Eleven PM360 2017 Brand Champion Award Winners gathered together before the Trailblazers Awards Gala last September for a deep dive into the importance of point of care (POC) marketing today as the industry shifts yet again under a new Administration. These thought leaders discussed the myriad methods and connections that can be brought to bear when POC is used as a tactical and strategical tool within holistic marketing initiatives—and how marketers can make the best use of POC opportunities. Croom Lawrence, VP, Strategy Practice at Merkle Health, moderated the event. Participants included:
- Robert Burke, Product Director, Xarelto, Janssen Pharmaceuticals, LLC
- Tiffany Crawford, Director, Professional Marketing & Promotions, Dermatology, Novartis Pharmaceutical Corporation
- Jackie Dorsky, Director, Strategic Marketing and Analytics, electroCore, LLC
- Harshal Deshpande, Director of Marketing, Promius Pharma
- Julie Holcombe, Senior Director, Marketing, Synergy Pharmaceuticals
- Kayte Lock, Director, U.S. Oncology Portfolio Marketing & Customer Engagement, Pfizer
- Tanja Martin, Sr. Manager, Global Marketing Operations, electroCore, LLC
- Alfonso (Al) Masucci, Vice President, IPF/ILD, Boehringer Ingelheim Pharmaceuticals, Inc.
- Marketer of the Year, Arpan Shah, PharmD, MBA, Marketing Director, Lexicon Pharmaceuticals, Inc.
- Nanci Silverman, Director of Consumer Marketing, Boehringer Ingelheim Pharmaceuticals, Inc.
- Michael Tomcsanyi, Senior Field Director, Integrated Health Systems, LTC, GPOs, Sunovion Pharmaceuticals
We would like to thank Health Monitor Network (HMN) for sponsoring this event.
Croom Lawrence: Good afternoon. I’d like to welcome all of the Brand Champions and also thank Health Monitor, who generously sponsored this event. Today we are focused on the point of care, where the physician-patient-brand dialogue comes together and point of care marketing opportunities emerge. Let’s start with simply defining what the point of care opportunity is today. Kayte, you have a point of care specialization. Would you share your thoughts, please?
Kayte Lock: I think point of care means different things to different stakeholders. For a patient, point of care is often associated with a doctor’s visit, either at their physicians’ office, hospital, an urgent care center, as well as when they’re going to pick up their prescription in a retail setting.
Similarly, from the HCP perspective, we see point of care at that prescribing decision, so that’s either in-office or in the waiting room or exam room, and within their electronic prescribing systems.
Croom Lawrence: Nanci, how would you see point of care?
Nanci Silverman: In my role, I focus on consumer marketing, so from the patient perspective, it really touches all aspects of the consumer journey. It could be at the moment of treatment decision, but it could also be along the adherence path. So it’s a way to encourage the dialogue between the doctor and patient, but it touches all aspects of the journey. Often we may we think of it as the bottom of the funnel, which is the initial conversion, but it’s much more than that.
Croom Lawrence: Excellent. Tiffany, may I ask your opinion?
Tiffany Crawford: Point of care is oftentimes thought of from a patient perspective—but there’s this little thing that’s called grant rate that we must take into consideration. At the end of the day, the prescriber makes the offering decision. So you have to utilize a parallel path perspective with one parallel being from an HCP perspective and the other parallel being from a patient perspective. This can ensure that a marketer increases his/her probability that their specific product is high in the prescribers consideration set—and then actually gets chosen as being prescribed.
Croom Lawrence: Al, let me ask your opinion, just on the definition of point of care.
Al Masucci: In the specialty arena, specifically with rare disease, patients are highly involved with their diagnosis and treatment decisions. And typically, there is very little information available because the disease is not as well understood. What we’ve been doing is providing that type of information to physicians and patients in high-quality and understandable formats.
With rare diseases, you see more patients involved in making decisions about their own therapy. So for point of care in specialty, consumer empowerment plays an integral role. When you’re looking at a disease that has a high risk of mortality, not only do patients get involved, but the caregiver plays a critical role also.
Croom Lawrence: Thank you. And Tanja?
Tanja Martin: If you’re in a specialty, by the time many of your patients walk in the door, they are already well educated on their specific disease state and the available treatments. That being said, I think when the physician, patient, and caregiver can all align on a specific treatment or therapy, that’s when the patient has the best chance for an optimal outcome.
Croom Lawrence: So in terms of alignment, Julie, how do you think about that regarding your brand launch and syncing up physician and patient messaging. Can we close the loop?
Julie Holcombe: To me, point of care does span the journey. It does mean different things to the patient at any point that they receive the information. Patients need to feel cared for, or validated, by the conversation or a message. We as marketers want to do everything we can to get that prescription request, right? However, we can have all the patients in the world asking for a product, but if they don’t end up receiving it, we’ve lost dollars.
So messaging to help prevent that loss between request, grant, and fill has become much more critical to not only validate, but to push, support, and continue to drive that script along the way—and then start all over again when it’s time to refill. As marketers, we can’t just look at that bull’s eye request conversation. That’s the point of care cost of entry. It does have to occur both before and after.
Croom Lawrence: So it sounds like point of care is really not just a tactical selection, but more of strategic consideration in which you’re priming well in advance of the point of care interaction and multiple touchpoints. From a strategic consideration, how are you thinking about setting up the narrative over time? Is that a function of planning? On that broader strategic notion, let’s ask our friends at electroCore.
Jackie Dorsky: We have an innovative therapy and, given their lack of experience with it, patients will inevitably have questions. Our ability to influence the physician-patient conversation at the point of care is thus critical to maximizing our opportunity and does require planning. From a strategic standpoint, one of our primary tasks is to think ahead to what those questions might be and provide doctors with the appropriate information, including informational brochures and instruction guides, to address them. We also have medical staff and in-house resources to further prepare our doctors for that conversation. In doing so, we empower our doctors to become our advocates when they’re speaking with patients about our therapy.
Croom Lawrence: So your planning is effectively laying out patient and physician messaging strategies as the cost of entry. Is that happening successfully with your firm? Arpan?
Arpan Shah: It’s a bit of a push and pull. In an ideal world, you’re working on both at the same time so that they’re having the right dialogue together. From my perspective, not every point of care is created equal. There are multiple points throughout the journey, and each one represents a distinct opportunity. And what you do before it, during it, and after it may be unique. The more you understand the journey, what the patient is going through, and what they’re looking for in that moment—that then starts to shape your tactical approach for that particular point of care opportunity.
Croom Lawrence: Michael, any thoughts on that topic from your end?
Michael Tomcsanyi: I’ll note that when you add in high deductible insurance coverage, you know that today’s patients are very savvy in how they spend their money. So throughout the journey, you do not want to have a disruption in the prescription and fill process due to cost. If it costs too much money, they’re out the door, or they seek alternative treatments. So the marketing plan must start from the disease state down to brand specific, touch all the points, and must also ensure the brand is affordable, whether through managed care coverage or copay deductibles.
Croom Lawrence: Sounds like everyone in this forum, as an industry leadership group, is thinking of it in a very strategic sense. But what’s different about it today?
Julie Holcombe: Digital has greatly changed how we execute point of care. Social and mobile have started to turn the tables too. The FDA, back in the day, didn’t have parameters for these channels, but they’ve put more rigor around what we need to do and how we need to think. We’re looking at all of this as a strategic piece of our puzzle. We’re moving from a point where we just took our campaign and popped it in the office, to asking how can we use that space in a way that’s much more meaningful for our patients, much more user friendly in that moment, and much more about what they need—not what we need. We can then put all these pieces together to provide content that’s more useful in the location where they may be.
So I like the evolution. I don’t think that point of care has walked away from tried and true, and that’s a good thing. Print materials like brochures still have a place in the office space as materials patients can physically take with them, point to, and reference when talking with their physicians. So I think those don’t go away. It’s just a matter of continuing to evolve with customer focus first.
Croom Lawrence: Tiffany, it sounds like you wanted to make sure other stakeholders are viewing materials. So how does it look from the physician perspective, when the patient team and marketing team are bringing together these messages and campaigns? How do we work together more collaboratively?
Tiffany Crawford: You hear a great deal in our discussions around getting the insights right for and on the patient journey. But I push my team and my consumer partner to realize that there is also an HCP journey that must be considered—and that you need to overlap the patient journey with the HCP journey to maximize the insight potential. Once you understand how those two journeys coexist—and why they coexist—then you can develop more impactful efforts that will accelerate business growth.
We’ve taken this collaborative effort a step further on my brand by mandating the above thinking as one of our strategic imperatives. This patient and HCP parallel thinking has helped us link our tactics more synergistically across marketing functions, which has resulted in our brand realizing elevated results from a holistic point of care perspective that includes both the patient and HCP.
Croom Lawrence: Is anybody detecting any digital signals when patients are in the waiting room conducting searches that are specific to what they need at the moment? Or are there any digital breakthroughs that can help you zero in on people close to the point of care interaction?
Harshal Deshpande: In my space, I’ve seen a lot of the migraine patients maintain their own diaries, and apps that provide those diaries. Any of these could be a signal. I would like to track when patients have their next doctor’s appointment, and track migraine episodes until the next doctor’s appointment. I look at episodes, along with doctor discussion guides, in terms of how patients are using them, and how they’re prepping for that next doctor’s visit.
Croom Lawrence: In the world of oncology or other highly complex treatment paradigms, are you seeing any innovations that can really support the patient experience in office?
Kayte Lock: There’s certainly been a tremendous amount of innovation in-office with the expansion of new digital technologies to deliver the patient information and education, even prior to their doctor’s visit. But one of the biggest opportunities lies in the specialty space in terms of how the patient moves from Rx decision through to fulfillment. So we support the patient by providing them with a number of different messages tailored to where they are in their journey—starting with disease education in the office or branded information, patient support services and resources, through to when they are picking up prescriptions and receiving a message to reinforce adherence and awareness of the different services available. As well, we partner with our specialty pharmacies to deliver patient education and clinical support.
Croom Lawrence: What’s the earliest possible patient touchpoint at which you convert from an awareness message into a known individual or someone who’s opting in, where you can really then engage in a more relevant program? Is there a way to improve that?
Kayte Lock: Taking into account the level of knowledge about the disease state as well as the competitive landscape, some brands may opt to develop the market through disease education, capturing patients’ attention in an unbranded manner, and then surrounding them through a number of different channels. It’s about meeting them where they are, whether it’s on mobile or through social, and then planting little breadcrumbs within that circle.
Al Masucci: I also think keeping it simple is the best approach to engage a patient in a more relevant program. Patients tend to do a significant amount of research on the internet and they get overwhelmed with what is available to them. Sometimes in rare disease, a lack of available information can create a high level of stress and anxiety. What we have been doing is providing this information to patients and their caregiver in formats they can easily understand. As a result, they are more confident in deciding what is best for their own care based on the disease state, product, and support programs outlined in the materials provided to them.
Croom Lawrence: Okay, so let’s dig into table stakes such as making sure the basic brochures and educational materials are there to establish the presence. What other must-haves should there be at point of care from the patient side? Bob?
Robert Burke: It goes back to what others were saying about disease state awareness. Because at the point you realize you have the disease, that’s where you start your search. Sometimes that may be in-office or at your home. But having that disease state awareness available at the time when the patient’s ready to receive it, to me, that’s the cost of entry.
Croom Lawrence: Yes. In effect, there’s an ecosystem that surrounds that, and a lot of ways in to a point of care experience—ideally connecting in cross-multiple point of care visits over time. Are we doing a better job of connecting the experience? If not, what’s holding us back from connecting the touchpoints across the point of care ecosystem?
Robert Burke: I think it’s hard to know who got what at which point in the journey. I don’t know, for instance, who did initial research at home or how much information they gathered, so I don’t know where they are in their journey when they go to the physician or to the pharmacist. Some people may be very well educated at that point, while others are just beginning to understand. That makes it hard to decide what’s the right information to serve them at this point.
Julie Holcombe: And I’ll tell you what’s an interesting factor. We may tailor content for one set of customers, but then they interact with another customer. So I can develop a digital piece because I know my consumer audience prefers digital, but the professional may not. I have to balance how to meet both sets of customers’ needs.
Tiffany Crawford: For many brands, the struggle with capitalizing on the holistic point of care paradigm is that a doctor’s time goal is to spend approximately seven minutes with patients per appointment time. Therefore, the challenge is to enable the HCP to maximize their seven minutes with patients without burden. The holistic point of care experience then begins with synergistic messaging across all of the touchpoint platforms (HCP, Consumer, Market Access, etc).
The intent is for brand owners to drive a patient into an office to ask for a specific brand by name utilizing differentiating messaging, i.e. in the surrounding doctor’s office space where the patient is immersed in the same message, and finally from an HCP perspective. The brand should educate the HCP on a synergistic clinical message that links to the patient and in-office messaging. This linkage across the different marketing platform will increase the probability that the patient will ask for a brand by name and will increase the likelihood that the HCP will grant that same brand or elevate that specific brand into his/her consideration set.
Julie Holcombe: Yes, the seven minutes patients get with their doctor is tight. But what’s tighter is the rep interaction with the physician, which is 30 seconds. So we’re trying to educate that physician in a tighter window of time about that seven-minute talk they will have with the patient—and how do we balance that as well?
I was also thinking around the peer to peer dynamic. There’s a great appetite for information in the patient base, and we see them going to communities and blogs, which underscores the credibility we provide. We have a responsibility to make sure that we’re helping to shape those discussions in a responsible manner, and make sure that within those communities, patients are sharing information about our brands and our products in a way that aligns with the true efficacy and profile of the product.
Croom Lawrence: Yes. Love the notion of the trust halo. Nanci, do you think there is enough evidence, measurement, and data, to really manage and orchestrate this new, complex ecosystem? Are you getting the data you need to be predictive, make good decisions, mixed decisions? Or what else do you need?
Nanci Silverman: We shouldn’t initiate an effort unless it can be measured. We have to have good data, and we have to look at it constantly to gain insights for optimization.
But I also wanted to add to our discussion about content. We talk a lot about disease education. My concern is that everything is very rational. We give patients information, but there’s an emotional side to receiving that information. Often, patients are confused, conflicted, even scared. So we have to find a way to help them with that information. It’s not enough to just push it out.
Croom Lawrence: Yes. And then one of the perennial topics when you’re looking at a data report: What is an insight? There are facts and findings, but are you effectively interpreting an insight, some lens into the human behavior. Again, did we actually touch an emotional nerve?
Nanci Silverman: I think that happens through search. You can see what patients are searching for. A lot of it is rational information, and some of it’s emotional. I think that’s the best place to understand patient unmet needs and then mine the data for insights.
Croom Lawrence: Michael, you have a background in field sales, long-term care, and integrated health systems. Are there any innovations in that ecosystem that you would suggest that we could think about differently relative to point of care?
Michael Tomcsanyi: I think the big changes are going to come in the telemedicine and the digital medicine areas. So the brick and mortar places are going to change significantly in the future. Everything will be done over the phone, or through a monitor on your body that sends all the data right to the physician’s office, and you’re going to be treated there. And so I think the experience is going to change greatly, from where you go to how you get treated from beginning to end. And that’s coming much sooner than people think.
Croom Lawrence: Okay, so we’ve talked about journeys, media mix, budget squeezes, the role of the insight, and the importance of delivering on both rational and emotional messages. Now, how do you perceive the range of delivery vehicles to accomplish both the rational and emotional delivery of a campaign?
Robert Burke: We have a wide range of delivery vehicles, and it ties back to your question about data. I’d say that one of the challenges we face is that we have access to a lot of data, but I’m not sure that it answers the real questions we have, or provides the insights you are asking about. Getting back to your question about search, we know who went to the website, what pages they went to, how long they were there, but we don’t know if we provided the information they needed. Did they leave with the emotional fulfillment regarding the knowledge they were seeking? Did we get there?
So when I look at the reports on number of clicks, number of impressions, and so on, it never answers what I really need to know. Was this engagement meaningful for the consumer and the HCP?
Arpan Shah: Yes, and in regard to the multiple channels, it’s interesting how many different digital avenues have emerged. The challenge becomes: Which ones are actually worth investing in piloting, testing, and seeing. A lot of them offer many shots on goal, better opportunity, but is an ad in an EMR something that’s meaningful to a physician because it’s now part of their new workflow?
Another challenge for marketers is sifting through everything new and determining, well, what actually will get it done? And where should we place our bets in the limited budget and try to justify ROI in something that may not be as measurable as we’d like it to be. So are we living by leading indicators and not ever getting to the end goal? That’s an added layer of challenge for us.
Croom Lawrence: In terms of small pharma versus larger enterprise pharma, can you move a little quicker and be more innovative?
Arpan Shah: You’re challenged more on your spend of the dollar typically in a smaller pharmaceutical company. So every dollar we want to spend faces a different level of scrutiny. But at the same time, we’re faster in our decision-making and the ability to try something new. That’s been my experience—definitely pros and cons.
Croom Lawrence: In small pharma, you might have an opportunity to walk the halls and form a close relationship with legal or the chief privacy officer. Is that relationship with legal working better? How do you form good relationships and build trust today?
Julie Holcombe: They’re part of my team—they have to be. And half the time I’m playing regulator. But I’m lucky in that I’ve worked more in my career with a regulatory team, legal team, and a medical team that’s willing to say, “That’s not going to work, but let’s figure out what will.” And when it can’t be fixed, it just can’t. I much more trust working with regulators because when they say no to something, I believe that it really is a no go, and move on.
Robert Burke: Julie, you made an interesting point earlier about the vagueness of the FDA guidelines. I think it’s tougher on the regulatory teams now, because if you look at the new guidelines issued by the FDA, it’s somewhat subjective. So I think it can be challenging to provide the right guidance to the organization.
Croom Lawrence: If you could have a conversation with the FDA, what would you tell them?
Julie Holcombe: If I could have a conversation with the folks at the FDA, I’d say “Spend some time with our customers to understand what it is they want to know. No one is arguing with what you’re trying to prevent. What we are arguing is that your mandates often prevent a better understanding of the product, which is what you’re trying to solve for.” If we could be better partners with FDA, that would be fantastic. I would just love to be able to work more closely with them, to share my insights.
Croom Lawrence: Is it fair to ask, if there was one particular innovation you could take into a concept review or take to the FDA, what would that be? In other words, back to point of care, let’s talk about innovation, your number one idea that you want to tackle first, which would change our ability to function and orchestrate the point of care experience?
Harshal Deshpande: Branded social is essentially closed. If that channel opens up, there is an opportunity to engage on that. Unbranded, yes, we do it all the time.
Julie Holcombe: Social is where I want to play, for sure, in a much deeper, branded way. But it becomes then a conversation about letting us talk to a customer the way they want to be talked to.
Harshal Deshpande: One more point. The crossing of branded and unbranded—why can’t you do that? Because the unbranded you’re doing right now, isn’t that directed to the patient that you’re targeting with your brand? Why can’t you combine the two? Why can’t you speak that language as a company?
Julie Holcombe: It’s about drug safety and risks. That’s what patients want to understand. They are reading this and are completely overwhelmed. It’s an emotional time. And although we’ve made such effort to distill it down to a certain grade reading level, you bring it to MLR, and they add this and that, which can lead to something that is very verbose.
Robert Burke: But the underlying question is: Is there a better way to provide that balance between the message you want to deliver while balancing it with risk? With digital, we can collapse things. We have people scrolling through PIs. It’s a waste because no one is reading them. We could add a link for people who want to read the PI. But more importantly, I think it would help us balance information to physicians and patients in a way that makes sense to them.
But, I don’t know that printing the PI achieves what we want because reading through someone’s package insert with the lengthy list of side effects doesn’t give a patient the right perception and it doesn’t give them the information they need about the risks and benefits of taking a drug.
Arpan Shah: The quality of life aspect that we can’t effectively talk about is very tied to that. We see our patients with the side effects at HCPs, but we can only communicate an end point, not the benefit of the end point.
Croom Lawrence: Tanja or Jackie, anything from your perspective?
Jackie Dorsky: Our ability to engage directly with patients at the point of care would provide the ideal platform to address questions about our therapy and support adoption from point zero. Obviously, with various HIPAA considerations, compliance, and other regulations in place, this is difficult to do. A concept to enable us to join the doctor-patient conversation in a compliant manner would be extremely valuable for all stakeholders. Further inclusion in the ongoing treatment of care would also help us to collect important data to continue to refine our solutions for our patients.
Croom Lawrence: Okay. We’ve covered a lot of ground. I think there’s a lot of agreement on reality and the core approach. Rodnell, I’d love to hear your thoughts about strategy or an idea, a table stake, and an innovation to help close the loop.
Rodnell Workman: From a strategic perspective, I think there’s opportunity to be even more immersed in the patient journey. We see the chance to provide organic and intuitive support—and tremendous room for growth remains. The potential for the industry is truly untapped. We’ve made great strides to this point.
As for innovation, I believe true growth will occur through evolving technology and deeper engagement. The growth of digital within the patient journey has become a key staple in POC. Digital provides convenience, variety, functionality, and natural ambiance within the doctor’s office environment. In the same way the TV entertainment viewing experience has evolved over the last decade, we will see a similar transformation in POC and its delivery of premium content.
The opinions expressed in this article are the participants’ own and do not necessarily reflect those of their affiliated companies or organizations.