Gamification in Pharma: Creates Engaging Patient Experience For Better Results

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On January 03, 2019, media reports flashed – “A video game-based ‘digital medicine’ tool can help reduce symptoms in children with autism spectrum disorder (ASD) and attention/deficit-hyperactivity disorder (ADHD).” This study was published in the Journal of Autism and Developmental Disorders, confirming the feasibility and safety of the tool called Project: EVO, which delivers sensory and motor stimuli through an action video game experience.

This initiative reconfirms that technology is becoming a great enabler to provide integrated, comprehensive and cost effective approach in treating many diseases, particularly with ‘Digital Medicine.’ The above report on ‘Project EVO’ is an example of application of the concept of ‘gamification’ in digital medicine. Many consider ‘gamification’ as a game changer to create an engaging patient experience with added value. It makes patients getting involved in the disease-treatment process, especially for effective self-management of chronic disorders.

I shall focus on this area in today’s article, giving examples wherever available. However, let me start by recapitulating what is ‘gamification’ in the pharma industry.

Gamification: 

The Oxford dictionary defines ‘gamification’ as: ‘The application of typical elements of game playing (e.g. point scoring, competition with others, rules of play) to other areas of activity, typically as an online marketing technique to encourage engagement with a product or service.’ It further adds, ‘gamification is exciting because it promises to make the hard stuff in life fun.’

‘Gamification’ is assuming increasing importance, with disruptive digital innovations gradually becoming game changers in the pharma business. This is mainly because, it can deliver to a specific group of patients, doctors or other stakeholders exactly what they look for – with precision.

I suggested in my article, published in this blog on January 07, 2019 that pharma companies should facilitate self-management of chronicailments,not just for better outcomes, but also for improving the quality of patient engagement. To achieve this objective,‘gamification’ could play a remarkable role-such as disease awareness and prevention and when afflicted its desirable self-management. This has the potential to create a win-win situation between patients and a drug company.

This is so important, as ‘the old paradigm of the paternalistic model of medicine is now transforming into an equal level partnership between patients and professionals, aided and augmented by disruptive technologies. This comment was made in a study titled, ‘Digital health is a cultural transformation of traditional health care,’ published in mHealth on September 14, 2017.

‘Patient-doctor partnership is critical in the new paradigm:

One of the major ways to develop a partnership between the treating doctors along with the product/service providing pharma companies and patients is through mutually beneficial ‘patient engagement’ programs with added value.

That such programs can create a unique patient experience of better outcomes at a lesser cost, has already been established by a number of credible research studies. Taking a cue from quantum benefits that this initiative provides, many pharma companies are now making ‘patient engagement’ strategy as an integral part of their overall market access program, including the process of branding.

What does an effective patient engagement strategy involve?

An article titled, ‘Patient Engagement: A Key Element in Pharmaceutical Marketing Strategy,’ published in the IgeaHub on May 29, 2016 defines ‘patient engagement’ as a concept that combines a patient’s knowledge, skills, ability and willingness to manage his own health and care with interventions designed to increase activation and promote positive patient behaviors. This measure also involves offering relevant services to patients.

To assess the opportunity of patient services in the pharma industry, Accenture conducted a survey titled, ‘Pharma’s Growing Opportunity in Patient Services’, on 200+ pharma patient services executives, covering seven therapeutic areas – heart, lungs, brain, immune systems, bones, hormone/metabolism, and cancer. The study concluded,the future of patient services that requires patient engagement, is bright. It elaborated by saying, this approach offers pharmaceutical companies a tremendous opportunity – for those willing to invest in the right places and let patients know about them in the right way.

To move in this direction, ‘gamification’ is an efficient way for the pharma companies to follow. Let us see below how does ‘gamification’ work on the ground.

How does ‘gamification’ work?

According to the findings of Innovatemedtec, ‘gamification’ with health apps typically works in the following three ways:

  • Allowing users to share progress and results with their friends or other users of the service, creating a competitive spirit to elicit more or better use of the specific health app service.
  • Giving virtual gifts, such as badges, medals, stars during each stage of progress, generating a sense of achievement for greater patient motivation levels in disease monitoring and management.
  • Advanced medical health applications can provide real-time biofeedback with built-in sensors. Or using a storytelling approach and explaining health literature related to diagnoses, medical procedures and patient behavior.

Thus, the primary reasons for introducing ‘gamification’ in the pharma industry would be to improve the disease awareness and increasing patients’ motivation for self-management for mutual benefits.

Improves disease awareness and motivation for self-management:

The precise rationale for ‘gamification’ in the pharma industry was nicely articulated in the ‘M.Sc. Thesis titled, ‘Gamification in the Pharmaceutical Industry – Exploring how European Pharmaceutical Organizations can build and use Gamified Mobile Applications to Improve Relations with Patients.’ This was written by Nanna Birkedal and jointly delivered by the University of Stirling and Lund University.

It highlighted: “Patients and industry experts both argue that awareness is important; constant reminders about healthy habits are pivotal for an improved lifestyle. Patients furthermore need to be motivated to act upon this and actively implement the required lifestyle changes. If pharmaceutical organizations succeed in helping the patients with overcoming challenges related to their illness by motivating them to enact the needed lifestyle changes, it will increase the perceived trust towards their brand and thereby strengthen their relationship with the patients. This research argues that digital gamification is suited for this purpose, hence why it may be advantageous for organizations to incorporate digital gamification …”

Why and how to motivate patients for self-management of chronic disease?

As I said before, after proper diagnosis of a chronic ailment and charting out a medical treatment pathway, self-management of the disease by patients plays a critical role. Thus, the question arises, how to motivate patients and more importantly, keep patients motivated for engaging in self-management of such nature.

There is also a need for continuous improvement of the ‘gamification’ process for a long-term engagement of patients, leading to progressively better outcomes. Many examples of success with ‘gamification’ are available for chronic diseases, such as diabetes.

One of the metrics used in ‘gamification’ to help diabetic patients stick with a digital health platform, making it a higher priority in their daily lives, is to provide useful timely information on their disease condition. This metric may include informing the user about some tangible changes in their health risks due to the disease. For example: “Over the last month your effective glucose has reduced the risk of losing your eyesight by 10 percent.” Accordingly, the patients may earn points or badges for using the app and accomplishing certain important tasks.

In this way, gamification can immensely help self-management through behavioral changes, improving disease outcomes. As Healthcare in America also reiterates: ‘There is nothing more motivating than knowing your health is improving in real time.’

Another study, and two examples of ‘gamification’ in pharma:

Another study titled, ‘Gamification: Applications for Health Promotion And Health Information Technology Engagement’, published by ResearchGate arrived at an interesting conclusion. It reiterated: ‘Game-based approaches (gamification) can provide ideal strategies for health promotion, prevention, and self-management of chronic conditions. However, there is a need to clearly define components and uses of gamification in healthcare for increased patient engagement in health information technology.’

Elaborating the point further, the authors emphasized that many health/physical activity apps provide feedback in a clear and concise manner and in a variety of formats (e.g., graphs, text or icons). The available option to share the feedbacks on social networking sites allows for further engagement by individuals and adds additional motivation and encouragement in attaining users’ goals. However, it recommends more studies to explore and identify the suitability of ‘gamification’ for health in clinical settings.

There have been several instances of gamification efforts health care with powerful effects. Let me cite just two interesting illustrations from mobihealthnews, as follows:

Conclusion:

As available from various literature, such as Healthcare in America, there are enough well-verified testimony, indicating that patients are motivated by gamified elements.

Consequently, some major global pharmaceutical companies have started testing the water. For example, the Media Release of Roche dated June 30, 2017 announces, the company has acquired mySugr - an Austrian startup that offers gamified solutions for diabetes management in a fun way, both for children and adults. It, reportedly, has more than a million registered users in 52 countries and is available in 13 different languages. Post-acquisition, it will be an integral part of Roche’s new patient-centered digital health services in diabetes care.

Hence, ‘gamification’ in pharma carries potential to be a win-win strategy in creating engaging, motivating and a unique patient experience in self-management of chronic diseases, for better outcomes.

By: Tapan J. Ray    

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Pharma: Experts’ Handholding is Pivotal in Digital Marketing Transition Phase

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“Pilman – A Tapan Ray Website on Helathcare” completes 10 years, today. 

Inspired by some of my dear friends, I created this website on January 14, 2009. Since then, reasonably well-researched articles, penned by me, on various aspects of health care, and the pharma industry, appeared in this blog – on every Monday morning of every week – uninterrupted – not even once. It did not just happen, I took a vow to make it happen with the same zeal, consistency and frequency, in the first 10 years of its launch – come what may. 

During this period, I have been humbled by tens of thousands of my dear readers, from all over the world, who went through these articles –  spending their valuable time. Today, with all humility, I bow my head before each of my readers to make it happen. After Ten years – a time has now come for me to decide what next. Thank you so much, from the very core of my heart.

Talking about digital marketing in pharma is virtually a fad now. It sounds so modern, sleek and is a great attention getter, especially in the tradition bound pharma industry. Advertisements of umpteen number of training programs are spilling all over. Even those who never worked with digital marketing in pharma, or possess any basic theoretical knowledge in this technology, are jumping into the fray. Some trainers claim to impart subject knowledge in the pharma domain, while others assert facilitating quick implementation of digital marketing by pharma executives.

Thus, the question that follows, why is the sudden interest in digital marketing for pharma by such trainers? What is happening in reality after these trainings? Is one blind man trying to help another blind man in this area, or it is a competition for sheer eyeball grabbing? Some friends in the industry do say, the common thread of ‘imparting training’ of this nature on digital marketing – outside any pharma company, is possibly the intent of ‘making a quick buck, while the sun shines.’

To me, this sounds too blunt a statement, as I reckon, expression of such a view will be unfair to formally qualified digital experts with proven experience of success in the pharma domain. Some of them also offer handholding young marketing professionals, with reasonable accountability, as they gradually transition from the traditional pharma to an integrated digital marketing model. In this article, I shall focus on this area by affirming, while digital softwares, tools and their applications aren’t anything new in pharma, making an integrated digital marketing process work effectively, is indeed a new necessity in the industry.

Digital tools and applications aren’t new in pharma: 

As I said, digital tools and applications aren’t new in pharma. For example, many Indian companies have already implemented likes of ‘Enterprise resource planning (ERP)’. This is basically an integrated business process management software that enables the organization to run their business processes, including finance, accounting, supply chain, sales, manufacturing and human resources, in an integrated environment. Some companies have also introduced field-staff reporting in digital format and online. Nevertheless, digital marketing in pharma being a new necessity, let me elaborate below what is digital marketing, and what it is not.

What is digital marketing and what it is not:

As defined by The Financial Times Lexicon, digital marketing is:

  • Marketing of products or services using digital channels to reach consumers. The key objective is to promote brands through various forms of digital media.
  • Digital marketing extends beyond internet marketing to include channels that do not require the use of the internet. It includes mobile phones, social media marketing, display advertising, search engine marketing, and any other form of digital media. 

And what digital marketing is not:

  • Digital marketing is not just yet another channel for marketing It requires a new approach to marketing and a new understanding of customer behavior.  

Pharma’s transitioning to integrated digital marketing is critical:

There isn’t any doubt today that transitioning into an integrated digital marketing for pharma is critical.

The paper titled, ‘Time for Pharma to Dive into Digital – New Medicine for a New World,’ published by AT Kearney advises drug companies to act now or get left behind. The paper makes some interesting observations to drive home this point, some of which are as follows:

  • Digital is changing the way healthcare is delivered, as pharma customers transitioning fast into the digital world.
  • Effective customer engagement in cyberspace with digital tools will increase customer reach, lower costs, improve sales, and enable greater value creation.
  • Necessary technologies are readily available for digital customer management in a cost-effective way.
  • Regulation, while not fully resolved, is becoming clearer.
  • Reduced effectiveness of traditional promotional expenditure makes the transition to digital marketing both critical and timely.
  • Digital disruption has rejuvenated many businesses. It is time for pharma to do the same.

In reality, many traditional pharma companies are still apprehensive:

Digital marketing sounds great. There isn’t an iota of doubt, either, that this new ball game help achieve many business goals with precision, in the complexity of pharma sales and marketing. When conceptualized and implemented creatively with hands-on involvement of both digital and pharma domain experts, its benefits could be exponential, instead of being incremental. All strategic business communication can be accurately targeted and delivered to precise stakeholders for better, faster and quality engagement, yielding desired outcomes.

Nevertheless, the reality is, as I sense through my direct interaction with pharma friends, many of them are still apprehensive of imbibing an integrated digital marketing, going whole hog. They carry ‘a fear of failure’, if… the initiative doesn’t work, for various reasons. Moreover, any possibility that they may even lose what they currently have for such disruptive measures, makes them quite edgy, as well.

Is the apprehension totally unfounded?

As I fathom, the answer is no. They have a genuine reason to think so, because they carry the can and prefer to avoid any kind of possible risk in the performance of their respective business. They may not be totally happy with the traditional model with decline productivity. But are not also willing to make any unfamiliar drastic change by replacing the traditional marketing model by a cohesive digital one, spanning across the organization.

Nether, do they want to take any such decisions where the requirement of employee competency for success will call for a drastic overhaul, which is understandable. Be that as it may, their feelings and the associated views can’t be brushed aside, either, – as they have been at the helm of pharma business with envious track records, since long.

Precise process, timing and the end-goal of digital marketing needs clarity: 

Interestingly, they all understand and agree that the transition from traditional to digital pharma marketing is inevitable. But they are not very sure about when should this transition commence for the India pharma business. Also, what are the sequential steps for the organization to move in this direction with least risk and chaos.

Many of them are also not quite clear of the end-goal of this process, which I think should go beyond offering just good drugs with unique features and benefits, to creating a unique full-service patient experience, with cutting-edge and ethical sales and marketing practices.

When to commence and where to start?

The following two pertinent questions that often arise need to be deliberated before a digital marketing initiative is undertaken by a pharma company:

  • When does a company to commence digital marketing?
  • Where to start with minimal risk exposure?

When to commence it?

Now – is the obvious answer. This is because, as I wrote in my article of June 11, with increasing number of pharma stakeholders using and interacting in the digital space, ‘consumerism’ is fast becoming a strong prime mover, even in the pharma industry. In tandem, patients’ longing for better participative treatment experience, at affordable cost, is turning into a major disruptive force in the healthcare space.Pharma players in the country, require to be on the same page, soon, to deliver sustainable results, before it’s too late.

Where does the transition from traditional to digital marketing start?

The answer will depend on marketing practices followed in a particular company, which digital experts will study and come out with an organization-specific action plan. Whosoever is the initiator of the project, the company CEO should be the final decision maker, with his total involvement in the project, for multiple reasons.

However, in my view, for those who are risk averse, it will be prudent to demonstrate that important marketing strategy when executed on integrated digital platforms, pay handsome dividend. Thus, I reckon, instead of replacing all traditional practices with a totally new and harmonized digital model, in one go, it may be better to add new marketing activities on digital platforms – having the potential to add significant value to the business, for example:

  • Capture and analyze useful information from various sources and functions within the organization, as inputs for marketing strategy formulation, by using state of the art digital tools and analytics.
  • Select those areas of sales and marketing where switching over to digital mode will add speed to the operation and the decision-making process. In any case there should be a parallel run of the traditional process and the digital one, for a pre-fixed time frame, to tighten the loose knots, if any.
  • Trying out social media under expert guidance. When used in innovative ways, it helps immensely to actively engage with targeted stakeholders, including patients, for getting a positive digital ‘word of mouth,’ besides important feedbacks.
  • Using mobile-friendly, well-targeted emails or text messages with useful, well-researched content eliciting response, either as feedbacks on selected business activities or on any other area useful for the business operation.

When ready for digital transformation across all functions of the organization, the CEO should solicit help of well-qualified professional digital experts, preferably from within the organization. If adequate resources are not available internally, experts in digital technology with a proven track record of success may be engaged from outside, equipped with high-quality pharma domain knowledge.

Conclusion:

As I said, digital interventions are not new in pharma. However, a well-harmonized digital marketing is. There could be many starting points for the transition from traditional to digital marketing. However, I reckon, low-risk initiatives to this direction – having the potential to add significant value to the business, would be prudent to start with.

Thereafter, the new and robust digital marketing platform – well-coordinated with all functions, need to necessarily undergo parallel pilot runs. The objective is to resolve the glitches in the new digital system, if any, minimizing business risks. The awareness and the need of digital marketing should preferably generate and be felt from within the organization. The trigger factor may be many, including the professional digital experts recently recruited or the CEO himself, who will decide how to cascade it down the line for effective implementation.

The name of the game is making the concept of digital marketing work effectively in the marketplace – separating the men from the boys, in the midst of cut-throat competition within the pharma industry. To take this giant leap, mere lip-services of external general advisors won’t be enough, and may not work, at all. This process requires a new approach to drug marketing digitally, involving a thorough understanding of patients’ and other stakeholders’ behavior. More importantly, in the transition phase of its implementation, handholding by high quality professional digital experts, ably supported by pharma domain experts, is pivotal for success.

By: Tapan J. Ray   

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Pharma To Facilitate Self-Managing Chronic Diseases For Better Outcomes?

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“India’s burden of non-communicable disease (NCD) is escalating, but still the country does not have sufficiently detailed data on NCDs for research and policy purposes.” This was captured in a recent study, titled “India’s escalating burden of non-communicable diseases,” published in The Lancet Global Health on October 03, 2018. Thus, many experts are pondering, how to contain this menace and lower the disease burden of NCDs, in this situation. One of the ways to address this issue is exploring some unconventional ways.

As several studies have established, improving ‘self-management’ of chronic diseases by patients, after proper diagnosis and a treatment plan being in place, is one of the pillars to lower the disease burden. One such study is titled, ‘Patients’ knowledge of their chronic disease,’ appeared on June 2013 – Vol 42 (6) issue in the journal of afp – Australian Family Physician. The paper highlights that effective tools, policies and other measures to help self-management, would facilitate the process. These arecritical not just for better outcomes, but also to reduce the overall treatment cost.

In a similar context, another recent article, titled ‘Why Apps for Managing Chronic Disease Haven’t Been Widely Used, and How to Fix It,’ published in The Harvard Business Review (HBR) on April 04, 2018 made an interesting observation. The authors wondered: “In an era where nearly, every consumer good and service — from books and groceries to babysitting and shared rides — can be purchased through an electronic transaction on a mobile device, it seems reasonable to think that more and more of our health care can also be managed using apps on mobile devices.”

This article will dwell in this area, based on several interesting and credible research findings. Nevertheless, to give a proper perspective, I shall start with a brief outline on the incidence of chronic diseases in India.

Increasing incidence of chronic diseases in India:

There are several recent reports confirming the ascending trend of non-infectious chronic diseases in India, two of which are as follows:

The National Health profile 2018, published by the Ministry of Health also records that between 1990 and 2016 the disease burden due to:

  • Communicable, maternal, neonatal, and nutritional diseases, as measured using Disability-adjusted life years (DALYs), dropped from 61 per cent to 33 per cent.
  • Noncommunicable diseases increased from 30 per cent to 55 per cent.
  • The epidemiological transition varies widely among Indian states: 48 percent to 75 percent for non-communicable diseases, 14 percent to 43 percent related to infectious and associated diseases; and 9 percent to 14 percent associated with injuries.

Alongside, the above article of The Lancet Global Health also underscores the following takeaways from its comprehensive analyses of NCDs in the Indian situation:

  • The three leading causes of mortality—cardiovascular diseases, respiratory diseases, and diabetes.
  • In absolute terms, these three diseases together kill around 4 million Indians annually (as in 2016).
  • Most of these deaths are premature, occurring among Indians aged 30–70 years, representing some of the world’s largest health losses, with enormous policy ramifications.
  • India’s Ministry of Health and Family Welfare is making efforts to establish policies and intervention strategies for prevention and control NCDs. For example, the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke, launched in 2010, and the National Program for Health Care of Elderly, launched in 2010–11, the article noted.

As none of the measures taken so far could create an appreciable impact, India needs to come up with a major intervention to tackle this escalating health issue, the article concluded. In my view, optimal use of modern technology in the self-management of such virtually lifelong diseases, can be a great enabler for patients to bring down the disease treatment and management cost, significantly. Let me hasten to add again, the question of self-management comes only after a proper medical diagnosis and a prescribed treatment plan for the same being in place.

The key benefits of self-management and the unmet need:

The key benefits of effective self-management of chronic diseases are many. However, the following four clearly stands out:

  • Improves Patients’ quality of life significantly.
  • Arrests progression of the ailment – containing associated disease related complications.
  • Substantially reduces the interval and number of follow-up visits with doctors.
  • Thus, reduces the disease burden appreciably.

Curiously, most traditional pharma companies are yet to take any major step to address, at least, the above four critical areas. They don’t seem to go beyond the conventional methods of disease related advices. Whereas, the crucial need to fetch a behavioral change in patients for participative self-management of NCDs, keeps lingering.

A number of research studies have also confirmed that ‘mobile health applications are promising tools for improving outcomes in patients suffering from various chronic conditions.’ One of these studies titled, ‘Smartphone app in self-management of chronic low back pain: a randomized controlled trial’, was published in the November 27, 2018 issue of the European Spine Journal.

Sensing an unmet need in this area, besides a large number of brilliant tech startups, many large and pure technology companies, such as Apple and Google have already entered this fray.

 A recent example:

Let me cite a recent example to drive home the above point. On December 12, 2018, CNBC featured an article carrying the headline ‘Apple now has dozens of doctors on staff, showing it’s serious about health tech.’ Some of the key points of this article are as follows:

  • The number of doctors on staff is an indication that Apple is serious about helping customers manage diseases, and not just wellness or fitness.
  • Doctors can also help Apple guide the medical community on how to use Apple’s new health technologies and to deflect criticism and also to win approval among doctors who fear liability and are already overburdened by technology.
  • Many of these doctors are also still continuing to see patients. That might also give Apple an edge by emphasizing the patient experience.

This example demonstrates how detail are the plans of these tech companies for gaining a firm foothold in the healthcare space.

‘Effectiveness’ and ‘future scope’ of self-management of diseases:

The article titled, ‘Self-Management: A Comprehensive Approach to Management of Chronic Conditions,’ featured in the August 2014 edition of the American Journal of Public Health (AJPH) reiterated some important points. It established the relevance, future scope and effectiveness of self-management of chronic diseases, as follows:

  • As chronic conditions emerge as a major public health concern, self-management will continue to grow as a crucial approach to managing these conditions, preventing illness and promoting wellness.
  • Chronic disease conditions are generally slow in their progression and long in their duration. Thus, self-management can offer those living with these conditions, a means to maintain or even improve their capacity to live well, over the course of their lives.
  • Self-management intervention programs that address specific diseases are showing success across multiple chronic conditions.
  • These programs have particular value that represents an amalgamation of the goals of the patient, family, community, and the clinician with everyone working in partnership to best manage the individual’s illness while facilitating comprehensive care.
  • Self-management reaches beyond traditional illness management by incorporating the larger concept of prevention by emphasizing the notion that those who are chronically ill still have a need for preventive interventions to promote wellness and mitigate the further deterioration of health.
  • If one considers the nature of self-management in all its elements and practical characteristics, it is not only a logical approach to health and health care, but also an optimal way to address chronic conditions as a major issue in public health.

Inducing a behavioral change in chronic disorders with health apps:

For effective self-management of chronic diseases, there is a need to neutralize the negative influence of the individual’s behavioral traits. Research studies have also established that behavior-change-focused interventions play an important role in this effort.

However, not all patients take adequate care for such changes to take place. While the treating doctor may play an important role of a coach in this area, in reality, they usually don’t find enough time to spend on each patient with NCDs. The McKinsey & Company’s publication titled, ‘Changing patient behavior: the next frontier in health care value,’ also reiterates that to address the rising cost of chronic conditions, health systems must find effective ways to get people to adopt healthier behaviors.

As I mentioned before, this space has attracted active interest of many tech players in business expansion. More evidence-based health apps are being introduced to help drive patient-behavior change for effective self-management of chronic diseases. There are reported surveys on weight management aided by health apps, where ‘ninety-six percent of respondents agreed or strongly agreed that using a diet or nutrition app helped drive positive behavior change and healthy eating habits.’

In my article, titled ‘Prescription Digital Therapy Now A Reality,’ published in this blog on May 07, 2018, I mentioned that in September 2017, the first USFDA-cleared mobile app has been made available to patients. The app has both safety and efficacy label to help treat patients with ‘Substance Use Disorder’. Studies have established that it is two-times more effective than conventional in person therapy sessions.

More recently, in September 2018, Apple’s smart-watch version 4 included a US-FDA cleared electrocardiogram (ECG), officially classifying it as a medical device capable of alerting its user to abnormal heart rhythms. In the same context, US-FDA Commissioner Scott Gottlieb, M.D., said that digital advances, creating a new technological paradigm of health tools and health apps., are empowering consumers to take better informed decisions on their medical care and healthy living.

Conclusion:

It has been well-demonstrated by research studies that evidence-based health-apps for self-managing chronic diseases improve outcomes, remarkably. Consequently, this has triggered some critical activities by purely tech companies in the health care space, even in India. The primary driver being a strong consideration of this segment as an opportunity area to meet an unmet need, where most pharma players don’t seem to be doing enough, as on date.

Before it gets too late, there appears a need to take a serious note of this shifting paradigm. The awareness of which should then play a critical role in developing marketing strategies for brands used in NCDs. Otherwise, non-pharma tech companies will eventually dominate this segment, armed with a different genre of technological prowess that they possess.

The article titled, “Evidence-Based mHealth Chronic Disease Mobile App Intervention Design: Development of a Framework,” published inJan-Mar 2016 edition of the Journal of JPMIR Research Protocols, epitomizes it succinctly:

“Mobile health technology creates a shift in the paradigm of chronic disease management. It offers new possibilities to engage patients in self-management of their chronic diseases in ways that did not exist in the past. To maximize the potential of mHealth requires the integration of research and expertise from multiple disciplines including clinical, behavioral, data analytics, and technology to achieve patient engagement and health outcomes. This paradigm shift also triggers a need for new approaches to designing clinical and behavioral support for chronic disease management that can be implemented through existing health care services and programs.”

These developments send a strong signal for pharma to facilitate self-managing chronic diseases, soon enough, for better patient outcomes and, in tandem, creating a win-win situation for both.

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

 

 

‘Unbossing’ Pharma Culture For Millennials – A Sine Qua Non For Future Growth

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Wishing All My Readers A Very Happy, Healthy, Peaceful and Prosperous 2019

‘Unbossing’ an organizational culture is an interesting idea – more in the context of promoter driven Indian drug companies of all sizes and scale. The word – ‘unboss’ is associated with nonhierarchical and open leadership culture, aiming to achieve value-based higher goals, across the organization.Not many pharma companies are attempting to imbibe this culture, just yet, barring a very few.

‘The organizational culture is something that comes with the job’ – has been the general perception of all working for the company, including most CEOs, since long. Pharma industry being a more tradition bound, and hierarchic, such acceptance is more visible in drug companies. However, some industry majors have started challenging this status quo by asking: ‘Has our organizational culture, over a period of time, become too hierarchical and somewhat archaic? Are we still clinging on to the dated, and somewhat fossilized views and practices of the great predecessors, which were quite relevant in those days, but no longer now?’

In today’s changing scenario, the corporate culture of a pharma company should be able to unleash the full potential of its employees, who are an increasing number of vastly talented millennials, with generational differences in behavioral pattern.  They come with different values, mindset, expectations, aspirations, and feel comfortable working in a an ‘unbossy’ culture.

In this article, I shall explore how in the new millennium some pharma CEOs are going beyond mere tweaking, to usher in a substantive change in the sensitive area of organizational culture, keeping pace with time. This seemingly rare breed of head honchos clearly recognizes that developing a positive corporate or brand image, starts with the development of an enabling corporate culture.

Let me now start linking the organizational culture and business practices with brand or corporate image, through stakeholder loyalty, to corporate business excellence – all in the pharma context.

Intended corporate image starts from practices within the company: 

Instead of being always combative to prove how unreasonable are the stakeholder demands emanating from the complex business environment, drug companies need to accept some hard facts, and act accordingly. One such fact is – a positive corporate image or reputation based on an enabling corporate culture that is aligned with organization’s identity and good business practices, help earn stakeholder loyalty and enhance business performance.

This concept has passed the acid test in several research studies, over a period of time, e.g. the research paper on ‘Corporate Identity and Corporate Performance’, published in Scandinavian Journal of Business Research (Beta), (ISSN 1504-3134. Its findings may be summarized as: It is important for managers to understand that while building a strong reputation, the intended image projected by the company, needs to be consistent with the actual identity perceived inside the company, especially by the important internal stakeholder – the employees.

This is because, a positive corporate image reflects the way customers perceive a company’s product and service offerings to them and vice versa. This is not a recent phenomenon. It has been happening over decades. But only a few companies have taken it seriously to bring necessary changes within the organization, by remolding the organizational culture in sync with time. This point was also vindicated by the August 1998 article on ‘The Effect of Corporate Image in the Formation of Customer Loyalty’, published in the Journal of Service Research.

The findings of the above study from the goods and service sector are based on theory of consumer behavior, cognitive psychology, and social cognitive psychology. It clearly articulates that corporate image has a significant, but the indirect impact on customer loyalty. The authors claimed that customer loyalty is also driven by positive corporate image.

A positive corporate image originates from an enabling corporate culture:

That developing a positive corporate image or reputation starts with the development of an enabling corporate culture, is also corroborated by the above article featured in the Journal of Service Research. It highlights that a favorable corporate image is formed through a process of continuous updating without any behavioral time-lag within the organization.

Like many other industries, this holds good in the pharma sector, as well, to excel in business. Itis fundamental to ensure that the concerned pharma company always enjoys the confidence and loyalty of its internal customers – such as employees, along with the external customers that include employees, doctors, patients, Governments and the general public, among others.

This is equally important to make sure that the overall organizational culture does not get fossilized, at any period of time. It should always remain in conformance with the changing needs of time – new aspirations of the employees to unleash their full potential, for the best possible business outcomes through customer delight.

Some early indicators of an image problem:

In the pharma industry, some of the early signs of a company’s brand or corporate image problems get manifested by its indirect impact on customer/stakeholder or employee loyalty. The symptoms may encompass a whole gamut of areas, ranging from high employee turnover, through difficulty in getting brand prescription support from doctors and hospitals, into deteriorating relationship with the government, culminating to declining company share value with business growth stagnating or going south.

Positive or negative culture originates from the C-suites:

Many may be well-aware that both a positive or a negative corporate culture originates from the C-suites – mostly starting from the CEO office, including his direct reports, percolating down to even the first line managers, across various functions. A CEO should obviously carry the can and be held accountable, unless such incidences are aberrations or restricted in some functional areas. The reason being, an adverse company reputation or image, usually develops when the concerned CEO’s primary focus is on short-term results – not investing enough time on developing a positive and enabling organizational culture.

As the famous Warren Buffett once said:“It takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you’ll do things differently.” This is important for all consider, especially in pharma, and in today’s scenario.

In the Indian context, one recent example, could be the ruckus created, especially in the United States and Europe, on the dubious quality and pricing of generic drugs. A bit older example is – how once top ranked Indian pharma corporate Ranbaxy almost vanished in the thin air, over good manufacturing practices and drug quality standards.

What culture would the millennials want with pharma companies?

The December 10, 2018 report on the Best Company Culture for 2018 of Comparably - a workplace culture and compensation monitoring site, highlight some important parameters on what type of organizational culture the millennials appreciate and look for. To illustrate this point, let draw the following examples from the report:

  • Open and collaborative company culture, where everyone is updated on the latest and greatest things happening to the company as a whole, across functions.
  • Autonomy with willingness to help, from all.
  • Everyone is trusted to do their job, no micromanaging.
  • Anyone can ask questions and provide input that will genuinely be heard.
  • Hanging out with each other.

These are just a few examples to get a flavor of the change. It is also quite likely that many senior pharma managers may say: ‘Oh! We are already doing these and much more.’ It’s a different matter, though, that millennials of the same company may not be on the same page with these managers.

Unbossing pharma culture – the ball has started rolling:

At the Forbes Healthcare Summit 2018, held in New York City from November 28 -29, 2018, the global CEO of Novartis - Vas Narasimhan, called for a cultural shift to cater to the millennial generation’s needs, expectations and aspirations at the work place. He said: “The goal we set out to do is create an ‘unboss’ culture.” Half of Novartis current 120,000 employee strength being millennials. This move is directed to enhance the company’s appeal to them. A part of ‘unbossing’ the company culture in Novartis would be relaxing the current rules, by allowing employees to wear jeans to work.

Expanding the point while talking to Business Insider, Vas Narasimhan said: “For many people, they love the idea of the culture change, everybody then wants to know why can’t it happen right away. So, then you have to explain to people, this takes time, leadership, it takes a lot of changes in how we work. But I think there’s been a lot of acceptance of the culture change, but now the hard work has begun.” 

Some key traits of ‘unboss’ culture:

The article titled, ‘5 signs that you might be an ‘unboss,’ appeared in YOURSTORY on April 08, 2017 explains: The word ‘Boss’ originates from the Dutch word ‘Baas’, meaning ‘Master’. Where there is a master, there are slaves, and that’s not a good thing. More often than not, this word leaves a bad taste in the mouth, and rightly so. Thus, in a ‘unboss’ company culture, the topmost quality that the person in-charge, irrespective of organizational functions should possess, is being ‘unbossy’.

Some common leadership traits that define a ‘unboss’ culture, as I sense from the above article, are as follows:

  • Giving a great importance to sharing of knowledge.
  • Quickly identifying the ability in others and bring out the best in each team member.
  • Never feeling insecure and passing on credit where it’s due and not coveting praise that’s rightfully others.
  • Being flexible enough and possessing maturity to also do the legwork when required.
  • Treating everyone the same, without playing favorites, ever.
  • Creating an environment of learning and encouraging the team to experiment.
  • Setting benchmarks for each individual member to assess their own career growth.

In the pharma industry, not many leaders, I reckon, possess these qualities. Some drug companies, both local and global, may pontificate about practicing these qualities, but the majority of employees may not experience most of these in the real work situation.

Conclusion:

In most pharma companies, including India, much of the workforce, in addition to field staff, constitutes of millennials, which will continue to show an ascending trend. Thus, it is critical to align the company culture to attract and retain talents from the new generation A large number of companies still don’t consider this issue as a priority task for the corporation. The example set by the Novartis CEO, as quoted above is refreshing, in that sense.

Moreover, a number of research studies have established that organizational culture helps form the context within which corporate identity and corporate image are established. There can’t be a better time for a relook at the respective organizational culture, as the image of pharma industry has still not found its bottom.

A positive image, irrespective of whether it is a brand or a company, based on a robust organization culture, establishes a stout emotional connect with stakeholders. This is central for a long-term business success, and vice versa. It isn’t an easy task for any pharma player, especially for the promoter driven Indian companies of all sizes and scale, but not impossible, either.

Be that at it may, with the pharma business environment facing increasingly strong headwind, ‘unbossing’ pharma culture for millennials, I reckon, is sine qua non for long-term success – from the corporate perspective.

By: Tapan J. Ray    

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

‘Data-giri’: Critical For A Rewarding New Product Launch

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Success in new product launches is a fundamental requirement to excel in pharma business – regardless of whether the drug is innovative or a generic one. For a novel, innovative molecule, associated risks are much higher, as it carries a huge amount of associated R&D expenditure.

The launch plan for a generic formulation or even a ‘me-too’ patented variety, can broadly replicate the first in the class molecule. Whereas, for any breakthrough innovative medicine – it’s a whole new ball game. There are virtually no footsteps to follow. Nonetheless, there is one thing common in both – a robust launch plan is pivotal to success, across the board.

In this regard, the March 2014 article titled, ‘The secret of successful drug launches’, of McKinsey & Company captures an interesting scenario: “About two-thirds of drug launches don’t meet expectations. Improving that record requires pharmaceutical companies to recognize the world has changed and adjust their marketing accordingly.”

On the same issue, Bain & Company also drew a similar outline with its article titled, ‘How to Make Your Drug Launch a Success,’ published about three and half years later – on September 06, 2017. It reported: “Our research shows that nearly 50 percent of launches over the past eight years have under-performed analyst expectations, and more than 25 percent have failed to reach even 50 percent of external revenue forecasts.”

The bottom-line, therefore, is – even if the success rate of new product launches has marginally improved, for various reasons, there still isn’t much to write home about it. In this article, I shall deliberate what type of approaches, when used with powerful cerebral inputs, could possibly improve this rate – significantly and sooner. Could it be with ‘Data-giri’?

What is ‘Data-giri’?

A good question. ‘Data-giri’ is quite an unheard-of terminology, probably was first used by the Chairman of Reliance Industries – Mr. Mukesh D. Ambani, on September 02, 2016. This happened when he announced the forthcoming launch of his mobile network ‘Jio’. At that time, light-heartedly he said:”We Indians have come to appreciate and applaud ‘Gandhigiri’. Now, we can all do ‘Data- giri’, which is an opportunity for every Indian to do unlimited good things, with unlimited data.”

As is known to many, the word ‘Gandhigiri’ is generally used in India to express the power in the tenets of Gandhism. Similarly, the expression ‘Data-giri’ may symbolize the power that the effective use of the right kind and quality of ‘data’ could provide. Unleashing the potential of relevant and requisite data for value creation, would assume critical importance, even in drug launches, more than ever before.

‘Data-giri’ in drug launches:

Right kind and volume of relevant ‘Data’ is fast becoming an important marketing weaponry. Its variety and quality of usage in business, would ultimately differentiate between success and failure.

Today, data usage in pharma marketing can no longer be restricted to just retail and prescription audits, supported at times by a few custom-made marketing research initiatives. The data that I am talking about here, covers mostly real-life and ongoing data in many areas, such as customer behavior, their practices, thinking pattern, aspirations, together with associated changes in trend for each – captured right from the early stages. The cluster of customers includes doctors, patients, healthcare providers and all other stakeholders.

To unleash the hidden power of data for gaining a productive space for brands in customers’ mind, building an arsenal of data for engagement in pharma marketing warfare, is emerging as a new normal for pharma players.

Accordingly, the bedrock of any strategic plan is shifting from – key decisions based mostly on gut feelings, to all such decisions standing on pillars of a large pool of well-analyzed data. From a new product-launch perspective, the basic data requirements would encompass some critical areas, which need to be focused on. I would illustrate this point with a few examples, as below.

Basic data requirements for a new product launch:

One such example in the above area, comes from United BioSource LLC (UBC) – a leading provider of pharmaceutical support service. It highlights 4 real-time basic data insights as critical to a successful drug launch, which I summarize as follows:

  • What market share I want to achieve?
  • Where are my potential high-volume prescribers?
  • What are the characteristics of patients who will receive my drugs?
  • Which physician specialties would prescribe my drug – immediate, medium and long term?

Successful companies do three things right:

Another example on what successful companies do right comes from the above research report of Bain & Company. It found that companies with successful launches do the following three things right:

  • They differentiate their drug through messaging, post-launch data and services.
  • They create broad customer advocacy via a superior customer experience.
  • They organize their launch as a micro-battle and ensure continuous ‘frontline feedback’.

The paper included a few other factors as, comprehensive market research, key opinion leader advocacy and competitive resourcing. The authors observed that pharma executives grossly underestimate several key success ingredients, including customer advocacy and organizing each launch as a micro-battle, with a real-time dual-feedback mechanism involving all concerned, to facilitate prompt intervention whenever required.

From both the above examples, none can possibly refute that without a meticulously created ‘data arsenal’, these exercises are feasible, in any way, for a rewarding new product launch outcome.

Data is fundamental to create a Unique Customer Experience (UCE):

As I wrote in my previous article, the expertise in creating a Unique Customer Experience (UCE) or aUnique Patient Experience (UPE) for a brand, would eventually separate men from the boys in the game of gaining product ‘market share’. Crafty use of data is fundamental for moving towards this direction.

One of the crucial requirements for UCE or UPE is taking a significant share of mind of consumers. This is possible by designing data-based cutting-edge differential advantages of the brand over others. In pharma marketing battleground, this could be done either – with only tangible brand features, or mostly with intangible benefits and perceptions, or an astute mix of both.

Data – essential to measure deviation against the strategic plan:

During any new product launch-phase, it is essential to capture and accurately measure all actual deviations against plan, taking place on the ground at each pre-defined milestone. The exact reasons for each need to be ferreted – both below or above expectations, for immediate necessary actions. This is important, as various studies indicate that the performance trend of a new product in the first six months from its launch, is a good indicator of its future performance.

All types of customer engagements, including selection of communication channels and platforms, should be ongoing research data-based. I emphasized this point in my previous article, as well. It was reiterated that ‘omnichannel content strategy’ for improving patient engagement and providing UPE, across all touchpoints in the diagnosis and treatment process, should be created over the bedrock of high-quality data.

Time for a switch from SOV to SOC:

Creating greater ‘Share of Voice (SOV)’ for a new brand, especially during its launch phase, would no longer work in pharma. This approach is based on the key premise of ‘Jo dikhta hai wo bikta hai’. This often-used Hindi phrase when translated into simple English, may be expressed as: ‘That which is seen is sold.’

In the pharma context SOV may be explained, as I understand: The percentage of total sales promotion and marketing activities for a brand within the sum total of the same in the represented therapy area. It is usually determined by measuring some key parameters, such as frequency and reach of doctors-call, or customer-contact, or even its rank in ‘top of mind brand recall.’

Greater SOV can make marketeers believe that enough is being done by the company to benefit potential brand consumers, which would help reaping a rich harvest. It may also reflect how busy they are with the execution of all planned-activities. On the other hand, consumer-experience may not be quite in sync with the intent and belief of the marketeers. They may not find enough value in the conventional brand marketing process. This is likely to happen much more in the future, as most consumers will want to experience a unique feeling of being cared enough by the company, while moving through all the touch points of the treatment process.

This trend calls for a major shift in pharma marketeers’ approach – from creating a greater SOV to offering greater SOC (Share of Care). I highlighted the importance of providing ‘care’ through several of my articles in the past, published in this blog. One such is titled “Creating A ‘Virtuous Cycle’ Through Patient Reach and Care”, published on April 09, 2018.

Conclusion:

The critical switch from SOV to SOC involves imaginative application of complex data of high quality.

A well-thought-out plan to fetch out critical answers aiming to provide UCE or UPE, will involve in-depth analysis of voluminous data of high quality, through modern-day analytics. From this perspective, fast learning of the art of ‘Data-giri’ is becoming a critical requirement for new product launch success in pharma, as we move on.

By: Tapan J. Ray   

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Rewriting Pharma Strategy For ‘Doctor Google’ Era

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In search of more and more information on an ailment, a large number of Internet savvy individuals now feel comfortable to consult ‘Doctor Google’ – much before approaching a qualified medical professional for the same. If and when they visit one, many would possibly have arrived at a ‘symptoms-diagnosis correlation’ – based on their own interpretations of the sessions with ‘Doctor Google’– right or wrong.

‘Doctor Google’ – a ‘weird’ terminology, was virtually unheard of, until recently. This name owes its origin to universally popular ‘Google Search Engine.’ The number of frequent ‘consultations’ with ‘Doctor Google’ is breaking new records almost every day – primarily driven by deep penetration of smartphones – a versatile device that helps to charting unhindered, anywhere in the cyberspace.

In this article, I shall not go into whether this trend is good or bad. Nonetheless, the hard fact is, in the modern digital age, this trend is fast gaining popularity, across the world, including India. I shall discuss below, why and how the impact of ‘Doctor Google’ syndrome sends a strong signal to pharma companies to rewrite their business strategies for sustainable future growth.

‘Doctor Google’ syndrome:

To be on the same page with all my readers, ‘Doctor Google’ terminology is used for the process of getting various disease, treatment or medicine related information from cyberspace and especially through Google Search.This practice is currently being followed by many individuals who arenot qualified medical professionals, but through ‘Google Search’ often try to self-diagnose a disease or medical condition, or other health related issues. Some may even cross verify a professional doctor’s advice with ‘Doctor Google’.

Today, it is not uncommon to visit ‘Doctor Google’ first, instead of immediately visiting a General Practitioner (GP) for seeking professional advice. The areas of such search may range from trivial to even serious health conditions. The bottom-line therefore is, prompt ‘information seeking’ of all kinds, including health, and forming an opinion based on available information, is fast becoming a behavioral pattern within Internet canny and smartphone equipped population, across the world.

Medical Journals also reported this trend:

This trend has been captured in medical journals, as well. For example, a paper on Dr. Google in the Emergency Department (ED), published by the Medical Journal of Australia (MJA) on August 20, 2018 concluded as follows:

“Online health care information was frequently sought before presenting to an ED, especially by younger or e-health literate patients. Searching had a positive impact on the doctor-patient interaction and was unlikely to reduce adherence to treatment.”

Yet another study titled, ‘What Did You Google? Describing Online Health Information Search Patterns of ED patients and Their Relationship with Final Diagnoses’, published onJuly 14, 2017 in the ‘Western Journal of Emergency Medicine’, came with a thought-provoking conclusion. Reiterating that Internet has become an important source of health information for patients, this study observed, many of these online health searches may be more general or related to an already-diagnosed condition or planned treatment, as follows:

  • 35 percent of Americans reported looking online, specifically to determine what medical condition they may have;
  • 46 percent of those reported that the information they found online led them to think they needed medical attention;
  • The majority of patients used symptoms as the basis of their pre-ED presentation Internet search. When patients did search for specific diagnoses, only a minority searched for the diagnosis they eventually received.

Availability of credible online ‘symptom-checkers’:

To help patients getting credible information on many symptoms, there are several highly regarded online sources for the same, such as, a Symptom Checker provided by the Mayo Clinic of global repute.

The purpose of this tool is to help narrow search along a person’s information journey. This is not purported to be a self-diagnostic tool. A ‘symptom-checker’allows searchers to choose a variety of factors related to symptoms, helping to limit the potential medical conditions accordingly. This tool does not incorporate all personal, health and demographic factors related to the concerned person, which could allow a definitive cause or causes to be pinpointed. It also flags, the most reliable way to determine the cause of any symptom, and what to do, is to visit a competent health care provider.

Further, the research letter titled, ‘Comparison of Physician and Computer Diagnostic Accuracy’, published in the December 2016 issue of JAMA Internal Medicine, records additional important findings, as follows:

  • Physician diagnostic error is common and information technology may be part of the solution.
  • Given advancements in computer science, computers may be able to independently make accurate clinical diagnoses.
  • Researchers compared the diagnostic accuracy of physicians with computer algorithms called symptom-checkers and evaluated the diagnostic accuracy of 23 symptom-checkers using 45 clinical vignettes. These included the patient’s medical history and had no physical examination or test findings.
  • Across physicians, they were more likely to list the correct diagnosis first for high-acuity vignettes and for uncommon vignettes. In contrast, symptom checkers were more likely to list the correct diagnosis first for low-acuity vignettes and common vignettes.

Nonetheless, the above examples further reinforce the fact that patients now have access to robust online health-related data, on various aspects of a disease treatment process.

Technology is rapidly transforming healthcare:

That technology is rapidly transforming healthcare is vindicated by the estimate that the global market for digital health is expected to reach £43 billion by the end of 2018. This was noted in an article, titled ‘3 ways the healthcare industry is looking more like Google, Apple and Amazon’, published in Pharma IQ on November 16, 2018.

Pharma companies are realizing that an increasing number of patients now have better access to online information regarding their overall health and medical conditions, including various prevention and treatment options with costs for each. As people take a more active role in managing their health, pharma players, especially in their engagement with patients, require moving from mostly passive to active communication platforms. Consequently, personalizing health care products and services is expected to become the new norm, making the traditional pharma business models virtually redundant, the article highlights.

While going through this metamorphosis, pharma sector would willy-nilly emerge as an integrated technology-based industry. More tech-based changes will call for in various critical interfaces related to an organization’s ‘patient-orientation’, which is today more a lip-service than the ground reality. Entry of pure tech-based companies such as Google, Amazon and Apple into the healthcare space would hasten this process.Although such changes are taking place even in India, pharma companies in the country are yet to take it seriously.

Pioneering ‘omnichannel’ engagement is pivotal: 

Again, to be on the same page with all, the term Omnichannel in the pharma parlance may be used for a cross-channel content strategy for improving patient engagement and overall patient-experience. This should include all touchpoints in the diagnosis and treatment process of a disease. It is believed, the ‘companies that use ‘omnichannel’, contend that a customer values the ability to engage with a company through multiple avenues at the same time.’ Thus, pioneering ‘omnichannel’ engagement is critical for a pharma player in today’s scenario.

A valid question may come up – is ‘Omnichannel (all-channel)’ patient engagement is just another name of ‘Multichannel (many-channel)’ engagement? No – not really. Interestingly, both will be able to deliver targeted contents to patients through a number of interactive digital platforms, namely smartphone-based Apps, specially formatted websites, social media community and the likes. But the difference is, as a related paper lucidly puts it - ‘Omnichannel approach connects these channels, bridging technology-communication gaps that may exist in multichannel solutions.’

That said, just as the above-mentioned pure technology companies, pharma players also need to learn the art of gathering a large volume of credible data, analyze those through modern data analytics for taking strategic decisions. This is emerging as an essential success requirement, even in the health care arena.

Precise data-based answers to strategic questions, as planned, are to be used effectively for omnichannel personalized patient engagement. This is fundamental to offer a delightful personal experience to patients, encompassing diagnosis, treatment, recovery, including follow-up stages of an ailment, especially involving the chronic ones. Only well-qualified and adequately trained professionals with in-depth pharma domain knowledge can make it happen – consistently, across multiple channels, such as social media, Apps and devices – seamlessly.

Real time customer data management is critical:

Virtually real time customer data management of huge volume that aims to provide ‘Unique Patient Experience (UPQ)’,is the lifeblood of success in any ‘omnichannel’ engagement. This is criticalnot just for right content strategy formulation, but also to ensure effective interaction and utilization between all channels, as intended, besides assessing the quality of UPQ. Once the process is in place, the marketers get to know promptly and on an ongoing basis, about the quality patient experience – as they travel through various touchpoints, to intervene promptly whenever it calls for. I explained this point in my article titled ‘Holistic Disease Treatment Solution: Critical for Pharma Success’, featured in this blog on October 29, 2018.

Credible data are all important – not just any data:

Real time voluminous data generation, coupled with astute analysis and crafty usage   of the same, has immense potential to unlock doors of many opportunities. The effective leverage of which ensures excellence in business. But most important in this endeavor, it is of utmost importance to ensure that such data are of high quality – always. Similarly, use of any high-quality data, if not relevant to time, in any way or outdated, can be equally counterproductive.

An article titled, ‘Hitting Your Targets: A Check-up on Data’, published at PharmExec.com on August 02, 2018, aptly epitomizes it. It says, no matter what sophisticated technologies a life sciences organization uses, and how smart its sales and marketing strategy is, if there are flaws and gaps in foundational provider data, the company will end up with wasted resources and lost market share. Implementing ongoing data governance and stewardship programs will help improve efficiencies, allocate resources, and target customers with increased precision.

Conclusion:

Going back to where I started from, it’s a fact that many Internet-friendly people now visit ‘Doctor Google’, much before they visit a medical doctor. Most probably, they will also arrive at a list of possible diagnoses, according to their own assessment.

While going through this process, they acquire an experience, which may or may not be new or unique in nature – depending on various circumstances. But the key point is, such patients – the number of which is fast increasing, are no longer as naïve as before on information related to a host of ailments. Consequently, the ‘pharma-patient interaction’ that has traditionally been passive, and through the doctors, will require to be more active and even proactive. This has to happen covering all the touchpoints in an involved disease treatment process where pharma is directly or indirectly involved.

To be successful in this new paradigm, pharma companies need to ensure that such ‘active communication’ with patients is necessarily based on a large pool of constantly updated credible data, exchanged through ‘omnichannel’ interactive platforms. The key success factor that will matter most is providing ‘unique patient experience’ through this process and its high quality. From this perspective, I reckon, rewriting pharma business strategy is of prime importance in the fast unfolding ‘Doctor Google’ era.

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Access To Comprehensive Healthcare Merits Multipronged Approach

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Since the turn of the new millennium, several high profile and flagship health schemes are being announced in India by the Union successive governments. Some of the important ones will include the National Health Mission, Rashtriya Swasthya Bima Yojana (RSBY) - a Health Insurance Scheme for the Below Poverty Line families and now Ayushman Bharat – National Health Protection Mission - expected to cover over 100 million poor and vulnerable families providing coverage up to 500,000 rupees per family per year for hospitalization related to secondary and tertiary care.

Besides, the Mental Health Care Act 2017 has been operational since last year. It was passed by the Rajya Sabha in August 2016, and the Lok Sabha on March 2017. The right to mental health care is the core of the Act.

Each of these announcements look good on paper and was accompanied with lofty government promises. Riding on the waves of hypes thus created, public expectations increased commensurately for getting easy access to a comprehensive and affordable health care, which now includes ‘Mental Health’ as well. Unfortunately, the Gordian knot in Indian public healthcare space continued to exist. As various reports  indicate, for example, one that appeared on November 27, 2018, – even Ayushman Bharat is apparently moving towards the same detection driven by some critical basic issues.

Consequently, scores of people still do not have adequate and affordable access to basic health care, including essential drugs – clamping price control notwithstanding. The government knows it well, as it increases vigil on drug pricing. Pharma industry also feels its scorching heat. Overall storyline remains mostly unchanged. The vicious cycle continues.

In this article, I shall dwell on a system-approach to delivering comprehensive public health care. The key objective is trying to figure out what is the core problem that most of these schemes are either not addressing or doing it with a ‘band-aid’ approach. One of the key requirements for improving access to health care significantly, I reckon, is a clear understanding on the characterizations of the critical stages of healthcare access and their dimensions, from the patients’ perspective.

However, before doing so, let me glance upon some health care related current and important facts, as uploaded in the government’s National Health Profile 2018.  

National Health Profile 2018:

As available in the National Health Profile (NHP) of India – 2018, following are some of the important facts, which are worth noting:

  • In the current budget year, public (government) spending on health is just 1.3 per cent of the GDP against the global average for the same at 6 percent.
  • Just one doctor serves a population of 11,000 people, which is way below W.H.O recommended a doctor to population ratio of 1:1,000. The scenario is even worse in many states, such asBihar with 1: 28,391, Uttar Pradesh records 1:19,962, Jharkhand with 1:18,518, Madhya Pradesh shows 1:16,996 and Chhattisgarh at 1:15,916.
  • Per capita public expenditure by the government on health, stands at Rs 1,112 that comes to Rs 3 per day. This puts India below other low-income nations like the Maldives (9.4), Bhutan (2.5), Sri Lanka (1.6) and Nepal (1.1).

These numbers provide just a flavor of the Indian healthcare space, as it stands today. Some may of course talk about legacy factor, but to move ahead more important for all is what is happening today in this regard. Yes, one more health mission, as mentioned above, has been launched on September 25, 2018 with similar hype as the past ones, if not more. Only the future will tell us what changed it brings to the ground. That said, I am not very upbeat about it either, as providing a comprehensive health care access has always been multi-factorial and will remain so. Let me now dwell on why I am saying so.

Understanding health care access:

The 2013 research paper on “Improving Healthcare Access in India” by erstwhile IMS Consulting group (now IQVIA), said that ‘health care access characterizes 3 stages,’ which from the patient’s perspective has 4 key dimensions. In the Indian context, these three stages are:

  • Accessing care: Physical reach and location
  • Receiving care: Availability/capacity, Quality/functionality
  • Paying for care: Affordability

Accordingly, healthcare access is a function of 4 key aspects:

  • Physical reaches to health care facility
  • Availability of doctors and medicines in those places
  • Quality of care provided by these centers
  • Affordability of treatment, if available there

Access to healthcare is slowly improving, but far from being enough:

All the above schemes of the government are primarily focused on ‘paying for care’ stage and ‘affordability’ of treatment, including drugs. To a limited extent it makes sense as the above study vindicates that ‘availability’ and ‘affordability’ have good impact on ‘access to health care’.

Since the inception of NHM, this approach, no doubt, has made some improvement in the overall access to health care in the country, as many studies indicate. The IMS Consulting study also observes that compared to 2004, more patients received free medicines in outpatient care in 2013 – over 50 percent of patients going to Government hospitals say that they get free medicines there. However, the outcomes of the same across the Indian states vary quite a lot.

Inadequate healthcare infrastructure and physical reach in rural areas:

Having noted that, grossly inadequate availability of public health care infrastructure – or when available physical access to many of those from remote villages, coupled with lack of availability of required doctors, paramedics, nurses and medicines in those dispensaries – often become major issues. Moreover, their capacity to providing quality care, besides longer waiting time, often pushes many – either to remain virtually untreated or to go to private care centers costing much more.

The study finds that such movement of people from public to private facilities leads to higher health care costs. Consequently, high usage of private channels drives up the out of pocket (oop) cost of treatment. Some of the details are as follows:

  • 74 percent of patients sought private consultation
  • 85 percent of ‘oop’ spending on health care was in the private sector
  • 81percent of patients incurred ‘oop’ expenditure for medicines

Curiously, 35 percent of patients in the study rated public health facilities as – good. Whereas an overwhelming 81 percent said so for private facilities. Nevertheless, associated high ‘oop’ expenditure for the same often becomes an economic burden. The large number of patients with chronic ailments, are the major sufferers.

Application of mobile-health could help improve access:

On improving access to health care in India, an interesting ‘Review Article’ titled, “Applications of m-Health and e-Health in Public Health Sector: The Challenges and Opportunities”, appeared in the International Journal of Medicine and Public Health, April-June, 2018 issue, makes some thought-provoking observations.

It says, while the use of mobile phone (MPs) has become commonplace in many industry sectors, such as banking, railways, airlines – the public health sector has been somewhat slow in adopting MP technologies into routine operations. Its innovative use can benefit patients and providers alike by enhancing access to health care.Smartphones’ usefulness in the treatment of chronic diseases – for example, monitoring of blood pressure, blood sugar, body weight, electro- cardiograph (ECG), has already been established.

The paper also suggests, mobile health (m-H) is more effective when tailored to specific social, ethnic, demographic group using colloquial language. If implemented craftily and systematically, m-H can revolutionize the scenario of the health care delivery system, in many ways. Optimal doctor-patient engagement policy for m-H needs to be formulated, outlining a legal framework and with multi-stakeholder collaboration.

Mental health still largely ignored:

Another important aspect of comprehensive health care is ‘Mental Health’, as more than 60 million Indians suffer from mental disorders, suicides being one of the major killers in India (Source: W.H.O, IndiaSpend). However, it is disturbing to note that awareness and access to mental health treatment, especially in the hinterland of the country, continue to remain ignored. Increasing incidences of farmers’ suicides, for example, notwithstanding.

This was further elaborated by the IndiaSpend report of January 30, 2018, which underscored:“Allocation to the National Program for Mental Health has been stagnant for the past three years. At Rs 350 million, the program received 0.07 percent of India’s 2017-18 health budget.This is despite the fact that an estimated 10-20 million Indians (1-2% of the population) suffer from severe mental disorders such as schizophrenia and bipolar disorder, and nearly 50 million (5 percent of the population) – almost equal to the population of South Africa–suffer from common mental disorders such as depression and anxiety.”

The report further highlights that, notwithstanding 15 suicides every hour and 133,623 suicides in 2015, India is short of 66,200 psychiatrists and 269,750 psychiatric nurses. It is also noteworthy, while a frugal sum of 0.06 percent of India’s health budget is for mental health care, the same for even Bangladesh stands at 0.44 percent (Source: W.H.O, IndiaSpend).

Conclusion:

From the above perspective, I reckon, although access to health care in India, except ‘mental health care’, is improving at a modest pace, it doesn’t seem to be anywhere near adequate, as on date. A holistic approach for a comprehensive health care access to all, through the public health system, seems to be the need of the hour.

That said, currently India is not meeting the minimum W.H.O recommendations for healthcare workforce and also in bed density. A large section of the population continues to lack affordable access to quality health care. Moreover, the importance of mental health is still unknown to many in the country.

Thus, in tandem with addressing all the three stages and four key dimensions of comprehensive health care access, it is imperative to leverage new technology-based       e-healthcare and digital devices like m-Health. Together, these will help provide and facilitate not just quality care to patients, but also complement the healthcare infrastructure, including doctors and paramedics – making quality and affordable health care accessible to all.

As I said in my article, titled ‘Mental Health Problem: A Growing Concern in The Healthcare Space of India, the ‘Mental Health Care Bill’, which is now an Act, redefines mental illness to better understand various conditions that are persistent among the Indian population.This is a good development, as it aims at protecting the rights of persons with mental illness and promote access to mental health care. Since, the current ground reality in this area is a cause of great concern, when will it be effectively implemented for all, is the all-important question.

It is imperative for all concerned to understand that improving access to comprehensive health care is multi-factorial issue. Therefore, it needs nothing less than a well-thought out multi-pronged approach for an effective solution.

By: Tapan J. Ray    

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.

Protect Generic Drug Margin Moving Up The Value Chain

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As an innovative drug molecule goes off-patent, it paves the way for market-entry of cheaper generic equivalents of the same. It benefits not just the patients, but all generic drug players awaiting this opportunity. But, in case of even those generic drugs enjoying 180-day exclusivity in the United States, the price erosion would still be significant, at least, 20 percent to 30 percent. Post 180-day exclusivity, intense competition between different formulations of the same molecule can bring the price down by even 85 percent or more, as compared to the original one.

While looking at the world’s largest pharma market, one sees an interesting scenario unfolding in this area. The Generic Access and Savings Report in the United States 2018 released on July 10, 2018 by the Association for Accessible Medicines, captures it well. Some of the key findings of which on generic drugs are as follows:

  • In 2017, generic medicines account for nine out of every 10 prescriptions filled in the United States.
  • Patients fail to fill their prescriptions for brand-name drugs at a rate 2-3 times higher than for generics.
  • 93 percent of generic prescriptions are filled at $20 or less.
  • Average patient copay for a generic prescription is $6.06.
  • Generic medicines generated a total of $265 billion in savings.

That’s a good story for the patients in general, and specifically for those who are in the United States. That said, there is a business aspect of this story, as well. In this article, I shall focus on that, venturing into the way forward. However, before proceeding further, for the understanding of all, let me briefly explain, what is this 180-day exclusivity period as described by the FDA in the United States (USFDA).

180-day exclusivity period for generic drug:

USFDA may grant some exclusivity to Abbreviated New Drug Applications (ANDAs) for generic drugs. For this purpose, under the Drug Price Competition and Patent Term Restoration Act, or the Hatch-Waxman Act, a company can seek approval from the FDA to market a generic drug before the expiration of a patent relating to the brand name drug upon which the generic is based. The first company to submit an ANDA with the FDA has the exclusive right to market the generic drug for 180 days. This is called 180-day exclusivity and:

  • Provides an incentive of 180 days of market exclusivity to the “first” generic applicant who challenges a listed patent by filing a paragraph IV certification and running the risk of having to defend a patent infringement suit.
  • Begins either from the date the sponsor begins commercial marketing of the generic drug product, or from the date of a court decision finding the patent invalid, unenforceable or not infringed, whichever is first.
  • In some circumstances, an applicant who obtains 180-day exclusivity may be the sole marketer of a generic competitor to the innovator product for 180 days
  • FDA does not send letters to the sponsor indicating the grant of exclusivity. The Orange Book is the official vehicle for dissemination of this information.

It is worth noting that some drugs have both patent and exclusivity protections while others have just one or none. Patents and exclusivity may or may not run concurrently and may or may not encompass the same claims.

Increasing pressure on margin:

Nevertheless, after 180-day exclusivity period or as in most other cases, cut-throat price competition starts among product proliferation. On the other hand, even after patent expiry, the prices of original brand name drugs keep attracting a substantial premium. According to another study: “Brand-name drugs have been shown to be priced 20 percent higher than generic drugs in the Netherlands, 30 percent higher in Germany, 50 percent higher in Canada, 50–90 percent higher in the US, and 80 percent higher in the UK.”

In today’s environment, generic drugs are under severe cost pressure also because of direct government interventions in many large markets, such as the United States. A couple of other factors also play a major role in squeezing the generic drug margin in several countries, such as:

  • Large wholesalers while fighting with each other to get the pharmacy business, often exert tough pressure on generic manufacturers to lower the price.
  • Other bulk buyers also do the same making the margin wafer-thin.

Its cumulative impact leads to commoditization of generic drugs.

Commoditization of generic drugs:

As is known to many, for a commodity there are many suppliers mostly without any tangible differentiating features and benefits. The same thing happens to generic medicines of the same molecule without any worthwhile difference in efficacy, quality and safety standards. Thus, the price of a generic formulation generally includes its total cost, plus a margin, and depends market demand and supply for products outside any price control. Intense competition within many players with more supply of the same molecule, often squeezes the margin out to a dangerous level.

This scenario was well captured in an 2018 article published in the Journal of Bioequivalence & Bioavailability (volume 10(3): 48-49 (2018) –48). It reiterated, cutthroat competition and public pressure pose challenges for ethical and generic pharma companies. 7 to 10 percent annual price erosion, increased competition coupled with other pressure push margins lower leading to decreased profitability.

Major costs did not change much:

Moreover, the major fixed costs involving raw materials, packing materials, labor and conversion expenditure did not change commensurately. The manufacturing process and yield improvement measures did help. But up to a certain point and not beyond that, to keep the quality of finished formulations within the accepted regulatory requirements of the respective countries, such as the United States.

The trend prevails in 2018: 

The above trend prevails even in 2018, in continuation with the previous year. One may recall that in August 2017, due to serious price erosion, several billion dollars in market value were wiped out for some top generic companies. These names include India’s homegrown Dr. Reddy’s Lab., besides Teva and Mylan.

The article titled, ‘Opportunities and Obstacles for Generic Drugs,’ published in PharmTechalso emphasized: ‘Continued pressure on generic-drug prices may reduce product development and limit manufacturing in the US. Numerous state officials have filed lawsuits against generic-drug makers for alleged price-fixing, and debate continues over brand vs. generic product labeling to warn consumers about safety issues. All these trends will shape generic-drug production and costs in the coming months.’

In this situation, the ability of the generic companies to find ways to increase their margin will be the key to success in this business, if not for a long-term survival too.

Ways to achieve it:

One of the novel ways to achieve this goal is entry into ‘Complex Generics’ business.

According to Market Realist – an independent investment research organization, ‘Complex Generics’ are attractive due to high margins. Unlike, commoditized generic formulations, ‘complex generics’ are not easy to manufacture and are generally used in specialty care, namely for treating serious chronic diseases or several life-threatening ailments, such as cancer, HIV or hepatitis C. To some extent complex generics create a market entry barrier for many generic players, due to higher manufacturing cost and complex processes involved in developing this genre of drugs.Complex generics may be classified into several categories, such as:

  • Complex Active Ingredients: like, peptides
  • Complex Formulations: like, liposomes, iron colloids
  • Complex Delivery System: like, locally acting drugs
  • Complex Drug-Device Combinations: like respiratory metered dose inhalers, transdermal system or a medicated adhesive patch
  • Biosimilar drugs

On October 09, 2018, a statement from USFDA Commissioner Scott Gottlieb highlighted a new effort to advance the development of generic copies of complex drugs to improve patient access to medicines. Gottlieb said, complex generics “aredrugs that, by nature of their formulation or delivery systems for example, are harder to ‘genericize’ under our traditional approaches. As a result, these drugs often face less competition. Today, we’re announcing a series of guidance documents that will advance the development of generic transdermal and topical delivery systems (TDS).”

This is an interesting development in the world’s largest pharma market.

Lucrative prices of complex generics:

Prices of complex generics are much higher than conventional generic drugs. According to Market Realist a complex generic could cost around US$ 6,000 per month to patients, but would still remain way below the cost of related original brand. Hence, it is a win-win situation – both for patients and also the generic drug manufacturers. Additionally, alongside benefiting patients in terms of cost, complex generics show potential to fetch higher profitability with a reasonable product differentiation.

The ball has started rolling:

It happened in a big way this year, when due to intense price pressure on generics, Sandoz division of Novartis took a major step. On September 6, 2018 - Novartis announced that it has agreed to sell selected portions of its Sandoz US portfolio, specifically the Sandoz US dermatology business and generic US oral solid portfolio, to Aurobindo Pharma USA Inc. It also said, ‘this transaction supports the Sandoz strategy of focusing on complex-generics, value-added medicines and biosimilars to achieve sustainable and profitable growth in the US over the long-term.’

Indian generic drug manufacturers have also sniffed this opportunity. Several Indian players, such as Sun Pharma, Cipla, Lupin, Reliance Life Science, Dr. Reddy’s Laboratories, Glenmark, Biocon and Aurobindo Pharma, to name a few, have made forays into complex generics, including biosimilars. All put together Indian companies have filed around 50 ANDAs in the United States. This number is good, but may not guarantee success for all the applicants. Only the quality of these ANDAs will determine how soon, or how late, or how expensive would be the process of getting marketing approval for complex generics in the United States.

Conclusion:

As ‘The Lancet Oncology’ editorial of June 2015 noted: ‘In recent years, generics manufacturers have increased investment in the development of complex generics.” I reckon, this won’t include a large number of drug exporters from India – not just yet.

The development process of complex generics isn’t everybody’s cup of tea. Thus, venturing into this area by any generic player of all sizes and scale, would call for greater commitment from the company concerned. This path is arduous as compared to conventional generics. If not navigated properly, cost may also be high in certain circumstances. For example, if and when the regulator asks more elaborate trial, or repeat trials, or even the marketing approval process itself could be tough to conform with. That said, complex generics are expected to eventually contribute a significant percentage of the generic market, as their approval challenges are overcome.

Be that as it may, to improve, if not for protecting the profitability of the generic drug business, transacted especially in the developed world, there doesn’t seem to be much option left now, but to move up the value chain.

By: Tapan J. Ray

Disclaimer: The views/opinions expressed in this article are entirely my own, written in my individual and personal capacity. I do not represent any other person or organization for this opinion.