Payer Access Special Feature: Different diagnosis

To reach payer audiences, companies have to focus far less on promotional tactics and show the value of their products.

 

As physicians play less of a role in drug choices for patients, and payers more, pharma companies – and the agencies that serve them – have found themselves shifting their tactics away from the promotion-voiced campaigns aimed at doctors. It’s account managers, not the sales reps, who hold sway with this audience. And meetings with payers come as infrequently as once yearly, not the every week, two weeks, or monthly that reps meet with physicians.

What do payers want?

So how do companies reach payers? Just like physicians, payers want information about the drugs companies are promoting. But the kind of information they want differs.

According to Danielle Bedard, managing director, inVentiv Health Managed Markets, whether the campaign is aimed at the physician or the payer, it’s important to have a consistent brand story. “You want to make sure you have a consistent brand story, that you’re communicating as one brand regardless of the audience,” she says. “But there are certainly differences between what will resonate with a payer versus what will resonate with a physician, and the campaign has to be based on their frame of reference and their goals.”

“It’s certainly important to look through the optic of a payer versus that of a physician, and understanding what are their important drivers for making decisions, what are the challenges and barriers, and what are their unmet needs,” says Gregory Novello, senior VP, strategy, at McCann Managed Markets. “Their optic is starting to overlap a little bit more with physicians than in the past, but they look at the economic much more than a prescribing physician would, although those lines are starting to blur as physicians take on more accountability for cost of care.”

Messages of safety and efficacy resonate across all audiences, Bedard says, but payers are going to be considering the impact to their plans in terms of overall costs of care and similar factors.

Ben Curtis, senior VP, director of integrated and strategic services at inVentiv Health Managed Markets, points out the teams at pharma companies that serve physicians and payers are different. “For physicians, you have sales reps, for payers, you have account managers, they have different tools that they use,” Curtis says.” A lot of times, when we think about the information that is provided to the two different audiences, all of them don’t apply. For example, we can talk to physicians about convenience, how a product may be more convenient for a patient and therefore they are more adherent.

“But that whole convenience story doesn’t necessarily resonate with a payer, because there may be a product that’s three times a day instead of one time a day, but costs half the amount. You’re really talking as more of a banker and more financially focused, so you either have to turn that story into something that resonates with them, or leave it out of the equation completely.”

Daniel Sontupe, executive VP of payer strategy at The Bloc Value Builders, The Bloc’s managed markets division, says the diversity of the managed markets audience makes its information needs very different. “Today, managed markets is a huge class – you’re not just talking about managed markets organizations like health plans or a prescription benefit managers, now you’ve got group purchasing organizations, you’ve got really large practices that run like businesses. You have integrated delivery networks, combinations of physicians and hospitals, and in some case, insurers. All of these different types of organizations have to look much deeper than efficacy and safety.”

At The Bloc, managed markets communications are examined through what the agency calls the “triple aim lens,” Sontupe says.

“What ‘triple aim’ is, and it’s really come to light through the Affordable Care Act, it’s three parts of a triangle,” he told Med Ad News. “The first part of the triangle is patient experience. So when you’re talking to health plans or these organized groups, these managed care organizations, you have to make sure you impact their member experience. What’s happening with that patient? Is it smooth? Is it simple? How does the patient respond there, because that’s very important to the provider component, the integrated delivery networks, the large hospital systems. Those organizations make money by providing a better patient experience. So that’s one angle we always look at. … We have to help drive population health outcomes. What does our product, or our programs with the product do, to help impact the population? What can we do more to impact the population? And then finally, it’s about net costs.

“So those are the three sides of the triangle: patient and member experience, population health outcomes, and net costs. What we want to do is position all of our communication materials, all of our campaigns, around that ideal.”

Bedard says when developing launch campaigns aimed at payers, the emphasis is on the overall value a therapy can provide, especially in terms of an unmet need.

Novello agrees. “The thing that takes on more prominence with a payer, at least to me, is making sure the brand can clearly establish an unmet need in terms of value to the payer, and that’s of value to their members and their provider network,” he says. “And what I mean by value is all the benefits of the drug, and hopefully differentiated benefits, in terms of clinical, divided by the cost.”

Highly differentiated and beneficial products are viewed more favorably than me-too products, he says. “They’re looking from a cost perspective to see what the impact would be on their budget as well.”

Patient experience is particularly important in the Medicare Star Rating System Program, Sontupe says. “Patient experience is included as one of the guiding principles as to whether or not some of these organizations will get paid,” he says. “So you’re absolutely looking to make sure that these patients have a positive experience, that they don’t walk around going, ‘I hated this,’ or, ‘I didn’t get this service,’ or ‘No one explained it to me.’ You want to be able to explain what is happening, why it’s happening, and really make it as understandable as possible, which is why health literacy becomes very important, and why these organizations need to focus on making sure these patients understand what’s happening, what to talk to their physician about, what to talk to their insurer about, and how to do that.”

Novello stresses the importance of talking about outcomes with payers. “You have to make sure there is outcomes evidence available for what you’re trying to prove about the drug,” he says. And when payers want to talk about outcomes, they want the results for an entire population – say, overweight patients with type 2 diabetes. “They want to know what specific patient population this drug should be used in,” Novello says.

Physicians, on the other hand, often want to know how an individual patient can do on a medication. “The physician will make a product choice based on the needs of the patient in front of them,” Sontupe says. “These larger organizations need to think about what the overall best choice is for all of their members.”

This means emphasizing “the economics side,” Curtis says. “You have to tell an economics story based out of that clinical story.”
At inVentiv Health Managed Markets, the agency uses value-active decision models, which allows the agency to show a payer how a clinical property of a product can help save the plan money, Curtis says.

But despite the emphasis on cost, there always has to be a scientific side to the message, Sontupe says, adding, “A lot of times it’s a physician, or at least a clinical pharmacist, making some of the coverage decisions for a drug.

“But what we believe is that if you are looking for how to position your product with the physician, it’s all about the brand or the drug. With the health plans and these organizations, it’s more than just the brand, it’s about how do you surround that brand with better services that are going to make people stand up and say, ‘Yeah, I am getting more value out of this now.’”

Shaping the message

When it comes to communicating with payers, the call cycle with a payer is very different than that with a physician, Bedard says. “You’re going to have less frequent meetings with a payer, so those meetings tend to be longer, and you’ll tend to be able to cover more content than a sales rep having a very quick meeting,” she says.

At the same time, in addition to live meetings, there is a need for nonpersonal communications because the account management teams are small and there are many payers to cover, Bedard says. This can take the form of e-mails or websites tightly tailored to payer information needs.

InVentiv Health Managed Markets has done research on the ways payers prefer to be communicated to. “What we’re seeing, from a topic perspective, is there are very specific things they [payers] want in very specific channels,” Curtis told Med Ad News. “The average account manager meeting is an hour long, with 45 minutes actually occurring. In those in-person conversations, they’re very much looking for the full value proposition of a brand and all of the different elements that can go into that economic and clinical story.

Novello and Karen Shoshan, VP, director of client services at McCann Managed Markets, emphasize that the account managers are most likely meeting with a payer about once a year and need to bring a lot of information to the table.

Account managers are using things such as PowerPoint much more, because they are giving full-fledged presentations to groups versus individuals, Curtis says.

“We’re also seeing from a nonpersonal perspective, when you look at the big four – journal ads, e-mails, search, and display banners – we’re really seeing from a percentage perspective, about equivalent engagement,” he says.” “If you think about clickthrough rates on an e-mail, on a banner ad, on the campaigns we run, some of our goals are around getting the percentage of the audience we’re targeting to the same clickthrough rates as we’ve seen on the physician side. So the same channels are effective, just pulling out the short-form communication and into a presentation format.”

Because payers want just the facts, with an emphasis on cost and economic value as well as clinical value, campaigns have to be well removed from the promotional voice mindset. In fact, there are those among the agencies that exclusively serve managed markets who prefer not to call the presentations they put together for managed care account managers “campaigns.”

“We rarely use the word ‘campaign,” Shoshan says. “One of the ways that we’re distinguished is a business-to-business type approach to marketing.”

“You can certainly say ‘campaign’ if there are multiple tactical elements,” Novello says. “But typically when you look at a campaign, there’s a big creative theme to it that matches back to the essence of the brand. It becomes a little bit different on the managed markets side, when you go to payers, you certainly want to align to the key elements of a brand, but it becomes more of a business-to-business sell.”

“Campaign” is a highly promotional word, Shoshan says, but there can be some room for creativity. “It’s something we give great thought to at McCann Managed Markets, finding the right blend in copy and art to create awareness, but not enough to turn off a payer because it’s highly promotional or overly designed. Payers are known for saying that they don’t want to see anything overly flashy or overly produced.”

According to Novello, “I think the other thing is [what is produced for payers] needs to align to the overall creative of the brand, but it needs to be done in a way that’s relevant to that audience. It’s not as simple as you take the professional campaign and slap that on all your programs and give that to the payer.”

If you compared a piece aimed at physicians and a piece aimed at payers side by side, you could detect that each item originates from the same place, “these things live together as part of the brand,” but the payer piece will be different, Novello says.
Payers are communicated to in more of a business-to-business fashion rather than “straight flashy advertising,” Novello says.

“The marketing message that you would see in a launch brand’s journal ads, we wouldn’t put anything like that in front of a payer,” Shoshan says.

Ultimately, in messages aimed at payers, “It’s all about accountability, it’s all about the quality of the outcomes that are received at the end of the day, in a cost-effective manner.”

Measures of success

When it comes to evaluating the success of programs aimed at payers, it varies for every brand, Novello says. “The brand will come up with goals that they want in terms of coverage and access on formularies,” he says. “Optimal coverage, which does not just mean covering the drug or the medicine, but also having the least amount of utilization restrictions on it. However the brand or the pharma company defines optimal coverage, that’s what it would be measured against.”

For the 2016 Manny Awards’ first-ever Best Managed Markets Campaign category, the winner was the program that The Bloc Value Builders produced to support the managed markets and patient marketing teams at Regeneron as part of their non-branded patient activation program. Regeneron markets Eylea for the treatment of diabetic macular edema.

The program encourages people with diabetes to get a comprehensive dilated eye exam at least once a year. Campaign components include a burden-of-disease presentation for account directors and a toolkit for case managers. The program was specifically designed to conform to the HEDIS measures from the National Committee for Quality Assurance, a private, not-for-profit organization dedicated to improving healthcare quality. There are seven HEDIS measures for diabetes that healthcare plans get evaluated on. One of these is having patients get a dilated eye exam.

“What we found is that the measure that health plans do the worst in for diabetes is getting patients to get that dilated eye exam,” Sontupe says. “As we peeled back the onion we learned that in type 2 diabetes, there is very much a disconnect between physician and patient. Physicians say, ‘I tell my patients to get their eye exam.’ Patients say, ‘I never heard my doctor tell me to get my eyes checked.’”

The conversation really entails the doctors overwhelming patients with the bad news about their blood glucose numbers and chastising them for not eating properly, so that the message about getting an eye exam is lost in the shuffle, Sontupe says. But diabetic macular edema remains a huge issue, as the condition can lead to blindness.

“What we did, in working with Regeneron and their managed care/market access marketing team, is we built a program to educate about the quality measure, so the health plans would understand that, and give the health plan tools to communicate the importance of getting the dilated eye exam directly to the patient, but also give the health plans tools to push back to the physician,” Sontupe says.

Since these health plans all have case managers who are communicating with diabetes patients – because the diabetes patient is the most expensive patient in a health plan, as they have many co-morbidities – The Bloc and Regeneron also built tools for case managers for when they reach out to a patient with diabetes, to educate about eye exams.

The case manager program went forward at the same time Regeneron’s physician and patient support programs were launched. “We wanted to make sure we hit from all angles,” Sontupe says.

According to Regeneron’s Emmanuel Harmon, associate director, market access strategy, and Bryan Conner, associate manager, market access strategy, the program is working because insurers and health plans have an interest in getting patients to have a dilated eye exam.

“We identified here that there is an opportunity here, for patients and for payer, to move the needle on that dilated eye exam rate,” Harmon says. Although the eye exam program is aimed at case managers, it also contains tools for physicians.
The program is ultimately aimed at patients, to provide them the tools along the patient journey, Harmon and Conner say. They are educated about what the eye exam results mean and the importance of identifying diabetic macular edema early.

“Together, all the assets in this program can be executed by a payer to their member population and to their physician network,” Harmon says. “We just kind of packaged it all up to give to them, ultimately, the payer needs to deliver it to their patients, but we did all the heavy lifting and all the legwork behind that educational material.”

Conner says the reason why Regeneron approached payers with this program is because more than ever, payers are responsible for delivering quality care to their member population. “And that’s not just through the way HMOs or payers used to do things traditionally,” Conner notes. “Now they’re being scored in terms of quality metrics, and they are juggling a lot of different disease states with a lot of different metrics they have to hit. This was one opportunity for us to take a little bit of the burden off of them and offer tools to them to deliver out to their member population.”

Harmon says because this program focused on the payer audience, it was not a branded program in support of Eyelea, and “it’s really geared on trying to provide education and promote quality.”

“All of the messaging and all of the presentations that accompanied this program has a very strong focus on the patient’s well-being,” Harmon says.

A program aimed at physicians would have more emphasis on the benefits and safety and features of the product, he adds.
One thing Regeneron learned from the experience is that patients with diabetes often have other eye co-morbidities, so the program may be expanded beyond diabetic macular edema to conditions such as cataracts, glaucoma, and diabetic retinopathy, Harmon and Conner say.

Regeneron does not yet have measures of how the program has increased the number of patients with diabetes getting dilated eye exams, since the HEDIS scores will not come out until February 2017. But Conner says when he attended a regional health insurance conference in Alabama, “We had such a crowd around [our booth] that it was just unreal.”

“The need for a program like this, especially in that area where there is a high prevalence of diabetes, we were told by case managers that they have a ton of resources about diabetes in general, but there has been a gap with the eye-related complications associated with diabetes,” he says.