By Howard Brock
— Howard Brock is head of commercial models and local market strategy for Campbell Alliance. Additional contributors include Renee Selman, president, patient outcomes, Adheris Health; Andrew Aromando, executive VP, business development, inVentiv Selling Solutions; Jeanine O’Kane, managing director, Biosector 2; and Leigh Householder, senior VP chief innovation officer, GSW.
Every market is unique, making national commercial or regional strategies less than optimal. Instead, companies would benefit from a local market strategy that ensures customer-facing teams have the right framework, messages, tools, and training that make sense for their markets.
Through our work across the industry, Campbell Alliance and our colleagues across the inVentiv Health organization have determined that applying a local market strategy requires an integrated approach across the organization that addresses all of the unique functional needs of the different customers and influencers.
Local market strategy defined
Across the United States, many different healthcare dynamics can be found, including the high provider and payer concentration in cities like Pittsburgh, the influential academic medical centers in cities like Boston, the more active role of employers in managing their healthcare costs in cities like Seattle, and the strict restrictions on pharmaceutical promotions found in markets like Minneapolis.
A local market is a geographic area in which market drivers combine to produce a common business environment that affects patient care, prescribing behaviors, and reimbursement. A local market could be a city, a region, or a state, or it could be the sphere of influence of an organized customer.
A wide range of drivers and influencers exist, making each market unique. For example, markets experience varying levels of provider consolidation, while some markets may have more complex organized customers than others, including institutions, integrated delivery networks (IDNs) and health systems, physician groups, payers, and Accountable Care Organizations (ACOs). The expectations and demands of patients and the influence of government—such as Affordable Care Act (ACA) compliance or state promotional regulations—can also vary from market to market.
Finding manageable ways to address local market differences can be challenging. We have addressed this challenge by setting up local market archetypes that simplify the alignment of the different customer needs. One market, for example, may possess a high concentration of academic medical centers that exert a great deal of influence and control over the provider community, whereas another may have multiple academic centers that are influential but do not exert control. Another market may be influenced by the presence of ACOs or (or ACO-like) organizations, which, given their focus on quality metrics and controlling costs, will have an impact on the way physicians and hospitals operate and get reimbursed. As the industry shifts toward personalized medicine, targeted therapies could be relevant to a patient demographic common to a particular geographic market.
Boston, Minnesota, the Northwest, and Pittsburgh represent examples of markets that have more influential payers. Boston, Cleveland, and New York, meanwhile, can be characterized as markets with more influential academic medical centers. Miami, Atlanta, and Tampa are markets where physicians have had more decision-making power and organized customers are more open to partnerships. Archetypes like these, combined with additional market considerations and account, physician, and patient segmentations, form the basis for execution of strategies and tactics.
Application of local market strategy
Implementing a successful local market strategy requires companies to make changes across the organization. The customer model must establish partnerships with key customers and other influencers within the ecosystem of a local market. Roles, messages, tools, and digital solutions—as well as product access strategies and tactics—must be adapted for each market environment. And patient support and adherence solutions need to be aligned to local patient demographics and needs. Pulling all of this through requires companies to reconsider how they allocate resources and coordinate and train teams.
Establishment of customer partnerships
The ACA and the shift in payment models has increased the burden on providers, organized customers, and payers to manage challenging patient populations. As more and more institutions and health systems shift to pay-for-performance models, they are increasingly worried about patient populations for which they lack a solution to manage them.
Many of these providers, organized customers, and payers are increasing their openness to partnerships with pharmaceutical manufacturers to help develop solutions. Such solutions include a combination of quality programs, data generation partnerships, shared investments in patient support and adherence, and increased awareness and advocacy to improve public perception.
The issue of patient compliance will only grow in importance because adherence is critical to meeting outcomes metrics. Local markets that have an ACO (or an ACO-like) system or institution will likely be more open to creating partnerships to address challenging patient populations, such as diabetes patients. Creative patient adherence partnerships or solutions can be used to help manage these patients.
For instance, recognizing that health outcomes are affected not only by biological factors, but also by social risk factors and environmental settings, a pharmaceutical company could do a public-private partnership to identify at the community level those who are vulnerable to certain chronic illnesses. As the vulnerable populations are identified—based on local social, cultural, and economic determinants—preventive measures could be put in place or access to treatment provided to those who need it most.
Smaller ACOs and IDNs might be willing to partner with pharma companies to address adherence issues based on the unique market demographics. Areas with lower socio-economic levels, for example, tend to see higher non-adherence rates because people may not be able to afford their medicine. Resources may also be focused on areas with higher elderly populations. Demographics related to racial background are also important, as some conditions are more prevalent in individuals of a particular race.
Adherence strategies must be personalized, coordinated, and optimized. Pharmaceutical companies cannot afford to simply throw money into every available adherence program to see what works. Instead, an integrated adherence solution should be based on data and segmentation to personalize it to the patient. The outreach effort then needs to be coordinated to avoid overwhelming individual patients. With the full range of channels at a manufacturer’s disposal today—including digital messages, mail messages, pharmacy messages, etc.—the danger exists of creating a white noise effect. Finally, the effort needs to be optimized by tracking the data to see what works and what doesn’t work in a given market or patient segment and efforts redirected accordingly.
Flexibility of customer-facing roles
Typically, companies will resource uniformly across the US, deploying the same amount of resources in Seattle as in Pittsburgh or Oklahoma City relative to some scale, such as market volume or market potential, number of prescriptions, number of doctors, or number of patients. In a local market strategy model, pharma companies need flexibility to be able to adjust their customer facing roles to a constantly changing marketplace.
With differential resourcing, the archetypes serve as a starting point that can then be customized through local market knowledge and planning. In a geography that is payer dominated, where doctors do not drive decision making, it would make sense to deploy fewer personal, customer-facing resources than in a market where prescribers are still the dominant decision makers.
Commercial outsourcing can facilitate differential resourcing by allowing pharma companies to easily on-board different customer-facing resource profiles that align to a particular market archetype. The ability to quickly scale up or down with the right resources provides an organization the flexibility to take advantage of a particular opportunity or mitigate the risk of a negative event. For these reasons, commercial outsourcing is thought of in much broader and often strategic terms.
Customization of marketing messages and tools
When implementing a local market strategy, tools and messages will need to be customized based on the dynamics in the local market. Messages in markets with tighter reimbursement, for example, might be more reimbursement focused, while in areas where physicians can make clinical decisions, the messages will be more focused on clinical information. Patient support messages will be applicable in markets where limited patient support has been established.
Innovative new technologies and digital channels are opening the door to new forms of customization and outreach. Consider a market archetype in which an organized customer has a treatment protocol over a set of affiliated physician offices to which a pharma manufacturer does not have access. In this instance, media opportunities as well as peer-to-peer communications could offer a solution.
From a media standpoint, improved targeting technologies are able to identify likely physicians by their geography so that when a physician is engaged in healthcare information in the New York Times, for example, it is possible to identify the individual as a physician and serve up an ad property or marketing content that might be relevant in that moment.
Alternatively, as physician-centric social media networks grow in popularity, it is possible to identify local market influencers within those online communities. It may be possible to identify individuals by specialty or patient type who are truly influencing their peers in those affiliated organizations online, opening the possibility of creating digital ad boards or feeding content via the emerging thought leaders.
Another market archetype may be characterized by a fragmented patient base, such as Miami, where the large Hispanic patient base receives fragmented services. A potential innovative solution may be to offer an opt-in text messaging services providing health education specific to an individual’s needs. This information can fuel improved conversations between doctors and patients, helping patients better understand the elements of their own care and improve their overall outcomes.
While we have observed many companies execute portions of the integrated local market strategy, examples of companies that have optimized their innovation through a fully integrated strategy are rare. By designing a local market strategy and pulling it through via an integrated approach, companies can establish trusted partnerships that change their perception within key customers, patients, and other stakeholders. medadnews