Aug21

Adherence Is a Dirty Word

Adherence Picture BlogInstant gratification is not fast enough.

That’s the short answer to what derails (or drives) patient engagement. It’s simple really—you’re asking someone to change their routine, visit the doctor, spend their money, change their lifestyle—for something that doesn’t necessarily have a recognizable payoff tomorrow.

We design programs, apps, and all kinds of resources to “encourage adherence,” but they may only add to this burden. So what, exactly, is that burden?

Try it yourself.

That’s what patient educator and advocate Catherine Price (@catherine_price) has folks do. Dubbed the Tic Tac Challenge, participants use Tic Tacs as placebo pills, to see what it REALLY takes to remember to take your meds.

I organized a small Ogilvy Payer “Adherence Challenge” among my Payer, Creative and Shared Service colleagues, with the help of our fabulous summer interns. In the true spirit of a new prescription, each person got a script (with varying dosing regimens) which was filled at the “intern pharmacy.” Some scripts even had a prior authorization (PA) hurdle, which required a trip to our Director of Operations to answer SOX questions, to mimic the health plan benefits investigations and appeals process.

So how did we do?

Well. I didn’t even fill my script. The PA hurdle I landed with proved too great a barrier in my schedule.

Others’ success ranged from “almost compliant except for one travel day” to sporadic compliance, and some reported back compliance—but only on workdays when it fit into a routine. Variations on time of day, taking with food, or polypharmacy had a noticeable impact on the adherence burden. While some had routines or other reminders to help them along, no one was 100% compliant. With so much going on in our lives, it’s no wonder it’s easy to forget.

 

What’s the answer?

Well, there is no single solution. Merely knowing that “you have to” is not enough. There needs to be a reason you WANT to take a pill every day. Health needs to be integrated into life, not an add-on to it. HCPs need to speak the language of their patients— à la shared decision-making—to truly engage patients toward the benefit that adherence gives them in their life. Technology, while helpful, cannot solve everything for the unmotivated patient (hit that snooze button again!). Far-off benefits are strongly outweighed by what the patient needs/wants/feels right now.

For us, this is just something to keep in mind as we design apps, resources and CRM programs. Simple, integrated, and aligned with the patient’s goals is the mantra I will be marching forward with. A patient cannot just be adherent (a supporter or follower). Instead, a patient must be an enthusiast—active in his or her health interests.

 

These insights came from my attendance at the Patient Adherence & Access Summit this past June. If you would like the full write-up from the summit, just shoot me an email and I’ll happily send it over!

claire.pisano@ogilvy.com

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Mar6

The Power of Payer: Prescribe All You Want…We Can Block You!

6808124Remember the Doritos slogan, “Crunch all you want, we’ll make more!”? What a mantra, supply and demand. So simple. So obvious.

Sure, prescriber demand plays a role in how available some drugs are, but at the end of the day health plans and formulary P&T committees within hospitals and large practices make category decisions that effect drug availability for patients and directly impact prescribing behavior. These formulary decisions aren’t made in a vacuum, and they can impact your brands, your marketing goals, and play a huge role in getting a leg up in today’s market.

So what do you know about all this? If your client came to you tomorrow in a competitive market situation—multiple new branded entrants, generic domination, or patient abandonment at the pharmacy—and they couldn’t get a foothold, what would you tell them? How would you break that wall? How do you partner with your clients to fulfill your brand’s true market destiny?

Consider what the payer marketing unit can bring to the table for you and your clients. More and more we hear our clients talk about access challenges broadly, issues with patient co-pays, or prior authorizations and step edits getting in the way of reaching marketing goals. In this changing healthcare environment there is so much to consider that plays a role in prescriber decision making, it goes well beyond the clinical profile of your brand. The smarter we all are regarding the holistic considerations of a brand, the better we can show our value as a marketing partner and offer uniquely impactful solutions to our clients.insurances

This is where the Power of Payer comes in. The payer marketing units at Ogilvy CommonHealth Worldwide want to help provide you with a strong background on health plan and environmental issues to more effectively reach your client’s marketing goals. We are actively working towards open house events for Ogilvy CommonHealth Worldwide in NJ and NY where we can share information specific to two hot topics:

  • Emerging healthcare models: What are they? How do they hold the keys to success in the market? What should we know about them? Better understand how they act and what these actions mean to our clients and their brands.
  • Payer for newbies: An overview of what a payer is. Who are payer customers and manufacturer clients? How do payer decisions impact overall market sales goals and category usage? Why do we need to consider them when building brand plans and overcoming marketing hurdles?

"Open House” Posting. Part of our “Create a Sign” Series.As part of the Power of Payer open houses, we will also showcase some of the unique work we have done to achieve market success as well as answer any questions you may have about the payer customer, unique challenges your brand may be facing, or just have a fun discussion around environmental trends!

Watch for more information and then mark your calendars to join us for the Power of Payer open houses.

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Jan7

The Great Migration

Wildebeest Migration
Physicians: Owners to Employees

In the animal kingdom migration is natural and instinctual, a relatively long-distance movement of individuals as a group, as defined in the dictionary. It is found in all major animal species. The trigger for the migration may be climate, availability of food, the season of the year, or a major habitat change or disruption. Whatever it is, migration means survival!

So if birds, fish, butterflies, and elk do it, just to name a few, why are physicians doing it? The answer is adaptation for survival due to environmental shifts.

The Facts

There are approximately 100,000 (or 1/3) fewer doctors in an ownership private practice setting today than in 2000.

Accenture researchers analyzed data from the American Medical Association and MGMA-ACMPE to determine trends in physician independence and practice ownership. Physicians were defined as independent if they owned at least part of a practice.

Table

 

 

 

 

 

 

 

 

 

**Projected.

Source: “Clinical Transformation: New Business Models for a New Era in Healthcare,” Accenture accessed 11/25/2013.

The Why

Top concerns prompting physicians to consider employment

Several issues are persuading doctors to think seriously about leaving independent practice. Accenture researchers surveyed 204 specialty and primary care physicians in May to identify the most pressing concerns.

87% cited business expenses.

61% named the prevalence of managed care.

53% were concerned about EHR requirements.

53% mentioned maintaining and managing staff.

39% cited the number of patients required to break even.

Source: “Clinical Transformation: New Business Models for a New Era in Healthcare,” Accenture, accessed 11/25/2013.

More and more physicians are facing excessive business costs as employers in private practice and decide the price of autonomy just isn’t worth it anymore.

The type of practice setting doctors choose is a decision affecting everything from their salary, practice relationships, and the hours they work. What’s more, given the changes taking place in the healthcare arena, selecting a practice model is no longer a simple decision made in one’s final year of residency. Managed care reimbursement for services and formulary protocols and practices restrictions have increasingly changed the healthcare delivery landscape, financial pressures, government regulation, and technological as well as administrative demands from payers— i.e., commercial health plans, GPOs, hospitals, Medicare, and Medicaid are influencing physicians of all ages and stages in their careers to reevaluate their practice decisions just to make a living. “Where is the doctor-patient relationship in all this?” many doctors have asked me over the past few years.

Many physicians after paying all their monthly expenses and staff salaries have little or nothing to pay themselves and turn to market research and advisory opportunities to supplement their income. Many physicians find this increasingly frustrating and start looking for other options like migration.

Migration takes many forms: just walking away and becoming a chief, retiring, teaching/academia, and physician concierge. One doctor I know walked away and just opened a bar. The answer for many physicians is migration to more of an employee type setting.

Let’s just focus on institutional practice and what that means to manufactures and marketers. The physician has moved from employer to employee—a big communications game changer.

Being part of a hospital or institutional setting relieves physicians of many of the financial and administrative burdens of owning/running a practice. It gives them retirement plans and also support services they may not have had before, and enables them to offer their staff better benefits. Doctors I have interviewed have followed colleagues in this migration of selling their practices, and liked the results.

The Implications

Autonomy is compromised in the new payer-centric environment for survival, and the opportunity for manufactures to have the traditional access to communicate, educate and cultivate relationships is now forever changed.

The implications are profound and we need to adapt traditional forms of communications, and find new and meaningful ways to communicate. We need to take a more critical view of some of the more recent options we tend to look toward, like websites. “No, not another website! We are already pulling down ones that are doing nothing for us!” many manufacturers say. I have heard that more times over the past few years than I can count. Today, a new website or iPad detail aid will not do it. We need to fully understand how physicians today want and need to be communicated to in their new environment; it is not one size fits all anymore.  We need to look at institutional barriers to access and develop business-to-business value propositions to gain access. And it doesn’t stop there. We need to look at multiple or customized  value propositions by HCP specialties, gender, age, cultural diversity, as well as regional differences to optimize brand opportunities for growth in the brief moments in time we have to communicate. Think of it this way: a 29-year-old female internist in Texas most likely looks through a different lens for communications, information, and decision-making than a 62-year-old male internist in Vermont. What do they have in common? Most likely today they are in an institutional setting, they want to help keep or get their patients well, and they have no time to talk to you in their growing payer-centric institutional environment.

The Way to Adapt

The answer for manufacturers and marketers is that we need to change. Look to nature and migrate how we think and constantly adapt what we do to survive.

The question is, how are you going to activate your migration?

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Nov22

Payer Marketing—What Happened to the Good Old Days?

prescription padLife was easy in the early days of payer marketing: create a formulary kit, negotiate a market share agreement with tier 2 status, and pull it through with some fancy formulary status flashcards. Yes, life was good back then. Did I say formulary kit? Yep, those have changed as well. The executive summary of AMCP’s Format for Formulary Submissions 3.0 states that it must include a “value statement of the pharmaceutical or biologic agent being discussed.” What does that mean? Is it about pricing? Dollars saved? Rebates? Historically, rebates have been used to gain preferred formulary position with reduced member out-of-pockets. But with over 70% of prescriptions written today being generic, that marketing approach falls apart. Things are further complicated by the fact that payers are much more willing to use step edits (required failure on a preferred agent prior to use of another agent) and prior authorizations to drive use of preferred therapies, as opposed to relying only on formulary positioning differences.

The value proposition is now the most important story a manufacturer needs to craft in the launch of a new brand—so much so that more forward-thinking manufacturers are designing arms of clinical trials that integrate economic and comparative measures to support the value proposition they feel will be needed to gain support from the payer community (traditionally health plans, employers, pharmacy benefit managers) at launch. And the payer audience is expanding as well. It now includes ACOs and other emerging health care provider models with responsibility for populations. Furthermore, the stakeholders at each account matter more than ever. It is imperative to go broader and deeper into an account beyond just the Pharmacy or Medical Director. New stakeholders are emerging such as the Quality Director, Case Management and others who are weighing in on formulary and coverage decisions.

It isn’t tough to see the link between the growing influence of payers and the dramatic drop-off of new product approvals in the past 10 years. When products are not strongly differentiated, payers worry less about depriving patients of choices. Now more than ever, payer marketing is about differentiation and “pill plus.” It’s about developing business-to-business relationships. It’s no longer fee-for-service—it’s fee-for-value. Gone are the days of disease management; today it’s about disease prevention. It’s no longer good enough that a drug works and is FDA-approved. That alone no longer guarantees access. It’s now about outcomes—in trials and in the real world. It’s about costs—costs per member per month, per quality-adjusted life year, medical cost offsets, productivity, absenteeism. This is what now needs to be communicated to the payer audience in ways that are clear and impactful.

When communicating to payers, pharmaceutical manufacturers cannot approach the next 10 years using the time-worn marketing methods of the past 10 years. Pharma pipelines are filled with specialty products, and the use of traditional and new utilization management techniques will only intensify in the coming years. In a post-Obamacare world, pharma’s priority is to develop ways of engaging payers that are customer-centric and that support patient outcomes. Only then will the payer audience listen.

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May8

Is It “Health Insurance,” or Merely Prepaid Health Care?

PillThe Affordable Care Act’s (ACA) goal is to provide health insurance coverage to those without it now, and it uses 2 main mechanisms to do so. It penalizes individuals without insurance, thereby encouraging them to sign up for health insurance. (In order to support this effort, the law creates state insurance exchanges to offer health plans to consumers.) The law also penalizes employers (with 50 or more employees) that do not offer health insurance to their workers. So, these employers will either need to add insurance if they don’t currently offer it, or maintain or modify what they now offer to their employees…or else pay a fine.

As the ACA proceeds to full implementation, it’s probably polite to say that various “inconsistencies” in the law are emerging. While “self-pay” employers may still exercise some degree of freedom in adding, maintaining, or modifying their health insurance offerings, the law is determining many of the characteristics of health insurance offered to the public via health care exchanges.

It’s interesting to note that 2 key requirements of the law undermine the basics of insurance, which is defined simply as “coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril.”

The first requirement is that all beneficiaries pay essentially identical rates, regardless of their risk factors. One of the few recognitions of varied risk among the population, an individual’s age, is still subject to constraint (older people cannot be charged more than 3 times the premiums charged to younger people). The other requirement is that insurance companies should ignore individuals’ preexisting conditions when writing new policies. While this rule is popular—no one wants to deny health insurance coverage to a cancer survivor—it also could encourage people to wait until they are sick before they purchase insurance.

Additionally, the law’s definition of an insurance plan’s “essential health benefits” may also contribute to an unintended result: a small set of insurance offerings on health care exchanges that are all generally very expensive, due to the fact that the policies are required to cover many things. One possible effect on consumers is that they will pay higher premiums.

Let’s go back to employers. Year-over-year health care cost increases have recently moderated, but over the long term they have traditionally been higher than the rate of overall consumer inflation. Some employers may use the soon-to-be-created state exchanges as an opportunity to withdraw the health insurance they offer to their employees. Employers who still plan to offer health insurance will continue to scrutinize costs and seek ways to mitigate their increases. They may continue to restrict the breadth of offerings in their health plans (a trend that is opposite to the expansion of essential health benefits above). Another mechanism that works is to shift more costs to their employees in the form of higher premiums, copays, coinsurance and deductibles.

So, in the 2 areas that the ACA seeks to create new health insurance opportunities (state-based exchanges and newly regulated employer markets), the individual will most likely pay a greater share of costs and have a greater responsibility to evaluate his insurance policy as well as the health care interventions he receives.

What does this mean for marketing communications?

One question facing employers, employees, payers and consumers will be the role and importance of deductibles, copays, and coinsurance. These patient payments are essentially behavioral-change tools, encouraging the patient to “shop wisely” because he is spending his own money on health care. Will these mechanisms continue to work as they have in the past? It may depend on which segment of the market grows larger: the state-based exchanges or the employer-provided plans.

On the one hand, if the law is encouraging fewer, similar insurance offerings on state exchanges, it will hardly be easy for insurance companies to differentiate one policy from another. If the offerings from health plans become expensive and undifferentiated, with most of their benefits “prepaid” by premiums, how much impact will deductibles, copays, and coinsurance have? Would this also complicate manufacturers’ efforts to differentiate their products to insurers, providers, and patients/members?

On the other hand, if employers are restricting benefits in their heath plans and shifting more and more costs to employees, employees will be using more of their funds to pay for premiums, and there may be less left for deductibles, copays, and coinsurance. With fewer health care dollars available, the employee may respond more to the cost effects of those patient payments.

Readers, what will be the health plan implications for related drug and device issues such as tier placement, contracting terms, and pricing? What marketing efforts are still needed? And to whom should they be directed?

Source:

  1. Merriam-Webster. Definition of “insurance.” http://www.merriam-webster.com/dictionary/insurance. Accessed April 22, 2013.

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Feb1

The Unintended Consequences of Personalized Medicine

Personalized-MedicineInnovative technological and scientific advancements in oncology have enabled scientists to unravel the biological complexity of more than 200 diseases commonly called cancer, and reexamine how these diseases should be classified, diagnosed, and treated.

Understanding how these diseases work and the applying of these insights to clinical practice have formed the foundation of personalized medicine, defined as the tailoring of drugs and other treatments to specific populations, based on their genetic profiles or other differentiating factors.

This concept provides a potential future in which prevention and treatment strategies will be individualized based on the molecular makeup of a patient and their disease, dramatically improving chances for better patient outcomes and reduced healthcare costs.

Those advancements may provide opportunities, but they also may pose potential unintended consequences to the healthcare system.

The aging American population, combined with an additional 32 million covered lives under the Affordable Care Act (ACA), and overall increased survivorship in patients have created new challenges surrounding affordability and accessibility to healthcare.

Increased pressure for greater clinical and economic advancements creates imbalance among innovation, quality, and cost. In addition, ACA requirements impose more disparity by requiring improved quality of care, greater transparency in reimbursement coverage, and performance-based payments.

Payers and providers who are responsible for the implementation and adoption of personalized medicine are challenged to navigate the new environment as they are the major stakeholders.

Full implementation of personalized medicine may create new challenges for stakeholders and their patients, such as:

  • More stringent regulatory framework requiring greater transparency and tighter reimbursement controls for costly diagnostic technologies
  • Loss of patients’ ability to make their own healthcare decisions
    • In an effort to optimize clinical outcomes and minimize costs, some current therapies are aligned with patients’ biomarkers in order to ensure therapies are targeted to a specific genotype mutation. A prime example of this can be seen in patients with advanced stage melanoma who have approximately a 3-month survival rate. There are two treatment options: one with a companion diagnostic test (personalized) and one without (non-personalized). Because the personalized therapy has a companion diagnostic test that specifically identifies appropriate patients, payers and providers may be influenced toward this therapy over the non-personalized in order to maximize therapeutic outcomes. However, this creates a potential unintended consequence involving the non-personalized treatment option, which demonstrates efficacy in approximately 20% of patients and can extend survivorship up to 3 years. Therefore, these patients may be denied potentially 33 months of extended life.

In an attempt to improve the overall healthcare system by managing costs through personalized, tailored treatments, new barriers are created that can directly impact patient outcomes and limit the personal choice of available healthcare options.

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Oct16

How Social Media Turned User Experience Upside Down

In the early days of the Internet, the web was essentially a collection of pages connected by links. The Internet user experience was called browsing for a reason: We’d jump from page to page in a haphazard way with little connection between each site. Our selection of where to go might have started with a web search on Yahoo, Lycos or Ask Jeeves, but afterwards our path was probably based on whatever links we were presented with. The browsing experience was unpredictable, full of surprises and often felt like a kaleidoscope. It was also a pretty flat experience because most websites were pretty flat: words on a page, perhaps with some images and a spinning leprechaun gif thrown in for good measure.

What’s important about this structure from a user experience perspective is that the user was in the driver’s seat, moving from one static page to the next. No web page was ever more than one click away from any other and—structurally at least—all pages were equal.

Fast-forward to the Internet of today, and the landscape has truly inverted this relationship between users and content. Rather than jumping from page to page, today’s user experience is more like a funnel that is persistently tilted towards us. All information seems to runs downhill into our browsers and devices. Information and services are curated, collected and aggregated on our behalf and delivered to us.

This means we spend less time exploring and more time consuming material that’s already been prescreened. And when it comes to news, we’ve become dependent on programs to bring events to us. We stand still on our own island and the world spins around us. Of course, what the Internet brings us is highly personal. Much of the selection is driven by our personal social connections: our Facebook friends, LinkedIn connections, whom we follow on Twitter, etc.

The web experience of today cannot be separated from the interrelated concepts of personalization and aggregation. Information, events, news and resources are selected based on our unique personal connections and then aggregated into a few convenient outlets for us to consume.

This phenomenon may have begun with social media networks (and in fact it couldn’t exist without them) but the changes wrought by personalization and aggregation are larger than the social networks themselves. It has profoundly altered the way we access and consume news and information. And has created a new means for us to evaluate and interact with content—whether we consider it credible and actionable, and whether we wish to share it, comment on it or republish it. Years ago we relied on the professional editorial staff at large media companies to determine what was newsworthy. Today we rely on our socially connected friends. Personalization and aggregation determine whether we will see a movie, buy a recording, go to a party, see an art exhibit or contribute to a charity. It even determines whether we are aware of these things in the first place.

From a user experience perspective, there are some key implications that need to be considered when developing websites and related interactive initiatives:

Navigation Is Only Half the Story

While it’s always a good idea to have a well-thought-out navigational system with a clear taxonomy, navigation is arguably less important than it has ever been. This is because users are increasingly relying on shared links such as those found on their social networks. They are either deep-linking directly to your content or viewing it in an isolated instance that’s created on the fly for their consumption.

Personalization With No Strings Attached

In order to personalize a site experience, it used to be necessary to put your user through a registration process. This is no longer the case. Users can now sign in to sites using their social credentials. APIs and OAuth, a widely used open-source protocol, allows users to identify themselves using their Facebook, LinkedIn, Twitter and other accounts without surrendering any personal information. For example, sites using OAuth can (with their users’ explicit permission) access profile data and friends’ activities and integrate that into the site experience. Using techniques like this, sites can display the names of your friends currently online, list what articles or topics they’ve liked or shared—all without capturing any personal information.

Context Is King

Because content is being aggregated and displayed outside of its original context, your assets may look and behave very differently depending on the setting and the device that your audience is using to access it. For example, let’s say you are developing a physician locator application. When accessing the application on a mobile device, it is possible to display the nearest physician based on the GPS that comes with the phone or tablet. On a desktop computer, users may need to input their location manually to get the same result. The implication is that we need to build flexibly so we can optimize the user experience based on the device and location.

Device Matters

The proliferation of devices has fragmented into a bewildering array of operating systems and screen sizes. Adding to the complexity, some devices accept input from mouse and keyboard while others respond to complex hand gestures or voice commands. Personalization and aggregation means that we need to think not only about where our content may travel but also on what kind of device and screen it will be displayed. Because new devices are constantly being released and operating systems are updated frequently, it can be an impossible task to accommodate all of them. For this reason it is a good idea to establish a list of what devices and operating systems you intend on supporting. While this list may need to change on a regular basis, it will give you a starting point for design and development.

 

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Sep4

Does the Bell Toll for Traditional Siloed Promotional Activities in a Leaner Compliance-Driven Pharma World?

Our clients are saying that the role of Medical Education will grow in years to come…potentially biting into other traditional areas of the marketing mix. Does this spell disaster for advertising or PR?

Ogilvy Healthworld Medical Education recently surveyed its clients to assess what the future would hold for Med Ed, and the results were both thought-provoking and intriguing. The clients we involved spanned marketing and medical affairs disciplines, in global, national and EMEA roles across a range of small, medium and large pharma companies.

Looking at how agencies would need to respond to changes and turbulence in the pharma environment, five key trends emerged:

  1. We are part of a shifting landscape: attitudes, budgets and people are moving away from Sales and Marketing to Medical Affairs and Market Access. This parallels an increase in educational activities and the slow erosion of PR and promotional activities or their metamorphosis into more educational content. Our clients are telling us: “Clinical data will increasingly be at the heart of educational tools and messages ….medical education will drive a more clinically focused brand strategy and what promotional work that remains will be subject to stricter and stricter regulations.”
  2. Our pharma clients are increasingly concerned about the risk of non-compliance and, in particular, inadvertent off- license promotion. As well as a sharper delineation between promotional versus non-promotional activities, there will be a drive to improve transparency between pharma companies, healthcare practitioners, payers and patients.
  3. The hands-off approach to pharma-sponsored Continuing Medical Education (CME) is becoming a double-edged sword: although companies have reduced regulatory control, they are under increased pressure—and face stiff penalties—if content is non-compliant.
  4. As healthcare professionals communicate increasingly in the virtual space, there will be less reliance solely on face-to-face communication. Digital communications will rise to deliver more cost-effective, innovative  solutions to more targeted audiences and enhance the value of face-to-face communications.
  5. As client teams continue to downsize, there will be a growing need for strategic communications planning expertise within agencies. Potentially, those with the greatest capability to become long-term strategic partners will increasingly be seconded in as interim managers: “As pharma becomes more risk averse and cost conscious, clients will need agencies who can lighten their load, in the new leaner, compliance-driven pharma world.”

In the relentless drive to rationalize healthcare spend and tailor therapies to meet unmet needs in increasingly segmented patient groups, new drugs will hit increasing scrutiny.   In this new world, data will be king—and Med Ed is ideally and uniquely equipped to use this information to justify premium pricing over cheaper, established medicines. Ultimately, pharma’s quest for improved transparency, trust and reputation must be underpinned by programs that lead to enduring change, but which are compliant in the stringent regulatory environment in which we operate. Medical education is not just about knowledge acquisition anymore. It must facilitate and drive behavioral change, among a range a stakeholder groups operating under strict regulatory compliance. While behavioral change is most effectively achieved when all communications disciplines are harnessed, including PR, advertising and market access, it will increasingly be underpinned by robust Med Ed.

Does the bell toll for traditional siloed promotional activities in a leaner compliance-driven pharma world?

 

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Aug30

A Common Goal for Clinical Trial Participants

The Olympics opening and closing ceremonies allowed us to reflect upon and appreciate the diverse world we live in. Watching the procession of athletes was proof to us all that Olympians come from all corners of the world, in very many different shapes and sizes!

The same can also be said for clinical trial participants.

By their nature, global clinical trials can be considered an oxymoron. From a patient perspective, their participation in a clinical trial is a very personal decision. Many patients choose to enroll in a clinical trial for access to a medication that might give them a few more weeks or months to live, or the possibility of improved quality of life. Other patients may choose to participate as they want future generations to have the opportunity to live life to the fullest, something that might have eluded them. The list can go on.

As an agency when we look at patient participation, we need to remember that the probability of two patients on the same study knowing each other is very slim, so there will never be the coming together of a group of likeminded individuals on a given clinical trial. Likewise, we want to avoid the possibility of patients discussing their study experiences for fear of un-blinding themselves, but we want them to embrace the fact that they are not alone.

There are many different tactics we can use to bring a sense of community, or belonging, to patients in clinical trials. The biggest hurdle to overcome is creating a program that can be inclusive to all patients. Of course, the answer here is that a) that’s impossible, and b) that’s not a smart solution.

Thinking back to the Olympic athlete procession, the mix of cultures and values on show reflected the diversity of a group, but together with a common goal, to win gold.

In clinical trials, we want patients to have that same sense of a common goal, of purpose. However, the way we share that message is very different. For some patients, they just require clear instruction from their study team and feel confident that they know their commitment to the study. For others, they want to receive regular bites of information, telling them how many patients have been recruited, which countries are taking part, etc.

The tactics that we implement to inform patients about a clinical trial and then to keep them motivated to continue in the trial are not off-the-shelf ticket items. We know that each patient recruited will bring his or her own set of beliefs and information needs. In business, we often use Myers-Briggs as a way to build teams and recognize the differences among us. We embrace those differences and slowly learn how to work within our structure. We must do the same when communicating with patients globally about their health and their decision to volunteer to be a research study participant.

Crafting solutions can be challenging. In these cost-conscious times, sponsors are looking for the most cost-effective way to get their message across. As an agency working in these lean times, we are moving forward with new technologies and communication channels to reach all patients. London 2012 showed what can be achieved in tough economic times. The athletes have proved that regardless of ethnic background or values, there was a common goal and everyone has been part of the greatest sports day the world will see for another four years.

The same sense of belonging can be achieved for clinical trial participants; you just need to know what makes them tick….

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Aug29

Communicating Value in Our Changing Healthcare System

Recently, the Supreme Court of the United States issued a 5-4 ruling essentially upholding the entirety of the 2010 Affordable Care Act (ACA). Many Americans, including the millions working in the healthcare industry, have questions about what the SCOTUS decision means. As many of the provisions of the law come on-line in 2014, the full long-term impact is not yet clear. What is certain however is the healthcare sector is changing, fast. The shift toward more patient-centered care and measurable quality-based healthcare outcomes started prior to the 2010 law, and this movement will continue regardless of the ultimate outcome of health reform.

Moving from volume to value

In the healthcare delivery system of the past, providers were paid to treat problems, not prevent them; financial incentives were based on volume versus outcomes and multiple providers with little coordination delivered care. All of which contributed to healthcare costs rising at an unsustainable pace. Now, however, a paradigm shift is upon us.

In the idealized healthcare delivery system of tomorrow, providers are incentivized to increase quality and improve outcomes across their respective populations, infrastructure and processes are used to reduce variations and better coordinate care, and healthcare spending becomes a purposeful investment in value. Indeed, almost three-quarters (73%) of C-suite healthcare executives in a recent survey by Forbes Insights and Allscripts agreed that providers need to begin shifting their focus from “volume to value” immediately.1

The changing definition of “value”

But what does “value” mean in our brave new healthcare world? Value is one of those buzzwords flying around that has been absorbed and redefined by different stakeholders.  For patients, value means improved access to healthcare, high-quality patient-centric care, and improved patient engagement including better patient-provider communication.  For providers, value means ensuring patients receive high-quality accountable care based on best practices, including improved coordination across provider types and sites of care. Additionally, value for providers can mean receiving fair compensation—something that novel delivery systems and payment methods, including patient-centered medical homes and bundled payment schemes seek to address. For administrators, value means ensuring a sustainable healthcare system by placing particular emphasis on reducing waste, errors and redundancy.  The meaning of value in pharmaceuticals is changing as well. Now, not only are safety and efficacy evaluated, but effectiveness and appropriateness of treatment are also considered, while quality of reimbursement is downplayed. Wired health tools, such as electronic health records, are used to support treatment decisions, improve collaboration and measure behavior and outcomes.

How to communicate value now

With greater alignment across audiences, tomorrow’s healthcare delivery system demands more integrated value messages. New ways of communicating with patients and establishing value for the healthcare provider may become even more important. For example, development of safer drugs requiring less counseling, less paperwork, and drugs that have easier access to brand information could become important criteria of differentiation. Information and messages could be tailored to various HCPs and distributed in a less vertically structured environment. Outcomes research may help inform patient-centered value perspective in messages. Also, in the increasingly collaborative provider environment, the patient, her advocates, caregivers, and multidisciplinary HCP teams (social workers, MDs, RNs, NPs) may become even more important audiences to consider. This is especially true for serious diseases where care typically crosses into different disciplines and healthcare settings.

The US healthcare system is changing at a rapid pace. Still, however, the innovative delivery systems that seek to balance quality, cost and access are still in their early phases of implementation. Staying on top of these developments to identify strategic opportunity and translating insights into value-driven communication is more important now than ever before. Proactivity and adaptability will be the defining characteristics of winners on the changing healthcare landscape.

1   http://images.forbes.com/forbesinsights/StudyPDFs/AllscriptsVolumetoValue.pdf

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