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KENT GROVES, PhD | VP, CLIENT LEADERSHIP GROUP, LIFE SCIENCES | [email protected] LAWRENCE | SENIOR DIRECTOR | [email protected]
1.877.9MERKLE | MERKLEINC.COM | © 2013 MERKLE INC.1
Life Sciences
Thought Leadership Series
HOW DIGITALLY CONNECTED PATIENTS AND HCPs ARE
CHANGING THE GAME: LEVERAGING CONNECTED CRM TO RE-INVENT
MEDICATION ADHERENCE
How Digitally Connected Patients and HCPs are Changing the Game
Life Sciences2
Executive OverviewThe ongoing lack of patient adherence — the degree to which a patient is able to or willing to follow medical advice — is one of the biggest drivers of unnecessary costs in healthcare today. In a recent study (June, 2013) the IMS Institute for Healthcare Analytics stated that more than $2.7 trillion was spent on healthcare in the US in 2012, and that the avoidable costs associated with higher medical bills due to non-adherence could be as high as $146B (5.4%).
As the healthcare system is shifting from pay-for-treatment to pay-for-outcomes, improvements in patient adherence are a national priority as the Affordable Care Act (ACA) goes into effect this year and throughout 2014. Bio-pharmaceuticals, Managed Care Organizations (MCO), and physician practices are all expected to improve patient compliance with actionable, insightful and tailored recommendations, which a patient will adhere to.
One example of this shift is through the growth of healthcare organizations characterized by a payment and care delivery model. That is, one that seeks to link provider reimbursements to specific quality metrics. Accountable Care Organizations (ACOs) are responsible for the quality, efficiency and relevance of the health care provided to patients and third-party payer/insurers.
All stakeholders need to re-evaluate the old approaches that effect medication adherence and consider a more connected, data enabled vision of adherence. This white paper details how to:
f Utilize mass personalization powered by “Big Data” to transform adherence into a more preference-driven and individualized experience
f Plan for and execute integrated adherence strategies through paid, earned, owned and shared media channels f Identify variable barriers to conquer patient non-compliance; align with tactical executions that make sense for both individuals and brands
f Get an early read from adjacent industry pioneers (eg. insurance, travel, entertainment, banking, telecommunications), by leveraging new marketing technologies to build customer loyalty
f Leverage Facebook, YouTube, Twitter and related social media channels, and better understand the role they play in the development of effective adherence strategies
f Score tactical capabilities, and identify how new digital tactics can be used to create a customer experience that will drive adherence via an integrated CRM roadmap
Brand managers are now in a position to leverage HCP and patient digital connectivity like never before. Those who choose to ignore the “new world order” will be left behind, as patients will build relationships with HCPs and brands who engage them on their level, with media that are meaningful to them, and serve to help them achieve their personal health goals within the context of their therapy.
$2.7TRILLIONSPENT ON HEALTHCARE
MORE THAN
IN 2012
3KENT GROVES, PhD | VP, CLIENT LEADERSHIP GROUP, LIFE SCIENCES | [email protected]
CROOM LAWRENCE | SENIOR DIRECTOR | [email protected] | MERKLEINC.COM | © 2013 MERKLE INC.
IntroductionTo initiate an appropriate discussion on adherence, we will begin with the patient journey. While there are many variables that ultimately impact medication adherence, the two largest considerations have to do with the patient relationship with their health care professional (HCP), and timing/impact of communication relative to the therapeutic content of a prescriptive intervention. Figure 1 provides a visual to the “lift” a brand should expect when engaging with patients closer to the start of their relationship with the HCP and discussions around their condition. We know the HCP-patient dialogue is the most critical component of treatment selection, therapeutic initiation and continuity. Once the patient leaves the HCP’s office, a number of non-compliance drivers take over. HCP influence wanes as memories of the office visit fade. This is particularly true for products that don’t produce immediate relief (lipid lowering products, anti-hypertensives, etc). An active presence of the Rx brand becomes more important than ever to extend and reinforce the influence of the office visit well after the initial HCP exchange.
The role of the patient has never been more important – especially in the brave new era of centralized health planning through the ACA. As we shift from a fee-for-service model to payment systems that reward health outcomes, patients’ ability to succeed on therapy requires a new mindset. They need to be proactive and systematic, basing decisions on the holistic view of their personal health and its associated lifestyle. Patients are able to choose for themselves how to improve their overall health through life tracking technologies (eg. quantified self-movement) to more personalized interventions that are based on data.
Figure #1 Relationship Between Patient Engagement and the Patient Journey*
Traditional Patient Adherence Flow
Patient Adherence Flow in the Digital Age100%
100%
95%
95%
60%
60%
40%
2.5%
100%
100%
90%
72%
50%
4%
Patient recognizes a problem
Patient does research
HCP issues an Rx
Gets an offer to opt-in to treatment & brand info
Receipt results in greater
persistency & compliance
Patient doesn’t fill Rx, problem persists, returns to HCP
Patient doesn’t fill Rx, problem persists, returns to HCP
Patient Opts-inPatient Fills Rx
Patient recognizes a problem
Patient does research,
visits HCP
HCP issues an Rx
Receives support from Brand, HCP, NP/PAs, peers
Ongoing connectivity, engagement,
adherence
Fills RxGreater
persistency & compliance
Point of initiation of broader patient engagement and initiation of adherence/compliance messaging
*This graphic demonstrates the relative impact on levels of compliance and persistency that may be expected by moving the primary point or broader patient: HCP engagement further up the patient journey
How Digitally Connected Patients and HCPs are Changing the Game
Life Sciences4
Historically, the majority of medication adherence programs have focused directly toward patients who have opted-in to a brand communication. Given the typically low opt-in rates of less than 5%, targeted communication is limited in its scope, affecting a small base that may result in an Rx lift of 1-3%. This communication depends upon the severity of the illness, difficulty with treatment side effects, or modes of administration. Within the context of the patient journey, the communication took place well after the initial point of inflection with the HCP, and after that first, critical patient discussion about the seriousness of their condition, value of the medicine, potential side effects and resources to access if they have questions, etc.
To have a significant impact on medication adherence, we need to fortify the point of initiation of therapy, namely the off ice visit and the first prescription, but also build patient trust and confidence with the Rx brand before and immediately after the prescription is written. Optimizing this opportunity will result in compliance and persistence that will drive the adherence engagement opportunity gap (Figure 2).
Exchanges between the HCP’s nursing/office/administrative staff and the patient must also be considered. This is where the pharmaceutical companies and individual brands have the opportunity to make the doctor’s job easier and take the lead. Working with health professionals to build relationships, through a variety of activities including:
f Integrating blinded electronic medical records (EMRs) into patient profiling f Analyzing digital media behavior data (Twitter, Facebook, etc) f Establishing patient segmentation influenced by disease activity, geography, HCP proximity, and channel propensity (to name a few)
f Matching digital fingerprints and profiles with known segments f Ultimately developing and providing the HCPs with patient content and support material to drive closer and more frequent exchanges between the patients and their physician
Figure #2 Adherence Engagement Opportunity Gap
Ptnts Receiving an Rx
Opportunity Gap
Ptnts Refilling after 2 Months
Ptnts on Therapy after 4 Months
Ptnts opting in to Messaging
Ptnts Filling an Rx
0
20
40
60
80
100
Historical Future
Rela
tive
Scal
e
5KENT GROVES, PhD | VP, CLIENT LEADERSHIP GROUP, LIFE SCIENCES | [email protected]
CROOM LAWRENCE | SENIOR DIRECTOR | [email protected] | MERKLEINC.COM | © 2013 MERKLE INC.
Supporting HCPs with this approach will establish strong partnerships between the pharmaceutical manufacturer and their brands, which in turn will pull the patients into a closer relationship with their HCP and result within stronger understanding of the value of their treatment including medication compliance and persistency.
Patient JourneyIf we were to start with a clean slate today, we would consider a fairly large range of tools, interventions and technologies that could be leveraged to drive stronger relationships between the patient and the HCP (and/or their office). Our first step, however, is to consider the patient journey (Figure 3), and their recognition that they have a health related problem that needs to be discussed with a healthcare professional.
The consumer (patient) wants and expects more. In fact, they are almost always 100% in control. In consumers’ minds, they’re making the best decisions and trade offs, no matter how ill advised, and almost always without fore-knowledge of the health impact of not taking their prescribed medication. Given potential unforeseen risks, patients are best served by a stronger relationship with their physician and most critically a more trust-worthy healthcare brand. This is very relevant, given an environment where 1 in 5 prescriptions were not f illed primarily because the patient doesn’t understand, believe in (or trust) in the value of the therapy.
The patient journey typically begins when they recognize that they have a bothersome symptom or concern for a legitimate condition. At this point they may start to “self-diagnose” by talking with a trusted friend or family member, or by browsing consumer health portals, facebook, twitter, advocacy sites, pharmaceutical manufacturers’ sites, and beyond. Alternatively, they may ask their HCP at the next visit or schedule a specific appointment, but this is more likely a tact in the case of an acute condition rather than chronic and ongoing concern. Chronic diseases with noticeable symptoms such as angina, shortness of breath, diabetes, respiratory ailments, pain, etc. are more likely to be researched, resulting in the patient entering the office with perspective, opinion and higher levels of expectation.
#3 Relationship Between Patient Engagement and the Patient Journey
In this graphic, the start of the patient journey (1) involves research by the patient themselves, family or the caregiver. At this stage the patient may also be trying OTC products or just hoping it will go away. The next stage of the journey is the HCP Visit (2), which will be followed by beginning treatment (3), which may or may not involve Rx. Historically we have not viewed the value of engagement with the patient and their interaction with the HCP in these early steps, and have focused our attention on continuing therapy (4), titrations or therapy modification (5) and maintenance (6). The reality is that steps 2 and 3 are critical to establish engagement, exchange, therapeutic understanding and most importantly, trust during the patient journey.
Level 1
NRx never filledLevel 2
NRx filled, taken improperly
Level 3 Doesn’t refill, discontinues
after NRx Treatment Works
Abandons Treatment
Start of Journey Begin Treatment Modify Therapy Today
JOU
RNEY
ACTI
VITY
ADH
EREN
CE
STAG
ES
1 2 3 4 5 6
In Pursuit of Patient Adherence
Life Sciences6
In consideration of the patient journey (Figure 3), the big chasm we need to address is that moment of impact, the establishment of trust and introduction to an advisor where the patient relationship begins before a single pill is taken. Step two is the HCP visit. We need to move beyond the notion that the brand marketer can start a third party exchange after they have filled their first Rx and still yield a scalable business impact. It’s too late and too limited as the brand has already lost as many as 25% of patients who never make it to the pharmacy. In other words, brand marketers are incurring needless waste and failing to optimize their health mission against thereby larger patient population. Broad, non-personal communications are less likely to see value, less likely to drive opt-in, and thereby, won’t generate scalable involvement.
The timing of branded adherence communications must also be re-thought shifting from a focus on the patient after the script is written to ensuring the brand relationship is being built before the first physician visit. Additionally, it needs to be relevant and accessible within the overall ambient social conversations that impact life within and far outside the physician’s office. The good news is thanks to the ACA, and MCO’s attention to results, relative to a population average, we now have the HCP’s attention to this as well.
The Physician, The Patient and The Pharmacy
Level 1 Non-Compliance
The patient never fills the first prescription.
Level 2 Non-Compliance
The patient fills the initial prescription, but does not take the medication as prescribed.
Level 3 Non-Persistence
The patient doesn’t continue treatment after the first
prescription is filled and they most likely fail to refill the
medication after the first prescription.
The future of adherence requires an understanding of the 3 primary stages of medication non-adherence:
1 2 3
7KENT GROVES, PhD | VP, CLIENT LEADERSHIP GROUP, LIFE SCIENCES | [email protected]
CROOM LAWRENCE | SENIOR DIRECTOR | [email protected] | MERKLEINC.COM | © 2013 MERKLE INC.
Privacy, opt-in and access to information aside, the dynamic of adherence is going to be driven by:
f Patients seeking higher Quality of Life (QOL) metrics. They want to get better, can’t afford not to, and expect a higher level of interaction and relationship with their HCPs
f MCOs are publically traded entities who, at the end of the day, are accountable to their shareholders, who expect a decent rate of return. They will push forward with Pay for Performance initiatives across Accountable Care Organizations (ACO), Multi-Physician Facilities and related health institutions. Baseline expectations around therapeutic results are understood and the standards are known. All HCPs will be evaluated against an ever growing understanding of what should and can be.
f Pharmaceutical Benefits Managers (PBM) will jump into this, as their revenue stream has historically been generating rebates from brands and generics, while offering a smaller discount back to their clients. As these deltas continue to shrink, they will need to support and drive patient adherence, which in turn will impact Rx volume.
f Pharmacists will expect more for dispensing something beyond an Rx, and they too will see their compensation revolve around the patient reported outcomes (PROs).
f Physicians have a choice. Incur the short term costs associated with building relationships with their patients, or suffer the long term consequences of reduced payouts from insurers, penalties resulting from failure to meet standards established through the ACA, or patient erosion as they seek HCPs who can help them move beyond acceptable levels of PROs.
Considering these 4 stages of adherence: technology, tools, media, and knowledge, demand exists within the marketplace for a new approach and better results. The emergeing approach will be challenged by privacy commissions, multiple levels of government, pharma’s medical-legal review, patient advocacy groups and in some instances the physicians themselves. But despite the apparent hurdles, failure to challenge the norms will result in continued growth of non-adherence as a major driver of health cost.
Click to watch Kent Groves provide insight into compliance approaches & considerations that resonates with today’s adherence challenges.
OUR INSIG
HT
How Digitally Connected Patients and HCPs are Changing the Game
Life Sciences8
Patient: HCP Engagement
In effect, the onus falls on the adherence planners and marketers to establish a systematic way to identify, serve and retain (high value) patients better than OTC or Rx alternatives. Additionally, they need to ensure customer interactions improve financial results, PROs, create competitive advantage and drive shareholder value.
Historically, pharmaceutical marketing included patient relationship management (adherence communication) further down the path after awareness, acquisition and conversion. Furthermore, in some cases the communication was (and is) done in isolation of the physican’s office. The physician was not even part of the equation. This all changes as we move forward, and look to personalize medication adherence—before, during and after the physician’s office visit - in an effort to modify individual patient barriers to treatment.
Adherence Objectives Redefined in the Era of Big DataA new breakout period for adherence marketers is being powered right now by new technologies that make mass personalization a reality. The fundamental shift as discussed for years is to meet customers where they are – and to address their personal needs and desires. Now, as we enter the era of the addressable consumer as powered by the digitization, we can finally put customers at the center of strategy and use big data to power personal, digital experiences in ways that competitors can’t duplicate.
The next generation of adherence marketing will be unlocked by organizations that can envision and execute automated, digital programs that ensure individualized care and address personal barriers to non-compliance.
Establish Trust
Patients believe the HCP and their recommendations
Drive Action
The patient fills the prescription and takes
the treatment “as recommended”
Follow-Up & Ongoing Evaluation
Regular connection with the physician or another HCP in their office to ensure meds are working and are being
taken as prescribed
Support Treatment
Based triggers which include follow-up &
reminders for ongoing management of therapy,
prescription fill reminders, condition/therapy updates
The essence of the Patient:HCP relationship is to:
321 4
9KENT GROVES, PhD | VP, CLIENT LEADERSHIP GROUP, LIFE SCIENCES | [email protected]
CROOM LAWRENCE | SENIOR DIRECTOR | [email protected] | MERKLEINC.COM | © 2013 MERKLE INC.
Given this, we must update how we think about the adherence roadmap overall to start by: (i) aligning organizational mindset, capabilities, and agency services; (ii) create tools and feedback loops to capture individual patients behavioral drivers and preferences; (iii) re-think approaches to brand strategy, marketing plans, tactical interventions, and performance analytics to power a new era in patient care.
In our view, the new brand vision and role must begin with an understanding of the health ecosystem from the patient’s point of view. Because we believe customer-centric and connected adherence programs provide greater freedom to source interventions based on the patient’s wants and needs, we believe we can align much closer to “how” an individual patient “trusts” – and thus deliver a more dramatically impactful program.
Understanding the Patient Ecosystem and Divining Personal ConnectionsMarketers have more tools to gather insights about the individual patient and their health ecosystem than ever before. More clearly than ever, both data analytics and behavioral insights must be combined to create the optimal blue print. And both business impact and patient value must be optimized. The business equation is often easier as an internal exercise to illustrate a forecasted campaign cash flow based on historic tactical response rates, benchmarks and a projected ROI. This financial ‘promise’ can be made from brand managers to the C-Suite well before the campaign goes live. But of greater challenge is planning for how to solicit, ideate or divine the customer brand connection that drives the desired behavior. The insightful planner or experience designer knows that consumers insist on the power of choice. And choice in the era of Big Data is driven by personalized experiences which require data, analytics and technology.
So if we begin with data — instead of assuming the standard tactical selection-like opt-in and static retention emails, an approach that has been mastered, we have to turn our thought process almost completely on its head. Instead of starting with the classic one-size-f its-all campaign models of the past, a programmatic experience approach across the customer lifecycle and across all channels and screens must begin with data and technology. To enable the view we must start with the individuals’ self-reported needs and preferences such as where they are physically and emotionally, how they like to consume content and from what source, and to solve a specific problem.
Click to watch Kent Groves explain the roadmap for digital health marketers to develop personalization, and recommend solutions to initiate interactions with the right content.
OUR ABILITIES
How Digitally Connected Patients and HCPs are Changing the Game
Life Sciences10
So how do we capture a snapshot in time of thousands or millions of individuals? Here is the quantum leap before us: the emerging power of big data to inf initely scale consumer prof iles and connect vast amounts of data to the individual. Robust ‘derived’ profiles are made available by combining dozens of data sets sourced from: Census Data, Real Estate Data, Wealth Indicators, Summarized Credit Data, Auto Data, Mortgage Data, Lifestyle Data, Demographic Data, Life Event Data, Transactional Data and Market Research surveys among others. As a result, experience designers can learn about individual preferences and behaviors prior to delivering the initial ‘handshake’ where preferences can be ref ined. Further, by asking the individual to customize preferences, and providing an opt-in, marketers too can invest new levels of customization and personalization all aimed at delighting the target, helping answer the unmet adherence need, all the while helping them make the best decisions about starting and staying on therapy.
The CRM revolution also has huge disruptive implications for traditional brand marketing. Think of a simple example of a major national brand like Astra Zeneca’s Nexium, the iconic little purple pill promoting relief from Heartburn. The color of the pill’s casing became ubiquitous for relief from heartburn and gastroenteritis, with the image of “purple” relief burned into our hearts and minds.
11KENT GROVES, PhD | VP, CLIENT LEADERSHIP GROUP, LIFE SCIENCES | [email protected]
CROOM LAWRENCE | SENIOR DIRECTOR | [email protected] | MERKLEINC.COM | © 2013 MERKLE INC.
Ah the good old days… unfortunately brand building in a world of on-demand content, ad skipping technology and greater digital expectations, the capabilities of mass personalization envision a more dimensionalized ‘Purple’ that must be creatively recast based on any number of relationship frameworks that speak to customers differently. ‘Purple’ can have a personality and voice tailored to the desired customer relationship but ‘Purple’ can simultaneously exist as a coach, a teacher, a father, a mentor, a friend, or any relevant personality envisioned to build a stronger emotional and rational connection with the customer, but also deliver tailored offers to solve informational, functional or emotional needs of the customer’s choosing.
Embrace a Brave New World but Take Simple Steps NowBigger brand strategies aside, and even before tackling the Big Data challenge, there are simple steps adherence marketers can take now to feel closer to their patients and deliver more personalized brand experiences:
Preference Centers
Ramp up use of preference centers to gather personal
preferences and inform more robust content marketing efforts tailored to key customer groups.
Audience Buying
Reach media target when seeking health information,
and also throughout other online activity to deliver greater reach
and frequency, and relevant message and offer sequences.
Surveys
Ensure defection surveys are in place to ask patients why they drop out or switch to a
competing therapy.
New Actors / Influencers
Fill chronic gaps with insights research especially for Allied
HCP’s who are key actors but rarely supported with
customized materials.
Content Marketing
Design a content marketing playbook and leverage SEO to address long tail search questions often missed by
top-of-the-funnel competitors.
Mobile, Mobile, Mobile
Leverage targeted ads on major healthportals to ‘acquire’ the prospect with ascript in hand and ensure the content,anticipate and answer their questions
immediately in real time.
Life Sciences12
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09/13
About the Authors
Kent has been consulting in healthcare for more than 10 years in the areas of healthcare provider segmentation, brand channel integration, CRM, marketing analytics and direct-to-consumer. Kent is published extensively in a variety of journals including, Research in Social and Administrative Pharmacy, Formulary, the Journal of Clinical Pharmacy and Therapeutics, and the Journal of Database Marketing. Kent is recognized as an expert in the area of factors influencing physician prescribing, and was the author of the chapter on Prescribing Behavior in Social and Behavioral Aspects of Pharmaceutical Care, 2nd Edition, released in March, 2009.
Kent has worked with a number of clients in the healthcare vertical including Sanofi Aventis, Pfizer, AstraZeneca, Genetech, Gilead, Novartis and Merck.
Kent has a BS from the University of Guelph, an MS from the University of Saskatchewan, and a PhD in Pharmaceutical Strategy and Policy from Dalhousie University. His PhD dissertation focused on the influence of pharmaceutical marketing strategy on physician prescribing behavior. Additionally, he holds the position of Adjunct Professor, College of Pharmacy, Dalhousie University, in Halifax, Nova Scotia, is a former Professor of Marketing at Acadia University in Nova Scotia, and holds the designation of Chartered Chemist.
Kent Groves, PhD VP, Client Leadership Group, Life Sciences [email protected]
For more than 16 years, Croom has led integrated customer relationship marketing engagements that have driven growth for Fortune 500 companies, particularly for pharmaceuticals, biologics, medical device, and health food brands. He recently joined Merkle as the Customer Experience Lead in Life Sciences.
Croom is recognized as one of the pharma industry’s most innovative marketers. He has helped brands at all stages achieve new trajectories in growth by identifying research-based insights, delivering breakthrough creative, changing patient behavior and improving health outcomes through effective marketing interventions.
Croom was one of the founding members of the Strategy & Insights group at Wunderman, DC, an early member of the Consumer Communications and e-Marketing groups at Wyeth/ Pfizer, Merck & Co, and the digital communications COE at Ironwood Pharmaceuticals, a pioneer in patient relationship marketing through paid, earned, owned and shared channels. He is one of the founding members of the Health Committee of the Word of Mouth Marketing Association.
He holds an MBA in marketing from the American Graduate School of International Management, and a BA in government and foreign affairs from the University of Virginia.
Croom Lawrence Sr. [email protected]
Merkle, a customer relationship marketing (CRM) firm, is the nation’s largest privately held agency. For more than 20 years, Fortune 1000 companies and leading nonprofit organizations have partnered with Merkle to maximize the value of their customer portfolios. By combining a complete range of marketing, technical, analytical and creative disciplines, Merkle works with clients to design, execute and evaluate connected CRM programs. With more than 1,700 employees, Merkle is headquartered near Baltimore in Columbia, Maryland with additional offices in Boston; Denver; Little Rock; Minneapolis; New York; Philadelphia; Pittsburgh; San Francisco; Hagerstown, MD and Shanghai. For more information, contact Merkle at 1-877-9-Merkle or visit www.merkleinc.com.
