Healthcare Agency Roundtable 2019

 

Executive management from the 2019 Manny Award agency and network winners & finalists provide expert insight on healthcare industry topics and predictions.

 

1) Med Ad News: As Democratic presidential candidates debate the plausibility of “Medicare for all” and other health insurance program ideas, the Trump Administration says monthly premiums for an average 2020 Obamacare health insurance plan will fall about 4 percent from 2019. Where do you see the U.S. health insurance industry heading?

Andrew Gottfried, President, Entrée Health: The key shift happening now in the US health insurance industry is the movement from volume- to value-based care. Defining value for payers, providers and patients – and aligning payments to measurable, meaningful value metrics – are a priority for US healthcare stakeholders. It’s important to understand that increased healthcare utilization (and healthcare spending) does not represent better population health. People don’t want more healthcare – they want more health. To that end, the industry, including many national private payers, are focused on addressing the social and economic determinants of health, which experts agree make up a majority of patient health influences. This is an issue of access – to healthcare, no doubt, but additionally to healthy food, social support, education, transportation and many other factors that contribute to the overall well-being of a population.

“Medicare for all” is a catchall term that can signify several different approaches to insuring the US population. While the underlying principle is that all citizens would be insured, the mechanics, and financial feasibility, of implementing such a system in the US remain unclear. The big question around “Medicare for all” is funding; even if we could get through the obstacles to implementation within the current system, experts estimate costs on the order of $30 trillion to pay for such a program. What is the nation willing to trade-off to invest that much in healthcare?

Daniel Sontupe, Managing Director, Associate Partner, The Bloc: While we can’t know the future of the US health insurance industry, we do know the present is extremely profitable. The top medical insurers reported massive profits in 3Q19, with United Health reporting more than $5 billion. What will the future bring? The Kaiser Family Foundation recently reported that a majority of Americans want a single-payer system. Is this feasible? What would happen to the economy if health insurance companies were no longer needed? Do Americans really understand what “Medicare for all” actually entails? In theory, the principles behind “Medicare for all” are wonderful. See any doctor, no one is denied coverage, no copays, no coinsurance (which is different than Medicare, since Medicare B today pays 80 percent). You need supplemental insurance to cover the rest. More importantly, do we really think our partisan political environment will ever lend itself to healthcare compromise? The future of healthcare is not Medicare for all, it’s in creating a government-incented environment in which all care providers are aligned in working towards the same goal – delivering and driving better health outcomes for a fair price. Insurers with the profits reported above should be held accountable to create adherence programs. Pharma manufacturers should be incented to provide rebates based on aligned value objectives and outcomes. Hospitals should be rewarded for executing regional programs to keep patients out of the hospital. Today, there is so much regulation preventing healthcare stakeholders from working together. It’s time to create legislation that mandates all stakeholders align to provide the best care.

Kristi Veitch, EVP, Human Resources, Intouch Group: Given the current political climate, it’s unlikely that we will see much change anytime soon, despite the platform on which any political candidate may be running. The Obamacare reforms are delivering as promised (if not better), and none of the candidates offering “newer/better” options has yet laid out in detail how their plan(s) would be funded without major disruption to the current system. This could end up backfiring on existing Medicare recipients and providers, as well as the candidate.

Kristen Roeckle, SVP, Managed Markets, Concentric Health Experience: The big themes in healthcare as we enter 2020 will continue to circle around costs to the system and affordability for patients. For the aging population, chronic conditions will need to be managed for longer periods. For millennials, health/wellness/mindfulness has become a pillar of everyday life, and costs associated with it are at an all-time high for this age range.

Affordable healthcare for all Americans is an ideal state, but the way that we get there will be a challenge. It will be costly, and the most obvious way to pay for coverage will be an increase in taxes or to lower the cost of care. While regulation could make medication and health services more affordable and accessible, the system we are working within is monstrous and lacks flexibility.

Seth Gordon, General Manager, EVERSANA: I’d like to break my response into two parts: Medicare for All and US health insurers.

Regarding Medicare for All, based on discussions with our policy leads – including Dr. Richard Stefanacci and PharmD Matthew Pakizegee – we see this as highly unlikely for a variety of reasons, one being the fact that employer sponsored health insurance has been the main way Americans have secured insurance coverage since 1945 – through tax incentives to employers who provide this benefit. Many employers’ plans have shifted costs to employees due to increased premiums each year, however, premiums have stabilized over the past 2 years, and in addition, as you note in the question Health Insurance Exchange polices have seen a decline in premiums. This recent change will make it more difficult for “Medicare for All” to get through the Senate even after 2020.

Even without Medicare for All, government spending on healthcare will increase through some expansion of Medicare and Medicaid. So, the government will have a larger role in healthcare and in providing care to specific populations including specific diseases. The interesting change that might result from the “Medicare for All” debate is the potential for a Medicare or Medicaid expansion into specific diseases, similar to Medicare coverage for patients with ESRD or ALS resulting in a ‘Medicare for More’ for those with rare diseases.

To protect their position, the US health insurance industry is morphing from payers to ‘payviders’ – where the payer and provider are one. Multiple examples exist demonstrating this shift from CVS’s acquisition of Aetna with its Minute Clinics, to UnitedHealth Group’s acquiring of DaVita Medical Group. Insurers will survive but potentially in a much different form.

Johanna Melendez, PharmD, VP, Strategic Planning Director, & Madhav Namjoshi, PhD, MBA, SVP, Strategic Planning Director, Mosaic Group, an FCB Health Network Company: Our healthcare delivery and reimbursement system has been criticized for inefficiencies, high costs, and gaps in coverage for many Americans. Today, more than 30 million Americans still do not have health insurance and even more are underinsured. Approximately 149 million Americans are on private insurance and stand to lose it if they lose employment.

The single-payer Medicare-for-all system proposed by Democratic presidential candidates Bernie Sanders and Elizabeth Warren aims to address these issues and would cover all 325 million Americans. An important aspect of this plan is the gradual phaseout and complete elimination of commercial private insurance. This would decouple employment status and health insurance coverage for thousands of American families. If a single-payer Medicare-for-all system is established, individuals and families would not lose their health insurance after a job loss.

However, implementation of this program is expected to cost taxpayers at least $20 trillion and will require an increase in taxes. Senator Warren has indicated that only one-tenth of the top 1 percent of wealthy Americans and large corporations will see an increase in taxes, the average middle-class family will not see a tax increase. She argues instead that the wages of middle-class workers are likely to increase since the health insurance costs that employers cut today will no longer be cut from their paychecks. Senator Sanders, on the other hand, has agreed that taxes for all Americans are likely to increase. The Congressional Budget Office has not given an estimate for the proposed Medicare-for-all system because there are too many unknowns at this point.

Dissolution of the private insurance industry is such a radical change that it is still being debated by the larger field of Democratic presidential candidates and would be a long shot for passage by both the House and Senate, given the current political climate.

More likely is that the insurance industry will have to work with a compromise that may redefine how they manage health benefits – similar to the way they needed to adjust when Medicare Part D was enacted. In fact, there are many proposals being put forth by the administration, members of Congress, and even the insurance industry that are focusing on the reduction of members’ out-of-pocket costs.

Some insurers have already started creating programs that offer more cost transparency and cost reductions for consumers, for example, the CVS ICER-influenced formulary, point-of-sale rebates, and Haven – the Amazon/JPMorgan Chase/Berkshire Hathaway healthcare venture.

We believe that there will be a continuing role for a private insurance industry in the U.S., but that it will look different from today. It seems clear that “business as usual” will not prevail. The call for healthcare reform is too widespread across both political parties and throughout the population. Insurers are exploring various models of coverage and care delivery to address this call for change. A winning strategy – or strategies – has not yet emerged, but we are confident that we will see continuing innovation from the private sector.

 

2) Med Ad News: Critics say advertising and public relations are driving the teen vaping epidemic, that marketing is the root cause (present company excluded, of course). How are health and advertising leaders going to successfully tackle the e-cigarette and vaping issues moving forward?

Jennifer Matthews, CEO & President, The Bloc: This is a significant challenge as the epidemic is widespread. Once a behavior or a fad takes root in teen culture, it can be difficult to stop it. That being said, the first step should come from the government in terms of regulating the e-cigarette industry. This is a public health crisis and these devices should be studied, evaluated, regulated, and perhaps banned from use in anyone under the age of 18, at minimum. We simply need to make them much harder to obtain. From a marketing point of view, regulators should aggressively move to cease all promotional efforts across paid and earned platforms. Juul’s agreement to greatly limit social media promotion in November of this year is, frankly, too little, too late. Given their success in engaging teens via social media to drive sales, they should be required to leverage that expertise to engage teens in effective education on the dangers of e-cigarette use. This should be amplified in partnership with national and local health and education groups to create an effective movement to end teen use. Given how rapidly this epidemic has evolved, there is urgency to act swiftly.

Deborah Lotterman, Chief Creative Officer, precisioneffect: By the time this issue hits the desk of medical marketers, how many more deaths will we have seen? How many more teenage lives pushed off course? A friend of my 17-year-old daughter wound up in the ER with a collapsed lung. But he’s not sure he can stop. Vaping is a pernicious health crisis – more dangerous every day than the domestic terrorism that has our children doing drills with their hearts in their throats just as our grandparents practiced duck-and-cover to “protect” from a nuclear attack. Health and advertising leaders should be on the right side of this, which is to be a strong voice in the effort to outlaw vaping products for nicotine for teens. And yes, let’s see the same leaders pressing for reasonable gun control.

Nick Rhodin, Managing Partner, Strategy, Sound Healthcare Communications: It’s shocking to me, as someone who watched my grandmother – a lifelong smoker – die of lung cancer, that the FDA allowed promotion of e-cigarettes and vaping to teenagers using the same tactics that big tobacco used for almost 80 years. Scare tactics have largely been ineffective in stopping smoking. In fact, many studies have shown that fear actually increases smoking among teenagers. The more outlawed and illicit the product becomes, the more attractive it is for teenagers who feel indestructible and rebellious. However, social norming and cost pressures have decreased cigarette smoking dramatically. For me, the advertising and public relations industry has a unique opportunity to get us out of this problem by using behavioral science and effective disease state education. Any new campaigns need to highlight that vaping makes people look uncool, associate it with dirtiness and social ostracization, and drive up the price dramatically through taxes.

Deb Deaver, CEO, Patients & Purpose: As an industry, when we have the opportunity to wrap our passion around a cause, we change behavior through heart-pounding, media-grabbing creative. To change the e-cigarette and vaping issues moving forward we need to put ourselves and teen activists, themselves, in the epicenter of the issue and educate rather than pontificate in social circles about the dangers. As advertising people, friends, siblings, parents, and loved ones of teens, we have the talent to create social, experiential, and influencer-glomming work. We can create an unstoppable platform for teen activists to influence other teens. And doing this would not only be truly purposeful work, it could change a generation.

(Stat: “From 2017 to 2018, current e-cigarette use – defined by use on at least one day in the past 30 days – by high school students increased 78 percent…” https://www.fda.gov/tobacco-products/youth-and-tobacco/2018-nyts-data-startling-rise-youth-e-cigarette-use)

 

3) Med Ad News: Organizations such as AARP and other prominent advocates support the recently introduced House bill H.R. 3, the Lower Drug Costs Now Act of 2019. Proposed benefits of the bill include lowering prescription drug prices by requiring Medicare to negotiate drug prices, cracking down on drug price increases, and capping out-of-pocket costs for seniors with Medicare Part D. While chances of passage for the bill (which will likely be revamped) in the Democratic-controlled House appear optimistic, the bill faces a hard road in the GOP-controlled Senate. Are we on the right track here in the continuing attempt to appease the many drug pricing critics, or do you have suggestions for a different route?

Wendy Blackburn, EVP, Marketing & Communications, Intouch Group: The drug pricing fight is not going away, and in fact we are likely just getting started as we approach a presidential election year. A number of different price reduction methodologies have been proposed at national and state levels – from drug price shaming via DTC, to drug re-importation, to suing manufacturers, to price negotiations and other parameters outlined in House bill H.R. 3 and beyond. No matter how it happens, the need to reduce drug prices appears to be the one issue that both U.S. political parties can agree upon.

For all the many approaches and proposals, I am not convinced we’ve explored all the potential solutions to this complicated problem. For example, the once-obscure “quality-adjusted life year” or QALY model, has been used in different variations in other countries such as Canada, Ireland, and the Netherlands for years. Using a complex algorithm, the model essentially calculates the value of good health. Recently it’s been gaining traction in the U.S. and has been credited for helping keep the price of newly-launched drugs such as Aimovig and Zolgensma lower than what was predicted.

At the heart of the drug pricing issue is a question that Americans have traditionally been squeamish to answer: How much is our health – our life – worth?

But, under pressure we’re now seeing companies consider – and in some cases voluntarily adopt – their chosen pricing based on this model.

Whether it’s the QALY model, an adaptation of it, or something else, I’d like to see the industry come together and discover the proverbial win-win solution itself. Because if it’s left up to our dysfunctional government to do so, I don’t expect the solution will be something that’s best for pharma and, indeed, for patients in the long run.

Kristen Roeckle: The Lower Drug Costs Now Act of 2019 is a necessary response to the public outcry regarding drug price and affordability, but many are skeptical about its passing through Congress, and subsequently about its ability to create a change in the disparate health system.

CMS is not currently able to negotiate their own price for medications, but if they were, one might assume that their massive leverage would force manufacturers to decrease costs. The potential for lower prices via CMS negotiation could benefit the commercially insured, as we often see trends start with Medicare and trickle over to commercial. The opposite might occur as well. All of this considered, the overwhelming concern in the market – the price of specialty, rare disease therapy, gene therapy, and oncology, etc – is not mitigated by this act.

Daniel Sontupe: Once again, the government focuses on quick fixes instead of creating solutions. Sure, lower drug costs are a great idea. But why? Are drug costs the reason healthcare costs are out of control? In a recent analysis of National Health Expenditure Accounts (NHEA), Rx drugs represent between 10 percent and 12 percent of healthcare costs between 2000-2017 and is projected to remain at the same level for the next 10 years. (source: https://www.healthsystemtracker.org/chart-collection/recent-forecasted-trends-prescription-drug-spending/#item-rx-spending-as-share-of-total-health-spending_nhe-projections-2018-27)

Yet our drug discoveries have cured hepatitis C and forms of blindness, driven overall survival rates in cancer, and improved cardiovascular care. In fact, the largest driver in maintaining drug costs is utilization. Because we have created drugs to treat chronic conditions, people live longer and therefore, take drugs longer. Additionally, drugs that cure a disease have a limited life cycle; therefore, pharma must charge a high cost to ensure it is worthwhile to invest in discovering them. So if drug prices are not driving healthcare costs, why aren’t we looking at other drivers? Is hospital pricing correct? What about insurance premiums? Why isn’t Medicare negotiating with every provider for the best price in every situation. Candidly, the issue should not be about drug price; it should be about drug value and ensuring products with value are used and that patients receive the proper support to help them comply with and adhere to treatment, as well as prevent the need for other higher cost treatments like surgeries. Instead of cutting the cost of drugs, how about providing patients with an incentive for taking better care of themselves and becoming active participants in their healthcare? Incent them for taking their prescriptions appropriately, incent them for participating in preventative programs, incent them for being active participants in their health. These simple incentives could go a long way for using the incredible profits generated by health plans.

Andrew Gottfried: It’s important to put the drug pricing debate in the context of the healthcare system as a whole. Prescription drugs represent about 15 percent of total healthcare spending in the US in the latest estimates. According to a recent JAMA paper¹, complex billing and coding processes make up the largest share of waste in US healthcare spending. Unfortunately, not many policies are focused on eliminating the unnecessary (or low-value) processes that present significant barriers to patient access to high-quality healthcare. We support efforts to increase patient access – including addressing patient affordability, reducing process burden on providers, and clearing administrative hurdles that get in the way of delivering better care and improving population health.

¹Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System: Estimated Costs and Potential for Savings. JAMA. 2019;322(15):1501–1509. doi:https://doi.org/10.1001/jama.2019.13978

 

4) Med Ad News: What healthcare topics would you would like to see addressed by politicians on the 2020 campaign trail?

Sharon Callahan, Chief Client Officer, Omnicom Health Group: I’m certainly not alone in wanting to know how each candidate would address rising medical costs, surprise hospital bills, and high prescription drug prices. But there are a few particular topics I’d like to see brought to the forefront of this conversation – things that need to be addressed when we talk about changing the healthcare system. Here’s what I’d really like to ask the candidates:

1. If the ACA is repealed in its entirety, as the Trump administration proposes, what is your specific plan for keeping private insurance companies from discriminating against people with pre-existing conditions?
2. How do you propose to fix the short-term plan loophole so that healthcare exchanges are not destabilized?
3. What’s your plan to ensure that everyone gets access to insurance, especially the poor?

Christopher Tobias, PhD, President, Dudnyk: Various healthcare topics are commonly highlighted, presented, and debated during a presidential campaign cycle. Topics emphasized during the current presidential campaign include how to best cover the 80+ million uninsured or underinsured in our country; how to better control healthcare costs; ways to increases levels of research and development in key therapeutic areas; and ways to attack the horrific opioid epidemic in our country.

One topic that deserves greater emphasis, I believe, is the implementation of universal genetic screening. The ability to sequence our genome, through whole genome sequencing or exome sequencing, is mesmerizingly powerful. What once took years, thousands of people, and hundreds of millions of dollars, can now be done in a few days and for a few thousand dollars. The speed and cost reduction of genetic screening is not even the most important point; of greater importance it is the powerful insight it has into our genome, which, by identifying thousands of genetic diseases, will help lead to improved patient care and treatment, and also to the next wave of therapeutic intervention. Technology often moves much faster than policy or regulation, but the possibilities of how genome sequencing can improve diagnosis, treatment, and overall patient outcomes is endless. We are now in an age in which cost should not prevent patients and families from receiving this technology, especially when more than 7,000 known rare diseases could be identified due to genetic variations that lead to disease manifestation. Yes, privacy protections for patients need to be in place, and appropriate use of genetic information needs to be ensured by healthcare insurers. Still, allowing this incredibly powerful diagnostic tool to sit idly by, with limited use is, in my opinion, unethical. My hope is that our presidential candidates will soon highlight this amazing genetic breakthrough and champion its implementation as well as promote the importance of providing adequate and responsible healthcare coverage for everyone.

Cora Meese, EVP, Director of Client Services, Entrée Health Princeton: I’d love to take a few steps forward in the conversation on pricing transparency. Clarity around costs for drugs and for medical procedures would benefit patients, physicians, overworked and over-stressed medical practice and pharmacy staff. While we clearly can’t immediately leap to “It should be like shopping for a car!” (which, not exactly the paradigm I’d aim for), I would love to hear some debate on costs and copays that make the picture clearer for patients. We’ve been talking about patients-as-payers for years now, let’s see some honesty on all sides and broaden the conversation to make the journey easier to understand.

Eileen Yaralian, EVP, Director of Strategic Services, DDB Health: So much of the focus in terms of healthcare discussion has been around the cost of drugs and ensuring healthcare for all. These are extremely important topics, because innovative medicine is only impactful if those who need it most can access it. One topic that, in my opinion, does not receive nearly enough attention is the inefficiency in our healthcare system. A huge portion of total healthcare spend is for the care itself, not for actual treatment.

According to the CMS (Centers for Medicare & Medicaid Services), prescription medicines account for just 14 percent of overall healthcare spending. Other hospital, physician, and nurse services accounted for the rest. In fact, the cost of overall healthcare services grew at 10x the rate of the growth of drug costs in 2017.

Many of us in the United States have the freedom to seek treatment from different physicians and institutions and get second opinions when needed. This is important as we empower people to be advocates for their own healthcare. The problem though, is that diagnostic findings and treatment records are still not being shared sufficiently across healthcare providers. The vast majority of hospitals in the United States are now using electronic health records, yet they all hold their discrete platforms with little or no communication across institutions. The lack of continuity of care is leading to redundancies in the process, driving up healthcare costs tremendously. I would like to see strategies to reduce these inefficiencies in the process and as a result, reduce overall healthcare spending.

Joseph Sklar, Chief Medical Director, Concentric Health Experience: An aging US population has resulted in a substantial demand on our overall healthcare system. As such, healthcare financing is one of the most critical policy issues that demands our attention. In recent years, wonderful medical advances have been made in numerous diseases. We need to ensure that all patients, particularly the generation that raised all of us, have access to these transformative therapies without fear of bankruptcy.

 

5) Med Ad News: As pharma companies and drug distributors continue to reach opioid settlements with U.S. states worth billions of dollars along with donations of millions of dollars in free medicines, are these companies (which deny any wrongdoing) shouldering too much or not enough responsibility/blame for helping fuel the opioid crisis with aggressive and misleading marketing campaigns that overstated how effective such drugs were for treating chronic pain and understated the risk of addiction? And as these settlements play out, what happens with continuing efforts to resolve the national opioid crisis heading forward?

Kristen Roeckle: With pharma at the helm and a broken system behind it, we have found ourselves in the midst of an epidemic. While it is refreshing to see pharma assume accountability, there are also other stakeholders that share in the making of this perfect storm. Health systems, administrators, medical schools, EMRs, pharmacists, patients, caregivers, payers, etc, are all negligent, and failed to alter the course of this social epidemic at various points. That said, during a crisis there should not be pointing of fingers, as blame will not bring solutions. By demonstrating vigilance and demanding alignment, we can work to right-size the problem, but the solution will not be successful if it is solely owned by one stakeholder.

 

6) Med Ad News: The promotion of new CBD products raises complex issues. The options available for marijuana advertisers currently are restricted. Mainstream advertising is a complex prospect, even in states where many forms of cannabis are legal. With demand for effective CBD marketing on the rise, how are advertisers navigating restrictions in this area of the industry?

Sonja Foster-Storch, President, Advertising, Syneos Health Communications: There is a lot of uncertainty in the promotion of new CBD products, however on any given day in healthcare marketing we are required to navigate restrictions no matter who the customer. Federal and state laws, as well as advertising policies across platforms, are changing constantly, making it difficult to figure out how to advertise CBD brands. In short, there are no clear answers on CBD advertising yet. CBD advertising requires a constant eye to policies and regulation changes. The guidelines for CBD products include many rules of thumb applicable to all healthcare advertising. Bottom line: know your state regulations; know your platform; make sure there is evidence to support health or medical claims; consider the age limits as well as what’s allowed in the marketing creative by state; watch for developments as they occur.

Mick Rogers SVP, Creative Director, Art, Calcium: Our role in the pharmaceutical advertising space is to not only increase potential profit margin for our clients, but to continue to market and promote products that benefit the patient population. Given this, opportunities in CBD from an advertising perspective are multi-fold – and will have far-reaching effects over the next several years. As more and more data becomes prevalent and restrictions are loosened at both a federal and state level, our industry is constantly looking for ways into the space – whether it be in marketing holistic remedies for joint pain and muscle fatigue to the use of the product to treat childhood epilepsy or address anxiety and stress disorders in the adult population as an alternate form of medication to SSRIs and anti-depressants. The challenge for the advertising community is and will continue to be navigating through the (often inaccurate) stereotypes associated with the product – and combating age-old misperceptions through continued clinical case studies, patient testimonials and success stories, and access to CBD in the marketplace.

 

7) Med Ad News: What are your thoughts about a coalition of pharmaceutical companies, publishers and other research funders recently calling on scientific and medical publishers to provide open access to research funded by pharmaceutical companies for the benefit of patients, science and wider society, making all research funded by pharmaceutical companies accessible to anyone and anywhere in the world?

Boris Kushkuley, PhD, EVP, Multichannel, Marketing & Consulting, Intouch Group: Open research can move science and discoveries forward in a very effective way. In fact, a significant number of new medications that were commercialized by pharma companies have their origins in academic research. Realistically, however, unlike academic research that is funded by public grants, research done by pharmaceutical companies (i.e., private enterprise) is worth doing only if it becomes proprietary and is protected by patents. The proprietary nature of results and enforced patents has been the only practical model considered up until now. Currently, the only information that pharmaceutical companies make public are FDA-required studies that are a requirement for product approval. The challenge is how to incentivize pharma to invest their own money in research, because, by definition, this investment must bring a return.

Evan Young, SVP, Executive Creative Director, Calcium: Open access to research, in particular to research funded by pharmaceutical companies both big and small, is an incredibly complex issue. But at the heart of it, and what’s truly driving the mission of organizations such as Open Pharma, is trust – specifically, the trust that pharmaceutical manufacturers can engender by adopting more transparent access to industry-sponsored research.

Few people, one would hope, would disagree with the basic principle at play here: that despite the results of industry-sponsored research, whether those results are positive or negative, industry transparency serves the higher-order benefit of bringing greater clarity to healthcare practitioners, researchers, patients, and the general public.

But the nobility of this cause quickly becomes gummed up when we start to get down to brass tacks. And unfortunately, the brass tacks here are dollars.

The publication of research has long been a for-profit business, and what we really need to examine is to what degree we want open access across the entire scientific and medical publishing world. Because for sure, if we imagine a world with widespread, complete open access, it would come at a cost. Revenue streams for publishing companies, medical societies, those employed by them or in turn reliant on that revenue (e.g., printing companies), and probably many other stakeholders I’m not aware of, would be impacted.

Boil it down, and the issues surrounding open access have no perfect solution. Our collective best bet is incremental change toward the goals of open access, allowing for compromise, adjustments, and readjustments by all parties involved along the way.

However, since advertising is a business that trades in thoughtful solutions, here’s one idea: make the pure content, the results of industry research, open access to all. (Data should be free!) But keep the commentary and the interpretations of the research firewalled off. Change the basic structure of the journal article so that the investigators’ “Conclusions,” or any other outside commentary/opinion/interpretation of results, is what you have to pay to see.

To read more in-depth KOL analysis of negative findings from industry-sponsored research? “I’d buy that for a dollar,” as they say.

Jason Dineen, Senior Vice President & Creative Director, Copy, Entrée Health Princeton: Breakthrough products exist thanks to publicly funded foundational research that precedes pharma-funded R&D. Wider society pays for the seed funding of early-stage science – and that research is publicly available. We’ve seen that open access nourishes the scientific community, and enables wider and faster research & inquiry. If pharma companies themselves are joining public universities, non-profits, and publishers to let the sunshine in, then let’s do it. Last I checked, wider society is also where most of our patients live. For their benefit and for their return on investment, share the science.

Deborah Lotterman: Open access is critical to the advancement of medicine. It’s now abundantly clear that innovation, particularly in cancer and rare diseases, is absolutely dependent on understanding populations and translating those insights for the patient that the clinician is treating now. This means using the power of big-data analytics to integrate clues from genomics and proteomics into a simple message for the doctor: if this, do that. To achieve this, we need numbers.

But too often, there simply aren’t enough patients to fill the trials that are asking the essential data-producing questions that will set direction in discovery for years to come. In our work with the Multiple Myeloma Research Foundation and the Harvard Business School Kraft Precision Medicine Accelerator, we’ve seen what’s possible when a community lowers the barriers and shares information.

Data is not a commercial differentiator. By itself, data is just numbers. It is the analysis, the surfacing of insights and knowledge from that data, that creates genuine value. The real differentiator, the competitive edge, is in the poignant questions and forward-looking hypotheses of scientists, marketers, patients and leaders that turn data into innovation. If everyone has access to the data, the playing field is level and those organizations that foster creativity and rigor, that commit to making big bets, will be the ones that prosper. As will patients everywhere.

Joseph Sklar: Access to knowledge is always a good thing, and we welcome these efforts. The level of immediate scientific transparency that is gained via open access to research not only facilities understanding but also spurs innovation. The best discoveries are always built on those that preceded them. Furthermore, the open access movement has ramifications that go beyond the scientific research community. Patients and caregivers who want to learn about how their medications were developed can go directly to the source material, avoiding any possible biases or misrepresentation of the research.

Seth Gordon: While open access to information would appear to benefit all stakeholders, there are unintended consequences to consider, such as the adverse effect on academic publications due to lost revenue from their subscription payment model that ultimately could impact the dissemination of best practices. Without this revenue, many academic publications will struggle to exist. So, while open access of publications of all studies has benefits for patients, providers, and future research, the big question will be who will be paying for it?

In this area, it is important to remember this major market change for, just as record companies lost their album revenue model due online access, a similar situation is going on in publishing as they too move to more open access online. The key will be managing any unintended consequences of this seismic change.

 

8) Med Ad News: How are your clients and healthcare organizations using digital therapeutics and digital medicines to improve adherence/outcomes and treat patients more effectively in what is considered an area of unmet need?

Greg Lewis, President & Partner, Calcium: This morning I overheard a really interesting conversation: two team members were comparing their sleep statistics with one another. One proudly commented, “I fell into REM sleep as soon as I lay down,” while the other challenged her data chart, calling attention to her peaks and valleys throughout the night. They then joked about how many steps they need to fit into their day to keep the “doctor app” happy. I was witnessing the mobile health revolution in real time – empowered consumers who have real-time data literally in the palm of their hands.

Digital interventions pose countless opportunities to improve adherence outcomes. Consumers, patients, and physicians are all inherently more informed, engaged, and motivated to keep their health at the forefront and are taking a gaming mentality to heal faster and stay healthier.

Paul Balagot, Chief Experience Officer, precisioneffect: The World Health Organization estimates that half the world’s population lacks access to basic health services. This huge unmet need creates a substantial opportunity for digital therapeutics to fill the gap.

Digital therapeutics can be applied in several areas such as improving accuracy and timeliness of diagnosis, improving treatment decisions, providing greater access to care at scale, and pre-empting clinical events.

The ubiquity of smartphones provides this broader access to care and allows the industry to tackle issues associated with substance abuse, heart disease and women’s health to name a few.

With so many people without adequate care, digital therapeutics provides new options and opportunities to improve and create a healthier society.

Jo Ann Saitta, Chief Digital Officer, Omnicom Health Group: Pharma clients are partnering with digital therapeutic and medicine companies to leverage DTx and medicines that complement existing Rx therapies and enhance care delivery. Pharma’s heightened adoption of DTx solutions is largely driven by the increase in real world evidence showing improvements in drug adherence and overall patient health outcomes. Over the last several years, digital health products have generated real world evidence to prove a positive impact on patient outcomes as well as significant reductions in healthcare costs. Hence, more are being approved by the FDA which leads to increased physician adoption, insurance reimbursement, and pharma commitment.

Diabetes management and cardiovascular health have been trailblazing therapeutic areas for digital health. For example, Abbott Laboratories received FDA clearance for Libre, a diabetes management digital therapeutic that comes with a companion mobile app. Additionally, J&J Innovation Labs awarded FibriCheck a health mobile wellness award for using a smartphone camera to detect atrial fibrillation.

Unmet needs in healthcare are prevalent within chronic disease and rare disease. New DTx products like NuvoAir, a lung capacity device, are part of medical research to be used as a combination therapy for cystic fibrosis patients. Regarding adherence, the seamless health data collection and sharing capabilities help patients make positive lifestyle changes and help physicians intervene more effectively. For example, GSK partnered with Propeller Health to learn about how their digital sensor technology can be used to track and optimize patient inhaler usage.

Alec Pollak, SVP, Group Customer Experience, AREA 23, an FCB Health Network Company: We see a newfound appreciation within the industry for starting with patient needs, and this is ushering in a new phase in digital healthcare, a phase that prioritizes valuable Customer Experience over technology and promotion. Digital therapeutics will be both drivers and beneficiaries of this new phase.

First and foremost, we believe healthcare initiatives that start with an authentic effort to fulfill patient needs expressed by the patients themselves have the most potential for high impact. Initiatives should not start life in service of a “critical success factor” or “strategic imperative,” but rather in service of a clearly defined, unmet, human need.

Patient support services built with a customer-experience-first approach can create significant competitive advantage and make a world of difference in patient outcomes. These services utilize psychological constructs like gamification or social motivation to spur on positive outcomes.

Teams that create these services understand that to really effect behavior change you need to motivate, not just educate. Communicating information by itself does not mean action will follow. The only way to understand what will truly motivate change is to understand the patient and the ecosystem they live in. Holistic support systems that serve the whole patient, not just the medical treatment, are rapidly becoming the price of admission.

For example, our client The Learning Corp offers a digital therapeutic called Constant Therapy that serves those recovering from stroke or brain injury.

“Patients are looking for tools that will alleviate many of their pain points with traditional therapy, so it’s vital that healthcare innovators are creating solutions that make clinically proven care more accessible,” said Michael Evers, CEO of The Learning Corp. “Like all patients, those in physical and speech therapy should be focused on their health instead of worrying about how they’ll be able to get the medical support they need to recover. Virtual therapy apps help eliminate several barriers of care by delivering it more directly while driving down costs.”

We find this to be true across categories and across the FCB Health Network. For example, over at Neon, an FCB Health Network Company, their client Pear Therapeutics is using prescription digital therapeutics to tackle one of the biggest unmet needs in healthcare – helping people with substance or opioid use disorder stay abstinent and in treatment longer. Pear Therapeutics integrates clinically validated, FDA-market-authorized, software-based applications with previously approved treatment paradigms to provide better outcomes for patients, smarter engagement for clinicians, and cost-effective solutions for payers. The company is pushing the boundaries of technology to transform medicine and extend the reach of needed therapies.

With current addiction treatment, the gap is clear: anything can happen once a patient leaves their clinician’s office. But once patients download reSET or reSET-O onto their smartphone, they can get 24/7 access to evidence-based therapy modules and an intuitive way to track triggers and cravings. Clinicians, meanwhile, can make the most of in-office sessions and inform treatment decisions with real-time data on cravings, plus insights on program engagement. In a clinical trial, reSET and reSET-O significantly improved abstinence and retention in treatment, respectively.

According to Pear founder and CEO Corey McCann, addiction therapy is only the first step for FDA-cleared prescription digital therapeutics. “We believe that prescription digital therapeutics hold promise in improving patient outcomes across a wide range of central nervous system disorders including psychiatry, neurology, and pain, and should become a vital part of tomorrow’s treatment paradigm across many disease areas.”

Projects like these have proved to us that serving true patient needs creates the greatest potential for improving health outcomes, and we should let the tech serve those needs instead of focusing on trends and fads.

Angela Tenuta, EVP, Client Services, Intouch Group: We are only at the beginning of this trend, and clients have not launched far into these areas. We have some who have run trials that prove that digital patient support + prescription medication(s) leads to better outcomes than the a medication alone. Some examples of digital patient support in this context are:
• tools that assist with administration (like injection trackers or medication reminders)
• closed social communities where patients can access emotional support from nurses or peers
• applications like Fitbit or food diaries that support behavioral change/healthier lifestyles

Seth Gordon: Just three months ago, in September, we partnered with Cognoa to advance the commercialization standard for prescription digital medicines: how they will be ordered, dispensed, and covered by insurance. In developing digital medicine solutions, Cognoa is working to solve a critical unmet need in behavioral healthcare by enabling earlier interventions and more personalized, accessible care. EVERSANA will develop and manage a go-to-market strategy that ensures comprehensive market access; deploys highly trained sales and clinical field force to reach and educate providers; and effectively supports the patient journey through prescription and intake, benefits verification, distribution, and adherence through personalized Hub and specialty pharmacy services.

Joseph Sklar: One of the greatest healthcare challenges that we face today is the rising prevalence of obesity. There are myriad health issues associated with obesity, including diabetes, cardiovascular disease, and various types of cancer. Effective weight management demands a comprehensive treatment plan, which includes behavior modification. Our partners at Novo Nordisk are dedicated to helping patients living with obesity effectively manage their weight to improve their lives. As such, Novo Nordisk is collaborating with Noom, a leading behavior change company, on digital health solutions focusing on weight management and education. Noom uses artificial intelligence along with data and wellness insights to understand individual motivations and obstacles, in this case, with regard to weight management. The ultimate goal is not only to help these patients lose weight, but also to help them maintain this weight loss for the long term.

Sonja Foster-Storch: It really is an exciting time to be in healthcare because of these digital advancements. We’ve seen our customers approach digital offerings in one of two ways so far. The first is to explore partnering with these organizations, particularly as vehicles for advanced patient support offerings. While many digital therapeutics work toward being considered a viable option for stand-alone therapy, much of pharma sees their value as additional behavioral guidance alongside a pharmacologic. That additional support has the power to not only provide better patient adherence, but ultimately better outcomes. That’s good for everyone.

The second is to take more of a wait-and-see approach. Some of our clients see the potential in these areas, so they’re happy to invest and provide recommendations from the sidelines. It’s very similar to the approach that Novartis took with Pear Therapeutics; exploring an opportunity to try to build something together. Others think there is opportunity, but are unsure of how quickly they’ll take hold given the challenges with reimbursement as well as patient and HCP adoption. No one has yet to crack the code on how to really do all of those things at scale, so in the interim, they’re sitting back, but keenly watching. There’s nothing wrong with either approach; it’s simply a matter of their comfort level with the evolution to a more Silicon-Valley-like approach to treatment options.

It will be interesting to watch how the digital therapeutics providers work together to treat the whole patient holistically instead of individual disease states. While aligning with pharmaceutical partners might be an easier thing to do in this more individualized approach to care, it’s less helpful to the patient who may ultimately need a number of apps or therapies to manage concurrent illnesses. These advancements are something that we’ll continue to monitor and discuss with our clients because of their potential power to impact patient outcomes. That will allow them to make informed decisions based on their comfort levels with either approach.

 

9) Med Ad News: Which new frontiers in data analytics are being explored and implemented to help improve clinical trial outcomes?

Hilary Gentile, Global Chief Strategy Officer, McCann Health: Currently, we know that 86 percent of all trials fail to meet their recruitment deadlines and when people fail to fill the trials in a timely manner, treatments are delayed from reaching people who need them.

Data can play a crucial role to help accelerate recruitment, and learning from the past can help improve clinical trial outcomes. Retrospective data and modeling can be used to inform results and rule out those who will not do well. Data can also be used for a deeper understanding of who is opting in. Clinical trial populations are often limited by geographic barriers, which excludes certain populations (very often, those of certain socioeconomic status). Greater aggregation and application of population data will allow clinical trials to be more inclusive and diverse, and therefore representative of the larger population and indicative of transferable data across population subgroups/variables.

The partnerships between big tech companies and pharma are on the rise, leveraging their combined strengths and knowledge. In particular, understanding disease, improving outcomes and accelerating R&D process are priorities of these partnerships and AI has a critical role to play. For example, 23andMe has now entered into the clinical trials market. The company states that 80 percent of its customers opt to participate in research and they are aiming to accelerate the recruiting process of clinical trials through their cohort of re-contactable research participants. Protection of personal data will be critical as these companies pursue their goals. These new data protection and privacy concerns are the basis of EU’s GDPR (General Data Protection Regulations) which strengthen the rules governing an individual’s right to data and consent.

Trials will increasingly use a combination of human and data modeling, or virtual and real-world results. Healthcare-related big data makes a holistic view of the human body available to doctors and researchers exploring the best treatment plans for their patients. We know that in the United States, the FDA is already planning for a future in which more than half of all clinical trial data will come from computer simulations.

Apple recently launched three studies using their research app which gathers health information for users who opt in. The Apple watch and phone passively and actively track health-related information such as heart beats and movement. This potentially can generate new learnings about the way people behave and contribute to their future preventive health understanding. As tools in our mobile devices and wearables become more accurate, they may be leveraged in clinical trials as a way for doctors to accurately gather ongoing monitoring that is sometimes only self-reported.

Even before the data deal with Ascension became known, Google Health was using their vast data on user searches to detect serious illnesses in advance of user identification, meaning that disease detection is happening in a passive fashion, ultimately leading to a greater ability to detect (and, hopefully in the future, prevent) diseases earlier in their manifestation – and drive to formal diagnosis and treatment.

These developments, where data play an increasingly greater role, are already having an impact on modern clinical trials and accelerating the pace of new therapies.

Prodeep Bose, EVP, Growth & Innovation, The Bloc: The first consideration for clinical trial outcomes has to be appropriate recruitment of patients. The medical era can be divided into BG and AG – before genomics and after genomics. And we are at the cusp of it – genomics, proteomics and biomics, and refined tools to identify and categorize a disease that was previously only understood symptomatically. Selection criteria are evolving to use this deeper understanding of the appropriate patient, as with the use of companion diagnostics.

The second area of impacting clinical trial outcomes through data and analytics are the services that become part of the trial protocol and the commercialization model. Proteus nanotechnology to track medication compliance or Pear Therapeutics’ remote care and monitoring platform are examples of this approach.

John Nelson, SVP, Director of Strategic Planning, CultHealth: We’ve had clients show interest in patient biomotion data that can more precisely demonstrate product efficacy over placebo through improvement in patient motion.

It’s a technology we’ve been integrating for many applications, but clinical trial outcomes is a natural fit given a need to mitigate bias from patient/investigator reported outcomes.

The next step is to identify the methods of approval and implementation with the FDA.

Megan Malone, VP, Engagement Strategy, Concentric Health Experience: Artificial intelligence (AI) techniques are being explored to modernize every stage of a clinical trial, from study preparation to execution. One area of critical importance is patient recruitment. AI can assist human recruiters in choosing patients who are more likely to have a measurable clinical endpoint and determining a population that will respond to treatment. Natural-language processing (NLP) and machine-learning technologies can quickly analyze different types of data within electronic health records (EHRs) to accurately determine a patient’s appropriateness for clinical trial involvement. These AI techniques and others are constantly being refined, meaning that, soon, clinical trials will become more expedient, helping pharma bring life-changing medicines to market more efficiently.

Brian Stack, Digital Lead, Brick City Greenhouse: Solid outcomes from modern day clinical trials are beholden to 1) finding and identifying the right patient, and 2) ensuring they can physically participate in the trials at the site locations. Our hectic schedules (both patients and HCPs) and the ever-increasing demand for convenience put a strain on such trials. The industry is forced to work even harder now to find and nurture clinical trial participants.

Similar to how almost every vertical in the business world is changing, technology and the acceptance of remote models are destined to change the way we treat clinical trials:

1. The use of artificial intelligence and machine learning is in the beginning phases of becoming a permanent fixture with our next-generation EHR platforms. Not only will this artificial intelligence help physicians diagnose and treat the most difficult ailments, it will efficiently help identify the most appropriate patients to participate in clinical trials based on a variety of factors – many unknown through the busy eye of a physician. These patients may be right under the stethoscope of physicians who are not aware of such clinical trials.

2. One critical component to successful trials is the need for patient monitoring during the trial workflow. “Monitoring” in a traditional fashion requires that the patient be physically present at a facility for reading of critical biomarkers and overall wellbeing of the patient – this could last for hours or even days. Everything in our lives now is available at our fingertips, and we expect everything to come to us, wherever we are. This is where remote monitoring comes into play. Our prediction is that tools like video conferencing and remote/@home biomarker testing will become more mainstream in the clinical trials realm, making it easier (and cheaper) at every step of the way.

Eileen Yaralian: AI and machine learning is one that is growing rapidly. It is being applied to optimize clinical trial recruitment and monitoring in order to optimize patient outcomes. This means that when patients and families make the sacrifice and commitment to enroll in a trial, they have a better chance of positive outcomes, which is a great thing for scientific advancement.

I think one of the challenges here could be that AI-mediated recruitment could bias results. The results of a trial with optimal patient participation and monitoring that might not reflect real-world practice may not be projectable to the broader patient population.

Jo Ann Saitta: Artificial intelligence, specifically the advances in machine learning algorithms and natural language processing, is enabling data-driven health outcomes for patients.

The ability for AI to perform detailed matching of patients’ medical records with clinical trial eligibility criteria is enabling two important improvements in clinical trial outcomes. First, advanced analytics are powering sophisticated protocol modeling of more efficient approaches to study design, such as adaptive and platform studies, as well as deeper feasibility assessments of available patient populations. Adaptive and platform studies improve clinical trial outcomes by allowing researchers to get more specific answers faster, and to evaluate treatments in more patient populations with fewer trials. Richer profiling of patient populations, especially the more accurate assessment of concomitant conditions and treatments, are shaping better informed protocol eligibility criteria and more relevant end-point development. Of course, end-point strength determines the value of study outcomes.

Second, data-driven protocol matching to patients can help research physicians accelerate study enrollment and increase patient selection accuracy. Reducing enrollment periods and the number of studies that are abandoned due to difficulty identifying suitable patients will undoubtedly elevate research outcomes over time. Likewise, the ability of companies like Deep6 and Antidote to apply AI across fragmented medical record data will increase the accuracy with which patients are screened against eligibility criteria, reducing participant variability and therefore the potential for inconclusive study outcomes.

Seth Gordon: When it comes to improving clinical trial outcomes, there’s an array of opportunities that are facilitated by data analytics. After discussion with our clinical trail leads, including Managing Director Sandra Shpilberg, let’s focus on areas related to clinical trial enrollment:

• Artificially intelligent audiences for clinical trial enrollment: We can use data analytics to design artificially intelligent audiences to show clinical trial recruitment approved materials in digital channels. Digital advertising platforms like Facebook, Instagram, and Google enable the creation of audiences based on prior conversion events. From these conversion events, we can create audiences, based on data analytics, who may perform in similar fashion when it comes to online pre-screeners for clinical trials.

• Data analytics for site selection and optimization: We can use data analytics to understand the geographical distribution of patients interested in a certain clinical trial. By overlaying the geographical data we receive from patients on a map of current sites, we are able to inform the clinical trial sponsor on the range, median, and average distance of current patients to current sites. These statistics can point to the need to open new sites or make other changes.

• Data analytics for message testing: We can use data analytics to test various messages for patients. Most diseases can benefit from accurate and simple communication points to patients about clinical trials. We collect performance data for various messages and use data analytics to identify winning messaging points that help us optimize our performance.

Better outcomes for clinical trials begin with finding the right patient population as soon as feasible, and data analytics is an important tool to use throughout this process.

Sonja Foster-Storch: Smarter clinical site selection can go a long way in reducing the risk associated with a clinical trial gone awry due to issues with patient enrollment. At Syneos Health, we are tackling this challenge with a new approach called Site Foresite, which takes into account both traditional and new factors that impact the attractiveness of a site to a patient. The “new” considerations, however, are the very same factors that have been front and center in retail decisions about brick-and-mortar locations for decades. Why not consider them for clinical sites? Things like Physical Access (walkability, available parking), Access to Patients (what’s the competition?) and Reputational Factors (Yelp reviews), when added to the mix, represent the best of what can come from cross-pollinating ideas across disciplines within the industry. These added dimensions, drawing upon data science innovations from the commercial world and applying them to the clinical space for the first time, have the potential to dramatically speed patient recruitment and reduce the accompanying cost.

 

10) Med Ad News: What health technology trends and developments pique your interest, which ones may shake up the marketplace?

Ed Mitzen, Founder of Fingerpaint: The use of virtual reality and augmented reality in healthcare is an area that excites me because of the ways it’s currently being used and the potential it holds for the future.

Long-term care facilities are using it to address social isolation, visually transporting residents, some of them bed-bound, to places and experiences all over the world. While it’s currently being offered like any other social activity, developers hope that clinical studies will eventually show these types of experiences can move the needle in preventative care for a variety of categories, including depression and Alzheimer’s.

Physical and occupational therapists are using it to not only make rehabilitation activities more fun and interactive with the hope of increasing adherence, but combined with the use of artificial intelligence, doctors are also able to determine in real time where someone is improving or where they are falling short. In the future, someone going through physical therapy might be able to perform the activities right from the comfort of their home. Meanwhile, the data are transmitted to a physical therapist who can adjust the exercises as needed from anywhere in the world. This would be a game changer for those in remote areas.

In clinical settings, VR and AR are being used to help train doctors as they prepare for very intricate surgeries as well as to explain complicated procedures to a patient’s loved ones. Imagine a parent whose child has to have heart surgery. Doctors are able to transport the parent right into the heart and show them how the procedure will be done.

Faruk Capan, CEO & Founder, Intouch Group: AI has really been hyped for the past few years, but rather than flashy applications like virtual assistants, chatbots or robots, I’m looking forward to seeing how AI-based solutions running behind the scenes – for example, in EHR systems or for the purpose of identifying potential patients or correlations, or to automate tasks that use up valuable human time – become more mainstream. One interesting use of AI that’s happening right now is by Prime Therapeutics, which is implementing AI to analyze prescription ordering data to identify fraud. Sanofi is using AI to understand people’s biological responses to vaccines, and Bayer is using the technology to distinguish patients who have chronic thromboembolic pulmonary hypertension (CTEPH) from those who have similar symptoms but do not have CTEPH. From R&D to marketing potential, AI-based solutions seem infinite.

Telemedicine is another exciting form of tech that has a lot of potential. We’re seeing significant use for mental health services, and private insurance claims for telehealth are on the rise. However, due to limited uptake from patients – more than half of patients say they’d try it, but less than 10 percent actually have — and challenges with how physicians get compensated, telemedicine is still very much in its infancy.

Steven A. Goldstein, Creative Director, Elevate Healthcare: Technology is racing to the future in so many ways right now that it is impossible to review it all in one discussion. Changes are coming so rapidly that the information covered here will probably become obsolete before this piece is published.

We are now seeing light years’ worth of technological progress in every calendar year. In our time we will see technology embedded in humans, and human characteristics built into technology. Healthcare professionals are able to attain super-human precision and effectiveness thanks to all the life-altering advances that have and will come to be. Technologies are reshaping physician and staff performance, as well as institutional efficiencies to optimize, medical device, inventory and pharmaceutical management, operational efficiencies across all floors, specialties, and administrative departments. Not to mention the application of robotics, 3D printing technologies, gene-sequencing, virtual- and augmented-realities, and device technologies. (For examples of recent technological innovations, see the chart below.)

EXAMPLES OF RECENT TECHNOLOGICAL INNOVATIONS:
Artificial intelligence (AI):	Differential diagnostics and treatment planning Analysis of imaging and data Optimization mapping
Augmented and virtual reality	Training simulations Experiential pain therapy Treating cognitive disorders
Next-generation sequencing	Identifying at-risk populations Targeting therapies to expected patient response Genetic testing en masse
Robotics	Surgical strength and precision Efficiencies and automation Maneuvering
Telehealth	Immediate personalized interaction Financial efficiencies Informing patient self-care
3D printing	Anatomical modeling Customized/individualized medical devices and tools Enhancing precision medication
Wearables/in-home/personal devices	Timely diagnosis and clinical support Precision dosing and monitoring Improved patient engagement Clinical trial participation

All that said, perhaps the most important change is the digitization of healthcare. Data are transforming the quality, immediacy, and relevancy of our understanding, decision-making, and actions. The quality and accuracy of the insights identified has become the single-most important force behind every individual, personalized medical decision patients and their providers will make from here forward. The other critical fact is that the individualization is becoming repeatable on a mass population scale. Medicine is no longer “one size fits all.” Now it is “for everyone, your size customized to you.” Every byte of health information is being analyzed, to connect every individual’s real-time health needs with the most appropriate, timely responses for their own personally optimized medical treatment and maintenance.

Examples in use today are automated, remote, wearable, and in-home monitoring and diagnostic tools that are being combined with artificial intelligence to keep electronic health records accurate, and to analyze, alert, and recommend appropriate therapy responses when medically necessary. The future will be even more intuitive and aggressive. Consider the Apple Heart Study recently conducted in collaboration with Stanford Medicine that used app data from Apple Watch to identify irregular heart rhythms, including those from potentially serious heart conditions, such as cardiac arrhythmias and prompting a telehealth doctor to provide medical intervention within minutes, by contacting the patient’s phone.

This type of real-time monitoring, assessment, and feedback using sensors, analytics, and telemedicine to deliver customized, personalized medical responsiveness is changing healthcare forever. Medical treatment has gone from educated guesswork to accurately informed. Instead of waiting for the heart attack to happen, we’re responding to signs; from passive to instant action. Old, slow, wait-based healthcare is a thing of the past, and aggressive informed response is here.

It may be the most important change yet in the lifetime of humanity… until the next technological advancement changes everything again.

Graham Johnson, Chief Product Officer, FCB Health Network: We are carefully following the rise of conversational user interfaces. Although they are often associated with smart speakers like Amazon Alexa and Google Assistant, they are part of a broader trend changing the way we interact with smartphones, laptops, and IoT devices. Simply put, conversational UI is a more natural way to interact with computers. Many digital tactics over the years were framed as “two-way conversations” with the end user, which was admittedly a stretch, but thanks to advances in Natural Language Processing (NLP) and Natural Language Understanding (NLU) – it’s a reality today.

Use cases around conversational UI in healthcare are rapidly emerging and becoming broader each day. Patients are overcoming accessibility issues, checking the status of prescriptions, finding urgent care based on both location and availability, and getting personalized treatment insights. Doctors are reducing paperwork, accessing reference information, triaging requests from patients, and getting seamless updates on their patients’ progress.

For marketing, it’s revolutionary. If you were to ask a marketer to identify the most important piece of content in a digital experience, they would go to their analytics package and point to the most popular page. Conversational UI provides a focus group with each user that might reveal that the most popular piece of content is something you are missing altogether. These data-driven insights can dramatically improve experiences and foster deeper connections with brands.

The release of the iPhone in 2007 ushered in the mobile-first movement which characterized digital efforts throughout the 2010s. We believe we’ve reached another inflection point where conversational UI will characterize the 2020s.

Bill O’Bryon, Managing Director, Patient Experience Project, an EVERSANA Agency: Big data will continue to be a major force in the technology landscape but shifts in consumer understanding and resistance to monitoring may disrupt some of the advances we’ve seen in recent years. With the California Consumer Privacy Act going into law on January 1, 2020 and many similar pieces of legislature in process across the US, American companies will need to be prepared for near GDPR levels of oversight into data collection practices. Once the law is enforceable in Q3 2020, industries will need to account for an increased ease of opting out of being tracked, resulting in less complete data sets which will result in less than optimal data modeling. Considering the wide adoption of machine learning techniques into the modern business, companies will need to adapt to this changing landscape and find a balance between leveraging the awesome power of artificial intelligence while protecting the sanctity of their customers’ privacy.

Barbara LePetri, MD, Associate Partner, Chief Scientific Officer, The Bloc: We do research in the hopes of improving health. Those that fund this research spend a king’s ransom for this research. To keep this important information behind a paywall does not seem to be in keeping with the goal of improving the health of patients. So I do believe that if industry funds studies, their findings should be available to all who may benefit, without a financial transaction.

But that’s only part of the story. The other part of the story is making this important information easy to find. It is said that the amount of information in PubMed doubles every 73 days. If we don’t develop a system to track results from the same study (i.e., substudies) or track information concerning the same disease or therapy – PubMed will become like EHRs – even more data to ignore. We must consider a way of tagging each article, through the use of tags, or through Blockchain smart IDs. If my daughter, who is a singer, can get paid every time her song is on the radio or streams on Spotify, we can certainly tag important research.

Paul Smith, SVP Associate Creative Director, Entrée Health Princeton: The most exciting macro trend is the fact that as a creative director, one of my regular partners at the agency is a data analyst. It’s exciting that we’ve gone so quickly from “should we go digital?” to clients calling “Help, we’re drowning in data.” Now the key is making the right connections, from population-level info from wearables, to building better analytics engines that allow us to imagine interventions where they’ll make the most impact. There are so many steps along the way where projects can take a wrong turn, so creative teams need to keep everyone focused. Let’s not pitch tech solutions for the sake of being trendy, instead let’s adopt some move-fast, iterative innovation that improves the patient experience while improving outcomes.

Sonja Foster-Storch: Digital therapeutics application is one of the most compelling trends, and has huge upside if it solidifies a clear place in patient treatment. There are some digital therapeutics that are being used as the actual therapy, and others that help support a respective therapy.

For example:
• On the “used as therapy” side, an app like Headspace could be considered “treatment” for depression or anxiety without medication.
• On the “medication support” side, apps like Glucose Buddy closely monitor blood glucose for patients.

Technology is core to fuel either side, but the one that shows evidence of positive outcomes is where the money will flow for support. Imagine there is proof that a digital therapeutics app can treat something like depression with positive outcomes. This would have the potential to become a lead therapy born completely out of digital therapeutics. Pretty amazing.

Either way, it will be interesting to watch what happens. Will this be supported by payers and providers at scale? Will it be efficacious for patients?

Brian Stack: We feel the ability to be laser-targeted through data in our communications is going to continue to change our marketplace as we move through 2020. Compared to non-health verticals, there’s a low percentage of marketing that leverages data and programmatic means. Healthcare is chock-full of data, but as marketers and the industry as a whole, we’re still learning the best way to leverage this data to be as impactful as possible.

Customer journeys are at the core of what we do. We’ve mastered the practice of leveraging research to understand how a patient or HCP moves along a condition or product lifecycle. Where do the gaps lie? It’s understanding the triggers and available data that can elicit a messaging shift. If an HCP is already an advocate of a brand, why should they be exposed to efficacy messaging? If a patient is already on a prescription product, should they be exposed to messaging that asks them to speak to their doctor about it? Absolutely not. Through the proliferation of available data, we have the ability to pivot our messaging to speak about other factors related to the brand that address the needs of that specific patient or professional.

John Nelson: Patient-friendly medical devices are in a renaissance period of sorts – and not so much the revolutionary types but the ones providing incremental advancements to existing device challenges. For example, the myriad of challenges of CPAP therapy for sleep apnea has awoken a wide range of device innovations and social media promotion, the likes we’ve never seen before.

The devices starting to shake up the market are the minimally invasive inserts that augment bioactivity. Going back to sleep apnea, new device inserts, under the skin, can stimulate airways to stop apnea-related snoring. They are highly safe to boot and include connective monitoring for HCPs to have a better picture of patient improvement – critical in categories with poor HCP-patient dialogue, like sleep apnea. Minimally invasive device inserts represent a deeper level of therapeutic response and tracking and, in my opinion, are just the beginning of a real revolution in human augmentation. For now, we’ll just take credit for reflection of its humble beginnings.

Eileen Yaralian: Telemedicine is a big one, and the adoption of virtual care specifically, has been intriguing. The United States is expected to experience a shortage of physicians during the next decade, and telemedicine can extend the time physicians are willing and able to work.

The uptake in categories has been tremendous in categories where patients aren’t comfortable having a discussion with their physicians, such as erectile dysfunction. It has also been gaining use in conditions where there is a strained HCP/patient relationship, like obesity. I’m curious to see how this will expand into other categories, especially the visual ones, like dermatological conditions.

Telemedicine is likely shake up the advertising space in terms of how we approach promotion. We are just at the initial stages of understanding how we can educate these physicians on our brands and how we can help to ensure our brands are prescribed appropriately and to the right patients in a virtual world.

Jo Ann Saitta: The number one digital health trend is not a technology, but rather a principle – data privacy. Data privacy is receiving unprecedented scrutiny, and patients and healthcare brands are becoming acutely sensitive to how data is used in communications and marketing. According to the 2018 Verizon Data Breach Report, one quarter of breach victims are healthcare organizations, which indicates that breach of patient data is a very present threat. We saw compliance of the GDPR law kick into high gear in 2019 and we’re awaiting the introduction of the California Consumer Privacy Act in 2020. All companies are keenly aware of data protection strategies that comply with regulations and retain consumers’ trust in protecting their data in the digital world.

Precision medicine aims to customize treatments to individuals using tools such as pharmacogenomics. It is a rapidly growing field with more than 200 drugs that have labels with information on pharmacogenomic biomarkers. Precision medicine will allow doctors to use patients’ genetic information as part of routine medical care.

The Cystic Fibrosis Foundation reports that researchers are at the forefront of a growing field of personalized medicine in which doctors will increasingly be able to tailor therapies for patients based on their genetic makeup. When it comes to cancer, understanding the roots and applying that information to tailor treatment based on the patient need is the ultimate goal. The ability to tailor the medical journey through gene-based personalized medicine poses a big shakeup – potentially reducing the impact that pharmaceutical marketing currently provides.

Paul Balagot: The growing presence of digital health clinics, like Roman and Hers, offer prescription drugs delivered right to your door. Patients still have to participate in an online medical assessment. However, when you consider some of the frustration and hassle patients feel when accessing care, scheduling doctor appointments, these digital health clinics offer the opportunity to get medicines in a more convenient way.

Digital health clinics currently offer treatment for conditions such as hair loss, erectile dysfunction, and skin issues. As digital health clinics expand their offerings to treat other conditions, their low barrier model of accessing treatment has the potential to disrupt how healthcare is delivered.

Prodeep Bose: This might sound less exciting than AI, but I do think remote physician consults are potentially a game changer – not just because they’re about to become mainstream, thanks to Payer adoption, but because of their potential for better doctors to be able to serve more patients, given the shorter average time needed and the breaking down of geographical barriers to specialized care, especially in rural areas.

In response, pharma must move towards remote selling with more science-heavy interactions with these high-value docs.

Greg Lewis: Health technology is advancing by the second. Diseases are being identified sooner, clinical trial monitoring is more precise, and patient education and compliance are more robust – all due to advances in technology. Artificial intelligence, machine learning, block chain, and big data are all valuable, but the technology revolution will march forward. Personalized solutions to complicated health problems will continue to be evident with gene modification and CRISPR.

In 2020 and beyond, it will be interesting to see if the telemedicine revolution truly becomes a patient’s first line of health intervention. Although digital platforms are robust and secure, will the personal touch of an in-office visit be preferable?

Hilary Gentile:

Biometric Tracking of Health Data
The rapid adoption of biometric tracking is occurring due to simplified user experience and greater value for the user for tracking their health data. Meanwhile, the addition of digital therapeutics will continue to set a new precedent in collaborative care guidance.

The Rise of Digital Therapeutics
Digital therapeutics have the potential to address unmet patient needs that traditional treatments and therapies have been unable to provide. As software and health care converge to create digital therapeutics, this technology is already helping to transform patient care and deliver better clinical outcomes. All of these advances allow for more in-depth and relevant health information to be collected, which is making this data meaningful.

From Paternalistic Medicine to Participatory Medicine
User-enabled diagnostics is one of the key trends that is enabling at-home testing and the broader availability of technology that enables patients to proactively come to their physician with their test results. As patients become more informed, they can gain deeper understanding of their disease and have more meaningful patient-provider communications. This continues to affirm a trend where the paternalistic role of the physician is being replaced by a more participatory process where the doctors are becoming more of an advisor in health decision-making as opposed to the ultimate authority and the patient is playing an active role in the shared decision-making about a healthcare treatment.

Voice-Activated Health and More
Human-centric technology is continuing to shape the way we engage with health-related issues. For example, all conversational interfaces are becoming more people-literate and behaving more like face-to-face interactions. The humanoid shift that chat bots have accomplished in just one year is astonishing. As a result, there is greater receptivity to interactions with health experts and health consumers. Voice will be a big player in customer experience and support in healthcare. As one of Alexa’s fasting growing audiences is the elderly, voice has the potential to allow people to be more independent for longer. When these devices are connected to other smart devices the elderly can control their home, turn lights on and off and even order things for themselves without having to leave their house. This has the potential to improve their quality of life because they can retain a sense of independence.

 

11) Med Ad News: What are your predictions for the healthcare industry in 2020 and/or beyond?

Ed Wise, CEO, Omnicom Health Group: My prediction is that the nerds and the geeks will triumph in our next episode. Deep science and medical breakthroughs will continue to drive our business and provide the greatest opportunity for growth. As the science behind cancer continues to develop at a rapid pace, the complexity of managing patients, understanding emerging and complex treatments, keeping up with the proliferation of clinical trials, managing companion diagnostics, targeting mutations, factoring costs in a reimbursement system that can’t keep pace, will all cause disruption and opportunity. Add to this the exponential increase in rare disease candidates and indications, and we have a market driven by complexity and specialism. This will not only mean we need to double down on our best scientific expertise, it will also cast a spotlight on our other specialists, including payer specialists, patient specialists, and specialists in data and technology who will help us leverage information in new ways to manage the accelerating complexity. This will be the moment when the geekiest among us shine.

Kim Wishnow-Per, President, McCann Managed Markets:
The healthcare market will continue to evolve and advance throughout 2020 and beyond. Great strides will be made in key evolving areas of healthcare, ultimately allowing for improved patient outcomes in a more economical manner.

Acceleration of “Value Based Healthcare”
Provider organizations as well as individual providers will increasingly be held more accountable for outcomes, total cost of care and the patient experience. This evolution will drive a more population health care management approach – fueled in part by the growth of integrated care delivery systems, greater access and utilization of data analytics and emerging alternative payment models.

The Business of Care: Consolidation and Integration
Consolidation via horizontal and vertical integration will continue across payers, PBMs, IDNs/health systems and other provider groups. Power and decision making will reside with fewer more powerful risk-bearing entities, limiting HCP autonomy, approach to treatment and therapy choice – thus requiring a more customer focused approach.

Growing Power of the Payer
Stricter formulary management will lead to increased barriers to prescribing, restricted provider drug choice and a more burdensome approval process. This dynamic will put even further pressure on drug pricing and margins.

Precision Medicine
Care management strategies will continue to evolve beyond the one size fits all approach to a predictive understanding of which treatments will work best in which patient groups. Significant advances in this area will result in availability of more genetic testing and treatments for a broader range of diseases.

Growth of Consumerism
Patients are evolving to more active decision makers in their own healthcare – primarily driven by cost shifting to patients, greater expectations for an elevated health care experience and greater access to health care information fueled by technology (eg. Dr. Google, patient portables, wearable health devices)

Telehealth and Mobile Health
Patients will have even more convenient access to health care services via a stronger emergence of telehealth and mobile health. As this area grows, it will become an established and integrated part of health care delivery.

Laurie Bartolomeo, EVP, Creative Director, Dudnyk: 2020 will continue to see the rise of the empowered patient in driving real change in our industry. Patient advocacy is paramount, especially in the rare disease space, to promoting progress in research and development, as well as ensuring adoption of orphan brands. Large advocacy organizations such as Global Genes and NORD are making great strides in legislation and policy that will support families affected by rare disease, as well as smaller, disease-specific advocacy groups that rally communities, raise funds, and appeal to scientists and physicians focused on meaningful discoveries. For parents, these organizations provide significant support for today, as well as promising hope for the future. Many of the rare disease advocacy groups that exist were started or inspired by parents looking to draw attention and resources to their children’s conditions, and their passion and hard work is at the heart of the incredible progress we are now seeing in this space.

Additional predictions include revolutionary new product development for previously untreatable genetic diseases, spurred by breakthrough science and increasing access to broad-based genetic testing; continued interest and increase in marijuana-derived therapies for a wide range of disease states; continued innovation in healthcare technology that gives people real-time, actionable data to support healthcare choices and treatment decisions; and, of course, the continuation of the trend of consolidation on both the commercial and marketing sides of the industry.

Jay Carter, EVP, Director of Business Development, AbelsonTaylor: To quote Rocky III: “My prediction? Pain.” Yeah, a little whimsical, but true nonetheless. Every election year promises to direct pain at our industry; that’s nothing new. In fact, in 1976, my first year of pharmacy school, required reading included Milton Silverman’s “Pills, Profits, and Politics.” (It’s still available on Amazon, if you’re interested). Guess what? Pharma was evil.

The important thing to note in 2020 is that there are few places to hide. Angst over drug pricing is bipartisan now. Neither PhRMA nor BIO have been successful in crafting truly intrusive promotion sharing the true miracles that our industry produces.

So what do we do? First – find that reason (other than the fabulous money you earn) to remind others why you do what you do. For me, it was work I contributed to in the middle ‘90s that truly changed the paradigm for treating breast cancer. It changed thousands of lives for the better. I am confident that each of you reading this can find a similar story. Share how your work contributes to the greater good.

Second – vote. And let your feelings be known to your elected officials. It makes a difference.

Third – support the organizations that are active in advocating for “us.” For the pharma and biopharma industry, that’s PhRMA and BIO. For medical communications companies, that’s the Coalition for Healthcare Communications, a group that my company is proud to be a member of, and I am proud to serve on the CHC’s board. Finally, if you work for an agency, the 4A’s is instrumental in addressing and advocating the needs of our industry in Washington.

Angela Tenuta: Interconnected data – it’s there and the industry is learning how to use it – will empower personalized medicine, personalized marketing, and personalized health.

Access – regulation change is likely to disrupt the world we know. Also, innovation radically redefining “point of care”: telehealth, Walgreens wellness clinics, etc.

Seth Gordon: 2020 may finally provide a clear vision into the future, due to the fact that it’s an election year. We are likely to see CMS finalization of several value based programs like Direct Physician Contracting, an increased focus on targeted and personalized therapies, and changes in care delivery that involve more technology and access to home healthcare services.

Brian Stack: Our younger generations are getting older, and those that suffer with health ailments that need our brands will dictate what the “new norm” will look like for marketing. These younger generations consume and trust information in a completely different way than the majority of our current targeting universe. Brands and company regulators will begin to get comfortable creating, reviewing, and publishing an abundance of content across text, still, video, and audio formats. Overly produced content will begin to feel less genuine by a majority of our viewers. Remember, these are the first generations raised by society to be content creators themselves!

Furthermore, the need to establish a true brand identity and voice through audio content will be more and more important over the next 1-2 years. Tools like Amazon Echo and Google Home are gaining traction at an incredibly rapid pace because it makes life easier. If we have a healthcare question, instead of reading and selecting one of the top 10 listings on the Google SERP, AI tools like Alexa will give you its best answer to your question (no choices or alternate POV). As purveyors of brands, do we want someone else providing expertise about our product? Our assumption is that brands will want to heavily leverage things like Alexa skills to promote content from the brand’s own voice.

Sonja Foster-Storch: For the tenth year, Syneos Health has published reports on the trends that are impacting our industry. It’s exciting to create this one at the change of a decade. So many of the micro shifts that we’ve seen nudging healthcare to change are coming to maturity, genuinely revolutionizing the way we live and work. We interviewed hundreds of people who work on the frontlines of healthcare to understand what industry shifts and market changes they’re seeing in their geographies and therapeutic areas of focus to identify the biggest trends set to change our world in 2020. From there, we were able to focus in on the 15 trends most frequently reported to show you where to focus in the year – or years – ahead.

So, what’s urgent for 2020? Big picture, our critical stakeholders are under more pressure than ever at a moment when distrust of those best positioned to help is at an all-time high. Radical changes in the interface of health are rapidly changing where people find care and how they learn about the possibilities of clinical research. In Clinical Development, the focus is moving more and more into the real world, from where people participate in early-stage research to how we cascade decades of decision-driving data and analysis. In Commercial, the conversation about value has reached a fever pitch. Across our industry, we’re taking huge strides to create more impact for patients, systems and our own organizations. We’re also raising the bar on what to expect from people and treatments.

You can find the top 15 trends set to change clinical research and treatment commercialization in the year ahead at trends.health.

Hilary Gentile:

Transparency, Forecasting Health Conditions and Shared Decision-Making
The call for greater transparency from brands will continue. Whereas non-health marketers might rely on intent-to-purchase data to understand future opportunities, there is an anticipatory aspect that people generate themselves in the health field. Through their self-generated discussions, which might include social media, they can provide information that forecasts health conditions. This predictive value could be valuable, as long as it relies on transparency both on the part of the brand and the individual.

Data can build trust between a patient and doctor in much the same way, as long as it is not abused. The patient controls the data, but in shared decision-making with the doctor.

Unprecedented Levels of Patient Ownership of their Own Data
A recent survey shows that 68 percent of people globally say they’re concerned about the erosion of personal privacy brought about by the increased use of technology and 85 percent of people believe the internet is evolving faster than our ability to keep it safe. Falling levels of trust have real-world implications for business. The idea of privacy is becoming been more relevant to the current patient population, and patients will demand to own their data at a level never seen before. Several brands have already developed ways where EHRs are owned by the patient. For example, Medibloc has created a digital currency where patients have full ownership of their own data but have the ability to “sell” it for discounts towards copays or as payment for products/services.

From Multi-channel to Omni-experience
Multi-channel will become multi-experience, where the single-interaction points will become multi-sensory, multi-touchpoint interfaces. We are already using multiple devices when consuming media, and these interactions must be augmented to be more experiential to have the desired effect, which will be the user expectation. While marketers are trying to figure out how to provide personalized messages and provide better brand experiences for customers through multichannel experiences, there will be the need for connecting all these communication channels and data, which may give rise to specialized agencies or dedicated efforts for doing exactly that.

Faruk Capan: It’s going to be an election year, so there will likely be a lot of negative talk about pharma, but I don’t think a lot of policy change will happen in 2020. In terms of pharma marketing, we must continue to focus on right-place, right-time messaging. Platforms like Salesforce and Veeva will provide better reach and targeting. AI deployed behind the scenes will play a bigger role in analyzing large amounts of data, making SEO more efficient, for example, and assisting humans with other repetitive tasks. Drug pricing will continue to be a major issue and spark public discussion.

Privacy protection will also continue to be an important topic. Google’s Project Nightingale, which has been partnering with a large health system to collect patient data, provides a lesson about what not to do: it’s currently in the spotlight for gathering patient data without the knowledge of doctors or patients. It’s very important that we be careful about our tactics and targeting. We must always look at our work from an ethical standpoint – even if it’s legal, is it right to do?

Ed Mitzen: How and where patients receive care are going to evolve. As younger generations, who grew up using technology and on-demand services, begin to make up a majority of the patient demographic, they are going to want to access care when and where it is most convenient to them. As a result, one area you are going to see a surge in is telehealth offerings and usage.

You are also going to see more comprehensive care offerings at nontraditional locations, such as supermarkets and big box stores. For the past couple of years, these establishments have been dipping their toe in the healthcare space to test the waters – but in 2020 and beyond, they are going to dive right in and attempt to capture a larger chunk of the healthcare market by offering a wider variety of convenient and affordable services.