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May 20, 2015

Diabetes. Heart Disease. Obesity. These are three preventable conditions that millions of Americans are living with today. Is misinformation or lack of information the cause? Are they educated but lack motivation to take necessary precautions? Each day people make numerous decisions that have a tremendous impact on their overall health. As health industry marketers, our job is to give them the right information, support, and inspiration to help them make judicious decisions to live healthy lives and prevent chronic conditions, when possible.

According to the CDC, diabetes, heart disease, and obesity are among the top diseases that are the most preventable. “Diabetes is the leading cause of kidney failure, lower limb amputations (other than those caused by injury), and new cases of blindness among adults.” One would think these consequences could provide enough motivation to make healthy choices, yet millions of Americans continue to be diagnosed because they fail to take action. Unfortunately, the number of cases keeps rising year-after-year. Fortunately, we can break the cycle and reverse the trend.

Knowing the facts & their future

The American Academy of Family Physicians stated that patient education and filling prescriptions have about the same impact on health outcomes. Our responsibility is to provide the necessary information patients need to understand the impact of these conditions, steps to prevent them and the difficult future they may experience living with these conditions if precautions are not taken. Empowering patients to act now, by taking steps to wellness, starts with education. Pharmaceutical brand marketers, health content developers, and healthcare providers must work together to create expert disease prevention content. But what is the right time and method to make an impact? The encounter must be highly engaging personal experiences filled with emotion, and distributed through key platforms for easy access by patients.

Support through connections
After educating patients and instilling motivation, the next step is ensuring prolonged commitment to health. This can be accomplished by creating connections between people through online communities and social groups. In a recent Remedy Heath Media study, 7 in 10 people said they were motivated by others to take an action such as eating healthier, exercising regularly, and getting a routine physical. It’s pretty amazing how contagious good health decisions become when surrounded by other like-minded individuals. Plus, there is the opportunity to make new friends who will push you when you need it most.

Through online outlets, health experts such as Amy Hendel (The Health Gal) – physician assistant, nutritionist, and health coach – provide connections for people needing support with their weight-loss, nutrition and fitness goals. These experts give people a sense of belonging and that they are not alone – they have somebody to turn to for trustworthy insights, advice, and guidance – keeping them focused and on track.

Other connections can be made through health and wellness social groups, like the one my wife started last year by connecting with neighbors, exercising together and sharing healthy family eating habits, grocery shopping, fitness tips, and more. Not only did it build a community focused on health and wellness, it created a support system sustaining their commitment. When a member of our wellness group cannot attend meetings the group reaches out and rallies together to ensure they remain engaged. Yes, peer pressure is still alive and well… but for good reason.

Remarkable health heroes spark inspiration

We have found that people become empowered through emotional storytelling. Remedy’s research indicates that among respondents who were highly motivated by emotional storytelling, 90% felt inspired after hearing an emotionally charged personal story.

To spark motivation, sites such as are developing emotional marketing programs including Be Well, Be Brave™, which captures the spirit of being brave by challenging themselves to lead a healthy life. Be Well, Be Brave™ presents emotional personal stories of everyday health heroes, who, despite huge hurdles, made important choices needed to live well. These stories depict the real-life transformations of people taking charge of their health. In turn, they inspire others to take action. The health hero’s story are chronicled in a long-form multi-media experience with video and text infused with expert supporting content – buying guides, diet and fitness plans – providing support, inspiration, and engagement for others to go above and beyond what they thought possible.

Whether it’s connecting online, through a social group, or via emotional storytelling, people need to spark their motivation to live healthier. That motivation comes from being educated, not just about where they are today, but what their future holds if changes aren’t made. Motivation will drive action and ultimately lead to a more healthy life, without the worry of preventable conditions. Remember, today the number of people being diagnosed with diabetes, heart disease, and obesity is climbing year-after-year; but by working together, our mission is to break this cycle, stop the trend, and reverse these growing numbers.

Ryan LeMonier

April 15, 2015

We know that the formation of healthy lifestyle habits is critical to overall health. However, adherence to exercise programs, medication regimens, or dietary changes can be challenging. So how do we help patients develop habits to improve their overall health?

Habits are defined actions employed without conscious thought.1 Habit forming potential of any behavior is often driven by two factors: frequency and perceived utility. The more frequently a new behavior occurs, especially within a short period of time, the stronger the habit becomes. Likewise, the more rewarding the behavior is perceived to be (its utility), the greater the chance for habit formation. The “Hook Model” is one method that we use at Health Union to build value and encourage habit-forming behaviors within our communities. Four key components converge in the hook model – a trigger, an action, a reward, and an investment2 – to create ecosystems that cultivate engagement habits and motivate people to live better with their health conditions.


Health Union communities use both internal and external triggers to encourage patient engagement. External triggers may include advertisements or comments from doctors, family, and friends; while internal triggers are leveraged when an action becomes strongly tied to a thought, emotion or preexisting routine, like checking email every morning. While we utilize some paid external triggers, like Facebook advertising, we’ve found that relationship triggers (social media sharing/word of mouth) and owned triggers (opting into a weekly newsletter) are most effective for long-term engagement. Owned triggers are most likely to prompt repeat engagement until a habit is formed, and relationship triggers support continuous community growth.


The more people interact with your product, the more likely they are to keep doing it. Our community engagement strategy creates a “funnel” approach to increase the level of participation over time, knowing that simple actions can lead to big changes in future behavior.3 For instance, our members may start as site visitors, then progress to following us on social media and engage in passive activities like anonymous polls. Passive participation may lead to newsletter registration and eventually active engagement by posting comments or personal stories. It’s important to make it easy for even the most passive patients to engage while still providing outlets for the most active members.


Provide a real benefit to action – with variability – and do it quickly! Show people that taking action results in a clear benefit. Of course, keep in mind that the preferred benefits vary from one person to the next. Make sure to clearly communicate what the reward is – whether that is answers to basic questions, immediate poll results upon voting, published results from surveys, or community support. Don’t assume the reward is obvious and communicate the benefit gained by others as well as that of the individual. Variability can multiply the natural effects of a reward and keep people coming back for more. All Health Union communities provide daily content that is relevant and useful, but the type of content, topics, and authors are varied to create novelty.


Encourage people to make an investment, beyond just lurking or passively clicking. This may be an emotional investment, an investment of time, or a contribution of personal information. Investment implies action that will improve the service for the next visit. And, the greater the investment, the more likely they are to continue engaging over time, thereby increasing the value of the product. For example, the simplest investment is to follow one of our social media accounts. However, we also invite members to “own” part of the site by participating in surveys and publishing personal stories.

What else can we do?

In addition to the four elements of the Hook Model, don’t forget to …

  • Remove barriers and provide support. Be aware of both perceived and actual barriers. For example, in response to a perceived barrier that weight loss is dependent on foregoing all desserts, provide recipes for healthier dessert options.
  • Strengthen self-efficacy, the belief in one’s own ability to complete tasks and reach goals. Since many people are uncomfortable asking their doctors questions, provide discussion guides to encourage dialogue focusing on areas where the patient is the expert – like how a condition affects day-to-day life.
  • Find what people are doing already, and make it easier for them by linking habits to daily routines.4 Our content strategy focuses heavily on giving people the information we know they are seeking, where they are already seeking it (with social media and search).

The ultimate goal is to create a cycle of interaction where the investment itself becomes an internal trigger. Members seek responses to topics discussed within the community – that desire for shared experience is the trigger to continue engaging. And then, they’re hooked!


  1. E. Morsella, J.A. Bargh, P.M. Gollwitzer, eds., Oxford Handbook of Human Action (New York: Oxford University Press, 2008).
  2. Eyal, Nir. Hooked: How to Build Habit-Forming Products.
  3. J.L. Freedman and S.C. Fraser, “Compliance Without Pressure: The Foot-in-the-door Technique.” Journal of Personality and Social Psychology 4, no. 2 (1966) 196-202.
  4. Bas Verplanken and Wendy Wood, “Interventions to Break and Create Consumer Habits, Journal of Public Policy & Marketing 25, no. 1 (March 2006): 90-103, doi: 10.1509/jppm.25.1.90.


Amrita Bhowmick

March 18, 2015

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.

Wendy Blackburn

March 17, 2015

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.

Amrita Bhowmick