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 BerkeleyWellness.com 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.
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”
In last month’s edition of the DTC Perspectives’ DTC in Focus newsletter, we discussed patient engagement and provided prescriptive thoughts on maintaining and even increasing patient commitment. This month, we take that thought one-step further (as well as, adhere to this month’s theme) and focus on patient adherence. The discussion includes whether the emphasis of such programs should be on both long and short-term medication adherence particularly in how they are resourced and measured.
A situational review
Current support programs typically devote a large amount of time and money ensuring patients initiate therapy. However, these programs never allocate time or funding to safeguard that the patient maintains adherence after that time period.
Studies indicate that patients with chronic diseases may not either grasp the severity of their condition; understand the literature they receive about their condition; or require multifaceted efforts to achieve adherence.
Current support programs operate in silos. While these programs are typically mapped out strategically, they are not executed in a coordinated fashion.
These silos execute patient adherence programs:
Co-pay card company
Reimbursement and benefits investigation vendor
Consumers, patients, and caregivers often are not satisfied with the content and creative contained in patient adherence programs
These targets at some point in the treatment process stop at Brand.com. All find the information initially helpful, but tend to look somewhere else for information because the information they want or need is not in the adherence program.
Patient adherence programs today are like an inverted hourglass. The strategy is thin at the top, disparate and expansive in the middle due to the silo construct, and then the program strategy attempts to narrow again. Yet, often this does not occur.
While all pharma brands say they have patient adherence programs, the reality is – and I am basing this information on my 20 years of experience – very few deeply engage and build a relationship with the patient; maybe 10% to 15% really execute this well. These programs work because senior leadership is committed to them for the long term, both in human and financial capital. (See last month’s column re: Biogen Idec.)
Operational issues still exist today
Along with the barriers already mentioned to pharma’s delivering quality adherence programs, there are two more barriers, and they are formidable.
First, product managers are no longer brand champions. Their roles now resemble those of purchasing procurement agents who buy a single program; their sole hope is to get noticed by senior leaders.
The second, arguably more significant complication is the FDA, namely its regulations. Companies have allowed their legal and regulatory teams to make business decisions regarding programs that minimize risk in terms of providing the evidence and content that patients and healthcare professionals want. The pejorative natures of today’s drug marketing regulations are designed to educate, not inform. Grant Corbett, a psychologist we have worked with says pharma produces content from the perspective that patients and others affected by disease are not competent to understand the information so brand programs need to “educate them.” He asserts companies should make the opposite assumption and assume the patient, caregiver and consumer understand their condition and work to provide information that fills in the knowledge gaps. This is where great programs in the marketplace are focusing their efforts today.
Answers exist today
The short-term lead generation and conversion marketing strategies of patient adherence programs are no longer viable. The key to winning at the ground level is to have the program’s patient advocate be part of the solution that has been prescribed. It is paramount to ground a multi-channeled adherence program in a scientifically validated model to instill confidence in patient and caregiver. Patients and their care team need to believe they have the complete and long-term support needed to overcome their disease. Moreover, to accomplish this, the program needs resource and execution in a coordinated fashion. These are the factors creating a real competitive advantage in adherence programs today!
While industry spends $10s of millions on various aspects of the entire effort, that resource is cut up into smaller chunks or pools of money. This causes all parties to fight for their chunk of the pie and to lose interest with the whole strategy. Senior leaders, in this age of consolidation of resources, must consider these programs at a total cost level and ensure they all are driving value. That is why we advocate bringing back the role of a Brand Champion, an individual or set of individuals who commit to a longer-term career path with the brand, who can oversee the convergence and collapse of the silos – and decide how to spend the money.
Finally, we are big proponents of the net promoter score construct. Two or three simple questions added to any program to assess the patient’s willingness to recommend a product to a family member or friend. This simple measure helps leadership teams stay focused on the end goal of customer satisfaction, regardless of the program’s timeframe.
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.