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March 18, 2015 Wendy Blackburn

At a recent pharmaceutical marketing conference in New York, speakers and attendees were focused on – and visibly concerned about – a massive sea change happening in healthcare. The concern went well beyond “the best way to implement wearables into pharma programs,” or “how pharma can get involved in social media.” This wasn’t about shiny objects. This was about business. The theme? The impact of the Affordable Care Act is here. And increasing scrutiny on costs and outcomes is having an unprecedented impact on our industry.

The conference-opening panel, titled “How Will Marketing Innovation Help Pharma Adapt to the Massive Changes in Healthcare?” highlighted this conundrum well. Monique Levy, Vice President of Research, Manhattan Research, may have sent a bit of a panic throughout the room with her provocative point that “it’s time to face the music: treatment decisions are not happening the way they used to be.” Levy cited Manhattan Research findings that the real treatment decisions are happening elsewhere, and, in her opinion, “the glory days of patient empowerment are over.”

It’s no secret that, thanks to the Affordable Care Act and a variety of other factors, more and more treatment decisions are being made by payers – not providers, and – to Levy’s point – not patients. Levy maintained that patients may have preferred choices – they may even ask their doctors about them – but the payers are in control. For an industry that, for decades, has viewed its primary audiences and critical decision-makers as physicians and consumers, this represents a fundamental shift. Craig Kemp of Merck Vaccines, who also spoke on the panel, agreed. “There are fewer options now to promote pharmaceutical brands, and there will be even less in the future … Things are changing fast.”

So does the rise of payer power mean the end of patient empowerment? A recent study published in Health Affairs provides an alternative viewpoint. In the two-year study, researchers analyzed patient “activation” levels for more than 32,000 adult patients at Fairview Health Services in Minnesota. For the study, activation was defined as a “metric used to quantify a person’s knowledge, skills and confidence in managing one’s own health and healthcare.” (Some might call that empowerment.) To summarize the findings, patients with higher levels of activation demonstrated more improved healthcare outcomes and lower healthcare costs. In contrast, those with lower activation levels experienced significantly reduced chances of positive outcomes and their healthcare costs were higher. Researchers saw costs increase or decrease as patients’ activation levels changed. In other words, empowered patients had healthier outcomes and cost the healthcare system less than their less-empowered counterparts.

This study proves ending patient empowerment may not be the best option after all. In fact, it provides an important link from patient empowerment to the two things that matter most to payers: costs and outcomes.

While there’s no doubt we are experiencing a massive shift in the way healthcare is “consumed” and decisions are made, it’s important to not lose sight of the big picture. Imagine a world, for example, where pharmaceutical companies adopted a model of only “selling to” and speaking with payers, leaving the HCP and consumer completely out of the discussion. Of all of the stakeholders in this decision-making mix, isn’t it the patient who has the most at stake?

Yes, there are more challenges and barriers than ever before. Yes, there are many unknowns about the future. But that doesn’t mean the industry must choose one audience over the other, or shift its focus completely from one realm to the next.

Think about the outcomes that matter to payers and how you can measure and report your products’ impact on those outcomes. Encourage ties between empowerment, education, outcomes, and cost. Prove the worth of your products. And if those products work better with adjunct services and tools, prove the worth of those, too, and they will be reimbursed.

And yes – still – think about what patients want and need, and serve that up. Empower them with knowledge, skills, confidence, and choices. Because it’s the patient – the true “end user” – that is the greatest reminder of why we are in this business to begin with.

March 18, 2015 Deb Silverman

Having split my career neatly into two halves – first non-pharma, then pharma – I feel I have a good sense of what best practices can, and should, be lifted from the regular world into pharma marketing. In my experience, attitudinal segmentation by disease area isn’t one of them. In the non-pharma world, a segmentation study can be extremely helpful, and can help you narrow your gaze to a laser focus on the unmet needs of the most valuable target audience.

To clarify, I’m talking about good old-fashioned customized attitudinal segmentation studies. The ones that start with a foundation of qualitative research to uncover the range of attitudes, perceptions, and needs that exist in your category, and then plug those dimensions into a quantitative survey – culminating in a neatly segmented pie of a condition-specific universe. Each of those slices represents a target that is more or less valuable to your brand, based on unique mindset and demographics. These segments go on to inform creative development and help you make sense of future tracking studies and copy testing.

In the non-pharma world, a segmentation study can be extremely helpful, and can help you narrow your gaze to a laser focus on the unmet needs of the most valuable target audience. For example, I imagine that, years ago, Volvo figured out that among the car-buying public, there were people with deep pockets whose greatest concern was keeping their kids safe. They then developed deep equity in owning safety –  literally – and in their communications, based on the understanding that this segment was real, and its needs unmet. Similarly, Dove was successful in the consumer packaged goods (CPG) world by segmenting the market and figuring out that an opportunity existed to serve the needs of women who rejected popular notions of beauty.

Why does this custom attitudinal segmentation fall short in pharma? Because there is a profound difference between pharma and non-pharma that reduces the value of segmentation. Primarily, there is a fundamental difference in how consumers enter the category in each world. In the consumer world of goods and services, people choose to be in the buying universe. One chooses to identify as a Volvo person vs. a Subaru person vs. an Audi person. One nominates oneself into that universe. One chooses to buy into Dove’s brand image vs. Chanel.

In pharma, the rules are starkly different; no one chooses to be in the diabetes club, or the psoriasis club. You enter these clubs kicking and screaming, and if you had your way, medicine would not be in your life at all. Yes, if you have a condition that is profoundly impactful, such as arthritis vs. an asymptomatic condition such as high blood pressure, you will enter the club sooner rather than later, but ultimately, regardless of the condition, pharma is the only category where the primary end users want little to do with it (which is why caregivers are such an attractive target… but that’s a whole other article).

So, how do you profile your best opportunity?

The fact remains that to anchor great communications and build a brand, it’s critical to understand what portion of the disease universe represents the best opportunity. The good news is that a different type of segmentation can play a role here; specifically, a segmentation of overall healthcare attitudes (as opposed to a segmentation of patients diagnosed with a particular condition). Everyone has healthcare attitudes, and everyone who consumes healthcare (that is, the entire human population) can be divided into recognizable healthcare attitude segments.

If you work in healthcare marketing, you have seen these segments under various names. There is the Proactive Health Preserver – the person who takes charge of their health, has a strong sense of identity, does not allow themselves to be defined by their condition, and plays a strong role in their own treatment decisions. At the other end of the spectrum, there is the Disengaged and Uninvolved. That nomenclature speaks for itself. And in between, there are another two or three segments that represent people you would recognize at a backyard barbeque.

The reason that general healthcare attitudinal segmentation is more valuable than a condition-specific one is that healthcare attitudes remain fixed across conditions, and often across time. A Proactive Health Preserver (or a Solution Seeker or an Uninvolved) with diabetes represents essentially the same type of opportunity as a Proactive Health Preserver with psoriasis. The condition-specific study does not need to be fielded, because you can predict in advance what the segments will look like and who will be deemed valuable in DTC terms. Spoiler alert: it’s nearly always the Proactive Health Preserver/Solution Seeker (or whatever he/she is called in your study), because they are the ones who are most open to medication and most influential in their treatment decisions.

Further, over time, attitudinal segments tend to remain stable, because they tap into profound perceptions about sense of self and authority that are central to who we are as people. For example, people with a strong internalized identity who are not defined by external circumstances (such as their diabetes) are likely to retain this mindset over the long term. They will see medication as a tool in their arsenal and will not avoid treatment because they don’t want to be “that guy with diabetes.” They will research treatment options and partner in their treatment plans.

Similarly, those who are unable to extricate their identity from their condition are not likely to change this attitude over the long term, and those who leave it all to the doctor are likely to continue doing so over time. This is opposed to other types of segmentation (such as patient-journey based), which, because they are rooted in an external temporal structure rather than an internal mindset, are not truly segmentations. Those segmentations map a patient population as it moves along a disease path. This information may be useful when developing a CRM program, but again, that’s another article.

What can a pharma company (and its agency) do to bring segments to life?

Rather than spend several hundred thousand dollars on segmentation studies that continue to reveal the same segments when the dust clears, a pharma brand team would be better off using existing data to bring their core segments to life. For example, by using the healthcare segmentation already provided by syndicated studies from Kantar Media (MARS) or The Futures Group, and then layering your disease state over that segmentation, we can then profile these augmented segments to determine where your best opportunity lies. The result is a detailed view of attitudes, demographics, and actual media consumption that is actionable. This profile can be cross-referenced with other sources such as qualitative research to flesh out the richness and detail of your target and bring them to life.

What can I do with my de facto segments? The segmentation keys (provided by the vendor) can overlay your de facto segments on to your customer database, so you can create customized messaging for priority segments. You can fold them into your tracking study, so you can track the impact of communications against the patients who are most valuable for your brand. And you can use the segment screening criteria to recruit patients into qualitative research. To learn how to do this, all you have to do is call whatever syndicated vendor makes the most sense for your brand.

So, I still need to do qualitative research? Yes! Leveraging off-the-shelf segmentation with an overlay of disease state does not negate the need for in-depth qualitative research among patients. Understanding how your patients think and feel at every step of the journey – the obstacles and opportunities at key touchpoints – is crucial. The research is also critical to bringing your segments to life in the rich and nuanced way that is necessary to anchor great briefs, and great work.

However, to ensure that your qualitative insights are reflective of your key segments, it’s important to put thought into recruiting these segments for qualitative, which can be done, again, by leveraging the segment tools that can be provided by the vendor. If that’s not possible, the next best approach is to apply a proxy for the segmentation key, ensuring all recruits are proactive about their health and influential in their own treatment decisions – attitudes that, when it comes down to it, are really the key criteria for evaluating the value of one segment versus another.

March 18, 2015 Robert Nauman

The goal of any support program should answer this question: What factors must we use in the program that will instill patient confidence in our product – and by default our company? Trust is built by a series of actions and those actions speak volumes more than any words or discount prices ever can! A recent article in eMarketer reported seniors do not trust pharmaceutical company sites and prefer WebMD more.  In this work, companies need to be brave and work harder to deliver a better “patient experience,” while a patient is “on the product.”

A situational review

  • Patients do not want a relationship with a product; they want an “experience.”
  • Federal regulations tend to inhibit innovation in these pharmaceutical support programs.
  • The pharma industry’s patient support programs, in terms of the information they provide, are not valued as they once were. So many other avenues are available, and considered more trustworthy, to patients to get information, including the Internet and patient advocate groups. Maybe it is time to give Regulatory and the other legal protectors some new assignments.
  • Competitive pricing could force excellent programs to be marginalized and undifferentiated (i.e. Gilead and Abbvie in hepatitis C).
  • Patient Engagement is the hot new topic. Not only is pharma trying to come up with a viable, profitable formula for PE, but the Accountable Care Act is forcing many ACOs, integrated delivery networks, and other health care delivery system to tackle this issue as well. With so many different health care systems putting their unique spin to the issue, other questions arise: what works, what does not, how to separate the good from the bad? Think mobile app development.
  • The industry has examples of good and bad pilots. When programs scale to larger patient populations, they lose their patient focus. Outside of specialty drugs, physicians will choose DTC efforts over patient support programs as a factor influencing prescription recommendations.

The first problem is inherent in the program itself: Not all are ground in proven theoretical based methodologies that assist with a patient’s needs. In our opinion, the way to connect and engage is remove the current program silos. Commercial organizations need to consolidate approaches, converge vendors, look to execute more than innovate, and, most importantly, measure and value engagement as much as they do reach and lead generation efforts. Senior leadership should consider looking at the total spend as many fail to ask if all those dollars being spent can be focused more effectively to deliver better program execution.

It has been done before

We frequently mention the work! Biogen Idec demonstrated this with its MS drugs (Avonex & Tysabri) in the in the late 90’s to early 2000’s. Its focus was execution excellence and customer support. The call center and customer relationship management approach acted as the quarterback of its patient focused efforts. Its current website says it handles 800,000 calls a year.

Patients wanted to know about what to expect on therapy, they wanted to know what side effects they would experience, especially with Tysbari’s known side effect, Progressive Multifocal Leukoencephalopathy ( PML). Because of the regulatory requirements, the company embraced this as an opportunity, not a burden, to disclose potential side effects. Moreover, in 2002, Biogen had to take these issues head on because of other products in the market and the high visible media reports on PML.

Back then, management felt it important to have an employee assigned to each patient or caregiver as the single point of contact and relationship steward. This required consolidation and coordination with the ad agency, PAP, HUB, Co-Pay Card, Reimbursement and Benefits investigation, specialty pharmacy and technology.

It’s not a stretch to say that, 13 years later, this plan is still literally paying off: To quote a recent Motley Fool: “Biogen Idec’s MS drugs include the billion-dollar blockbuster drugs Avonex, Tysabri, and Tecfidera, as well as the company’s newly launched Plegridy … Sales of Biogen Idec’s MS drugs increased 47% to $7.93 billion, and its total sales increased 40% to $9.7 billion last year.”

In conclusion, keep in mind these points:

  • Doing this right with patients will produce the brand’s best product advocates.
  • Switch the metric quantified! Measure and reward commercial and medical teams on the number of patients who get better on the therapy as a result of the product and support; not on how many new patient starts were achieved in the past week. Measure engagement, get engagement is what produces real results!
  • “What have you done to help a patient on our product today?” should be stuck on a post-it on every employee’s computer, laptop and iPad.

If the product works, produces outcomes, and patients can easily access information they want, this will help them. They will get started on therapy and realize the value of staying on therapy for the long term. Consider who saved Tysabri from a market recall.

March 18, 2015 admin

In such a strongly regulated industry where it is most important to avoid a downslide, pharma is falling behind in digital health. Risk taking and innovation suggests being open-minded for failure. As Robert F. Kennedy said, “Only those who dare to fail greatly can ever achieve greatly.” The path to success is filled with risk taking: adventurously shifting the predictive and precise, sustainability, quality-based and patient-centric healthcare delivery models away from the reliance on profitable drugs and moving towards resource allocation in digital health to engage patients in new ways.

Predictive and Precise Healthcare Delivery Model with Data Analytics: Real-world evidence and outcome research not only identifies high risk patients but also anticipates medical issues to create customized care plans for individuals as well as improves patient population health through data analytics in the predictive and precise model. Digitally leveraging this model with telehealth efforts, such as wearable devices, can result in pharma partnering with equipment manufacturers to deliver patient adherence information. Headsets which track brain activity and sleep patterns, and sensored “esmart” clothing which monitors blood pressure and heart rate can allow for medication content to be analyzed and then used to form clinical decisions. mPharma and smart devices can digitally leverage this model with real-time, self-tracking, and progress feedback devices and apps, such as 1) food and movement tracking apps; 2) compliance apps with automatic prescription refills; and 3) sensor supported diabetes apps that create a new demand for test strips.

Sustainability Healthcare Delivery Model with Community and Personalized Content: Fostering digital patient-to-patient interaction instead of information exchange exclusively between patient and physician is a key factor in the sustainability model. Online patient communities, such as PatientsLikeMe, digitally leverage this model by allowing for patient reciprocation of objective medical information that results in resourceful discussions about a patient’s personal experiences with different medications that have proven efficacy. Physician communities such as KevinMD and Sermo also can digitally leverage this model with physicians acquiring value through sharing online information with other medical experts about new and successful drugs. Both communities not only promote certain medications but also create pharma brand loyalty.

Quality-Based Healthcare Delivery Model with Physician Tools: Reimbursement depends on measures which promote clinical expertise in the quality-based model. Physician tools support the diagnosis and selection treatment, increase the efficiency of the care process and improve the rapport between the physician and patient. Digitally leveraging this model with IBM’s Watson shows that physicians are on the forefront of technological care access with virtual assistants to facilitate physician referencing and decision making and also improve patient confidence in the progressive capabilities of their physicians who they believe will prescribe the newest and most effective drugs on the market. Electronic Health Records (EHRs) are utilized as cloud-based solutions that integrate data resulting in research and clinical trials that lead to faster results. Patients are engaged via recruitment for clinical trials and the post-market monitoring of safety and efficacy with prescription medication.

Patient-Centric Healthcare Delivery Model with Patient Tools: Consumer experience and understanding patients in their daily lives to achieve patient adherence is the main emphasis of the patient-centric model. Patient tools such as Quick Response (QR) codes that allow patients to interact with chosen information at their own pace can digitally leverage this model. Specific QR codes for each product can be imprinted on prescription bottles and boxes leading patients directly to the online product website. Patient education explaining use, dosage, and safety information can be highlighted through animations, interactivity, and videos from medical practitioners. Remote monitoring support programs can provide information about a patient’s surgically-implanted device that allows constant observation of functioning organs and the skills patients need to manage them. Monitored results can be programmed to text patients’ phones to remind them about upcoming medication doses. The information can be collected and returned to the physician in real-time which would allow for any necessary intervention to be delivered immediately.

In summary, technologically leveraging the predictive and precise, sustainability, quality-based and patient-centric healthcare delivery models with data analytics, community and personalized content, physician tools, and patient tools, respectively, will bring pharma up to speed with current digital health efforts resulting in improved outcomes. Pharma will always invest money where it believes it can secure the highest return, but risk is of utmost concern. At the moment, pharma envisions the highest gain and lowest risk opportunity in developing drugs and not in developing ways of digital patient engagement. By pharma taking a riskier, spirited leap of faith and engaging patients through digital health, greater progress will be achieved.

Gupta, Anu, Schumacher, Jeff and Sinha, Saptarshi. “Digital Health:  A Way for Pharma Companies to be More Relevant in Healthcare.” Booz & Company. (2013)
“Healthcare Delivery of the Future:  How Digital Technology Can Bridge Time and Distance Between Clinicians and Consumers.” EHealth Research Institute. (2014)
“Wearable Tech Regulated as Medical Devices Can Revolutionize Healthcare.” MDDI Medical Device and Diagnostic Industry News Online. (2014)
Palgon, Gary. “Secondary Use of Healthcare Data. and Health:  Use the Cloud to Harness Mainstream Patient Data for Valuable Research.” Contract Pharma. (2013) Brueggeman, Jessica. “Managed Markets:  Operation Patient-Centricity.” Medical Marketing & Media. (2014)

March 17, 2015 Chemelle Evans

Children and fools speak the truth, they say. When Galileo first said that the Earth travels around the Sun, he was held for a fool. When industry pundits say that patients are at the center of the life science Solar System, they, too, are sometimes accused of throwing around mere buzzwords. But that doesn’t make it any less true. Patient centricity matters for the sake of patients as much as for the sake of business. So how can it be done well?

1. Prioritize face-to-face encounters
Of course, we do market research, social listening, and a myriad of other activities to gain insights and improve business strategies. Those things are needed and necessary. However, how many of us are actually engaging patients personally? While words can convey a great deal of information, but visuals, the voice, the face, and body language all provide relevant context to what is said. Nothing shows greater respect and a higher level of interest than taking the time to be physically present and interact personally with someone. When was the last time you actually had a conversation with someone who had the condition you are working on? If that was not recent, perhaps that’s the place to start.

2. Be human
If you ask patients what’s most important to them when they choose a healthcare provider, overwhelmingly, they’re looking for someone who cares how they’re doing. For a number of reasons, pharmaceutical brands can be perceived as lifeless, cold, necessary evils. They are viewed as merely pills, injections, or infusions, and their benefits sometimes get lost in the commercial mandatories for people to only find that they can’t remember why this brand was a good idea in the first place. We shouldn’t be content with just being “necessary.” Successful brands have a human face, because they work with real people living with the disease, and they offer real support rather than just marketing messages.

3. Include care partners
A large body of literature points to the importance of close family and friends to help patients adhere to their treatment regimen and to provide for the right care at home. In some disease categories, reaching care partners is arguably more important and more appropriate than reaching the patients themselves; think of Alzheimer’s, autism, or any kind of pediatric disease, where it’s mostly physicians and care partners making the most important decisions on the patient’s behalf. A parent caring for a child with a disease will struggle with a different set of worries than someone caring for a spouse, so customization is vital. Care partners often end up being just an afterthought, but in our experience the best patient communication programs have always taken loved-ones into account early in the process. Being mindful of how an illness affects not only the person, but also those around them, is a critical consideration in the communication strategy.

4. Be relevant – tell stories
Research points to three main drivers of medical adherence: patient comprehension, recall, and motivation. Only one messaging format can address all three supporting factors to improve behavioral outcomes: stories. As studies at the University of Princeton have shown, storytelling can lead to neural coupling, where the brains of listeners essentially mirror activities happening in the brain of the storyteller. What this means is that if you hear a story, your brain comes close to actually experiencing the story. Stories get our attention, so our brains are switched on, which helps us understand and remember what we’re being told. And since stories also stimulate us emotionally, we are more open to messages that encourage certain behaviors.

5. Choose peers as messengers
The most credible messenger for any target group is a peer. Testimonials and personal recommendations by people in our inner circle have always had the strongest influence on our most important life decisions. We trust people who are just like ourselves more than total and utter strangers. Storytelling is good, but it has to be culturally appropriate; i.e. your messengers should have a similar demographical background as the target group. Don’t speak through “the average person on the street,” but through “the average person living with the condition,” or a person just like the ones you’re trying to reach.

Bottom line: Engaging with patients takes commitment and preparation. Yet, regardless of brand, it needs to be done – it’s about accepting the facts surrounding the entire healthcare universe. It’s about listening to “fools” like Galileo.

March 17, 2015 Amrita Bhowmick

People actively involved in their health and healthcare generally have better outcomes in managing their condition. So how do those of us working in healthcare and healthcare marketing motivate people to get more involved? While we don’t have all the answers, Health Union has learned some valuable lessons and practical tips for enhancing patient engagement since launching our first platform,, more than four years ago. Here, we share some key insights from our recipe for cultivating active, engaged patient communities, and hopefully, help marketers avoid common pitfalls.

1. Listen to patient communities
Our mantra – the community is always right! Observe patterns of engagement to learn what interests patients and what doesn’t. Success will come from aligning your agenda to respond to their needs, which will continue to evolve over time. For instance, early in the lifecycle of our community, Health Union created a series of yoga videos that could help patients with rheumatoid arthritis increase strength and flexibility. Unfortunately, we offered a great solution to a problem that our current members weren’t interested in fixing. However, as our RA community continued to grow – and interests became more diverse – these yoga videos eventually became relevant to a certain segment of the community. Engagement often depends on offering the right content at the right time, and it’s important to continually assess the needs of patients as your audience grows.

 2. Segment based on behaviors, not demographics
In our communities, we observe similar behavior patterns at various phases throughout the patient journey. For example, in people with type 2 diabetes, we recognized that patients who were newly diagnosed, adding a new medication, or lapsed treaters were all relating to tips-and-tricks-type of problem solution articles. So, we created a profile for these “frustrated quick-fixers” and developed a strategy to develop this type of content on many different topics. Once you recognize a behavior segment, seek to understand what’s driving those behaviors and find multiple ways to meet the true underlying needs.

3. Meet people where they are
Make it simple for people to engage, regardless of how much time, knowledge, or interest they have. The easier it is for people to engage, the more likely they are to do it, and keep doing it! While this seems obvious, it is important to keep in mind that what is easy for one person, may not be easy for another. Provide multiple, unique, and easy opportunities for people to participate where they are and according to their comfort level. We often initiate engagement on Facebook (without requiring a site visit) since patients are already there and willing to participate with a like, share, or comment. On our websites, anonymous polls enable “lurkers” to participate. We also build content to meet the needs of different types of community members. While some content is simple, basic information that can quickly answer commonly asked questions, other content is more detailed with higher-level scientific data.

4. Validate concerns or challenges first, and then offer solutions
Most people know what they should do to improve their health, but they don’t take action, for many reasons. Choosing healthy behavior is difficult. We’ve learned that we can increase engagement and empower our community members when we acknowledge and validate the challenges of making health improvements before offering solutions.

Many people with migraines become frustrated when encouraged to exercise by their healthcare providers. For some, exercise can trigger a migraine attack; for others, migraine is chronic and getting out of bed is exhausting in itself. Exercise tips and advice are often met with negative reactions among the migraine community. However, when we acknowledge that exercise can be a challenge for people with migraine and offer varying ways to increase physical activity while managing potential migraine triggers, we create a positive connection and encourage healthier behavior.

5. Align interests and opportunities
Once you learn what interests and motivates your audiences, provide more opportunities for them to get involved. Use past performance to guide strategy. Experiment with variations on proven areas of interest to create new ways to engage. For instance, we received an overwhelming response to our annual Migraine In America survey, making it clear that people with migraines are seeking opportunities to be heard, share their opinions, and compare experiences. As a result, we started building more feedback mechanisms into our communities – from quick polls and questions for our Facebook community to creating specific opportunities for patients to opt-in for survey invitations from corporate and academic partners.

While there are many ways to create and maintain patient engagement, these principles are some of the most critical for success.

Editor’s Note: This is the first installment in a two-part series from Health Union. Check out our April issue of DTC in Focus to read about making engagement a habit and how these principles apply to adherence and patient support.

March 11, 2015 Ritesh Patel

Since 2009, the nascent medium called social media has blossomed into something that is now entwined into the very fabric of our personal lives. Billions of people flock to Facebook daily. Some 90% of journalists now get their news and news ideas from Twitter. LinkedIn has dramatically altered how we find and recruit talent, and YouTube has completely changed how we watch videos. Newcomers like Instagram and Pinterest are also garnering hundreds of millions of users.

Social media outlets have revolutionized the healthcare industry and are quickly becoming the preferred resource for individuals seeking healthcare information. Patients turn to social networking groups to find others who are battling the same diseases (for patients preparing for the same type of surgery, following tweets helps demystify the process, and ideally reduces anxiety about upcoming operations), share advice, recommend doctors, even send other members a virtual hug. Clinicians connect to share information and learn from each other.

Through it all, the pharmaceutical industry continues to either ignore this medium or dabble in it in a way that feels like an afterthought. There is still a fundamental misunderstanding of this medium and how it could be applied. While patients, advocacy groups, and the likes of the Mayo Clinic have flocked to social media, most of the pharmaceutical industry has largely ignored it.

It’s not to say nothing is being done – some major companies have established centers of excellence (created to understand this medium), hire agencies to help them and manage the process, and educate internal stakeholders. Some have dabbled with a single platform, like Twitter (corporate communications) or YouTube. But most have continued to say “No social media” in relation to the promotion or marketing of their products. When people have dabbled, it has mainly been around paid media on social channels – that is, advertising.

Brands have limited roles in our actual social life. We just have to understand how and where we can be part of the conversation. In our regulated industry, we’re limited in what we say, so we say very little. Once we’ve recited our label, we’re going to repeat what’s on it (and maybe offer a coupon). So, absent any true guidelines from the FDA, what can the industry do? Particularly now that most every manufacturer is looking at ways to “go beyond the pill” and promote more of a patient-centric approach to their business.

Social media should be viewed more as a way of doing business and less as a means of promotion. While promotion is a component, there are now aspects of social that can be applied to a number of areas, in a compliant way.


Socializing customer service

Industry leaders all provide programs for customer service that are manned by call centers all across the US. There are SOPs that are 10 years old that these centers abide by. These same SOPs could be applied to providing service via social channels, particularly Twitter or Facebook. Banks and financial services companies, who have a similar (but not the same) regulatory environment, have figured out how to do this. Combining social listening and customer service could enhance the patient experience and help with the patient-centric positioning most companies are striving to achieve.

Twitter has been embraced by the corporate communications function to blast out press releases, socially responsible acts committed by the firm, and medical meeting information. However, there is little engagement. This should change now that the FDA has provided guidance on the use of limited-character platforms.

Paid social will grow as more and more media planners come to grips with this medium, especially at drug launch. Planned and managed properly, paid social can be a great vehicle for targeting patients with an unbranded message for disease awareness campaigns. There will still be challenges in using this medium for branded media, primarily due to Important Safety Information (ISI) requirements.

The use of YouTube is a requisite now in most marketing plans. However, it is tied mainly to MOA or KOL videos. Tools such as are now enabling the capture of true patient/user-generated content that can be moderated and put through the same legal and regulatory framework that exists for other content.

From a patient perspective, the biggest opportunity for pharma will be with Facebook as it begins to hone its healthcare strategy. Even though pharma already has a presence on Facebook, pharma is all over the map with regard to Facebook communities. There are unbranded and branded communities, as well as communities based on partnerships with third parties.

Pharma has created product pages, such as and, disease awareness campaigns like, and unbranded presences such as

Pharma should look to truly engage the patient on these communities. By partnering with Facebook, pharma companies could:

  • Provide better, up-to-date product and scientific information in patient-centric language
  • Work with advocacy communities on Facebook to raise awareness of a disease
  • Expand the use of Facebook to reach specific audiences, such as rare-disease communities who are very active on Facebook


In summary

The marketing function of the pharmaceutical industry needs to begin focusing on changing its thinking around social media, to more of an engagement-oriented model and less around advertising and promotion. Social should be viewed as an integral part of the overall marketing mix and not something that is siloed or the domain of corporate communications.

Granted, this relegates the use of social media to a couple of areas, such as those outlined above. But that is much better than doing nothing at all, or doing it badly.

March 6, 2015 Bob Ehrlich0
Bob Ehrlich
“Patient engagement…will be a company survival imperative.”
-Bob Ehrlich

We have an impending health care cost crisis facing many Americans. Anyone with employer subsidized insurance has seen their share of the cost rise over the years. My personal premiums as a Pfizer retiree have risen every year and now approach $5000 a year plus my deductible. So before I see much reimbursement I pay close to $7000. I know this is still a good plan and much better than what I would pay on the exchange.

On those state and federal exchanges, my premiums would run about $8000 and a deductible of $6000 would be normal. So most health insurance is really for an unexpected serious illness beyond what we would expect in a typical year. Most years I do not reach my deductible, and that is a good thing because it means I am relatively healthy.

So whether one has employer or exchange-based insurance we still are paying our own way much of the time. I know we get that free check-up once a year and a couple of other freebies under the ACA. The fact is, however, that anytime a doctor wants to do a procedure, test, or write a prescription we are paying for all or much of it out of pocket.

I have been getting used to that with my dentist for years since I have no dental insurance. As most of you know teeth somehow are extremely expensive to repair. That tiny porcelain crown costs $2000. My tiny little titanium implant cost around $4000. Lacking dental insurance makes one very attentive when the dentist recommends a procedure. I have lost all reluctance to push back on price and actively explore cost of the procedure. I also negotiate. I am no longer reluctant to show emotion and skepticism when told that little tooth somehow needs work.

We can certainly expect patients to react to this cost shift by engaging in traditional consumer behavior. The idea that patients accept whatever the doctor suggests will be affected by cost. As unseemly as it is, patients will be challenging their provider on price/value. They will demand in advance understandable explanations as to cost and the alternatives.

Drug companies have for years been the recipient of tougher negotiations by insurance companies. Insurance companies have increasingly passed on the cost of branded drugs to their patients. So, the bottom line is drug companies are faced with a marketing problem. How do they convince patients to pay higher fees for their drugs? While tiered formulary has been a fact for years, it is getting worse.

As patients start demanding value for their money, drug companies need to change their engagement strategies. Added value can be achieved in many ways. That can be through pill size, dose, frequency, side effects, packaging, efficacy, multi-indications, and follow up service.

While patient engagement has always been a goal of drug marketers, it will be more of a company survival imperative in the future. The new patient, driven by cost pressures, will demand value for premium priced drugs. Drug companies may not yet be ready to deal with the empowered patient armed with information and angry at their rising health expenditures. I would hope drug executives are acutely aware of this new consumer power. Successful drug companies will be those who stress price value and respect the rising power of the patient.