Morten Hjelmsoe

One of the things that we’re hearing a lot about right now is big data. We’re told that we’re entering an era of big data that will come to transform business and government services alike. For data, so the thinking goes, the bigger the better. But, asks Agnitio’s Morten Hjelmsoe,  is this always the case?

There’s no doubt that big data is very useful. As organizations create and store ever more digital data, they can use it to make informed decisions on everything from product inventories to employee morale. And, through the growing use of sensors embedded in products, it’s increasingly possible to offer novel after-sales services and even proactive maintenance. That way, customers may not even notice as preventative measures are taken before a failure occurs.

It’s also thought that big data will enable an ever-narrower segmentation of customers and therefore make possible more precisely tailored products or services. But it’s here that I take issue. While we certainly do want better segmentation, crunching vast data repositories might not be the best way to get it – particularly in the pharmaceutical industry.

Big data, old paradigm
The problem is that big data actually operates using an old-fashioned paradigm. This says that we need to deal with people in groups. So we start off with data about everyone and then look for patterns; effectively chopping the data down to size and creating some more manageable groups at whom we can target our communications.

If you think about it, this big data approach is actually a little odd. In effect, we are taking data from individuals, squashing it together into a big pie and then chopping it into slices. Why would we do this if individuals have already told us what they are interested in? The process makes it less individual and therefore less relevant. Why deal with groups at all?

Small is beautiful
The reason that companies need the big data is because they don’t have the “small” data. But pharma actually does!

Like no other business, we physically see our customers, if not every week but then at least several times a year in most markets. I know of no other B2B industry that has such frequent face-to-face interaction with its customers.

This customer contact is a tremendous resource but one that until recently we haven’t been able to tap; we loaded up our reps with information but they come home empty. That individual “small” data was lost. But not any longer.

New digital technology allows our sales force to understand each healthcare professional’s personal needs and interests, keep track of it, and respond. In effect, we now don’t need to force fit customers into any kind of group. This means we can give them highly relevant information. And that means higher value for the customer.

So get your reps into play. As an industry, we are in the best position to focus on the individual and we now have the tools to make it happen. When it comes to data and the pharmaceutical industry, my advice is to go small and think big.

Morten Hjelmsoe is founder of Agnitio.

Peter Houston

You know this: digital marketing means you have the potential to get your message in front of more people than ever before; search and social media offer reach on an unparalleled scale. According to global internet analytics firm Comscore, there are 13.7 billion searches conducted on Google every month. With 60% of US consumers saying they looked for health information online in the last year, that’s a lot of potential patients.
The problem is, that reach is available to everyone else from top-10 pharma to your local Deli: We’re all publishers now.

Actually we’re not all publishers, we’re all authors. Publishers — certainly in the traditional sense of the word — would never allow most of the content on the Internet out of the slush pile. And it’s the public accessibility of that slush pile that might just provide Pharma with its best opportunity to be heard above the noise.

Content marketing — the art of creating and distributing relevant and valuable content to attract, acquire, and engage a clearly defined and understood target audience — is being hailed as the brightest hope for marketers desperate to cut through the Internet’s clutter. So far so good – Pharma has been producing quality, expert-led, evidence-based content for ever.

If you read some of the content marketing blogs you would think these geniuses had just invented the concept. But content marketing has been around almost as long as marketing.

• John Deere, America’s favourite tractor manufacturer, released the first customer magazine in 1895
• Guess what brand of flour my mother-in-law has on her kitchen shelf. Here’s a clue – she swears by her BeRo Flour cookbook first published in 1923 and now in its 40th edition.
• Have you ever wondered why the world’s leading restaurant guide is named after a tyre manufacturer? Back at the turn of the last century Michelin published its first restaurant recommendations to give drivers a good reason to burn more rubber.

What is new is the importance marketers are placing on real value delivered through content. Possibly the biggest reason for this new focus on quality is that Google, the daddy of web search, got tired of people gaming its search algorithms with sub-standard content

To combat SEO tactics that had more to do with keyword stuffing than content quality, Google changed the rules of the game with its Penguin algorithm, introduced this time last year and already headed for its third update. I won’t even begin to pretend to understand how Google’s algorithms work, but I do know they are focusing more and more on the quality and ‘shareability’ of content to improve the search experience and this puts content marketing firmly in the frame.

There’s also the added benefit that, rather than interrupt people with unwanted sales pitches, content marketing offers a non-interruptive approach to customer communication. The ideal is to create a regular stream of valued, trusted content that customers will actively seek out and share.

Pharma’s content-marketing opportunity is to make sure that when a doctor or a patient goes searching for health information — which they are doing more and more — the right content is there waiting for them. When they get exactly what they want, when they want it they’re also happy to pass it on to friends and family. The problem is pharma doesn’t like sharing.

Content marketing principles — valuable content that engages a clearly defined audience – might have been at the heart of pharma’s efforts to help HCPs and patients understand and adopt new treatments for years. Pharma should have a head start in the content marketing race, but it’s firms like Marriot, Old Spice and American Express that are getting noticed for their content marketing efforts, because they love people to share their content

“As a well-oiled content machine that knows how to build relationships, pharma should thrive in this new era,” writes Dr Candice O’Sullivan of Australia’s Wellmark agency on PharmaForum. “Here is an industry well used to the rigours of consistently producing high-quality content — the number one challenge for most content marketers — but finds it virtually impossible to ‘share’.”

O’Sullivan closes by describing Pharma as an industry “too preoccupied by the risks involved to be able to make the most of this opportunity”. Sound familiar?

Peter Houston is former Group Content Director for Advanstar Pharma Science. He is now an independent media consultant and founder of Flipping Pages.

At the beginning of the Reboot Camp – held at New York City’s Alexandria Center on April 12 – Intouch Solutions’ CEO Faruk Capan declared the days of Don Draper effectively over. The route to patients’ hearts and minds isn’t Old Fashioned cocktails and intuition; it’s solutions based on patient, provider and payer needs, and making disparate data streams pool around brand objectives.

Katherine Patterson, global marketing communications manager, growth initiatives, GE Healthcare

Katherine Patterson, global marketing communications manager, growth initiatives, at GE Healthcare, gave the keynote address, which focused on clarity of mission in marketing execution, and the importance of marrying science and emotion for consumers. Marketers too obsessed with social media, or the newest digital platform, might impress only themselves. “It’s like peeing down your leg…hot to you, but nobody else,” said Patterson. In Japan, for example, GE Healthcare’s medical device customers “are moving back toward print” as a preferred marketing channel, although growth markets “want digital,” and they want it on their mobile devices, she said.

Citing Eric Topol, currently director of the Scripps Translational Science Institute, Ben Chodor, CEO at Happtique, said we’re not too far away from a time when physicians prescribe more apps than pharmaceutical drugs. Chodor is betting on Topol’s prediction; Happtique, a mobile health application store, will “curate” mobile apps for docs through a private, customized dashboard of Happtique-certified health apps. The company’s patent-pending software would allow physicians to electronically prescribe apps to patients. Chodor says he’s lobbying the SEC to reimburse medical apps, noting that some private plans already do.

Happtique doesn’t make apps itself, but Chodor appeared before the US House of Representatives’ Energy and Commerce Subcommittee on Communications and Technology in March to support FDA’s regulation and definition of mobile medical apps. “It’s relatively simple to take an app through FDA” [for a medical device designation], and it only costs between $10,000 and $20,000, he said, noting that 75 mobile devices/apps have already been approved. Chodor said the Affordable Care Act’s medical device excise tax – “the absolute worst tax ever” – should not be levied on smartphones or apps.

Asaf Evenhaim, co-founder and CEO of Crossix, reminded Reboot Camp attendees about the unfathomable amount of individual consumer or patient data that exists for marketers, while insisting on the importance of privacy and HIPAA regulations. His company collects this data to create “propensity scores,” which serve as the basis for highly specific predictive models. The models can then be used to predict healthcare purchase decisions.

Where does all that data come from? Some of it is volunteered, some is collected invisibly through cookies, Facebook and other online aggregators, and some of it – but not Crossix’s data – is gleaned from trolling social media channels and blogs. Passive data collection, said Intouch Solutions’ senior vice president David Windhausen, is revolutionizing pharma marketing and health itself. Windhausen said he looks at his Nike FuelBand in the evening, and if he hasn’t been active enough, it’s time to exercise.

Windhausen’s talk lovingly described the Sanofi mobile app “GoMeals,” an app for diabetics specifically, but also for anyone who wants on-the-go nutritional facts about nearby restaurants (among other things). An attendee representing Sanofi – which is an Intouch client – let slip that GoMeals, and possibly the iBGStar glucose meter, would start to integrate passive data from wearable tracker gadgets like Fitbit or the FuelBand as early as this year.

Capping off the Reboot meeting was Augustin Fou, founder and chief digital strategist, Marketing Science Consulting Group. Fou emphasized the importance of recognizing how patients’ habits, expectations, and actions – in the context of healthcare – have changed, and how they continue to change. He referenced a Capgemini Consulting report on “digital maturity” that placed pharma at the very bottom of the list.

Despite regulatory hurdles and because of an explosion in mobile technology, data capture, and the influence patient’s have on the delivery of healthcare, pharma marketers could use a reboot. But they’ll need to back-up some of the dusty old tropes of yesteryear, even those that precede Don Draper. As GE Healthcare’s Patterson noted, Aristotelian rhetoric, comprised of ethos, pathos and logos – in equal measure – works as well in a sales detail as it did in symposia. The occasional Old Fashioned might be okay, too.

Improving brand adherence rates requires pharma marketers to have access to two growing bodies of knowledge. These are: 1) carefully evaluated evidence for what can improve brand revenue, and 2) informed forecasts of trends.

How can this knowledge help?  Many recent industry programs have achieved only a 1-3% increase in adherence, and ROIs of less than 3.  To realize results of 20%+ and ROIs above 3/1, critical appraisal of the past and direction to probable futures are needed (several pharma companies have achieved 38%+ lifts in persistence with this new knowledge).  This experience can provide the pharma marketer with a needed guide to planning and program implementation.

At this month’s Center for Business Intelligence (CBI) Patient Adherence and Support Summit (April 29-30), in Philadelphia, brand directors and marketers will have a unique opportunity to hear senior VP’s, consultants and academic researchers provide their perspectives on what we know and need to target in 2013.

The event will begin with a keynote panel speaking about the changing DNA of patient adherence programs.  Presenters will be VP’s and Senior Directors from Eli Lilly, GSK, Sanofi, and Shire.

For the first time since the inception of CBI’s Strategic Patient Adherence (SPA) Awards, there will be a look back at where the winning programs are today.  This panel will follow presentation of an Adherence Roadmap by Dr. William Shrank, a prolific adherence researcher.

Tuesday will include a unique opportunity to hear one of the world’s most cited industry researchers, Merck’s Dr. Colleen McHorney.  Dr. McHorney will be reviewing the history of adherence research and how the paradigm has shifted.

For more information on this event, now in its 12th year, go to:

http://www.cbinet.com/conference/pc13116#.UVx-3KLvHE0

For more information on this article, you can reach Grant Corbett, Principal, Behavior Change Solutions, Inc. at grant.corbett@behavior-change-solutions.com.

See also:  http://blog.pharmexec.com/2013/03/12/changing-the-dna-of-pharma-patient-adherence-programs/

Conducted across 46 states and with a group of 400 respondents, the sample was representative of just how many nurse practitioners, physician’s assistants, clinical nurse specialists and certified nurse midwives there are in the US. The demand for NPPs is leading to higher pay and an increased respect within the payer community. Aetna now considers nurse practitioners, for example, to be primary care providers and reimburses them for their services thusly.

When considering what influenced their behavior as prescribers the most, the survey found that NPPs tend to consider efficacy, their experiences with the drug, and price, in that order. As 82% of the respondents indicated they had no restrictions when dealing with sales representatives (17% had certain restrictions, and 11% said they were completely restricted), and that most respondents were open to support from them, why have sales reps and pharma by and large neglected to address this demographic?

Brenda Rizzo, author of the report and an advanced practice nurse herself, says sales reps make calls “based upon prescribing behaviors, and on that basis alone, NPPs are pretty much invisible.” Misconceptions about NPPs abound, according to the report, including that they prescribe based on a protocol set by their physician practice partners, that if they have the ability to prescribe, they rarely do, or that they are simply refilling prescriptions that have already been decided on by a physician. Pharma “doesn’t realize that this is an audience that makes independent prescribing decisions, and that having the right information to make those decisions is incumbent on pharma companies; to provide it to non-physician prescribers is equally important as it is to provide that information to physicians,” emphasizes Rizzo.

So what kind of information do non-physician prescribers want? As a group shown to be active attendees of national conferences and maintaining exchange of advice among colleagues and fellow professionals, first and foremost the information should be sharable and accurate to provide trustworthy resources that can further facilitate dialogue and be spread easily. Secondly, NPPs listed printed education materials from pharmaceutical companies as one of their top-rated tools when looking to improve patient compliance. More specifically, 61.3% of respondents, when asked about what kind of support they’d expect from pharma companies, said “Education about the pharmaceutical drug or medical device directed to the NPP for the patient,” 54.5% responded “Disease state information to educate the patient.” and 51.5% said “Assessment tools to help identify problems that can be addressed.”

NPPs, as this study shows, not only want to engage, but expect valuable engagement tools from pharma to help make their jobs easier. With primary care taking on a new definition that includes long-term, patient-focused care, the physician’s ability to orchestrate outcomes is increasingly being diluted and in need of help from nurse practitioners, physician’s assistants and other NPPs. As such, pharma needs to keep a keen eye on these providers: payers, private practices, and health care facilities have already gotten the memo.

By Morten Hjelmsoe.

Since the early days of the internet, we’ve been busy creating websites and other digital channels. It’s not an exaggeration to say that most pharmaceutical companies already have hundreds of websites and still more are coming. And now everybody is building apps.

There’s a lot of activity and in many ways that is a good thing; these digital channels have the potential to reach a lot of people. That’s why they are assumed to be the future of pharmaceutical marketing; the expectation being that we’ll move our customers to these more efficient channels of communication.

Yet there is a problem: how are we planning to get the medical professionals to connect to them? It’s pretty obvious that most of these initiatives don’t attract the numbers of people that we were hoping for; and they are nowhere near to being the cheaper alternative channel of communication we anticipated.

Morten Hjelmsoe

Asking people to make an effort — whether it’s going to work, seeing a movie, or visiting a website — will only happen if you believe that the benefit outweighs the effort required. In other words, if the content that you’re asking your customers to invest energy in looking up isn’t both highly valuable and accessible with a minimum of effort, then they just aren’t going to go.

The only one who knows what’s valuable for you – is you!

The fact is that what’s valuable for one person may be totally irrelevant for another. That’s why the huge industry effort of pouring digital content into web “libraries” often ends up being, for the audience, both irrelevant and a poor investment of their time. Content has to be both relevant and easily accessible for the individual. And that doesn’t just mean putting it “out there” in a nicely designed website. That fact that there are lots of examples of precisely this, I believe, demonstrates that companies often update their technology without updating their thinking. They are still trying to do an old-fashioned “push” rather than a “pull” that technology now makes possible.

New channels might feel like pull communication because healthcare professionals can go and pull out the information, but it’s deceptive. Really it’s still a push, though a passive one. So if push is saying, “Here’s is what we want you to know,” then most channels are saying, “Over here is some information I want you to know.” True pull communication, by contrast, is about saying; “What do you need to know and how would you like it delivered?”

The rep as pull-channel tailor
The good news is that we already have the best pull agent we can imagine. And that’s our sales force. Empowered with pull marketing technology, our reps can not only personally connect healthcare professionals with new channels but also make them relevant to each individual. That means that each customer can now have his or her own tailor-made channel.

So rather than saying, “There’s a library over there with everything a healthcare professional needs to know on this topic,” we can now say, “Here’s the precise knowledge you’re seeking – presented in a way that’s just for you.”

Which would you choose?

Morten Hjelmsoe is founder of Agnitio. You can read his first post here.

To read the March cover story in the PharmExec digital edition, click here.

Epigenetics is the study of changes in human gene expression, in particular from environmental factors.  Pharma is also experiencing epigenetic change.  Human genes are formed from DNA, which are instructions much like a blueprint.  Similarly, the environment is changing pharmaceutical DNA and how brand marketing is instructed.

For example, pharma’s genetic dependence on traditional blueprints (and standard agency recipes), targeting revenue from new molecules in the pipeline, is no longer sufficient for survival.  The environment has limited the availability of new blockbuster brands.

Similarly, the environment is changing the DNA of our belief systems. Here I am speaking of the evidence for effectiveness of patient medication adherence interventions.  How is this changing the DNA of brand marketing?

For more than a decade, we have believed that medication non-adherence was the result of patient knowledge and capabilities.  This has driven marketing focused on “patient education”, “segmentation” to identify profiles of patients based on their “barriers” (or “deficits”) and “tailoring” to help customize needed changes in the foregoing.

We have assumed that patient knowledge, of their disease and treatment, and their health literacy capabilities, for example, are critical to patient adherence.

However, the evidence now tells us that our assumptions were wrong.  More than 100 published studies show no correlation between a patient’s level of knowledge of their disease and treatment, and medication adherence.  How many valid studies show a correlation?  None of which I am aware.  Studies have shown that patient knowledge can be increased, but no increase in medication adherence has resulted.

Similarly, recent systematic reviews show no evidence that health literacy is associated with medication adherence in adult or pediatric populations.  As one of these review papers summarizes:

“A critical element of successful self-management is medication adherence. On this front, the evidence has been mixed. Although patients with limited literacy have more trouble understanding primary and precautionary medication label instructions and are less likely to be able to report the name of their medication, there is no consistent finding of worse medication adherence among patients with limited literacy.”

In fact, there is evidence that patients with “adequate health literacy are more inclined to purposefully not adhere to their discharge instructions.”

Do health literacy interventions improve adherence?  A 2011 systematic review found no evidence.

What about the promotion of health literacy programs?  Again, a 2011 review reports:

“…current research on health promotion for participants with low health literacy provides insufficient information to conclude whether interventions for health literacy can attract the target population, achieve an effect that is sustainable, or be generalized outside of clinical settings.”

“Tailoring” messaging based on patient characteristics has been a proposed as a solution to patient barriers.  However, a 2012 review paper, on the efficacy of tailored interventions for self-management outcomes of type 2 diabetes, hypertension or heart disease, concluded:

“Tailored interventions had no impact on self-management activities such as medication adherence, self-monitoring, exercise, smoking, or diet control.”

So, there is no peer-reviewed evidence to support developing pharma marketing strategy or tactics based on these assumptions of patient deficits.  Money spent in interventions based on these beliefs will produce limited or no ROI, as industry cost-effectiveness evaluations show.

What does the evidence, both academic and industry, show improves medication adherence?  This will be part of what you will hear at the Keynote Panel Discussion at CBI’s Patient Adherence and Support Summit (PASS) on Monday, April 29^th in Philadelphia.  I look forward to seeing you there.

Grant Corbett is principal at Behavior Change Solutions, Inc. He can be reached at grant.corbett@behavior-change-solutions.com.

The line between physician marketing and consumer marketing has blurred as the facets of a brand campaign – from disease and drug-mechanism education to efficacy, safety and lifestyle claims – dovetail across the traditional physician-patient separation.

“We know that DTC advertising is often the catalyst for patients initiating conversations with their physicians about their untreated or undertreated conditions,” wrote Janet Woodcock, director of the Center for Drug Evaluation and Research, in an email on the changes. “The decision to restructure the divisions reflects our commitment to continue providing close oversight of DTC advertising.”

Before it got upgraded to a “Super Office” in 2011, OPDP was fondly (or sometimes not so fondly) called DDMAC (dee dee mac), which stood for the Division of Drug Marketing, Advertising and Communications. When DDMAC turned into OPDP, the office was split into two divisions: the Division of Consumer Drug Promotion, and the Division of Professional Drug Promotion. As OPDP, the steady stream of warning and untitled letters continued unabated, mostly chastising pharma marketers for misbranding, off-label, overstating the efficacy or minimizing the risks of a product, or the misuse of a color scheme, in one famous educational piece created for Novartis.

With today’s announcement, ODPD, pending final review, will rename its two primary divisions. They will now be called the Division of Advertising and Promotion Review I, and the Division of Advertising and Promotion Review II. Review of promotional materials will be separated and organized by therapeutic class, not by professional or consumer. “ODPP concluded that a structure that integrates the review of health care professional-directed and consumer directed promotion across the two divisions” would meet the stated goals of increasing efficiency, improving work distribution, and eliminating redundancy, wrote Woodcock.

“Our ODPD reviewers will continue to use a comprehensive surveillance, enforcement, and education program to foster superior communication of labeling and promotional information to both health care professionals and consumers,” she wrote.

Tom Abrams remains head of ODPD. For a list of the new review groups categorized by therapeutic area, click here.

If a patient or physician encounters pharma-created content that doesn’t pop with relevance or utility, it doesn’t matter how multitudinous the channels are that carry it. There is no patience online for bad content.

Pharma has the resources to create, or hire someone to create, great content. But the problem is that great content lies in the eye of the content beholder. Complicating matters further, that single set of eyes may find certain content relevant or useful in one channel on one day, but may have different needs or expectations in another channel, next week. Digital marketers hope the answer to the problem of effective mass personalization – a term that reads like an oxymoron – is big data and better analytical tools for parsing it. If enough data is compiled about a given patient, for example, it follows that sophisticated, real-time analytics will be able to predictably advise brand managers on precisely what information a patient needs at any stage of her journey, in whichever channel she prefers.

Needless to say, that level of sophistication hasn’t yet occurred in the healthcare industry. Speakers at the ePharma Summit in New York this week appear hopeful that it will happen soon, but many acknowledged the organizational changes that need to happen first.

Continuous questing for new data streams can be a quixotic endeavor, leading to “analysis paralysis,” said Nancy Phelan, VP, customer strategy and operations at Bristol-Myers Squibb. Internally, pharma needs to “think differently about the talent and skill set” needed on the commercial side, and organizations must liberate digital marketing from fixed events like budget cycles and calendar-based points of action (POAs). Companies should institute “real-time processes and decision-making” for digital marketing execution, said Phelan.

On a mobile health panel, Sharon DeBacco, senior director, customer communications and operations at Ironwood Pharmaceuticals (and formerly an AstraZeneca consumer marketing leader and brand director on Nexium and Crestor), said “mobile is a marketer’s dream,” but it’s stuck on the fringes of healthcare, in wellness and fitness apps on the one hand, and in sensors and devices for critical care on the other. Missing is the middle ground patient and his chronic condition. From a content management standpoint, mobile can be “challenging and confusing,” acknowledged Scott Wolf, EVP, sales, at Everyday Health. DeBacco said the challenge for mobile is how to combine the many transactional activities phones and tablets are typically used for, to develop first a greater understanding and then a unified program for consumers.

With regard to the future of professional promotion, “pharma needs to find its way back into doctors’ lives,” said Jordan Safirstein, an interventional cardiologist. “Taking a doctor out to eat and giving them journal articles is antiquated…it doesn’t work.” Sales reps are less effective today because “physicians have no say anymore in what drugs are on the formulary,” said Kecia Gaither, vice chairman, department of Ob/Gyn, director of maternal fetal medicine, at Brooklyn’s Brookdale University Hospital and Medical Center. “That decision comes from the chief financial officer,” and to a lesser extent, the head of pharmacy, she said.

Asked about what pharma can provide to physicians, Safirstein said embedding reference texts within EMRs is one opportunity. “The most common thing I see [in the hospital] is a resident walking down the hall, staring at a screen. Pharma must take advantage of this.” What about copay cards? “I’ve never heard a patient say, ‘Thank God you gave me that coupon card,’” said Safirstein, adding that the biggest innovation to the healthcare system in recent years was the launch of generic versions of Lipitor and Plavix.

Despite ongoing challenges in digital promotion on the consumer and professional side, 72% of the healthcare companies surveyed for a recent Best Practices report said they planned to increase their digital marketing budgets by more than 10% in the next two years. Even with additional resources, will pharma be able to craft relevant and useful messages for individual patients and physicians, and deliver them successfully? The best way to find out what questions a specific customer wants answered, right now, is to ask. The best way to meet that need is to provide an answer, fast. Whether big data, new technology and analytics can help pharma provide that kind of mass personalization – at an acceptable scale and in the context of strict regulatory controls – remains to be seen.