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June 26, 2015 Bob Ehrlich0
Bob Ehrlich
“Patient engagement will be the hot new topic…”
-Bob Ehrlich

We are hearing the term patient engagement a lot these days. It is the subject of many blogs, articles and conferences. But what is it? That depends on who is defining it. From a drug makers perspective patient engagement is getting prospective drug users to know about your disease category, drug and keeping them persistent and compliant once taking it. From a provider perspective, it means the process of dealing with patients from appointment setting, office visit, post visit follow up, and handling patient questions and concerns.

From the patient perspective it means how do providers and drug companies deal with them as customers. Patient engagement has become a popular term lately. It has emerged out of the changing dynamics of patient care. The patient today is paying more of the bill through higher co-pays and deductibles. They are much more sensitive to what things cost and their share of it.

That means they no longer will be blindly doing whatever the doctor tells them to do in terms of tests, prescriptions, and procedures. Physicians are ill-prepared to engage patients. The busy provider is now being peppered with cost and coverage questions. They also are being asked to justify what services they perform on a cost/benefit basis. These busier than ever doctors are now being asked to be cost experts. That is very difficult with the opaque nature of what services cost.

We are seeing a shift continue in the growth of patient knowledge. Combined with that patients being asked to pay more and we get a patient who demands to be consulted on what is done for them and at what cost. Patient engagement also means more digital medicine, as busy patients and doctors are going to rely more on remote exams, monitoring, e-consultations, and electronic health records.

A more engaged patient is more likely to be a healthier patient. Having access to more information, through face to face and digital platforms, will help patients understand what care actually makes a difference in terms of outcomes. Patient engagement means more business opportunities for health media and application providers. The physician’s office and retail pharmacies will become central in the effort to engage patients through existing and new media applications. ​

Clearly, engaging patients means providers need to rethink how to delight consumers through the entire process of care. I am sure we are at the low end of the customer delight scale. Successful providers will stress patient engagement and satisfaction. Drug companies are part of that process. I am sure most consumers are not yet delighted or engaged very well by drug makers. Satisfaction is a function of many things. Drug price, efficacy, dose convenience, side effects, follow up services, clarity of message, ease of contacting, and dealing with problems are all factors in engaging and satisfying patients.

I expect patient engagement will be the new hot topic across the provider world. There is absolutely no reason that health care cannot rise to levels of customer satisfaction of other industries. We have a long way to go but the winners will be those that recognize patient demands and satisfy new expectations.

June 25, 2015 David Maricich0
DTC Perspectives | DTC in Focus
Healthcare connection concept

Value-based reimbursement models have emerged to encourage new efficiencies aimed at improving population health and lowering the cost of care. With the realignment of incentives, the companies and organizations that comprise the healthcare ecosystem: primarily hospitals, medical groups and payers with connections to medical device, pharma, mHealth and others, have been working more closely than ever before. Some organizations have felt forced into changes while others have embraced the shift with an entrepreneurial spirit. Since this ecosystem largely didn’t exist until a few years ago, this change presents many challenges as well as opportunities.

There’s no better time for healthcare organizations to embrace this movement and surround themselves, both internally and externally, with those who understand the process innovations and new technologies emerging within this ecosystem to support value-based care. Simply put, this matters because the opportunity cost for those who take an overly conservative and siloed approach could be significant.

The Secret to Success

While technology is extremely important to the evolving healthcare ecosystem, the foundation for growth and increased efficiency comes from process innovation and perhaps something much simpler. When speaking about his company’s legendary success, the late Walmart CEO, Sam Walton famously stated, “We’re all working together. That’s the secret.”

Taking cues from the integrated delivery system model pioneered by Kaiser Permanente, Mayo Clinic, Geisinger and others, traditional health systems are starting to follow suit. In addition to providing leading-edge care, University of California San Francisco (UCSF) is also innovating in the boardroom. In a recent Modern Healthcare report, Mark Laret, CEO of UCSF Medical Center, discussed the importance of moving academic medical centers forward.

“We want to be able to go to the market and offer employers an insurance product and a delivery network that rivals what Kaiser Permanente does in the Bay Area,” Laret said. “Kaiser has been phenomenally successful in integrating how care gets delivered and doing it in a seamless, patient-centered way. The rest of us who are fragmented really need to change our mindset. So with John Muir Health and UCSF working with 15 or 20 other physician, hospital and other providers in the region, we are looking to be able to take financial risk for the care of populations, starting as soon as 2016.”

Innovation and partnerships in healthcare delivery are also showing up in plain view, right on Main Street. There are increasing numbers of walk-in clinics located inside retailers such as CVS and Walgreens. Staffed largely by nurse practitioners, these settings are inexpensive and streamlined, according to The Economist.

In fact, Walgreens’ locations in Arizona recently rolled out lab testing services in conjunction with Theranos, the disruptive diagnostics company founded by 31-year-old Harvard drop out Elizabeth Holmes. Profiled in rock-star fashion by The New Yorker, Forbes and a host of other marquee publications, Holmes has been compared to another successful Silicon Valley dropout, Steve Jobs. From a tiny drop of blood, Theranos offers customers a range of tests, saving time, money and patient discomfort. Even Sam Walton’s Walmart is getting in on the action. According to The Economist, the company plans to become a leading seller of low-cost health services in the future.

Many are taking note. According to a recent HealthLeaders report, the affiliation of retail clinics and hospitals expands access to services, speeds care, helps control spending, and drives patient referrals.

Back to the Future

With the advent of the Apple Watch, many news outlets have been calling to mind the classic Dick Tracy comic strip in which the first wearable communication device appeared in the 1930s. In March of this year, Apple CEO Tim Cook announced while unveiling the new device, “I have been wanting to do this since I was 5 years old. The day is finally here.”

This is just one technology that will create new opportunities for adherence, diagnostics, provider communications, patient-wellness support, and a wealth of other applications. Many are seeing not only the opportunity for better patient outcomes, but also the substantial economic benefits provided by the adoption of new technologies.

By utilizing telehealth, patients save an average of 5 hours, and their family caregivers save close to 9 hours per appointment, according to UCSF in a recent San Francisco Examiner report. Furthermore, patients reported high satisfaction with their telehealth visits. “I think this is going to be the way of the future,” Dr. Cynthia Kim, a specialist in pediatric pain management and associate professor of pediatrics at UCSF said to the Examiner. “It’s truly changed my practice. There’s just no way we could keep up with our clinic unless we did this.”

Inspiration and Perspiration

Perhaps the words of legendary innovator and iconic businessman Henry Ford are the best to keep in mind as organizations navigate new opportunities and risks associated with changes in the healthcare ecosystem: “Coming together is a beginning; keeping together is progress; working together is success.”

To support the goal of the Triple Aim, it will take the persistence of many bright minds from all areas of the healthcare ecosystem. For the true innovators, this goal of improving population health and quality of care while lowering costs can be achieved simultaneously with increased market share and profitability.

June 25, 2015 Karla Horton
DTC Perspectives | DTC in Focus
Social media networks tree

Now that the majority of brands have established a social media presence, they’ve shifted from developing social media strategies to asking how they can use them to maximize patient engagement. But in order to identify the value of their efforts, marketers must gain an understanding of who they’re reaching, the social channels consumers prefer and most importantly, what content will strengthen patient relationships.

Who are the BFFs of Healthcare Social Media?

So who are the BFFs (Best Friends Forever) of healthcare social media marketing? Or in other words, which healthcare consumers are most receptive to social media campaigns? To find out, adults 18+ who consider social networking sites to be a valuable source of healthcare information were profiled. According to the Nielsen Scarborough MARS Healthcare Study, BFFs tend to be young, as almost half are 25-44 years old. They tend to skew slightly female, predominantly white, with moderate education (high school or some college) and an average annual household income of about $69,000.

While half of BFFs consider themselves to be in excellent or very good health, 75% have had a family member hospitalized during the past three years. Additionally, they’re influencing the choices of those family members, as 73% say that friends and family come to them for advice about healthcare and medications. So while BFFs of healthcare social media account for only about 8% of the US adult population, their influence is much farther reaching when it comes to healthcare decision making.

Preferred Social Media Outlets

Facebook is the primary social media outlet for BFFs of healthcare social media marketing, with 68% saying they have visited the site during the past 30 days. YouTube comes in at a close second, with a little over half (53%) visiting that site during the past month. Instagram ranks third at 18%.

While there are many similarities among BFFs that frequent each social media outlet, there are some unique aspects that marketers should consider. Facebook and YouTube reach a slightly older audience, average age 38 and 37 respectively, while, not surprisingly, Instagram BFFs skew younger, with an average age of 32. In addition to Instagram’s more youthful audience, these BFFs are also more likely to belong to an ethnic group, with almost half identifying themselves as African-American or Hispanic. YouTube offers the best opportunity to reach male BFFs, as 42% of its audience is male, compared with 36% for Facebook and 25% for Instagram. This highlights how important it is that marketers use a variety of social media outlets and accommodate each audience as they develop their content strategies.

Content to Drive Action and Engagement

Examining the lifestyles, attitudes and healthcare behaviors of social media audiences provides great insights into the types of content that will resonate with patients. The more closely the content matches the patients’ interests, the more engaged your audiences will become with your social media outreach.

So which topics should marketers leverage most? When it comes to health, stress is a subject that just about everyone can relate to. In fact, two out of three BFFs consider themselves to be very or somewhat stressed, and about one-third say their stress level is much or somewhat higher than it was a year ago. Weight management, exercise tips and healthy eating are other topics that will resonate with BFFs, as three out of five believe they are overweight or obese, while half say they’re currently dieting or have been on a diet plan. Parenting, maternity care and pediatrics are also hot topics. BFFs are 48% more likely to be planning the birth of a child during the next 12 months, and 44% already have a child under 18. Additional interests include alternative and holistic approaches to medical practice and emerging healthcare treatments.

It’s also important to understand how BFFs will respond to your social media content, specifically what actions are they likely to take as a result of the exposure. When asked what actions they have taken during the past year as a result of exposure to healthcare advertising, BFFs of social media marketing reported being 128% more likely to discuss a healthcare ad with a friend or relative and 102% more likely to conduct an additional online search for information. These percentages indicate that BFFs are hungry for valuable healthcare content and further emphasizes the influential impact that BFFs of social media marketing can have in building awareness of your services.

Increasing the value of your social media presence takes planning and patience, but the payoff can be substantial as it reaches a highly influential group of healthcare consumers. Your social media BFFs are your brand ambassadors, and they have the power to propel a single post through their channels and reach thousands of potential consumers. Understanding who they are, their interests, and preferred social media outlets will allow you to build a successful social media strategy where the recommendations of BFFs build significant and far-reaching marketing momentum.

June 25, 2015 admin

Senator Edward M. Kennedy’s landmark speech at the 1978 Democratic National Convention in Memphis, Tennessee emphatically brought attention to our nation’s health care dilemma, establishing his stance on health care as a matter of right and not of privilege. The human right to health care means that “services must be accessible, available, acceptable, and of good quality for everyone, on an equitable basis, where and when needed.” Supported by approaches and behavioral science theories, including the Health Belief Model and the Theory of Planned Behavior, mHealth and telemedicine embody the ideals of the right to appropriate care at a suitable time in the correct place.

Decreased Time and Cost of Health Care +
Increased Health of Population and Quality of Care =
High Return on Investments in mHealth and Telemedicine

By incorporating the following five approaches of mHealth and telemedicine into our health care system, lower cost and higher quality care for all becomes a clear reality.

  1. Remote analysis services. Highly trained professionals work as a pooled resource with fractional employment providing 24/7 coverage with services such as telepathology and teleradiology.
  2. Remote monitoring technologies. Patients switch from serviced on an inpatient basis to monitored on an ambulatory system.
  3. mHealth monitoring technologies. Disease managers prevent hospitalization for conditions such as heart failure by accessing daily weight information and proactively assisting patients with fluid retention before a crisis occurs.
  4. At-home triage services. Televisits from nurses and PCPs decrease emergency room visits.
  5. Telemedicine appointments. Providers accept patients upon their current availability and
    reduce the amount of wasted underutilization.

Applying the Health Belief Model to mHealth

In a study comparing traditional to mobile app self-monitoring of physical activity (PA), the Health Belief Model (HBM) concept of perceived benefit showed that app users self-monitored exercise more often than non-app users (2.5 days vs 1.25 days per week) and reported greater intentional PA than non app users (150 kcal vs 50 kcal per day).

The concept of perceived barrier to wearables involves difficulty with location tracking using Bluetooth (narrowband) and measurable issues in accuracy, time latency, and consistency. Signal strength is an unreliable indicator of distance considering wireless network effects such as obstructions, reflections, refractions, multipath and reception. One innovative solution is ultra wideband (UWB) radio which enables resilient location and distance measurements.

Efficiency of Narrowband vs Ultra Wideband
with Time Latency and Visual Effects

Cues to Action
The concept of cues to action comes to the forefront through instant feedback from such wearables as pedometers or activity monitors. The data acts as a reward when results are high and as a challenging motivator when results are low. Forty percent of trackers indicate that feedback prompts them to ask a doctor new questions or seek a second opinion. Trackers share their results with others in common language in online support groups either to receive and give encouragement or take part in competitions.

Applying the Theory of Planned Behavior (TPB) to Telemedicine

Subjective Norm
In a study to determine patient use of walk-in clinic telemedicine services for minor ailments compared to emergency room visits, 73% of respondents mentioned that the opinions of their family members would be important considerations. Normative interpersonal channels more strongly influence their decision making than mass media channels which solely gather information.

Perceived Behavioral Control
Perceived e-consultation diagnosticity occurs when the patient believes that images and sounds transmitted through technology are under their control. As remote patients, they perceive that enough accurate information is relayed electronically to allow physicians to understand and evaluate their symptoms and health conditions without being present to “touch and feel” them.

The attitude of the patient surfaces with increasingly knowing their rights to quality care and believing that telemedicine improves access to quality care. Patients suffering from chronic illnesses that live in rural areas and have limited access to doctors due to disability or age have virtual visits with PCPs or specialists not always available to them.

In conclusion, most Americans are not “at the tip of the iceberg way up high in the health care services” as Senator Kennedy stated in his 1978 convention speech. The road to managing our health care crisis is paved with a golden opportunity. The HBM and TPB behavioral models show that quality care offered universally and equitably at a lower cost is a reality with the growing use of mHealth and telemedicine. Now is the time to allow digital health to propel our nation’s health care system forward to realize our desired outcome.


Darmon, Luc. “Wireless for Wearables.” Embedded Computing Design. (2014)

Newell, Derek. “5 Ways Mobile Apps Will Transform Healthcare.” Forbes. (2012)

Paddock, Catharine, Ph.D. “How Self-Monitoring Is Transforming Health.” Medicine News Today (2013)

Serrano, C. I. and Karahanna, E. “An Exploratory Study of Patient Acceptance of Walk-In Telemedicine Services for Minor Conditions.” International Journal of Healthcare Information Systems and Informatics (IJHISI), 4(4), 37-56. (2009)

Turner-McGrievy G.M., Beets M.W., Moore J.B., Kaczynski A.T., Barr-Anderson D.J. and Tate D.F. “Comparison of Traditional Versus Mobile App Self-Monitoring of Physical Activity and Dietary Intake among Overweight Adults Participating in an mHealth Weight Loss Program.” Journal of American Medical Informatics Association, 20(3), 513–8. (2013)

West, Darrell. “How Mobile Devices are Transforming Healthcare.” Issues in Technology Innovation. Center for Technology Innovation at Brookings. (2012)

June 25, 2015 David Barwig

Pharma insiders sometimes dismiss the marketing campaigns of consumer-packaged goods (CPG) as being too far removed from our work to be relevant. “They have such big budgets! They don’t have our restrictions! What can we learn from them?” A lot, we think.

Group Account Director David Barwig, who is new to Intouch Solutions’ New York office, has a background in the CPG industry. From SC Johnson to “Got Milk,” his multichannel experience has developed the digital side of many household brand names, and his expertise is now coming into play for several of our pharmaceutical clients. We talked to David about the biggest things he believes pharma can learn from CPG marketing. Here’s what he had to say:

Stop Creating Hubs

It’s a common strategy in pharma digital marketing to create a hub and drive people to it from all of your other efforts. A lot of brands spend a lot of money doing just this. That model is where CPG was three years ago – but that’s not what they do anymore. Today, they simply put content right where people will see it, without paying a ton to drive traffic or connect with the right partner. They deliver content that people care about, out in the world where people see it naturally.

And it’s saving them money. Sure, you may spend more time and money on approvals for the different versions of content necessary, but when you look at “cost per eyeball,” it’s far more cost-effective. The model is changing, and pharma brands that can catch up will save a great deal on media costs.

Plan to Feel Safe

It pays to learn where on social media your brands are being discussed because it may not be where you expect. For example, one of my Rx brands is often discussed on Pinterest, with infographics and recipes. Based on the patient profile, that wasn’t what we expected, but it turns out that the caregivers and family members are the more active ones on social media in this case, and that’s where they are. It’s a little more effort, but when you do some investigation and planning and map out a workflow, you can feel far more secure that your social efforts will pay dividends. That means even people who are less than familiar with social channels can feel more secure. And it means that you can minimize risk and know where you can afford to be more inventive and creative.

Maximize Tech

Something that I notice more often with my pharma clients than I saw with my CPG clients is that they often have very robust, enterprise-wide solutions for content management and analytics. I find that pharma invests in global tools that can do a great deal, whereas, in my experience, consumers often had outdated technology. However, the downside of this is that there is often inconsistency in the expertise that different brands have in using those tools. Like that common quote about humans only using 10% of our brains, some pharma brands have great tools but just don’t have the specific expertise to get the most out of them and make them work together.

Be More Dynamic With Bigger Data

Pharma works with target demographics, but they miss out on the CPG focus on personas and context. I may know that my brand’s target is a 55-year-old male with a 50-year-old female caregiver. But often I don’t know what their mindset is at each step in their day, at each phase of the disease. In the consumer world, they invest in that, and that’s what they target, with much more complex and precise messaging. It was often a budget issue for pharma in the past, but today, phenomenal data capabilities and dynamic targeting are more accessible and affordable than ever. We can change messaging and creative for different seasons – or even different times of day or locations. We can help caregivers prepare against common problems or help patients stay on track and accountable. Dynamic, responsive, data-driven customization makes sure that what shows up for the customer – patient, caregiver, or healthcare professional – is perfect.

Keeping a Sharper Competitive Edge

I know that pharma sometimes thinks CPG work is an easier playing field, but it’s important to remember that the average consumer product has incredibly narrow margins and extremely high competition. They may have simpler rules and bigger budgets, but they also have a harder fight. That’s why they invest in such planning and detailed research. The smallest edge can be hugely important. They stay on top of developments in market-research technology and marketing breakthroughs because they have no other choice. Necessity can keep you sharp, and I think that’s a lesson we know in pharma as well.

June 18, 2015 Bob Ehrlich0
Bob Ehrlich
“I am honored to have known him.”
-Bob Ehrlich

Our colleague Marker Weigand passed away last week. Marker was a DTC colleague at Amgen who was stricken with ALS. He will be remembered by all who knew him as a wonderful person and loving family man. I am always shocked when someone so young passes prematurely. I knew Marker as a Facebook friend and as a DTC colleague. I used to see him regularly at the DTC National along with many other friends from Amgen.

His passing reminds me of how important our role is in developing cures for these horrible diseases. We usually see these diseases from afar and when a friend gets a rare life ending disease it hits hard. I remember Marker as one of the nicest people I met through my DTC experience. We honored Marker in 2010 as a top 25 DTC marketer. He was a well recognized industry leader.

When someone like Marker dies it reinforces the belief that what we all do is so important. We are part of an industry that is trying to cure disease made up of dedicated people just like Marker. His passing should remind us all that our role is not about market share but about saving lives. We sometimes get caught up in business metrics that are really not all that important. I am shocked and saddened that a young man like Marker was a victim of an insidious affliction like ALS.

I was not aware of Marker’s struggle until I was notified of his death this week. I am honored to have known him. His passing certainly gives me perspective on what is important in life. To my Amgen friends I express my condolences and will always have fond memories of Marker.

June 11, 2015 Bob Ehrlich0
Bob Ehrlich
“I am unclear what FDA will do with the results.”
-Bob Ehrlich

The FDA is interested in researching how drug ads are perceived when viewed alone versus with a spouse. They feel that when viewed with a spouse, drug benefit and risk may be interpreted differently. I think the study could yield interesting information. Does viewing with another person cause different benefit/risk takeaways? The FDA has a comment period ending 6/25/15.

Of course, the question is how FDA would regulate differently based on what is found. If viewing together causes increased risk concern, what changes would FDA make? The same goes for benefits. One would assume that two people viewing might remember more of the risk discussion since that is generally more complex than benefits. On the other hand, how would that change what is mandated by FDA?

Since FDA cannot regulate who watches an ad and with whom they watch, then how actionable is the data collected? Assuming joint viewing changes the perception, so what? My guess is that viewing with a spouse changes perception differently by drug category. A man with ED watching with his wife is probably going to have different results than for an allergy drug.

I think drug companies themselves are very interested in spousal influence on drug awareness and doctor inquiries. Clearly drug companies know spouses impact these decisions and create ads that mirror real life spousal discussions. Many DTC ads use husband and wife discussion to advertise drugs.

I am unclear what FDA will do with the results. I put this study in the nice to know category but far less important than risk communication studies they are also doing. We can assume that ads are viewed differently when watched together versus alone. Unless FDA can mandate how an ad is watched, then this study seems to be unnecessary. I expect FDA has a rationale for what would be done with the results in terms of guidance changes or other regulatory considerations. It would be interesting to hear what they say would be done with the results. In the comment section of the proposal they mention this study will benefit public health understanding. That, however, is such a broad answer that it has no practical interpretation regarding regulation.

The drug companies are skeptical based on comments already received. Lilly and Abbvie question the practical impact of this study. So do I. Interesting study but not likely useful in regulating advertising. This seems to be more of a study that a university or health think tank might do since they do not need to have a practical outcome. FDA, however, should only do studies that might change how they regulate advertising..