Pharma marketers spend much time and effort developing and improving ways to support patients in their specific disease areas. This is important work. An estimated 150 million people are living with at least one chronic condition in 2015, and by 2030 the number is estimated to grow to 171 million.
However, this effort does not take into account an important reality: many patients are dealing with more than one condition at the same time. This means that current efforts may be too narrow to offer the full breadth of support that your consumers need every day. Almost one in three Americans has multiple chronic conditions (MCCs). Specifically, about 27.9% of adults aged 45 to 64 and more than half (51.6%) of adults 65 and over suffer from two or more chronic conditions, with the major burden of MCCs on older Americans aged 65 and over. As the baby boomer generation continues to age, the problem is expected to increase.
The CDC reports that the most prevalent combination of two chronic conditions in the United States is hypertension and arthritis, and for people who have the most common combination of three diseases, they add diabetes to that duo. Other common chronic conditions include high cholesterol, heart disease, cancer, depression, substance use disorders, asthma, HIV/AIDS, and dementia. But what makes this challenge so pervasive is that even though these diseases are most common, there are many others. Each person is unique, and so are the health challenges they face every day.
The price of living with MCCs is steep: 71 cents of every dollar of US healthcare spending goes to treating people with MCCs, according to the US Department of Health and Human Services Agency for Healthcare Research and Quality (see the details in a great infographic here). And these are definitely your customers. People with three chronic conditions fill an average of 23 prescriptions per year, and that number jumps to 50 prescriptions per year for people with five chronic conditions.
What can we do to provide information and support for people with multiple conditions? It is a conceptual, logistical, and IT challenge to be sure, and one that pharma does not face alone: government, nonprofit groups, and other health organizations are also structured to provide support that is segmented:
The nonprofit National Council on Patient Information and Education (NCPIE) recently launched a 10-step adherence program called Accelerating Progress in Prescription Medicine Adherence: The Adherence Action Agenda as part of its campaign platform at www.bemedicinesmart.org. Though the resource gallery includes links and resources for the most common, costly, and preventable of all health problems in the US, there is not one place where patients can turn to address all of their conditions and symptoms.
Data aggregators, sites you probably know that are set up for patients to log their health data to be combined with others and inform clinical research, are set up for patients to track their diagnosis and treatment for one disease/condition at a time.
How can pharma marketers face this challenge to help their patient consumers? It’s a multi-faceted problem, but here are some starting points to open the discussion:
Stop focusing on just disease and focus instead on the tools of coping, juggling and living. Not only do most people have more than one medical condition, but everyone is trying to get through each day successfully managing their health along with their relationships, their jobs, and more.
Engage with patients the way patients want to engage (not the way pharma prefers). It’s not about controlling the message – instead, put yourselves in your customer’s shoes, work to deeply understand their journey, and see how you can help.
Provide peer-to-peer support. When it comes to their health, patients want to hear from people that they feel are like them. Because it is likely that others are dealing with multiple conditions, peer support that connects patients with real people who have volunteered to share their experiences and provide support can make a significant impact on disease management. Helping to connect people so they can share what has worked for them in their journey means they can learn from and help each other.
The takeaway here is that the convergence of social media, empowered patients, and The Internet of Things has brought us to a point where consumers expect the tools they rely on to blend seamlessly into their lives, providing the information and support they need, the way they need it. Pharma needs to help patients navigate the complexities of their own health in all aspects, not just around one drug.
Wu, S. Green, A. “A Projection of Chronic Illness and cost inflation 2000”
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 HealthAffairs 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.
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, www.Migraine.com, 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 RheumatoidArthritis.net 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.