The healthcare system is changing. Not only are we moving to a system that is based on delivering health outcomes, but pharma’s customers are changing (ACOs, IDNs, etc.), reimbursement models are shifting and patients are becoming more empowered through digital media and new technologies like wearables. Ultimately, pharma companies are now expected to deliver more value beyond the pill to help improve overall health outcomes.
PM360 asked a panel of digital experts in the industry: How will marketers need to better use digital tools and marketing initiatives to provide more value under this new outcomes-based system? What kind of digital “pill plus” services can pharma provide to add value to their medications? How can pharma use digital tools to better reach and/or serve payers and providers who are about to take on 32 million more customers? How can digital help pharma manage the rise of new group organizations such as ACOs and IDNs?
The transition from pay for procedure to pay for performance and population health management will be critical to the success of the PPACA. Ensuring quality through the collection and reporting of health outcomes and process data allows the system to provide incentives for improving quality and cost of care.
Moving forward, physicians seeking Medicaid or Medicare reimbursement will be required to demonstrate a commitment to quality care by reporting process, outcome and quality metrics similar to those measures health plans report today. As physician practices take on quality metric reporting, digital tools will be necessary to collect, manage and report data in meaningful ways. As of now, under the PPACA, Medicare is required to include “an assessment of patient experience and patient, caregiver and family engagement” on the Medicare Physician Compare website. By 2015, experts in this area predict that Medicare may tie physician reimbursement and pay formula in part to the measurement of patient experience. On the hospital front, reporting patient experience survey data is already a requirement for receiving full reimbursement.1
There are significant advantages to using digital tools to collect this data. Digital tools are easily adapted to survey design and content, and mobile-based digital tools and text messaging can be used to capture patient experience after a visit. This allows the patient to focus more on the medical issues of the appointment and perhaps more opportunity to be honest on the survey. Using digital tools will also cut down on patients “lost to follow-up” after a visit by providing another way for the patient and provider to engage and reduce the chance that the patient will not continue with care or treatment.
For valuable insights into survey design look to the American Medical Association (AMA) and the U.S. Department of Health and Human Services (HHS) – Consumer Assessment of Health Care Providers and Systems Clinician & Group Survey (CG-CAHPS).
1. Berry, Emily. “Sharpening Your Survey Skills: How Practices Can Measure Patient Satisfaction.” American Medical Association website. http://www.ama-assn.org/amednews/2011/04/18/bisa0418.htm. Accessed September 3, 2013
This is an exciting time. Nine out of 10 physicians use the Internet or an app to help make critical decisions, get educated and stay on top of medical news and information. And, four billion prescriptions are filled—and tracked—annually. Adherence helps improve health outcomes and also saves the health ecosphere from additional costs of coverage and care. Data can make a difference. Digital is the most effective and efficient way to deliver this information, while protecting privacy. For better reach, digital tools need to be used at the right place, at the right time and with the right information. As the number of customers grow, marketers can help drive better health outcomes by using data-driven digital methods to more accurately target their message to the right audience, vastly improving relevance and engagement, without increasing their costs.
Partnering for Analysis
This means that marketers need to work with companies that can provide intelligent data analysis so they can capitalize on information from audience insights, market research, innovative targeting solutions and outcomes measurement. In addition to using this data to better optimize campaign performance and measure the efficacy of your marketing programs, it also gives marketers the ability to provide consumers and healthcare professionals (HCPs) with more content that is of interest to them. Marketers can use the information that HCPs and patients provide online to personalize information and support for these users. Using these data assets can provide marketers with significant and measurable ROI, not to mention valuable insights on attitudinal and behavioral changes for HCPs as well as consumers.
Data for data’s sake is no benefit; data has to be collected, evaluated, used to better drive a positive change in behavior, and the results need to be measured. Marketers must form partnerships with companies that can provide real-time data feeds as they are collected to improve overall campaign performances.
As marketers, we have the opportunity and the responsibility to listen to the needs of patients and offer solutions that alleviate burdens that come along with disease management. Solutions go beyond the benefits a treatment may provide at a single point in a patient’s disease. We have to understand all stages of the disease and identify when further education and intervention is necessary. This information will ensure awareness of disease risk, prevent further progression, build preparedness for daily management and challenges they may face, and, importantly, maximize the time they spend with their healthcare providers making decisions.
Digital Path Optimization
As consumers, we are all accustomed to going online to seek more information on a topic of interest. Patients are no different. Through focused efforts, digital technology allows us to connect the dots between what needs patients are looking to fill and the solutions we offer—treatment and beyond. We should optimize ongoing campaigns by improving the way we communicate to patients, understand the way they seek or engage with information and provide them the most straightforward path to answers and intelligence. This happens through digital path optimization. It ensures a qualified audience is being reached in relation to the information we have available. Qualitative assessment may tell us if the information we are providing is leaving patients satisfied or unsatisfied. Then we should optimize the path to serve up the most fulfilling experience. For the short term, we then could refocus digital marketing efforts away from people we don’t have information to satisfy and towards information seekers who will benefit from our experience. In the long term, we can collect information about patient needs that drive development of tools and resources to ultimately improve disease management in a personalized way. The sooner we can use the dynamic technology available to serve patients on an individual basis, the further we are to advancing treatment as a whole.
As the sharing of information and the ability to make data-driven decisions become ever more important, digital tools will provide the backbone of success for pharmaceutical marketers operating under this emerging outcomes-based system. Building information technologies, such as electronic patient record systems, and making effective use of data for healthcare delivery at the physician and patient levels will also gain in importance. From the pharmaceutical marketing point of view, the tactics that will provide the most value in the near term will be the “patient engagement” programs that lead target patient populations to change behavior, especially regarding chronic diseases and lifestyle management.
Pharma marketers who can best build patient engagement tools through multiple channels—tools that mesh traditional and digital communication—will be best suited to truly help organizations support health management issues for individuals and populations. The hallmarks that best lend themselves to these specific digital solutions for patient engagement are:
- Robust educational materials
- Self-tracking and success tools
- Care coordination touch points
- Secure online/mobile messaging
In the emerging healthcare system that is based on delivering positive health outcomes, it is through engaging patients with relevant and effective educational programs that pharma marketers can leverage the digital channel to give healthcare providers the tools that can make patients more aware of their disease state—and therefore become better engaged in the patient’s own personal care. Health plans, physician groups and hospitals looking to realize the financial benefits of ACOs should give serious consideration to better partnering with pharmaceutical companies to create digital engagement interventions that encourage patient compliance and improve the quality of physician-patient communication both in the office and in the hospital.
Digital marketing is not just about “surviving” the new healthcare environment; it’s the very key to thriving. While personal connection to a health provider remains central to patient care, digital tools are altering the way that patients understand and adhere to physician recommendations. Millions of new patients are entering the system. Helping to reinforce the patient-physician connection—to empower and inform patients, while supporting professionals with accessible, expert guidance—is a critical way for pharma to show that an informed environment impacts outcomes.
An innovative product is only as good as its manufacturer’s ability to deliver it to patients in need and to help ensure its optimal use. Digital technology enables companies to support that process like never before. By seeking opportunities to leverage digital health tools and resources, pharma can better share its wealth of knowledge and data supporting best-practice care.
Today, a website or app can not only enable physicians to access clinically reviewed patient instructions—information critical to improved adherence and outcomes—but it can also send them to patients through a HIPAA-compliant service. Savvy marketers know that point-of-care communications influence the moment when the patient is most likely to take action.
Today’s value-based care system may feel like a whole new world but, at its core, it remains centered on the patient-physician relationship. Pharma has a tremendous opportunity to leverage the speed and accessibility of digital connections into support for the patient-care dialogue. By helping providers share expertise and engage patients in their own care, pharma can demonstrate authority about its products, as well as its commitment to providing real-world outcomes value.
In the future, as the healthcare system makes the transition to one based on outcomes, what will differentiate one product from another may be less about distinct data sets, but more about the ability to support safe and efficacious use outside of the pill or injection itself. These “pill plus” services can come in different forms, but ultimately they will need to add value to the medication the patient is taking. For instance, as wearable technology evolves, I envision a world in which the devices will become so ubiquitous and easy to use that the healthcare professional and the patient will easily be able to monitor progress together remotely. Much like the Holy Grail of the super-adherence program, the next generation may be in pursuit of the best product support app or technology. It is not inconceivable that payers’ formulary decisions will be influenced by the digital support provided by a product.
Helping HCPs Deal with New Patients
Another change the healthcare system is facing is the addition of 32 million more customers. As healthcare providers adjust to serving these new customers, there are several ways that pharma will be able to help make this transition a little easier. For starters, the industry can use digital tools to ensure a better user experience. As a result of more coverage, a wider range of patient demographics will have access to medicines and will require an increased level of education and multicultural content distribution. Healthcare providers will be challenged to handle increased numbers of patients that will tax their already dwindling time with patients. The pharma industry can help providers and patients by providing more levels of information and better handling of certain patient questions with more patient-friendly language. This includes multilingual content.
In the evolving healthcare environment, all stakeholders’ (pharma, hospitals, physicians, pharmacies, payers, technology companies, etc.) efforts must revolve around patient needs. Pharma must strive to move beyond being just the purveyor of medicines to a transformative model that positions the industry as deliverers of comprehensive health and wellness solutions in partnership with the medical establishment.
But what lens does pharma see through? One could argue that pharma views patients and the support pharma provides strictly through the lens of lifecycle management and the discontinuation of that support upon patent expiry. However, this is in contrast to patient-centric, consistent and long-term support throughout the course of their disease. Therefore, pharma should consider moving from individual brands supporting patients in a therapeutic area, to patient support from a corporate responsibility or industry perspective. This would be a true “beyond the pill” philosophy.
Pooling resources and investing in the development of new technologies may be one answer. Google has been making impressive strides in diabetes technology that may revolutionize treatment. Their advances in remote glucose monitoring via contact lens technology is designed to help improve the lives of patients with diabetes by easing adherence and closing the loop with physicians. Google has also partnered with Apple to form Calico, a new health technology company which will focus on health and well-being and, in particular, the challenge of aging and associated diseases.
The opportunity for pharma to have a huge role in the convergence between medicine and digital technology is clear, and these partnerships and potential partnerships will have a profound effect on improving patient outcomes and the overall economic cost of treating the world’s most chronic diseases. For pharma, a slight shift in thinking can put them in the center of the evolution.
Non-product specific digital and social media tactics can add value to medications. Specifically, initiatives connecting patients to each other and providing disease information, support and resources are extremely effective. In rare diseases where patients lack credible information about their condition and feel alone, patients are forced to take care into their own hands because healthcare professionals may lack the knowledge too.
Those who market drugs for rare diseases have the opportunity to add value through “pill plus” services, yet this requires a targeted digital approach to find, diagnose and manage patients. Pharma companies must support their brands with unbranded digital initiatives that drive earlier diagnosis, connect patients and caregivers with healthcare professionals who are experts and keep patients informed. These programs can provide ongoing clinical trial information and strategies for living with the disease.
Support Through Credible Information
For example, programs developed for Novartis, Net Alliance and Facing TSC supported rare disease patients by providing credible information on the condition, health and wellness, medical resources and success stories that drive earlier diagnosis and empower patients. When patients are armed with this education, they become advocates for their treatment. Many become “fans” of the brand and company, endorsing both across their social networks, creating an ever-increasing digital/social “buzz.” This patient- and disease-focused approach enables pharma to steer user-generated efforts from point of treatment through the entire patient journey without being overbearing.
Providing a good product with good data, keeping pricing competitive and offering reliable customer service is still crucial. However, pharma also has to leverage digital trends to champion unbranded programs that truly help the patient, caregiver or community affected by the condition, especially in rare diseases. Programs such as NET Alliance and Facing TSC that provide credible, informative patient solutions are invaluable in gaining consumer confidence and increasing brand awareness and endorsement.
To drive better patient outcomes, HCPs need: 1) an accurate view of patient progress in order to make informed clinical decisions and 2) support in ensuring that patients comply fully with those decisions. Pharma companies can provide tangible “pill plus” value by creating innovative digital programs and tools designed to serve these needs.
Pharma’s early efforts to improve patient monitoring have focused on health and/or medication tracking via mobile apps and web dashboards. Adoption rates, however, tend to be low—most pharma-sponsored tools require work on the part of the patient, few offer the patient any concrete value in return for their diligence, and few tie in the HCP. Companies like Tictrac are gaining traction by aggregating self-reported data along with data collected automatically through APIs, including both health data (e.g., weight, blood pressure, sleep, exercise, diet) and non-health data (e.g., calendars, travel schedules, e-mail). Tictrac rewards patients for their efforts by providing helpful insights into their health through data analysis. Pharma brands can use the Tictrac platform to enable HCPs to tailor programs for their patients, monitor progress and identify potential lifestyle patterns that may be affecting health.
Targeted and timely reminders delivered through digital channels (e.g., e-mail, SMS, apps) can help improve compliance, but studies show that more than three-quarters of patients are deliberately noncompliant. To really move the needle, education is key. Pharma can help by developing engaging patient education materials, such as digital teaching aids designed to help HCPs clearly explain treatment decisions to their patients. The patient-HCP relationship also directly affects adherence. Pharma can create digital offerings that facilitate and improve patient-HCP dialogue and offer true two-way communication. Lastly, pharma brands can leverage EMR platforms to integrate seamlessly into the physician’s workflow, with co-pay assistance and other offers at point-of-care to maximize fill rates.
“Digital” and “value” should be synonymous, as there is very little room within most digital experiences for unsolicited messaging. The new outcomes-based model introduced by the ACA simply raises the stakes for marketers. Despite the shift in reimbursement, what healthcare stakeholders truly need hasn’t changed all that much—the deep desire to make informed, confident choices about their health. There is a ton of opportunity in those needs for marketers who understand how digital can help. Three ways include:
1. Wearables are everywhere. Physical activity can be tracked and logged. Digital marketers should think about their customers’ “analog” experiences and consider how they can help by using sensors. An injection can ping a network and save to a device, and almost any activity can be placed on a digital continuum and then fed back to the user in a way that makes for better conversations with his/her doctor.
2. With the money potentially saved in the pivot from fee-for-service to outcomes-based payments, there will continue to be a tidal wave of startups looking to be part of the disruption. According to Rock Health (bit.ly/RockHealthRef), almost $400 million of venture capital funding was poured into digital health startups in January, smashing previous records. Digital marketers should be investing in relationships with potential pilot partners.
3. One key piece of the outcomes puzzle will require freeing physicians up to actually spend time with their patients. Physicians need help in four areas: Knowledge, stature, their practice and better patient outcomes. Multi-screen is the new norm with 64% of U.S. physicians owning digital devices (desktop, tablet and smartphone). Digital marketers should see these mobile devices in the exam room as an opportunity to save physicians time by making best-in-class patient education materials available across screens. Before a physician prescribes your product, ask yourself: Where’s the digital starter kit? Is it complete with an intro video? Can disease-state communities join?
Pharmaceutical marketers have long accepted that it is not enough to simply ask patients to take a pill without providing the tools to help them manage their disease and make necessary lifestyle changes. In diabetes and cardiovascular disease, for example, many companies have made a strong commitment to providing patient education aimed at helping people stay on therapy, change their diets and become more physically active. Nevertheless, in a value-based delivery environment, in which ACOs receive payment for meeting specific health quality benchmarks, pharma is expected to play a bigger role. Not just in the direct value that the therapies offer in the treatment of patients, but also in the broader integrated approach needed to help prevent and manage disease (and thereby reduce costs).
Fortunately, with the fast-paced evolution in digital technology, it is now possible—in many cases—to create an enduring pharma-patient connection that will benefit all parties involved.
“Pill Plus” Services
Pharma should continue its efforts to help patients become better stewards of their own health. No matter how good the therapy, if people don’t take medications as prescribed, and continue to make poor lifestyle choices, they will need increasingly elaborate and expensive care. Many pharma companies have already embraced this challenge with patient education and adherence apps (such as Janssen’s Care4Today and Biogen Idec’s Copaxone iTracker). To further engage the patients in the reduction of long-term healthcare costs, pharma has a great opportunity to partner with the makers of fitness trackers (such as Fitbit and Nike), and wearable monitors (perhaps the recently announced Google glucose monitor contact lens) in order to create condition-specific solutions that will help patients make smarter lifestyle choices and continually monitor their health.