By Jon Brulloths

Healthy Advice™ Networks provides consumers and healthcare professionals with relevant and accessible health information at the point-of-care and is the largest and fastest growing health information company with programs in the physician’s waiting room, exam room, back-office, and hospitals. Over 53,000 primary care and specialty physicians throughout the U.S. have chosen Healthy Advice products for their patient-education needs. Leading pharmaceutical and health and wellness brands sponsor their award-winning programs. For sponsors, Healthy Advice programs provide a proven way to educate patients and physicians at the time treatment decisions are being made.

PM360: Before we start talking about trends in Point-of-Care, it’s important to establish a working definition. From your vantage point, what is Point-of-Care in today’s environment and what is the biggest misconception?

Deborah Schnell: I think that when you say Point-of-Care, people immediately think of it as a place, a location. Simply put, I believe they think of it as a doctor’s office. But that’s really not Point-of-Care today. Point-of-Care has evolved beyond a location. Simply placing a TV ad on a screen or a print campaign on a billboard is not Point-of-Care.

Today’s sophisticated Point-of-Care programs are more than simple advertising. They leverage education to really impact patients and change behavior. Certainly, they utilize the location, the physician’s office, but they use that location to pull through their integrated strategy, their formulary coverage, their loyalty programs, their adherence programs; their brand message becomes a fully integrated strategy with the doctor and patient as center focus.

When designing effective education programs in office, what are the things marketers should consider most?

There are a number of things, but I think it begins with “Who is your actual target audience?” Marketers have two customers, the patient and the office staff. Programming that’s disruptive or annoying to the staff will be turned down or turned off, and the patient will not receive the brand’s message.

Secondly, marketers need to remember where they’re delivering the information. Some disease states require the privacy and intimacy of the exam room, and some waiting rooms, such as those in Pediatrics, are just too full of distractions to deliver a message. Marketers must take advantage of the moment. The brand message that is delivered into someone’s living room or family room is not necessarily the most effective message to be delivered in a doctor’s office. In the doctor’s office, the patient is focused on his or her health and is only moments away from a diagnosis or treatment plan.

How has the way you communicate and educate patients today changed, and how do marketers need to adjust?

Patients today are more sophisticated customers. Consumers are looking for information targeted to their needs and want to participate in their health. It’s no longer sufficient to deliver a one-dimensional message where one size fits all.

The most effective marketers tailor their message to the target audience and leverage technology to customize their message by market, even down to the individual office level. This can include promoting the brand’s formulary coverage, opt-in patient insurance programs, and in this difficult economic environment the brand’s rebate or patient assistance programs. Some target large Hispanic populations by delivering their message in Spanish to designated zip codes. This clearly strengthens the communication with their target audience. Beyond targeting, marketers need to ride the wave of rapid technological change. Your readers might find it interesting that according to Socialnomics, it took 38 years for radio to reach 50 million users and 13 years for TV to reach 50 million. It took a mere nine months for Facebook to reach 100 million users.

Clearly this means that the most effective Point-of-Care marketers will leverage multiple channels, such as print, digital, mobile text, 2D bar coding, and online to deliver their message to the broadest range of patients. Since consumers are receiving their information through all of these different channels, marketers must realize that unless they incorporate all of them, they run the risk of missing a large portion of the consumer and patient
population.

With revenue allocation as tight as it is, what do marketers need to know to give them the confidence that Point-of-Care is the right decision for their brand?

First of all, Point-of-Care is highly measurable, and it begins with the quality of the physicians in the network, not necessarily their decile but their prescribing volume. There are some fundamental questions marketers should ask Point-of-Care providers. (1) Are the doctors high-category writers? (2) What are their historical results for this category? and (3) What are the ROIs generated for other brands in their network? This should give the marketer a strong indication of the network’s performance. Marketers should also ask for an analysis of their brand to forecast how well it will perform in their network.

All measurement criteria should be predetermined up front and executed by an independent third party. To ensure accurate ROI results, we strongly recommend that ALL doctors in the program be measured and not a subset.

With the right program, marketers should expect ROIs that exceed traditional DTC, anywhere from 2:1 to 6:1.

What shifts have you seen in terms of how clients are evaluating results to ensure they’re getting the return they require?

Marketing budgets are getting tighter and tighter, and marketers are becoming more accountable for the dollars they spend. CPM is no longer the gold standard of traditional media modeling. Marketers want to know the expected ROI, and the NRx growth or new scripts, as compared to the national average. A strong primary care program should yield average gains of 8 to 10 percent. In addition, refills are becoming increasingly important. According to Wolters-Kluwer’s Insight Report, the abandonment rate for branded drugs was up 68 percent from 2006 to 2008, with the last quarter of 2009 the highest in recent history.

As an example, a mature cardiology brand in our network was reaching patent expiration and wanted to drive late stage lifecycle management. Focusing their educational message on compliance, they achieved a 3.82 percent RRx (refill rate) increase.

One of the other areas of change is OTC products: More consumers and patients are turning to OTC for first line therapy. Historically, these products relied solely on qualitative measurements, such as ad recall and purchase intent. However, taking our comprehensive database of network physicians and third-party vendor relationships, OTC brands can now determine exact purchase increases. Linking encrypted patient insurance claims with grocery store shopper loyalty card data, we can identify actual brand purchase as opposed to only purchase intent.

How can brands benefit from Point-of-Care, and does it replace DTC advertising?

Point-of-Care is not about replacing DTC but can be a more efficient spend for marketers challenged to deliver greater volume with fewer dollars. Point-of-Care delivers their message before treatment decisions are made—right before patients see their doctors. It really is an “outsmart vs. outspend” strategy. With limited budgets, spending in DTC can be like “boiling the ocean.” Small investments typically don’t pay out.

While mass DTC drives broad base awareness, it doesn’t necessarily cause patients to take action. In fact, according to a study conducted in 2007 by Harris Interactive, 52 percent of consumers take action when they see an ad at point-of-care, as opposed to only 16 percent with print ads.

Traditional media as we know it is rapidly changing. According to Advertising Age, in an August 2008 article entitled “Ad Skipping: Just Wait, It’s Going to Get Worse,” 23.4 percent of all TV households have DVRs, rising to 37 percent by 2012, and 85 percent are skipping three quarters of the ads. As consumers shift the way they get information, marketers need to understand that their marketing mix should be reallocated accordingly. It’s not about Point-of-Care or DTC; it’s about the right combination to maximize the effectiveness of the overall spend.

Do results vary in your program? If so, to what do you attribute that?

Fundamentally there are a number of things that contribute to the success of a brand’s in-office strategy. So if we assume all brands have good formulary coverage, an ad that is well branded, designed to take advantage of POC, and a favorable PI, why would one brand get better results than another?

The extent to which the brand leverages POC as part of an integrated brand strategy versus a stand-alone tactic or simply placing their ad at POC, is the key to huge success!

Let me share several examples of how one brand achieved ROI’s in excess of 7:1

They began by allowing us to build a webpage for their sales force to access; a site that showed all the physicians in their territory that were participating in the program. It also featured the disease state educational segments that patients would be seeing, allowing the sales reps to leverage their sponsorship of the program with doctors. Secondly, they customized on-screen messaging in those offices where they had rep coverage to include a call-out “Ask your Doctor for a sample”. They promoted their cash savings program and the patient support programs in those markets that had a high share of generics in the category. Additionally they customized by region and called out formulary wins telling patients “Philadelphian’s, Brand X is now Tier 1 on United Health Care”. And lastly, they made certain their ad made excellent use of their brand name, keeping the written brand image on screen as frequently as possible, thus driving the brand, not the category.

After Reviewing the Bio’s of your Sr. Mgt. Team I see that many of you built your careers outside the pharmaceutical industry; IBM, P&G’s CPG Div., RJ Reynolds, to name a few. Do you think that this diverse industry background benefits your clients and if so how?

Having worked across a number of diverse industry verticals gives this management team extreme depth of expertise in problem solving and unique approaches to market challenges. We have seen how other industries deal with adversity and come through it successfully.

For quite a long time the Pharmaceutical industry was very insular and enjoyed great success and profitability. The philosophy was “if it is not broken, don’t fix it” and a “This is the way we have always done it” attitude. Not a great deal of novel ideas. But look, that is true of virtually every industry in good times; manufacturing, distribution, automotive, high tech. True innovation typically comes when people are forced to think differently, when margin pressures are tight and budgets are trimmed.

The broad based background of our management team has served our clients exceedingly well in the past and has proven invaluable in these challenging economic times where breakthrough thinking is paramount. Let me give you an example.

Pharmaceutical manufacturers struggle with how to reach physicians, with almost 2/3rds restricting rep access and over 23% are no-see docs. Compounding the problem are the restrictive PHRMA guidelines that prohibit any branding of mugs, pens, etc., in the back-office. Even more basic is the simple fact that physicians simply don’t have time to spend with their reps. So how can they effectively get their message in front of doctors?

The answer, PracticeWire; wall mounted digital screens in the back-office where physicians work, delivering real-time medical information and breaking news from over 40 respected peer reviewed medical journals, while putting sponsoring brand messages in front of doctors all day every day!

Interestingly, they said it couldn’t be done; that doctors would never allow us to wire up the back office. Well, in our launch year of the product we exceeded installation goals by just over 33% with a physician waiting list for 2011 installations, while answering our client’s access issue!

Let’s talk a little more about that. How does it work with regard to the Pharma regulations?

PracticeWire is allowed in the back office because it is not branded information. As I said, It is late breaking medical news gathered from over 40 respected news sources and journals and delivered digitally to a screen mounted in the physician’s back office. For every three doctors in the practice there is one so for example, for nine doctors there would be three. PracticeWire is located in high-traffic areas so both physicians and their staff can see it. It was created for doctors by doctors with doctors and was in Beta for over two years. We actually used similar cameras to Homeland Security because we wanted to test whether physicians would look up at a screen, whether they would continue to watch it, and how much dwell time we could get with it.

We did a lot of research. As a matter of fact, over 53 percent of doctors told us that historically they got information from journals, yet over 50 percent of them said that it’s three or four weeks before they have time to even pick up a journal. PracticeWire gives them information real time, all day, every day. We don’t create the information; we simply deliver it

One of the other things that our research told us was that doctors don’t have one place they go for information; they may go to Harvard or Mayo or Web MD, but they always have to hunt for information. This has one website where they can go for more information. We know they don’t have time to read full articles when practicing so the companion website provides greater depth that they can access at their convenience. They can also get online CME.

PracticeWire is customizable down to the location level. It’s a split-screen on the bottom, providing trailer information for local information like pollen or mold count. So if, for example, a patient comes in coughing and sneezing, the physician can readily see that it may be because of increases in pollen count in their area that day. It also gives OSHA and HIPAA guidelines and the practice can put their standards of care up for their staff. In today’s litigious environment, it’s a safeguard so if they are ever asked if they train their staff, they can answer with confidence that they do all day, every day.

Practices and pharmaceutical companies love it. I was talking to one of the senior VPs at a large pharma company and asked him what he would pay for top of mind awareness in the doctor’s office, especially in light of the access issues so many sales representatives are experiencing. He said that while he liked the awareness, what he really liked about Practice Wire was that it reminded him of the old days when he felt like his was really bringing value to doctors.

If readers remember only one thing from this article, what would you like them to remember?

That Point-of-Care is not about location, and just being in-office does NOT guarantee success!

Deborah Schnell is President, Sales & Strategic Planning Healthy Advice Networks.