Feb10

Don’t Worry, Be Monkey

Three years ago, while living in Shanghai, I wrote about how the world would be witnessing two ancient, amazing theatres of faith and perseverance that test the extent of human endurance and also showcase how transmittable diseases can spread much faster in a small space of time, across huge geographies.

MonkeyThe first is the celebration of Chinese New Year, which is celebrated across China, Taiwan, Malaysia and Singapore as national holidays, but nowhere more so than in Mainland China. The mass exodus from cities to villages to celebrate the new lunar year involves nearly 600 million Chinese covering over 3.6 billion journeys in under 2 weeks in a grueling journey back to their hometowns, and back again. Compare this with just about 100 million Americans travelling domestically over the peak holiday season. 1

The second is India’s Kumbh Mela, an ancient pilgrimage held every 12 years in India, where the equivalent of the entire population of New York congregates daily to bathe in the sacred rivers to attain spirituality. The Mela itself is a huge planning exercise for various NGOs and health bodies who need to ensure that millions of people stay free from diseases and health risks. 2

Nearly 3 years on since my last write-up, as one gets ready for the whimsical yet wise Year of the Monkey that starts on February 8th and the Kumbh Mela reaches its auspicious 12-year cycle, it’s an opportune moment to think about how these two acts of faith invariably must have a health impact that affects hundreds of millions in just a matter of weeks.

In China, getting from one part of the country to another is an ordeal at this time. Stakes are highest on long-haul routes, and the train route from Beijing to Urumqi is about as long as they come. The trip will take over 40 hours and covers 1,998 miles to finally reach the northwest Xinjiang Province.

Passengers crammed in seats share their floor, bathroom and luggage space with the standing passengers. For the next 2 days, migrant workers rub shoulders with bubbly university students. Policemen, cooks and white collar workers face each other across cramped booths, and the combination of card games, grain alcohol, cigarettes and forced cohabitation offers an alarming chance of communicable diseases—especially when faced with travellers moving from one side of the country to the other, from all walks of life and backgrounds, alongside a lack of comprehensive vaccination posing some alarming questions. While there are no available facts on this, it is something to think about, especially if it’s giving a virus the chance to be carried from one end of China to the other in the approximately 3 billion+ journeys that are already taking place.

If one interprets the Monkey’s characteristics as an outlook for 2016, it would probably tell us to stop all this unnecessary banter about health and simply ‘Don’t Worry. Be Monkey.’ One can’t argue with thousands of years of celestial knowledge as simple as that.

Moving from humanity’s largest migration to a side of Asia that reinforces the role of nature in Asian values, the ‘Ardh Kumbh Mela’ is set to take place by the banks of all the four rivers considered sacred by Hindus in India—Ganges, Yamuna, Saraswati and Godawari. Rivers have always held a special place in Hindu mythology, as these are considered to be the carriers of life and fertility. This fair is perhaps the largest and peaceful gathering in any religion around the world. It never ceases to amaze anyone who has visited during this time.

Mark Twain, the intrepid traveller that he was, visited the Mela in 1895 and best summarized it by saying, “It is wonderful, the power of a faith like that, that can make multitudes upon multitudes of the old and weak and the young and frail enter without hesitation or complaint upon such incredible journeys and endure the resultant miseries without repining”.

You can’t mention the Mela without hearing a comparison with the Burning Man, the offbeat American gathering that takes place in the Nevada desert. While they are vastly different in size, they do share the sameness that one would experience in temporary ”pop-up” cities that appear and disappear over a matter of weeks. In terms of healthcare data, medical tents that offer emergency services see about 5,000 patients across 10 medical tents a day. In all of this, though, at the Kumbh Mela, which can swell to 60 times the attendance of the Burning Man, health clinics are likely to utilize emergency medical services only once a day. That’s a remarkable display of how massive crowds can manage themselves relatively safely and get home in one piece. This however is only one part of it. The less spiritual fact is that rivers like the Ganges (considered extremely holy) are unfortunately filled with chemical wastes, sewage and even human and animal remains which carry major health risks by either direct bathing in the dirty water (e.g.: Bilharziasis infection) or by drinking (the fecal-oral route).

I refer to these two large-scale Asian events – the advent of the new lunar year and the Mela – because they act as a perfect mirror to what drives this wide populace in its multitudes of pilgrimages and celebrations. A perfect diaspora of what represents humanity in all its colours, shapes and forms. It is at once tangible in its tribulation and intangible in providing confidence and enlightenment. The health risks are real, but not enough to keep hundreds of millions of Chinese from seeing their loved ones again, or for tens of millions of Indians to reconnect with their inner spiritual self. A ritual that has gone on for millenia.

When we interpret the world around us knowing such a mass of humanity is going to such levels of endurance, I believe it offers us a chance to understand what drives us against such odds and risks. Maybe it’s within these individuals, each striving to get home or to a new spiritual plane, that the bigger picture can be seen. Health is rational, emotions are not.

So in this age of Aquarius, while millions strip off their clothes to soak in sacred muddy rivers halfway across the world, and an entire population crams into trains, buses and any available transport to get home to see loved oneslet’s pause and say, ”What’s to worry? It’s all Monkey.”

“Gong Xi Fa Cai” – Happy New Lunar Year of the Monkey.

 

CONTINUE THE CONVERSATION:
Questions? Comments? You can contact the author directly at blog@ochww.com.
Please allow 24 hours for response.

Resources:

  1. http://www.chinahighlights.com/travelguide/special-report/chinese-new-year/
  2. https://sacredsites.com/asia/india/kumbha_mela.html
Also posted in behavior change, Culture, Great Ideas, Health & Wellness, Healthcare Communications, medical affairs | Tagged | Leave a comment
Dec8

Biosimilars: You Won’t Feel a Thing (For Now, Anyway)

With the recent launch of Zarxio™, the pharmaceutical industry has been buzzing about the impact of biosimilar products. But how quickly will biosimilars enter the US market, and will their impact be as strong as some forecasts predict?

Biosimilars are made through a more complex process involving living cells as compared to generic versions of small molecular products, which use an exact copy of the chemical makeup of the original. Because manufacturing techniques are considered proprietary, there are slight differences between reference products (the original, branded product) and the biosimilar, thus the first set of hurdles to rapid uptake.

FDA guidance has defined requirements for a product to demonstrate biosimilarity to a reference product; however, final guidance around interchangeability and labeling of biosimilars remains open. The gap in defining interchangeability opens a host of clinical hurdles that biosimilars will face in patient and physician adoption, adding layers of complexity to diseases and treatments that already require heavy time investments around treatment decisions. Indications for biosimilar products may be different from the reference product; multiple biosimilars may be considered equivalent to the reference product, but not to each other; sub-populations, including treatment-naive or -experienced patients, may have different responses to reference vs biosimilar products.

Beyond clinical hurdles, regulatory and payment hurdles are additional speed bumps that biosimilar products will need to pass. Unlike the European Union, where biosimilars have been available for years and there are centralized price and access controls, the US market is more fragmented and local pricing and reimbursement will impact prescribing. The recent consolidation of large payer organizations nods to stronger bargaining power for drug pricing, but discounts for biosimilar products are not expected to be as steep as price differences for traditional small molecule products. Novartis has said they will sell Zarxio™ at a 15% discount compared with Amgen’s Neupogen® making it a lower-cost alternative, but requiring large volume shifts before significant savings will be realized. Even in the European Union, biosimilar pricing has been modestly lower than reference products, price erosion has been gradual, and the shift of market share to biosimilar products has varied widely across therapeutic categories.

Additional legal challenges will likely also slow momentum of biosimilar products. Although patent infringement rulings were in favor of Novartis, nuances in the manufacturing of biologics will continue to introduce new hurdles for biosimilars –disclosure on proprietary manufacturing processes that impact the efficacy of biologic products will continue to provoke relations between pharmaceutical companies and manufacturers of biosimilar products. Beyond the legal risk required, the high cost of manufacturing biosimilars will create additional barriers to entry.

In favor of biosimilars are provisions within the Affordable Care Act (the 2010 passage of the Biologics Price Competition and Innovation Act opening the door for biosimilars), payment reform and bundled payments supporting physician use, and the increased scrutiny on the value of healthcare in the United States.

Other questions remain open: will patient education and support for biosimilars match the reference product, or will specialty pharmacy and large health systems pick up patient support services? How will the integrity of pharmacovigilance be impacted when switching has occurred? What will happen when physicians need to overturn automatic substitution for a specific patient, despite interchangeability?

The introduction of biosimilars has opened the door for many changes to our healthcare landscape, with the promise of large savings in the future. Yet there are many questions to be answered and changes to be made across a large and fragmented system before biosimilars take a majority share, spanning legal and regulatory hurdles, clinical considerations, manufacturing challenges, pricing and contracting incentives — So for now, you probably won’t feel a thing.

CONTINUE THE CONVERSATION:
Questions? Comments? You can contact the author directly at blog@ochww.com.
Please allow 24 hours for response.

Also posted in Branding, clinical trials, Design, Health & Wellness, Healthcare Communications, medical affairs, Pharmaceutical, Pharmacists, Research | Tagged | Leave a comment
Oct9

Fire All Your Reps

Fire All Your Reps Image BlogOkay, that may be a bit extreme. But marketing drugs to HCPs is no longer a guarantee of sales.

As the US healthcare system has shifted its focus from “fee-for-service” to the dual goals of increasing quality while decreasing cost, the power of the individual HCP has been on the decline. Centralized systems of care (ACOs, IDNs, large hospital systems or physician group practices) function to meet these goals by implementing standard methods of delivering care, that the individual provider executes—including the menu of drugs he or she has to choose from, and when.

Consider the September 24 Wall Street Journal article detailing the refined sales strategy that pharma companies are taking. Focusing on the sales call of a “key account manager” to a large system administrator (rather than the 2,600 doctors within the system), the article details much of the impact that pharma is seeing from the changes to our healthcare system. As insurers and the federal government increasingly implement payments based on the effectiveness of care, large systems take control of how care is delivered to manage the costs. A handful of decision-makers at these organizations control how care is delivered—eradicating the influence of the rep on the prescribing doctor.

Pharma has already shifted away from the sales rep who makes the pitch to the doctor. Consider the information from ZS Associates, a consulting firm: 50% of the doctors in the US are considered “access restricted” in some way, and in 2005 pharma companies employed over 100,000 sales reps—which is down to 63,000 in 2014.

While the role of the individual provider has become less influential, the sales rep still has a role to play. Pharma’s marketing and sales approach needs to mimic what its customers are doing—coordinating efforts across all levels and locations of care, and providing targeted support at the pivotal interaction points. Pharma companies have piloted and implemented these integrated sales teams at key locations, and their prominence will only increase as HCP access continues to decline. As emerging delivery models become more sophisticated, the traditional “clinical data” approach will become only a small piece of the drug value story, while economics, efficiency, care coordination, adherence and wrap-around support share the spotlight.

So fire all the reps? No. But we need to redefine their role to better support the new world we live in.

 

CONTINUE THE CONVERSATION:
Questions? Comments? You can contact the author directly at blog@ochww.com.
Please allow 24 hours for response.

Also posted in Culture, Healthcare Communications, Pharmaceutical, Sales Reps, Strategy | Tagged , , | Leave a comment
Sep23

Access to High-Cost Medications: A Balancing Act

UKBlogImageSmallAs continuing innovation moves us further toward personalized healthcare and the development of targeted treatments, how can patients across Europe ensure they have fair access to high-cost medications?

Securing reimbursement remains one of the biggest challenges to delivering market access for new treatments. The debate around balancing tight health budgets with fair access for patients is shaping the way governments and payers respond to these advancements. Cancer treatments are a specific concern, especially those designed to target rare and aggressive cancers, and as such have a particularly high development cost per patient.

So what’s the way forward?

This was the question posed by the Ogilvy Healthworld UK Market Access team earlier this summer when we brought together a panel of leading experts in front of an audience of industry figures, academics and patient representatives.

The panelists discussed the issue from the viewpoint of each of the 4P’s of healthcare—payers, prescribers, policymakers and patients—to chart out the future course of reimbursement.

What was the outcome?

After a far-ranging debate, five key ideas stood out as important for taking the conversation on the introduction of high-cost medicine ahead:

1. While schemes like the UK Cancer Drugs Fund have been a success, they may prove unsustainable in the long term. New systems to assess and support the uptake of new treatments must be a national priority.

2. Three key areas that will affect the cost of medication over the next decade are:

– Technological development; as new innovations make treatments more expensive, not cheaper

– How care is delivered; and potential cost-savings that can be made in reforming healthcare systems

– Whether health systems can reform the way that healthcare is funded to support uptake of new technology

3. New treatments will not necessarily lead to cost-efficiencies, but rather higher costs for payers. This means that demand and pricing must be controlled to maintain a healthy balance between supporting innovation and ensuring access to new medicines for patients.

4. Current value assessments are too narrow and need to be reformed to better reflect their full value. As newer medicines that raise costs are developed, a more complex assessment model will be necessary to ensure that their total cost/ benefit to the healthcare system can be successfully mapped.

5. If payers are to be able to afford new high-cost medicines, cost-efficiencies must be found in the delivery of services. Although healthcare systems should remain a center of healthcare delivery across Europe, it was agreed that the way they operate must fundamentally change to provide care in the most effective way possible. This should be focused on reducing hospital visits and supporting “community-based care” systems.

 

CONTINUE THE CONVERSATION:
Questions? Comments? You can contact the author directly at blog@ochww.com.
Please allow 24 hours for response.

Also posted in Culture, Fair Balance, Health & Wellness, International, medical affairs, Medicine, Pharmaceutical, Technology | Tagged , , , , | Leave a comment
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

CONTINUE THE CONVERSATION:
Questions? Comments? You can contact the author directly at blog@ochww.com.
Please allow 24 hours for response.

Also posted in adherence, Culture, Healthcare Communications, Patient Communications | Tagged , , | Leave a comment
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.

CONTINUE THE CONVERSATION: Questions? Comments? You can contact the author directly at blog@ochww.com. Please allow 24 hours for response.

Also posted in Branding, Clients, Healthcare Communications, Managed Care, Marketing, Reimbursement | Tagged , , , , , , | Leave a comment
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?

CONTINUE THE CONVERSATION:
Questions? Comments? You can contact the author directly at blog@ochww.com.
Please allow 24 hours for response.

Also posted in Fair Balance, Healthcare Communications, Managed Care, Physician Communications, Reimbursement | Tagged , , , , , , , | Leave a comment
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.

CONTINUE THE CONVERSATION:
Questions? Comments? You can contact the author directly at blog@ochww.com.
Please allow 24 hours for response.

Also posted in advertising, Healthcare Communications, Managed Care, Marketing, Physician Communications, Reimbursement | Tagged , , , , , | Leave a comment
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.

CONTINUE THE CONVERSATION:

Questions? Comments? You can contact the author directly at blog@ochww.com. Please allow 24 hours for response.

Also posted in behavior change, Health & Wellness, Healthcare Communications, Managed Care, Patient Communications, Reimbursement | Tagged , , , , , , , , , , , | Leave a comment
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.

CONTINUE THE CONVERSATION:
Questions? Comments? You can contact the author directly at blog@ochww.com.
Please allow 24 hours for response.

Also posted in behavior change, Healthcare Communications, Managed Care, Reimbursement | Tagged , , , , , , , | Leave a comment