We asked our panel to give us the latest on adherence programs customized to the patient:
- What makes a great, patient-centered adherence program? How do you use customer information to optimize message and medium?
- How do you increase message diversity, ensure a dynamic patient experience, and make the contact a dialog rather than a monolog?
- Is “patient-centric” really ready for prime time?
- Alyson Connor
- Alex Dong
- Chris Dowd
- Julie Manganella
- Matthew B. Martin
- Ross Quinn
- Amanda Rhodes
- Louis Shapiro
- Lisa M. Tate
- James Woodland
Partner and SVP, Strategic and Behavioral Services
What makes a great program? We recently did an independent study of patient support programs in 13 chronic disease categories. We based our evaluation on six evidence-based principles that are key to creating a highly effective patient-centered adherence program. Most seem like common sense, but when you look at programs in-market, most don’t address even half of these. Too often adherence programs only address functional barriers to adherence such as cost or forgetting to take medication. To truly affect long-term adherence, especially with chronic conditions, programs must go beyond and address underlying psychosocial barriers. It’s also not enough to do really well in just one or two areas. Brands must consider the totality of patient needs and deliver a program that speaks to them across all of the following considerations: 1. Incorporating good health education principles 2. Addressing treatment attitudes 3. Addressing illness perceptions 4. Facilitating healthy patient–provider communication 5. Connecting patients to social support resources around both access to care and medication 6. Integrating patient programs into the brand’s broader marketing efforts and objectives “Patient-centric” is definitely not ready for prime time. A surprising finding of our research is that more than half of major brands for chronic diseases don’t even have a patient support program. It also showed that few programs are truly patient-centric across all six measures of effectiveness, although several set best-in-class standards in one or two particular areas. Cymbalta’s Promise Program succeeds in providing content and tools to help patients understand their condition and track their progress more objectively. This program scored a perfect 100 percent rating for its effectiveness in addressing illness perceptions. Rebif’s MS Lifelines provides comprehensive support services through a virtual support tool and “Patient Ambassadors”—current patients acting as mentors. MS Lifelines illustrates how brands can go beyond functional barriers (cost, side effects, etc.) to address psychosocial barriers. This program does a better job than most at maximizing the potential of the adherence program by integrating it into the brand’s broader patient and professional marketing efforts.
VP, Marketing, Technology and New Products Development
Health Monitor Network
A great patient-centered adherence program enables behavioral changes. Facilitating an effective dialogue between the healthcare providers, the patient, and caregivers is critical to success. Collecting, integrating, and acting on a large amount of patient data requires the effective collaboration of business and IT. At the core, you need solid technology infrastructure and business rules capable of handling data from multiple sources, providing insights into patients’ needs and motivations, and delivering programs that can change patient behavior through health education. How do you ensure message diversity? Segmentation! Marketers must not only put patients at the center of every decision but also must understand what decision to make for each type of patient. Steps traditionally taken when marketing to doctors must now be done for patients. And patients differ in their needs, motivations and beliefs, so they should be addressed accordingly. Once segmentation is completed, it is essential to put together a direct patient education program that will shift patient beliefs and behaviors. The delivery medium decision should be based on how the patient wants to communicate—via physician, office, online, print, mobile, live, television, tele-support, etc. The key point is that the dialog is based on patient education, moving toward action, and ultimately adherence. Is “patient-centric” ready for prime time? I think we are moving in that direction. Traditionally, the primary customers/decision-makers were the physicians (prescribers). Changes in the healthcare system are pushing more of the financial responsibilities onto the patients. Patients now are playing a more significant role in making the ultimate “purchase” decision. The more successful marketers understand patients are becoming more active in managing their health and have access to a large amount of information. Prescribing decisions may not ultimately be clinical in nature; they may be financial, behavioral or emotional. Realizing the final decision is now collaboration between doctor and patient; learning how to facilitate that dialog is key to success.
SVP, Market and Product Development
The key to a great program? Keep it simple. Remember that patients are consumers first; they struggle to remember to take their medicine in the same way they struggle to remember to save a little money out of each paycheck; they know they should, and they want to, but other things get in the way. So, provide multiple entry points and modes of interaction. Communicate with each participant using his or her preferred mode. Tie incentives to adherence behaviors. Collecting and integrating information is at the heart of every good adherence program. In our case, because our adherence programs tie adherence behaviors to valuable co-pay offers, patients respond positively; this linking process creates a great collection tool. Acting on information is tougher. Many creative solutions we brainstorm with clients are later shot down in med/reg review. So, we often rely on straightforward but proven systems: ask how patients want to be contacted, and help drive adherence using digital and mobile tactics. Message diversity starts at opt-in, when patients choose how they want to be contacted. Messaging includes refill reminders, surveys, video messages, event reminders, links, HCP visit reminders, etc. Messages roll out based on the product’s typical patient lifecycle. For example, a recent program had multiple sets of messages based on when patients first filled the Rx, after two weeks on therapy, time for a refill, and after refills. Individual refill behavior automatically triggers messaging. I think patient-centric is moving into prime time. For example, we have developed a desktop/mobile startup package that leads patients through a series of questions during registration. The application delivers Time Release Messages based on each patient’s situation and preferences. This application has a patented feature called Auto Updating, which allows the marketer to change the Time Release Message at any time. The marketer can consider even weather, news events, or stage of disease when deciding what patient message is most appropriate. (Time Release Messages and Auto Updating are trademarks of PSKW)
SVP, Marketing & Creative Services,
A truly great patient-centered adherence program stems from relevant insights that acknowledge how patients feel and address their emotions through compelling messages. To be effective, it’s important to understand patient behavior as well as emotional drivers and triggers. Our approach is committed to analyzing de-identified health consumer data and insights. We have conducted qualitative and quantitative patient research across numerous chronic conditions to understand drivers and barriers of patient behavior related to taking prescription medication. Marrying this primary research with privacy-protected data housed within our robust patient-level longitudinal database helps us understand the “whys” behind the “whats” (i.e., why patients do/do not comply with prescribed therapy regimens). It’s this level of understanding and holistic view of the health consumer journey that allows us to develop more customized messages and ultimately deliver measurably healthier outcomes. To create a dynamic patient experience our research has shown that information needs to change and evolve throughout the health consumer journey. What is of interest to a new patient on therapy is not the same for someone who has been on medication for six months. While both might have concerns with side effects, for example, emotional factors may impact their adherence in totally different ways. We recommend that brand messages acknowledge the different mindset and behavior patterns throughout the treatment continuum —this is what leads to a truly dynamic patient experience. Patients are certainly ready [for patient-centricity in prime time]. What drives success is a consumer-centric strategy and message. While there are some great examples within pharma, overall, the industry has to do a better job. We firmly believe in and are committed to patient-centricity—for us, the health consumer is at the core of everything we do. (Health Consumer Journey is a Catalina trademark)
Matthew B. Martin
Product Manager, Patient Programs
The single solution to patient adherence is…there is not one solution. Consequently, brands must use a variety of adherence-support initiatives to keep an already-acquired patient adherent. Identification of the best solution can vary from “just ask” to a series of tailored tools that reward adherence. Successful adherence initiatives utilize several tools simultaneously to establish the brand-to-patient relationship. Once this dialog becomes a relationship, adherence quickly follows. Successful ongoing patient-centered relationships start with an initial conversation between the patient and the brand. This typically is through a patient-initiated program opt-in via phone or brand website and gives a brand the opportunity to let the patient decide how he or she would like to interact. Brands with successful communication plans allow a variety of vehicle choices including mail, reminder calls, email, and even text messages. Giving the patient a choice of vehicles may result in a 40% greater opt-in for ongoing communications. If a brand “just asks” patients about communication preferences, it not only allows the greatest communication opportunities but also makes the patient feel more in control of the discussion and therefore willing to participate in the dialog. As another adherence-support vehicle, brands that quickly identify and proactively engage patients who are non-adherent are able to assist this potentially lost patient in course-correcting back onto therapy. For example, brands already using a copay card as an adherence-support vehicle may consider offering increased instant savings when the savings offer is used within 5-10 days of the refill window to further encourage refill compliance. These reward-based solutions result in around a 20% greater patient adherence and put the brand’s adherence message into the patient’s decision cycle by rewarding the patient behavior. Although these are only two of many solutions available, a multi-tool approach to adherence messaging supports a dialog with patients as well as rewards adherent behavior. Effectively using varied, integrated initiatives better ensures that brands are able to have an effective two-way relationship with patients rather than a more one-way “direct to” communication channel.
Managing Partner, Director of Customer Integration
Concentric Pharma Advertising
Not only is “patient-centric” ready for prime time, it’s required to be successful. In today’s digital age, consumers expect us to be patient-centric, putting their needs in front of ours and creating a patient experience that leads to better outcomes. How do we achieve this? Listening! “Listening” makes the difference for a great adherence program. Listening before an initiative launch, during and after. It’s important to understand that adherence barriers are multi-dimensional and dynamic. People are not inherently adherent or non-adherent. While someone may be non-adherent today to their cholesterol medication, if a friend has a heart attack, tomorrow that same person may be adherent. At the same time, the barriers in place at one point of the patient journey may not be a factor down the road. For instance, early in therapy many patients are unwilling to accept the reality that they now must consistently take medication. Yet later in therapy, once a patient has accepted that fact, that concern becomes less relevant, and he or she may become more concerned with long-term safety. Listening to patients allows us to understand the key adherence barriers they are facing at each stage of therapy, as well as to monitor their current adherence profile to allow for immediate response. There are many touch points that can be accessed to “listen” to the patient, and in turn, provide dynamic, relevant messaging. Examples include enrollment into an adherence program, activation of co-pay assistance cards, tracking card usage, patient longitudinal tracking, and ongoing surveys throughout the relationship. Leveraging nurses/call centers to provide support not only drives adherence but also provides real-time, real-world feedback to refine the program to be more relevant. At the same time, brands should be wary of falling into the data-overload trap. It’s important to solicit and capture only data that will drive marketing decisions. Otherwise, enrollment forms start to look like mortgage applications, and the opportunity to provide a relevant experience based on actionable data is diminished. Pharma marketers should consider listening one of the most valuable skills they can develop, not only for driving patient adherence but also for developing a strong brand able to succeed in today’s constantly evolving market.
Director, Client Strategy and Solutions
McKesson Patient Relationship Solutions
To effectively combat non-adherence, pharmaceutical and medical-device industries must leverage patient-centric approaches that provide value to patients beyond the clinical benefits of the pill or device. This approach helps promote patient engagement and drive positive behavior changes, such as increased medication adherence or positive device outcomes, which ultimately improve patients’ quality of life. As mobile health technology spreads, manufacturers are reaching patients through new channels to deliver medication or physician-visit reminders, condition-specific health information and support, and clinical-trial locators. While using a channel that supports dynamic interactions is important for engagement, more channels may not necessarily equate to more engaged patients. The key is discovering the specific barriers patients face and deploying the right message at the right time to help them overcome these barriers. For example, a patient with diabetes who is newly prescribed insulin may face denial, feel overwhelmed, and feel like a failure because he or she didn’t succeed on oral medications—all of which can lead to non-adherence. An experienced insulin user may have other barriers, such as not testing blood-glucose levels or challenges with lifestyle management. Messaging must be tailored for both patients to drive action and improve adherence. One successful tool is a behavioral-coaching platform to help identify and address barriers. By delivering patient-centric behavioral coaching, you can build trust and establish relationships over time to ultimately impact adherence. We are able to deliver behavioral coaching either by our trained patient support representatives in our contact center or in the pharmacy through our Sponsored Clinical Services network of retail pharmacists. We have also found that integrating a behavioral-coaching platform with other traditional disparate marketing tactics can both improve adherence and also drive product trial and migration, and elevate overall patient support. For example, this approach can help patients maintain follow-up doctor visits, remind patients on dialysis to stay current on labs, or help glaucoma patients maintain proper dosing. Ultimately, the strategic balance between patients’ needs and brand goals results in a scalable adherence solution that builds patient engagement, giving brands the ability to optimize patient spend and identify communication strategies most likely to meet the needs of targeted patients.
SVP, Business Development
American Medical Alert Corp.
Patients are more likely to adhere to treatment and protocol requirements when they feel supported. The following represent common reasons for non-adherence: perceived lack of efficacy, non-symptomatic disease state(s), side effects, patient forgetfulness, complex drug regimen and cost. In our pharmaceutical solution (Patient Support Programs), the key components to a patient-centered adherence program are the marriage of human contact—allowing for trust, empathy and understanding along with technology— to enhanced accuracy and timeliness. The model utilizes a tiered approach with the availability of an adherence device. The process recruits four tiers of agents: traditional answering service agents, concierge specialists, case managers and clinicians. The agents or “Care Specialists” are specialty trained in the disease state to which they are assigned. The patient’s goals, preferences and other information are incorporated into every call—each patient’s details are stored in a secure CRM to support effective touch points. Each program is customized using intelligent scripting. Care Specialists are continually re-trained through a company Certificate of Excellence Program. This program is part of the client’s customized package and is updated regarding the specific disease state every six months. This allows the Care Specialists to focus on empathy, what to expect with treatment and the importance of adherence. The program’s clinicians maintain certifications in specific disease states to which they are assigned through professional organizations and on-site training through our Clinical Development Program. Patient-specific goals lead to increased adherence, personalized support and identification of adverse events. Care Specialists and Clinicians are trained in various techniques to ensure the patient is included in an interactive dialogue by combining measurable questions with personal touch scripts—this allows for a dynamic patient experience and guarantees the capture of vital data for effective outcome reporting.
Lisa M. Tate
CEO, WomenHeart: The National Coalition for Women with Heart Disease
We’re a patient-centered advocacy organization serving 42 million American women living with or at risk of heart disease. The coalition is committed to educating patients to assume responsibility for important aspects of their care. A patient-centered approach insures that information about the options, risks, benefits, financial impact, and alternatives for treatments and medications is provided in a balanced manner using simple, accurate, and culturally appropriate, language. Treatment plans that reflect expectations for the effects of therapy on personal and family functioning, quality of daily life, and long-term functional capacities are presented in an unbiased and understandable way. The patient-centered approach improves the match between the chosen option and what matters most to the patient and increases the likelihood of adherence. A recent example of patient centered research in which we were involved is the current study on spontaneous coronary artery dissection (SCAD) that is taking place at the Mayo Clinic. Through our online community, in 2009, two women SCAD survivors connected as they were preparing to attend a WomenHeart Science & Leadership Symposium we sponsored at the Mayo Clinic. They realized, along with many of their heart sisters from around the world who were also in the online support community and who had experienced SCAD, that there were no answers as to why, how and what happens next in those who experience this rare and often life threatening heart condition. When the ladies got to the Mayo Clinic, they approached Sharonne Hayes, MD, director of Mayo’s women’s heart clinic, about doing a study to find answers. And, so, this patient-centered research project was born. The first steps were completed in Fall 2011, and now the second phase is recruiting patients and family members for a larger study in 2012. The patient-centered approach will hopefully help find answers as to why and how SCAD happens, if it is hereditary, and if it can be prevented. (See the August 30, 2011, Wall Street Journal article for more on significant steps in initiating and implementing patient-centered research.)
VP, Media Operations & New Ventures
Communications Media, Inc.
The key to patient adherence is providing relevance and value to patients. This is not a new idea, but it’s one rarely implemented in marketing. As marketers, we need to take cues from startups already solving this puzzle. One example is a company called Asthmapolis (www.asthmapolis.com), the future of healthcare as we see it. The site not only tracks medication use but also takes everything one step further. How are patients using it? What is going on in the environment that day in that patient’s neighborhood that could affect his or her breathing, and is that indicative of a local pollution problem? How can we have physicians remotely monitoring that patient? By continuing to think “what else,” Asthmapolis is on the right track. As an industry, we need to walk in patients’ shoes. We need to leave the office and spend the day with a doctor or patient. We need to think beyond “mobile” and “print” and “social” and instead think about value. One issue that haunts me is the overwhelming adherence problem with transplant recipients. In theory, there is no greater motivation than death. And yet 35% of renal transplant patients are non-adherent to their anti-rejection drugs. But then, I do understand the feeling of no longer wanting to be a patient—the feeling of denial that keeps you from wanting to take one more pill every day. So we need to be better than that—we need to take many approaches and continue to combine creativity, emerging media and (perhaps most of all) heart to provide value.