To meet patient’s need for speed, Pharma needs more lawyers

What kind of crazy talk is that? Everyone knows that it is the legal and regulatory teams and the whole review committee process that keeps Pharma moving at a lugubrious pace. Certainly that’s the biggest excuses I hear for why patient complaints languish in the blogosphere or why websites aren’t updated on a regular basis.

It can’t be the shear size of the pharma organization that slows decision-making. Larger companies have shown they can be nimble when it counts. Take Apple, the largest company in the US and how their rapid fire response to the Taylor Swift incident. It took Apple less than one day over a weekend to reverse a policy about paying royalties during the Apple music trial period. And Apple’s senior vice president of Internet Software and Services, Eddy Cue, communicated it simply with a tweet.

Moving faster requires real teamwork, the type of teamwork highlighted in Fortune magazine’s recent profiles of the small teams within big companies like Nike, Starbucks and J&J. And it is shared goals that fuel these integrated teams’ stellar performance.

In my opinion, Pharma’s sluggishness comes down to the antiquated brand team structure. Most teams are comprised of three marketing sub-teams (HCP/Patient/Payer) overseen by a legal/regulatory/medical review committee with an entirely different reporting structure. Operating in siloes, these different departments often have different, and often, conflicting goals. The legal and regulatory departments are charged with protecting the company and the brand marketers are charged with growing the business.

But what if the Pharma brand team was a fully integrated team—with marketing, legal and regulatory all aligned around improving patient outcomes?

More crazy talk! What if reviewing patient comments, whether online, over the phone and deciding how to respond, was a daily job shared by all? What if lawyers attended focus groups? How about the regulatory team member meeting with patients at an advocacy event? What if everyone was co-located? What if marketing/legal/regulatory acted as a unified SWAT team dedicated to listening, responding and creating new ways to improve patient health?

For the SWAT team concept to work legal and regulatory colleagues must function as full members of a brand team, not just as a panel of judges at weekly review committee meetings. That’s where the idea that Pharma needs more lawyers (and regulators) comes in to play. Moving faster means brand teams should include marketing, legal and regulatory expertise to make decisions on a daily, if not hourly basis.

With consumer expectations regarding company response time rising across all industries, speed needs to be the rule in Pharma rather than the exception. And contrary to expectations, moving faster requires ongoing, rather than foregoing legal and regulatory input. Simply put, Pharma needs more lawyers (and regulatory experts) to move at the speed of patients.

Tom Brady and Atul Gawande: Designing a Different End Game

Tom Brady and Atul Gawande, two Bostonians with wildly divergent careers, both take the same approach to designing a different end game; they flout the conventional wisdom to achieve their objectives. For marketers wanting to change the trajectory of their brand, company, industry or career, these two prominent Bostonians show the power of doing things differently.

Tom Brady, the New England Patriots quarterback, has always been vocal about wanting a different end game, one that would keep him playing high-level football in his 40’s. So according to a recent New York Times Magazine article, Tom defies conventional training practices designed at building strength in favor of those that create more pliable muscles. He credits his unique training practice with sparing him from career ending injuries, ultimately enabling him to win 4 Super Bowls (so far).

Atul Gawande, Boston surgeon and best selling author, challenges the more medicine is better medicine dogma that runs deep in our American cultural veins. Gawande addresses the literal “end game” in his best-selling book Being Mortal, to propose a radical new approach on appropriate care in our last years. Rather than doing everything possible to ensure maximum patient safety and longevity, Gawande contends that instead, a doctor’s role is to ensure that people leave this earth in a way that respects their values and priorities.

To do this, physicians and family members need to understand what constitutes quality of life from the patient’s point of view. In one example, Gawande tells of a daughter’s surprise at her father’s definition of quality of life as “being able to eat chocolate ice cream and watch football.” Her father had been a professor emeritus so she assumed he would not have wanted to live unless it was as a fully functioning intellectual. It was this knowledge that helped her make an entirely different choice for her father when faced with a life and death decision by her father’s surgeons.

I wasn’t so lucky with my father. The idea that more medicine, more effort, is not always appropriate was a totally foreign concept to me for most of his illness (and most of my life). So the poor guy cycled in and out of the hospital to rehab a number of times, getting weaker with every visit. By the time a palliative nurse friend of mine, helped me to see the light, it was too late. Having made the decision to bring him home after our post-dinner talk, I received a call the next morning that he had died in the Rehab institution.

While I can take comfort that my father seemed to enjoy all the attention he received at the Rehab facility, I often wonder if he would preferred a different ending. With my 88-year old mother, I have an opportunity not to make the same mistake.

The lessons of Gawande’s Being Mortal and Tom Brady’s historic Super Bowl victory transcend their individual career choices. Their work is testament to the truth of Einstein’s definition of insanity–doing something over and over again and expecting a different result. These two different men offer the same valuable lesson about the need to challenge the status quo to achieve a different result.

In the pharmaceutical industry where my company, extrovertic, does most of its work, there is a lot of organizational dogma about how to drive sales. It includes “HCPs write prescriptions, not patients,” or the time honored “the sales representative call is the best way to reach physicians.”

I know a lot of talented and progressive marketers who are confronting these doctrines on a daily basis. It’s hard work to be the one constantly going against the grain. But the experiences of Tom Brady and Atul Gawande are proof that a successful end game is worth the fight.

Patient Shopping in Our Lifetime?

This was the one of the final questions asked at a recent Elsevier conference where I was a speaker. The panel charged with answering this question was largely pessimistic. Panelists felt that the byzantine system of setting prices for both medical procedures and pharmaceuticals made it unlikely that consumers would ever get the cost data required for effective shopping behavior. They couldn’t imagine that anyone in the industry would step up to the challenge of making prices more transparent.

There is certainly reason for their negative outlook. For example, a recent study by Verilogue and Duke Medical Center found that when oncologists discussed  breast cancer treatment options with patients, costs were only discussed in 20% of the cases. If patients can’t get information on the costs and outcomes of various medical and drug treatments, then they can’t make the appropriate trade-offs.

In my opinion, the Elsevier panel was right and wrong.

Right because strides towards increased pricing transparency won’t come from within the industry. But wrong because change will be instigated from outside the industry—by government, non-profit organizations and entrepreneurs unencumbered by the war wounds of fighting vested health care interests.

Here are a couple of examples that provide me with hope:

  • On the non-profit side, there is the Minnesota Community Measure Up coalition. They created the Minnesota D5 program, which provides effectiveness scores for treating diabetes by individual clinics/HCP offices.
  • Newer health care services like Counsyl, a genetic testing company, have actually built cost transparency into their business model. Counsyl has developed a proprietary tool that allows patients to calculate their exact costs once their particular insurance policy is factored in before they sign up for the service.
  • Iodine, a newcomer in the cost and rating business for drugs, has developed a very easy interface to help consumers start evaluating the cost/quality trade-offs for different medications.

Information will drive true shopper behavior.  Contrary to popular belief, patients can make educated choices. Patients don’t reflexively opt for latest and the greatest medical solution. As reported in the New York Times, a recent study in the Annals of Surgery, found that parents actually made the cost effective choice regarding appendectomies for their children.

When parents were told that both conventional and laparoscopic surgery yielded the same results, but that conventional surgery was far less expensive, two-thirds of parents chose the less expensive conventional surgery. 31% said that the information they received was the primary driver in their decision and 90% liked having a choice.

Pharma companies are going to have to learn how to market to health care shoppers rather than patients. This means that not only will pharmaceutical companies have to include cost in their outcomes studies with payers, they will also have to convince health care shoppers that their drugs represent a good value for the money.

And much like restaurants and hotels, Pharma companies will have to regularly monitor the various patient quality and cost rating systems to make sure their medications are fairly portrayed. A bad rating will have a direct impact on revenues, as consumers fail to start or stop using a medication, based on a rating they saw.

Pharma companies will need to include these products ratings from patient sites in their analyses of sales results. I predict that these analyses will show a direct correlation between consumer ratings and revenue. And when that happens, it will be the dawn of the era of the true health care shopper!

Follow the Money to Patient Engagement

4 Reasons why Pharma will finally become patient-centric

Pharma Financial Stars Lie with Patient-Centricity

Pharmaceutical marketers have been talking about Empowered Patients ever since I joined Pfizer Pharmaceuticals in the mid-90’s as one of their first consumer marketing hires. But despite all the talk, most pharmaceutical companies are nowhere near being patient-focused.

Pharma marketers know things are changing but are holding onto the HCP-focused status quo for as long as possible. In fact, I was recently asked by a Pharma Exec charged with driving patient engagement, “When do we really have to get serious about patients?” They felt that their primary customer was still the physician.

But ever the optimist, I believe that the next 2-5 years will represent a seismic shift in pharmaceutical marketing. Away from a singular focus on the physician towards a more patient-centric way of being. And that’s because patient-centricity is increasingly critical to a pharmaceutical company’s growth and financial health. As Watergate’s Deep Throat said, “Follow the Money.”

To my mind, there are four market trends that are helping to realign Pharma’s financial stars towards patient-centricity:

1. The Dawn of Health Care Shoppers-Historically, consumers exhibited very little true shopping behavior, even as they became increasingly responsible for their health care costs. This lack of true shopping behavior was largely because consumers had little visibility into costs and quality data and therefore couldn’t make the necessary trade-offs.

But that is changing.

Health care reform, combined with private sector efforts, are increasing transparency around both costs and quality, allowing consumers to start making trade-offs with their health care expenditures, including medications. Patients will move from merely asking a physician for a particular drug they saw advertised on television to making a highly considered decision to pay for drug A or drug B.

With this true decision-making, patients will be able to move markets. As this market moving ability starts to show up in pharma company regression analyses, Pharma companies will be stumbling over each other to be the most patient-centric.

2. The shifting economics of their customers-HCPs, Hospitals and Integrated Delivery Systems won’t be rewarded on the quantity of services they deliver anymore, but rather on the quality of those services and the patient experience. The smart pharmaceutical companies are going to look for ways to help their customers deliver better patient outcomes and experiences. And that is going to require additional investment to prove their patient interventions actually deliver.

3. The exploding orphan drug opportunity-Specialty and orphan drugs now represent the path to financial growth for many Pharma companies. And along with the orphan drug opportunity comes the empowered patient. These patients play a significant role in which drugs get into clinical trials, get approved by the FDA and reimbursed by insurers. If a company is in the Orphan Drug space, then by default they have to be patient centric. I predict that this “patient centricity” will eventually work its way into larger, primary care marketing practices.

4. Patient Reported Outcomes (PROs) in clinical trials will increasingly become commercial differentiators-In many categories, pharmaceutical researchers have already captured patient-reported outcomes, particularly on quality of life. However, these metrics have had little true commercial value since the FDA has been leery of approving claims based on patient reported outcomes. I believe that the FDA’s new focus on patient centricity, as witnessed by their “Patient Focused Drug Development” initiative may signal a growing acceptance of PRO claims. And as PROs become more important to the commercial success of a medication, so will the patients.

It is this alignment of Pharma’s financial stars around patient-centricity, that makes me believe that pharmaceutical companies will finally begin to truly embrace the empowered patient. Just follow the money. It never lies.

Bad Mom, Wonderful Woman: A Tale of One Health Plan

Improved patient experience. As a health care marketing professional, I see the topic everywhere. As a patient, though, it is often nowhere to be found. Here’s my Tale of One Health Plan. One day, one health system, two appointments, two dramatically different patient experiences. In one visit I was a “A Bad Mom,” in the other, “A Wonderful Woman.”

Bad Mom, Wonderful Woman

 

 

 

 

 

 

 

 

 

 

First the “Bad Mom.” At a Children’s Center” in an affluent hospital, my 15-year old daughter and I entered what looked like beige food court in a mall, little booths for each pediatric specialty ringing the room. Threatening signs dotted the walls cautioning against letting your children bounce on the furniture.

I approached a booth with a simple question. “What time was my appointment?” I had made the appointment for 3 pm but had received a confirmation call for 2:45. Asking one of the Booth Ladies, I was told, “I don’t know when your appointment is for, just sit and wait for the doctor.” This patient experience told me that the hospital’s time was more important than my own and that I could not be trusted to come to an appointment on time.

At 2:43, after eventually learning my appointment was for 3 pm, I decided to dash to the hospital coffee shop on the floor below. When I came back at 2:55, my teenage daughter was nowhere to be seen. Going back to the Booth to ask about my daugther’s whereabouts, the original Booth Lady didn’t even look at me, but told her companion Booth Lady, “I told the mother to wait for the doctor. This patient experience told me I wasn’t a person, but an individual filling a role, and doing it badly at that. Bad Mom, Bad!

Contrast this to my mammography later that day. Not only was I greeted by a friendly woman, I was given thorough instructions reinforced on a patient handout. I was then whisked away into a spa-like changing room, complete with honey colored wood lockers, thick terry robes and ethereal Spa music playing in the background. To top it all off, I got a bracelet commemorating breast health awareness month when I left. I was a “Wonderful Woman.”

Yes, this was the same health system. But no one had bothered to think through how an individual person might experience it’s different parts in her different roles: parent, patient and parental caregiver. I know a unified patient experience is possible.I increasingly use another health system in my area, the Summit Medical Group. The receptionists are uniformly friendly, even when you as the patient screw up. For example, one of the receptionists noticed I missed an appointment in another department and made a call to have them squeeze me in so I wouldn’t have to come back again. That patient experience told me I was an important individual whose time was valuable.

Now the medical care I receive in both systems is excellent. But if I needed a new doctor, I would go to Summit Medical Group. And I am not alone in judging a system by it’s support personnel. According to PwC Health Research Institute, 60% of consumers said staff attitudes are a key factor in evaluating their provider experience. The lesson here is to make sure the patient experience is understood and designed from the patient’s perspective. And that starts from the moment the patient picks up the phone to schedule an appointment.

Chief Customer Officers: Fancy new title or path to meaningful change?

Now that health reform seems here to stay, pharma companies are racing to get on the customer focus bandwagon with new Chief Customer Officer (CCO) positions. The most recent example is Sanofi’s new Chief Patient Officer position, which is promoted as  “a First for a Top 10 Biopharmaceutical Company.” This announcement follows Intarcia’s creation of a Chief Customer Experience and Outcomes officer, publicized as “an officer level position for which there is no precedent or analogue in the Bio-Pharma industry.”  Companies are stumbling over each other to be seen as the most customer focused pharmaceutical company.

Image by Bill McChesney

What remains to be seen is whether these CCO positions actually alter the practice of pharmaceutical marketing. How many times in the past have pharmaceutical companies announced progressive new initiatives only to have the ideas wither on the vine from lack of resources and insufficient political clout? Think of the multicultural marketing plans gathering dust in bookcases all across Pharmaland.

It will be interesting to follow Sanofi and Intarcia as the two companies embark upon their customer centric journey. While both companies operate in the diabetes space, they couldn’t be more different. Intarcia is an emerging biopharma company with a novel diabetes treatment/technology in Phase III. Sanofi is a pharmaceutical giant with a full portfolio of diabetes medications and devices.

Business history would suggest that Sanofi has the steeper climb to meaningful transformation. Corporate culture has proven to be an innovation killer across industries. Take for example, the News industry. Online journalism has flourished in independent start-ups but proved to be an uphill battle in established organizations like the New York Times and Washington Post. According to former Washington Post journalist, Ezra Klein, the reason is in part due to an entrenched “culture of journalism,” centered around the print product (see recent New York Times article Vox Takes Melding of Journalism and Technology to a New Level ).

Similarly, pharmaceutical companies have deeply rooted cultures in direct sales to physicians. This direct sales culture explains why “non-personal promotion” took so long to take hold despite the explosion of no-see doctors. Much like the newer media companies who designed their news organizations around the Internet, new pharmaceutical companies like Intarcia have the opportunity to build an organization from the ground up around a patient focus.

But even emerging companies need to be vigilant against importing internally focused sales cultures into their organization. Witness Vertex pharmaceuticals. Despite an early focus on developing an innovative commercial model, the traditional sales force culture managed to marginalize many of the newer, patient focused initiatives. The Antidote by Barry Werth, which chronicles the Vertex INCIVEK launch, is a good read about stymied efforts to create a new kind of pharmaceutical company.

As large pharmaceutical companies go, Sanofi has embraced change, altering how it organizes its R&D (see extrovertic blog post “Four Lessons in Change from Inside the R&D Organization), rapidly adjusting the pricing of its medications in the face of market outrage and its adventurous approach to social media. So I wouldn’t count them out in the race to be the most patient/customer focused diabetes company. What remains to be seen is if the practice of either company changes enough to make a meaningful difference in patient lives, at a reasonable cost.

Thanks for letting us share!

Dorothy