions.

A greater emphasis on accurate customer segmentation and targeting will also be important in order to identify and profile the decision-makers and influencers of these products. While personal selling remains an essential communication channel, the Internet will continue to represent a cost-effective, targeted medium for specialty, high-science products, including on-line communities and social networking.

Additionally, the increasing influence of payers and the high cost of biotech and drug/device products are placing a renewed focus on patient outcomes. This in turn is adding pressure on our clients to demonstrate clinical value and cost-effectiveness. An understanding of this changing reimbursement landscape, and how to communicate this to all stakeholders, will be critical to commercial success.

It is incumbent upon healthcare communications companies to acquire and maintain a deep understanding of this increasingly complex and fast moving marketplace, in order to create meaningful and impactful communications for clients. We are pleased to once again be leading advancements in marketing communications approaches for the benefit of our clients as this new, fast-paced, and increasingly complex marketplace unfolds.

Concentric: There is no question that in healthcare marketing the subject matter is becoming more complex. The challenge will be, as it always has been, to make the science easy to understand and relevant to our diverse customers. That means complex science needs to be simplified without being marginalized. We need to focus on what is important to each of the various customers with whom we communicate. That is what we have always done. The advantage we have now is, however, that we have a seemingly endless and rapidly evolving communications and interactive learning technology available to us. This technology makes it possible for people to learn what they need to know in a way that suits their learning style and proceeds at their pace. The technology is becoming more sophisticated but remains, for the most part, user friendly.

Ed Wise: I think you can suggest that it is not the increasing complexity of the science that is the issue, but the increasing complexity of the regulatory environment, payer issues, and the diversity of the marketplace. Whether you are talking about a small molecule or a MAb, the core messaging still comes down to standard efficacy and safety parameters. However, with reduced access for sales reps, massive “me too” and generic competition, and more restrictive formulary access, it is becoming increasingly difficult to even establish a dialogue about the science, whether simple or complex. The challenge is more about discovering innovative and targeted communication venues than discussing MOA or mechanism of disease. Reaching the right audiences with fewer reps and dollars is requiring pharma companies to look into new channels that are more targeted and cost-effective.

Art Chavez, partner, The StoneWorks: We are in the business of communications, arts, and sciences. Our industry is unique in that we have to communicate science through the visual arts and creative copy. Science has always been complex, and, to be honest, what is becoming more difficult is coming up with truly unique and simple creative ideas.

Techniques of persuasion have not and will not change. Customers make decisions based on a combination of rational and emotional reasons, and it is our job as advertisers to identify the insights that drive the decision-making process. The challenge today is in breaking through with truly innovative strategies. In hard economic times, tolerance for risk decreases. Thus, many pharmaceutical companies are falling back on old-fashioned communication strategies rather than embracing new ideas. Many conservative clients will not consider a program that does not already have a proven ROI. Meanwhile, no truly unique strategy has ever been tested. We often find ourselves in a Catch-22 of sorts: Our clients demand novel programs but will not fund initiatives that do not have a track record.

Kathy Magnuson: Clients’ expectations of their agencies have been fairly consistent over the years: “Partner with me and help me drive sales of my brands.” The way agencies executed against those expectations has evolved as other stakeholders have become involved in the discussion and shifted the focus onto newer media, executing with reduced budgets, changing the model for how work gets delivered, teams are staffed, etc. As the science becomes more complex and personalized, clients will have the right to expect that their agency partners will be well versed in the science, knowledgeable about their competitive environment and their customers, and will continue to make strategic recommendations that drive the brands to success. It is incumbent upon us as agencies to ensure we have the proper resources allocated against each business to deliver against that expectation.

Dudnyk: Certainly, pharmaceutical science is getting more complex, and the quick answer is for an agency to maintain a top-notch scientific department that can stay abreast of the latest innovations, and proactively keep agency staff ahead of the information curve. We have also found that everyone in the agency – from account service to creative to editorial and research – has to be savvier with the science, more in tune with increasingly complex therapies. And this has changed the type of candidates we choose to bring on board as associates.

What’s more, devising the appropriate messaging to a wider, yet more diverse audience is growing more complex as well. For instance, traditionally, communications about a pharmaceutical brand may have been mainly to a physician audience; but in a biotech, device, or combination therapy, the message has to be individualized for physicians, hospital staff, and various influencers and decision makers.

But by far, an aspect of the business that has grown increasingly complex to manage is the regulatory environment. Based on recent, unfortunate, much publicized events with pharmaceutical therapies, DDMAC has had to more strictly enforce standards. New drug claims are always scrutinized thoroughly, but now even data claims utilized in past communications for approved drugs gets a more critical review. This, in turn, increases the vigilance of our clients’ internal regulatory departments (and with good reason). Everyone has to be on top of his or her game.

Given the current financial scenario, we would suggest it’s more necessary than ever to be bold and assertive in order to build a successful brand, yet this complex regulatory climate is making brand building more challenging than ever. Ultimately, the answer will not be to cave in and make every brand campaign or image bland, safe and non-comparative; the answer will be to find new ways to aggressively communicate brand advantages in a challenging regulatory environment. That is the type of complexity we feel the most urgency to manage right now.