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While Pharma Leadership Change This Atypical Skill Counts

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Effective September 01, 2019, the global pharma major Sanofi will have a new CEO, as the present CEO retires attaining his retirement age of 65 years. This appears to be a mandatory announcement from the company, as is required during the top leadership change in any large and listed organization.

However, there is something novel, as well, in this announcement, especially when specific qualities, skills and experience of the new CEO were highlighted by the company’s Board of Directors. According to Sanofi Press Release, the new CEO – Paul Hudson “has proven his strategic vision, his strong leadership and his ability to achieve the greatest challenges, particularly in terms of innovation and digital transformation.”

Among the stated experience and skills, the one that appeared atypical to me, is the experience of digital transformation, particularly in the position of the CEO of a global pharma major. I In this article, I shall, therefore, explore, why knowledge and experience in this atypical skill is gradually becoming critically important for pharma leadership positions, at all levels.

Why is the need for digital transformation of pharma business?

According to the Internet Trends Report 2019 by Mary Meeker, at 3.8 billion internet users, more than half the world’s population is now online and it is growing. This number would obviously include patients.

As we know, the core purpose of pharma business is to offer a unique patient experience during any disease treatment process. And, the expectations of which from Internet-savvy individuals will be significantly more for various related reasons.

To achieve this objective, drug players would always require to be in sync with customers’ perceptions, expectations and aspirations, among others. Moreover, it’s also not ‘one size fits all’ type of a solution. These will significantly vary for different patient groups, so are the processes of engagement with them – based virtually on real-time information.

Interestingly, the core purpose of digital transformation is also to facilitate this process, with a great amount of precision. The entire process of creating a unique patient experience, involves generation of a massive amount of customized data, customize analysis of which is done through sophisticated analytics, and thereafter, translating and using them as key strategic business inputs, on an ongoing basis. Traditional organizational methods, systems and processes are incapable to deliver the same. Hence arises the crucial need of digital transformation of the organization, across the board.

The transformation is not just about software, hardware and data: 

That said, it is also essential to realize that digital transformation is not just about software, high-tech hardware, mobile apps and sophisticated wearables and data. These are, of course, some of the vital tools – used while transforming a company into battle readiness to create and provide a unique customer experience.

Such unique experience for each customer should cover all touchpoints, spanning across – before, during and after treatment with the company’s medication. This, in turn, helps generate an increasing number of prescriptions from doctors, which otherwise would not have been possible, following the conventional means.

Why this atypical skill is in demand today?

Like any other transformation process within an organization, digital transformation should necessarily be driven by the company CEO, having adequate experience in this area. Even the Board of Directors of many pharma players believes that such a CEO can facilitate the process faster and more effectively. Hence, the demand for this atypical skill is increasing, also for a pharma CEO position, besides leaders in various functional areas, as it is being considered as pivotal to achieve the core purpose of a pharma business, in the digital world.

Thus, if a CEO doesn’t properly understand, how the digital world operates with increasing number of visitors in the cyberspace and convinced about its relevance for business excellence, the organization would ultimately lose its competitive edge. One may, therefore, question, did the need for this atypical skill also arise during the selection of the new CEO of Sanofi?

Is this atypical skill for a new CEO more important now?

The answer, I reckon, could be both, ‘probably yes’ and also ‘no’.

‘Probably yes’, mostly because, being an uncommon skill for a pharma CEO, so far, it arrested the attention of many while reading ‘Sanofi Press Release’, for the appointment of their new CEO. Nevertheless, Sanofi is not the first pharma company placing so much of importance on digital transformation, especially for the key leadership positions. In an interview with the Wall Street Journal (WSJ) of February 18, 2018, the CEO of Novartis said: “We need to become a focused medicines company that’s powered by data science and digital technologies.”

Why it is so important for a pharma CEO?

The AT Kearney paper titled, “New Medicine for a New World – Time for Pharma to Dive into Digital,” also captured that an increasing number of pharma customers are now getting engaged and have started interacting in the digital space, more than ever before. This trend is fast going north – becoming an ‘in-thing’ of the industry, as it were. But more probably to be seen as trendy or display that they are also in it, by ‘dipping a toe in the digital waters.’ Whereas, ‘it’s time to take the plunge,’ as the paper cautions them.

‘Plunging into the digital water,’ doesn’t mean sending people to some external training program – with the word ‘digital’ prominently featuring as the course objective. It means bringing out ‘digital transformation’ of the entire organization, spearheaded by the CEO. The leadership of each functional area would then implement from the same playbook, with a structured and custom-made plan designed specifically to achieve the vision, mission, goals and values of the company.

We have recent examples of, at least, two top global pharma majors taking a plunge in the digital water to make the digital transformation of the organization a reality. The key purpose of the same, is to create a unique customer experience, being on the same page with them, in more effective ways, for business excellence. To move in this direction, the organization must imbibe the non-negotiable principle – ‘digital first,’ across the organization.

Only the CEO can decide ‘digital first’ as guiding organizational principle:

None other than the CEO of a drug company, can decide that ‘digital first’ will be the guiding principle of the company, across all the functional areas of the business. As the above paper articulates, it ‘should be explicitly incorporated into core business processes.’ It further says: ‘Top management must challenge any parts of the business that have not explicitly considered the opportunities from digital in their plans.’

Functional leaders to be in sync with digital transformation: 

All in the pharma organization, across all functions, must work for the end consumer of any pharma business – the patients. Every single employee in the company should strive delighting them with the company’s products and services, at every touchpoints, during their quest for relief from illnesses. As I said before, this is the single most important factor that determines not just the pace of growth of a drug company, but help enhance its reputation, too. It goes without saying, its ultimately the patients who are playing a catalytic role in the digital transformation of an organization.

It is essential for the CEO to make sure that entire corporate, functional and even departmental leadership teams are in tune with the need of digital transformation of the organization. Despite the detail explanation, if some remain unconvinced about the rationale behind the transformation of the core business process, the right leader should assume the responsibility.

This is because, even with one loose knot at the leadership level in this area, the entire objective can seriously get thwarted – down the line. Such changes, as, if and when required, can be achieved in various different ways, not through attrition alone. For example, by encouraging them to work with members of his peer group who can set good examples to emulate.

Brand promotion to physicians will still remain as important:

In tandem, no company should lose sight of the fact that their face-to-face interaction with physicians, will continue to play an important role in brand promotion. Primarily because, doctors and hospitals help patients to get desired solace from ill-health by prescribing recommended medicines, and consequently, will keep prevailing as an integral part of the pharma marketing process, supported directly or indirectly by every employee in the company.

The key challenge in digital transformation:

The key challenge in the digital transformation of a pharma company is broadly possible inflexible or a rigid mindset of some of its leaders. This is generally fueled by the fear of moving out of their respective comfort zones – rather than resources and expertise required to make the technology put to use. A well-running-business with a grand idea for the future, will generally be able to garner necessary resources and other wherewithal, without much problem.

All pharma leaders should always consider themselves as an important solution for the future success of the organization, Otherwise, he or she may be construed as a part of the problem and a hindrance in achieving the corporate goal and should make way for the capable ones, in this area. Hence, selecting leaders with the right spirit to make digital transformation effective, is so critical for the CEO.

To commence this journey, the leaders may either be willing to acquire the experience of a disruptive digital transformation, guided by the domain experts or may be recruited from outside having the necessary experience. Collective and well-coordinated steps towards this transformation can neither be tentative, nor should it commence without having the right leader at the right place with required will and experience.

Digital players entering into health space with game changing ideas:

Pharma players should also note, how the big technology companies, such as, Apple, Google, Microsoft and Amazon, besides many startups, are trying to create space for themselves in the health care arena. Several of them are also trying to reinvent health care with zest, much beyond what traditional drug companies could even envisage, till recently.

The digital transformation of the organization would help drug players to align the company’s business model with the tech companies in those specific areas to reap a rich harvest. More opportunities will also unfold – either to collaborate with them for targeted projects or moving into the tech space with well-calibrated measures, for business synergy. Without digital transformation of business, either facing such competition or benefitting from the available opportunities, will be challenging for drug companies.

Conclusion:

In the digital world, while patients are emerging as a key driver of change in the health care space, traditional pharma operational systems, including sales and marketing are likely to give a diminishing return on investment. Although, many drug companies can sense this ongoing metamorphosis, several of them are still wondering how to go about it. Moreover, to test the ‘digital water’, some of them have started converting several traditional operational methods, systems and processes in the digital format, as well. Yet, are unable to fathom, why such efforts are not clicking – leading to a quantum increase in the operational efficiency – in pursuit of excellence.

The good news is, global pharma organizations, such as, Sanofi and Novartis, besides several others, have realized that incremental performance improvements with small tweaking here or there, across the organization, aren’t just enough. The corporation needs to move towards a holistic digital transformation, spearheaded by its CEO, having experience in this process. This new breed of pharma CEOs, well-supported by his team of leaders, fostering a burning desire to produce pace setting results, can usher in this ‘disruptive’ transformation. Because, they realize, traditional pharma operational systems, when tempered through the fire of the digital transformation process, can yield game changing outcomes for the organization.  The entire process, as it comes to fruition, helps delivering greater customer value, creating a unique customer experience – similar to what customers want – on an ongoing basis.

In fine, strategic intervention of this genre, initiated by the CEO and cascading down the organizational hierarchy, creates a whole new patient-centric outcome, which is much more than what a company can get through re-engineering the operational processes. Hence, especially the young mangers of date, may wish to note note that during virtually every leadership transition, this atypical skill is now likely count much more than ever before – with an ascending trend.

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.

The Game is Changing: Ensure Better Treatment Outcomes: Leverage Technology

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Today, several pharma players, mostly ‘encouraged’ by many non-pharma tech companies, are trying to gain, at least, a toehold in the digital health care space. It is visible even within the generic drug industry. Such initiatives, as they gain a critical mass, will remold the process of doing – almost everything in the pharma business, catapulting the concerned drug companies to a much higher growth trajectory, as many believe.

This is quite evident from an interview of Fierce Pharma with the senior management of Sandoz – the generic drug arm of Novartis, that was published on May 14, 2019. The honchos said: “We’re looking across the whole value chain to make sure we’re embracing digital and technology wherever we can. So that means from the way that we innovate, to the way that we sell and the way that we operate and do day-to-day business.” The process covers “a whole range of activities from how you use AI and automation, all the way through to prescription digital therapies.”

I discussed about leveraging technology in the pharma space to address many burning issues – both for patients and the pharma industry. One such article, “Focus on Patient Compliance To Boost Sales…And More…”, was published in this blog on May 20, 2019. It establishes that even world-class sales and marketing programs can, at best, ensure higher prescription generations, but can’t prevent over 50 percent revenue loss from those prescriptions, due to patient non-compliance.

Interestingly, the issue of ‘nonadherence to treatment’ is being debated, since several decades. Various conventional measures were suggested and also taken. But the problem still persists in a huge scale, with probably an increasing trend. Thus, fresh measures, preferably by leveraging modern technology, are of high relevance in this area.

In this article, I shall illustrate the above point, with one of the most exciting areas in the digital space – the digital therapeutics. This is a reality today and marching ahead at a much faster pace than many would have anticipated.

Unfolding another disruptive innovation in healthcare:

One of the articles that I wrote on this subject is ‘Unfolding A Disruptive Innovation in Healthcare,’ which highlights a different facet of the same subject. Thus, let me begin today’s discussion with a recapitulation of some important aspects of a drug, particularly the following ones:

  • A large number of patients don’t find many drugs accessible and affordable during the entire course of treatment.
  • Drugs have to be administered orally, systemically or through any other route
  • Alongside effective disease prevention or treatment, many drugs may bother patients with long and short-term side-effects, including serious ones.
  • Treatment outcomes can’t often be easily measured by patients.

These are, of course, known to many, but several questions come up in this area, which also deserve serious answers, such as:

  • Are drugs indispensable for the treatment of all types of disease?
  • Can a holistic disease treatment be made more accessible and affordable with radically different measures?
  • Can the same effectiveness of a drug, if not more, be achieved with no side-effects with a non-drug therapy?
  • Can outcomes be significantly improved following this process, as compared to drugs?

In search of answers to these questions – arrive digital therapeutics:

In search of answers to the above questions, a number of tech savvy whiz kids. dared to chart an uncharted frontier by asking themselves: Is it possible to treat a disease with a software – having no side-effects, but providing better cost effectiveness and treatment outcomes to patients?

Today, with the signs of healthy growth of the seed – sown with the above thoughts, ushers in – yet another game changing pathway for disease treatment. The quest for success of these pathfinders can benefit both – the drug innovators and also the generic players, in equal measure, besides patients. Digital therapeutics is an upshot of this pursuit.

Its ‘purpose’ outlines – why it’s one of the most exciting areas in digital space: 

The Digital Therapeutics Alliance well captures the purpose of digital therapeutics, as, “Improving healthcare quality, outcomes, and value through optimizing the use and integration of digital therapeutics.”

What do digital therapeutics actually do?

There are several, but quite similar descriptions of digital therapeutics. For example, Deloitte described digital therapeutics as software products used in the treatment of medical conditions, enabling patients to take greater control over their care and are focused on delivering clinical outcomes. It also highlights, ‘digital therapeutics are poised to shift medicine’s emphasis from physically dosed treatment regimens to end-to-end disease management based on behavioral change.’

Digital therapeutics offers all positives of a drug and more:

In indications where digital therapy is approved and available, the new approach offers all positive attributes of an equivalent drug, with no side-effect. There isn’t any need of its physical administration to patients, either. Deloitte elucidated this point very aptly: “As software and health care converge to create digital therapeutics, this new breed of life sciences technology is helping to transform patient care and deliver better clinical outcomes.” More importantly, all this can be made available for better compliance and at a cheaper cost in many cases.

For example, according to the article published in the MIT Technology Review on April 07, 2017, carrying the title ‘Can Digital Therapeutics Be as Good as Drugs?’: “Some digital therapeutics are already much cheaper than average drug. At Big Health, people are charged $ 400 a year, or about $ 33 a month to use the insomnia software. The sleeping pill Ambien, by contrast, costs $ 73 for six tablets of shut-eye.”

Two basic types of digital therapeutics:

The Digital Therapeutics Alliance also underscores: “Digital therapeutics rely on high quality software to deliver evidence-based interventions to patients to prevent, manage, or treat disease.” It further elaborates: “They are used independently or in concert with medications, devices, or other therapies to optimize patient care and health outcomes.” In line with this description, the above MIT Technology Review article, as well, classifies digital therapy into two basic categories:

  • For medication replacement
  • For medication augmentation

It also says that the digital therapy for sleep (sleep.io), belongs to the first category, making sleeping pill most often unnecessary and with outcomes better than those of tablets. Whereas, the second category includes various disease specific software apps that improve patient compliance with better self-monitoring, just as co-prescription of drugs.

Nonetheless, the same MIT article gave a nice example of ‘medication augmentation’ with digital therapy. The paper mentioned, Propeller Health – a digital company, has inked a deal with GlaxoSmithKline for a ‘digitally guided therapy’ platform. The technology combines GSK’s asthma medications with Propeller Health made sensors that patients attach with their inhalers to monitor when these are used. Patients who get feedback from the app, end up using medication less often, the study reported.

The first USFDA approved digital therapy:

Let me give one example each of the launch of ‘medication replacement’ and ‘medication augmentation’ digital therapy, although there were other similar announcements.

  • On November 20, 2018, by a media release, Sandoz (Novartis) and Pear Therapeutics announced the commercial availability of reSET – a substance use disorder treatment that was the first software-only digital therapeutic cleared by the US-FDA, for medical prescriptions.
  • Closely followed by the above, on December 21, 2019, Teva Pharmaceutical announced US-FDA approval for its ProAir Digihaler for treatment and prevention of bronchospasm. Scheduled for launch in 2019, it is the first and only digital inhaler with built-in sensors that connects and transmit inhaler usage data to a companion mobile application, providing insights on inhaler use to asthma and COPD patients – for prevention and better treatment of the disease.

Many other projects on digital therapeutics are fast progressing.

Conclusion:

Stressing a key importance of digital therapeutics in chronic disease conditions, McKinsey article of February 2018, titled ‘Digital therapeutics: Preparing for takeoff’, also underlines: ‘Digital therapeutics tend to target conditions that are poorly addressed by the healthcare system today, such as chronic diseases or neurological disorders.’

It also, further, emphasized that digital therapeutics can often deliver treatment more cheaply than traditional therapy, by demonstrating their value in clinical terms. It illustrated the point with US-FDA’s approval for a mobile application that helps treat alcohol, marijuana, and cocaine addiction, well-supported by clinical trial data. The results showed 40 percent of patients using the app abstained for a three-month period, compared with 17.6 percent of those who used standard therapy alone.

I now come back to where I started from. The pharma ball game is changing, and that too at a faster pace.Ensuring and demonstrating better treatment outcomes for patients – both for patented drugs and the generic ones, will increasingly be the cutting-edge to gain market share and grow the business. Thus, leveraging technology to its fullest is no longer just an option for pharma companies. The evolution of digital therapeutics as a game changer, vindicates the point.

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.

Focus On Patient Compliance To Boost Pharma Sales…And More…

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One high-impact area in the healthcare space that often finds its place in the backseat is – patient noncompliance. A term that is commonly used in regard to ‘a patient who does not take a prescribed medication or follow a prescribed course of treatment.’ It comes with a steep price, for causing serious adverse impact not just on human health and health system, but also in the pharma business. Intriguingly, such incidents are still not scientifically monitored enough and vigorously acted upon, both globally and locally.

The World Health Organization (W.H.O) has also flagged it as a huge problem, as it reports, 10 percent to 25 percent of hospital and nursing home admissions result from patient noncompliance. Furthermore, about 50 percent of prescriptions filled for chronic diseases are not taken correctly, with 40 percent of patients not adhering to the treatment regimen.

In this article, just after giving a flavor to its financial cost to patients, I shall dwell mostly on its impact on the pharma players, as overcoming this important problem doesn’t generally fall in the area of strategic focus for most of them. Finally, I shall explore how drug manufacturers can translate this problem into an opportunity – as the third growth driver for business, creating a win-win situation for all.

Economic and health impact on patients:

Noncompliant patients suffering from both acute and chronic ailments, pay a heavy price, not just in terms of longer suffering arising out of complications, but also incurring significantly more health expenditure for treatment of the same diseases. According to IMS Institute for Healthcare Informatics, on average, less than 40 percent of patients around the world are fully complying with their treatment instructions.

Even in the Indian context, the problem is no different. Let me illustrate the point with the example of a chronic disease, such as Asthma. The article published on June 26, 2018 in ‘Lung India’ – the official publication of Indian Chest Society reported: “The mean annual direct costs among compliant and non-compliant patients were ₹14, 401 and ₹24, 407, respectively. Percentage of hospitalization was less among the compliant group (6 percent) when compared with noncompliant group (17 percent).”

The study concluded, asthma is not only associated with patient-specific impairment, but also creates a significant economic burden for the family and society. The major contributors to the burden are the medication cost and hospital admissions. Patient compliance with prescribed drugs can help keep asthma under control, thereby decreasing the economic burden and emergency hospital admissions – avoiding the economic risk from ill health with high out of pocket payments.  Productivity loss is another under-appreciated source of economic loss contributing to indirect cost. The rising costs of investigations, interventions, and treatment of chronic diseases further complicate the problem.

Economic impact on pharma business:

According to November 16, 2016 report, published by Capgemini and HealthPrize Technologies, globally, annual pharmaceutical revenue losses had increased from USD 564 billion in 2012 to USD 637 billion due to non-adherence to medications for chronic conditions. This works out to 59 percent of the USD 1.1 trillion in total global pharmaceutical revenue in 2015.

The report highlights, besides medication nonadherence being a serious global health issue that needs to be addressed immediately, it also happens to be a critical business issue for pharmaceutical companies. Thus, it is the only area of their business where a sharp strategic focus “can generate significant top – and bottom-line growth, improve outcomes, and create substantial savings for the healthcare system – all at the same time.”

Major reasons for patient noncompliance:

Several reasons are commonly attributed to patient-noncompliance to medicines, such as:

  • Lack of knowledge of its health and economic impact
  • Importance of completing the full-course of the drug and dosage regimen for long-term remission, following immediate relief
  • Untoward side-effects and other inconvenience
  • Forgetting therapy because of preoccupation
  • Financial inability to complete the prescribed treatment regimen due to the high cost of drugs.

Nevertheless, the 9th Edition of Global Research Report by Capgemini Consulting underscores that reality is more complex. Patient adherence initiatives, if any, when undertaken, even by pharma companies, often lack a thorough understanding of the root causes of discontinuing treatment and failure to effectively engage patients with a holistic approach to the issue. It also emphasizes: “Individual tactics are tried by different brands and then discontinued as budgets and priorities shift, before their impact is known. Successes are seldom pulled through and expanded across the organization.”

Using it as the third major growth drivers for pharma:

The two primary factors that drug manufacturers are leveraging to boost growth of the organization are:

A.  New product introduction – gradually extending to line extensions and new indications. One such illustration is the cholesterol-fighting drugLipitor of Pfizer. The lifetime sales of this brand as of the end third quarter 2017 generated a stunning USD 150.1 billion of business for the company. Incidentally, Lipitor patent expired in 2011. There are many similar examples, including Humira of AbbVie.

B.  Regular and hefty price increases for already marketed products, for various reasons, but almost regularly. According to this 2019 report, percentage price increases, on a huge base, of some of the world’s top pharma brands were as follows:

  • AbbVie: Humira, a blockbuster drug with USD 15 billion in sales in the first 9 months of 2018: +6.2%
  • Allergan: Many of its brand-name drugs, including dry-eye medication Restasis: +9.5%
  • Biogen: Multiple sclerosis drug Tecfidera: + 6%
  • Bristol-Myers Squibb: Eliquis, a drug that prevents blood clots and is on pace for USD 6 billion in sales in 2018: + 6%
  • Eli Lilly: Type 2 diabetes medication Jardiance: + 6%

Many studies have captured the importance of regular price increase, as a key pharma strategy, not only to drive the internal growth, but also to keep their investors, as well as, the stock market on the right side. There are examples that for some of the top global pharma players, this strategy was directly responsible for 100 percent of earnings-per-share growth in 2016, and more than 20 percent of the revenue made in the first three quarters of 2018.

On the other hand, some top analysts’ findings highlight that drug companies serious strategic focus just on the issue of patient noncompliance with novel tactical measures, could fetch as much as a 30 percent increase in annual earnings per share for many players, even in India.

This brings up to the point – can strategic focus to minimize patient’s non-compliance, supported by adequate resources, be the third growth driver for drug companies?

Can focus on patient noncompliance be the third growth driver for pharma?

For a moment, leaving aside the above two primary growth drivers, if we look at the estimates, as quoted above, well over 50 percent to 60 percent of a brand’s potential sales is wasted due to patient noncompliance. Isn’t it huge? Can this be ignored? Obviously not. Instead, why not pharma converts this problem into an opportunity, with a sharp strategic focus, leveraging technology.

Translating this potential opportunity into reality is neither very easy nor is every company’s cup of tea. But the reward for the winners is indeed phenomenal. To chart on this frontier, one of the toughest barriers, besides a winner’s mindset, is getting access to credible and meaningful patient-data, for various reasons. On the other hand, it isn’t an insurmountable problem, either – especially, with today’s rapidly progressing technology.

Some companies have started the long march:

According to the review article, published in the New England Journal of Medicine: ‘The ability of physicians, to recognize non-adherence is poor, and interventions to improve adherence have had mixed results. Furthermore, successful interventions generally are substantially complex and costly.’

Realizing that it as a potential opportunity – disguised as a problem, several pharma players have started thinking about exploring this not much charted territory, confirm reports coming from different countries of the world. To give an illustration, November 22, 2016 edition of Fierce Pharma reported: ‘Pharma companies have more recently joined the conversation with partnerships and programs that include adherence aims.’

It is generally believed today that rapid ascendency of modern technology, and its strong influence on people, will help create a new awareness of its current adverse impact both on patients and the drug companies.

What else could be done in a much wider scale?

Digital interventions, such as smartphone apps, are becoming an increasingly common way to support medication adherence and self-management of chronic conditions. In this regard, the May 14, 2018 study titled, ‘Smartphone apps for improving medication adherence in hypertension: patients’ perspectives’, published in the journal of Patient Preference and Adherence, concluded as follows:

‘These data showed that patients can identify the benefits of a medication reminder and recognize that self-monitoring their blood pressure could be empowering, in terms of their understanding of the condition and interactions with their general practitioners.’ But some loose knots are still to be tightened.

Tightening the loose knots:

Having leveraged the state of the part digital technologies to tighten the loose knots in this area,a host of AI-enabled smartphone health and diagnostic apps, capturing patient compliance details, especially in chronic disease areas, are fast coming up. Most of these are being developed by large, small and medium sized non-pharma pure tech companies, including startups. For example, according to reports: ‘With the release of the Apple Health Record and Apple Watch with a single-lead ECG, it’s evident that Apple has officially entered the healthcare space.’

A good number of these apps have received even the US-FDA approval, such as: MyDose Coach - a reliable dose calculating app for type 2 diabetic patients who take insulin once-daily in concert with physician guided insulin recommendations. Or, GoSpiro – a home spirometer, to measure air output from the lungs for COPD patients and connects wirelessly to provide hospital-quality data regarding breathing.

That many non-pharma entities are trying to create a space for themselves in a high-tech, but non-drug treatment segment within the pharma space, has prompted, several drug manufacturers to rewrite their marketing playbook, incorporating this ‘new notation’.

It’s real now…for some:

As the above Fierce Pharma article reported: ‘Pharma companies have more recently joined the conversation with partnerships and programs that include adherence aims; efforts from Verily and Sanofi and IBM and Novo Nordisk have recently made the news.’Further, on November 07, 2018, in another report it brings to the fore that Geisinger Health System has developed mobile apps to manage asthma with AstraZeneca, and a wearable app to manage pain with Purdue. It also joined forces with Merck to develop tools for patients and caregivers to improve care coordination and medication adherence.

Moreover, on February 09, 2019, Japanese drug major Astellas and WiserCare - a company that develops healthcare decision support solutions, announced a collaboration that includes improving patient adherence to care plans, and improve the overall care experience.

In tandem, concern on patients’ data privacy, may also now be addressed, possibly by making use of blockchain or similar technology for such initiatives, as I discussed earlier in this blog.

Conclusion:

‘Acquiring new customers is important, but retaining them accelerates profitable growth,’ is the theme of an article, published in Forbes on June 08, 2016. Therefore, just as any other business, this dictum applies to the pharma industry, as well, especially in context of patient noncompliance to medicines, with a clear strategic focus to minimize its impact on performance.

The major reasons for patient noncompliance ranges from ignorance of its adverse impact on health to side effects, forgetfulness and right up to inability to afford full-course of the prescribed drug treatment. Despite its continuity over decades, adversely impacting patients, health system and the pharma players, it won’t be prudent to infer that no attempt was being made in the past, to address this critical issue. Nevertheless, those measures have not worked, for many reasons, as we see today from various research studies in this area, even in the Indian context.

Once again, intervention of technology to make patients compliant to medicine, is showing promise for following it up more vigorously. That some global drug majors are entering into collaborative arrangements with non-pharma, technology companies of various sizes, sends a signal of the emergence of a third major growth driver for pharma, as discussed above.

This issue is so important, especially considering that the low hanging fruits of R&D have mostly been plucked, just as regular hefty increases of drug prices are meeting with tough resistance, squarely. In this scenario, a robust strategic focus on patient compliance would not only boost pharma sales but would also reduce the disease burden of a large section of people significantly. This will benefit all and harm – none.

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.

Is Pharma Communication In Sync With Doctors’ Expectations?

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Not many pharma companies, especially in India, undertake any ongoing data-based analysis to gain insight on expectations and change in behavioral pattern of their customers, particularly doctors and patients. Many developments are taken as obvious, such as, when busy practitioners don’t want to give much time to a medical rep for brand detailing, if not any time, common spontaneous inference remains – ‘they are too busy.’ These responses are mostly without any data backup. Thus, meaningful efforts in finding ‘productive alternatives’ continue to remain elusive.

As making personal calls to some top medical practitioners becoming increasingly difficult, non-personal outreach for them tend to significantly go up. It often happens without any quantifiable assessment of how each of these targeted doctors is responding to even the non-personal outreach of the company.

That this is happening, was captured in a world-wide survey by ZS Associates in 2016. It highlighted: ‘The number of digital and non-personal contacts that the pharmaceutical industry now has with physicians exceeded its number of sales rep visits to doctor offices.’ It is worth repeating, this finding comes from a global survey.

Lack of insight in this area, could give rise to an avoidable disconnect between many pharma company’s core communication strategy, and what individual doctors would like to hear from them and in what way. Unless this issue is addressed sooner, it could be a strong invisible barrier to brands’ success, if not the image, too. Thus, in this article, I shall explore its implication, the key factors driving this trend, and most importantly, how to bridge this gap. Let me start with the well-established trend of increasing volume of non-personal contacts and hasten to add, by ‘non-personal’ I mean situations where a person is not physically present.

Increasing volume of non- personal outreach:  

In these days, personal interaction of medical reps with doctors, despite being traditionally important, is just one of the many channels for delivering requisite content to them. With increasing difficulty in getting top prescribers’ time, for effective brand detailing, many more non-personal channels are fast opening up.

Today, even in the Indian context, more than half of the total outreach volume of many drug companies, especially to such prescribers, are taking place through non-personal promotions. These include activities, such as:

  • Both, general and personalized e-mails
  • Mobile alerts to achieve various different objectives
  • E-detailing
  • Continuing Medical Education (CME)
  • Speaker program with associated arrangements and fees
  • Sponsoring medical events, seminars, symposia
  • Advertising in medical journals

Whereas, a little less than 50 percent of the total outreach by volume, still take place through in-person interactions with medical reps for brand detailing, as studies indicate. Interestingly, for known products, such contacts are often no more than just brand reminders.

The productivity of such calls needs to be measured and quantified, just as what is required for various non-personal channels, including digital – the contact volume of which is fast increasing for several companies. Curiously, despite this prevailing scenario and in some cases, a declining performance trend notwithstanding, higher promotional budgets continue to be available, based on hope and supported by optimistic forecasts.

The key reason attributed to this trend:

The article titled ‘What healthcare professionals want from pharma’, published in Pharma IQ on April 23, 2019 wrote about a key research finding on this subject. It emphasized, ‘only 46 percent of physicians worldwide are “accessible”- defined as meeting with a pharma sales rep in 70 percent of requests in the past year – a figure that has declined from 78 percent in 2008.’

On the same issue, the survey brought out two other important points:

  • 38 percent of physicians restricted MR access, and
  • 18 percent of physicians “severely’’ restricted MR access

The question that follows is, how much doctors’ time is taken by non-personal communication?

Doctors’ time taken by non-personal communication:

The above article also found: ‘These doctors estimate they receive more than 2,800 contacts from pharma reps each year via digital and non-personal marketing channel – contacts that consume an estimated 84 hours per year, or two full work weeks of their time.’ This level of “white noise” makes it imperative to rethink strategies for reaching prescribers, the article added.

What do doctors do with non-personal communication?

In this situation, understanding when doctors open doors to MRs, read promotional emails, commit to speaker events, and engage with other sales and marketing channels could be the difference between gaining market share by delivering a strong customer experience and failing to keep pace with a competitor. This was one of the key findings of ZS Associate’s 2017 Access Monitor study.

Thus, gaining insight on individual customer behavior for personalized customer engagement, would help create a cutting-edge competitive advantage for pharma players. With this acuity, astute pharma marketers would require prioritizing their focus on communication channels and platforms – alongside resource allocation for each.

Current resource allocation:

As reported in the above survey by ZS Associates, while marketing executives and doctors notice the increase in non-personal communications, pharma players, in general continue to allocate around 88 percent of their total sales and marketing budget to the sales force. This is despite non-personal communications – including digital, now comprising 53 percent of the total marketing outreach, as captured in this worldwide survey.

The survey findings do raise a point of caution as it says: ‘If pharma companies continue to increase investment in less expensive digital communications without considering customer preferences, physicians may feel overwhelmed and eventually ignore them.’ Thus, it will be important for drug companies understand doctors’ expectations in this area.

Pharma – doctor communication: Expectations and gaps: 

On the doctors’ front, there are two important developments that pharma marketers should take note of:

  • Core expectation of doctors is much clearer now:  As one of the above studies clearly indicate, the core expectation of all practicing doctors, from both personal and non-personal contacts with the drug companies, is to get the ‘news that they can use’, in their respective medical practices.
  • Availability of multiple expert sources/channels to fetch relevant medical information: The reality today is, medical representatives are no longer the only credible source for many busy practitioners to get useful medical information, not just for the molecule, but also for specific brands. ‘And with more choices, physicians increasingly prefer to learn about products on their own terms,’ as the above worldwide survey points out.

Hence, there exists a gap between how and what type of content busy practitioners expect from pharma companies and how and what the drug companies actually deliver to them. There isn’t an iota of doubt that this gap has to be bridged for making sales and marketing efforts more productive.

It demandsa deep insight into the way doctors gather medical information – based on real-time data analysis. This is critical, considering the role it plays for success in generating increased brand prescription support.

Acquiring insight into the way doctors gather medical information:

There are four key elements, I reckon, to acquiring insight into the way doctors gather medical information:

  • What each high-value medical practitioner considers as ‘the news that he/she can use’ in their practice, which would also help a company to generate increasing brand prescription support? Its answer should be the key driver for targeted content development.
  • How a doctor would prefer to receive it – as a personal or non-personal communication?
  • What would be each such doctor’s most preferred channel or platform to receive this message?
  • How to create an effective and measurable synergy between personal and non-personal communication for each important prescriber?

As too-much, too-frequent and too-many types of communication may often be counterproductive, delivering the right content, on the right platform, through the right channel for each top prescribers, would likely to pave the way for success in this effort.

Real-time monitoring to increase the strike rate is important:

This is relevant for both personal and non-personal communication and would include several areas, such as, after getting appointment of a top specialist, with great difficulty, what results follow after the interview concludes. Or after sending important and even personalized emails, how to monitor whether doctors are opening those, reading and acting upon, as intended.

This is no rocket science. There are ample mechanisms to make it happen. However, it is important to decide first, which of these means would suit a particular company the most, for effective implementation. That said, leveraging modern technology and constantly updating it, is the only way forward, for sure. While the task is difficult, but is certainly achievable – with the optimal mix of right resources and perseverance.

Conclusion:

When the expectation is, to build a strong pharma brand with a long-term success record, the only tool is effective communication of brand-value to target customers – in the right way, leading to tangible value creation for all. The source of communication being respective drug companies, one can be sure that it will be relayed to targeted receivers, such as doctors, patients and other stakeholders. However, none can be too sure whether the receiver will be willing to receive it the way it was planned by the source – and through the same channels.

Like many other industries, pharma customers are also becoming more selective in receiving, accepting and acting on medical communications, according to individual expectations and preferences. Several research studies have confirmed this emerging trend. Simultaneously, it is also getting revealed that most communication of a large number of drug companies are not quite in sync with doctors’ expectations. As a result, return per dollar/rupee spent on such communication is fast declining.

Thus, it’s time for a significant course correction – with a sense of urgency, as discussed above. No doubt, all pharma players have a strategy in place to make their brand communication effective. Nevertheless, what they should also focus on, is to align their communication with doctors’ expectations.

It is, therefore, imperative that pharma communication is made in sync with doctors’ expectations – not based on a couple of interviews with them, as it were, but by analyzing a massive pool of credible data, leveraging modern technology. Otherwise, high value prescribers may keep considering reps visit as ‘noise’ and remain indifferent to such outreach.

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.

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.

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.

‘One Indian, One Health Record’: Is EHR A Tentative Intent?

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The ongoing march of technology, at a scorching pace, transforming our everyday personal – working and social lives. This is palpable. In tandem, it is also making traditional processes of doing successful business less and less productive, over a period of time. The same is more than visible in the healthcare space too. One such field – although not so widely discussed just yet, is maintaining Electronic Health Record (EHR). This is so important for both patients and healthcare providers to ensure significantly better treatment outcomes at a lesser cost, and reducing disease burden of disease too, in that endeavor.

EHR being a systematic, ongoing process of maintaining health records of every individual, help provide prompt, effective and safe health care for all. It helps immensely whenever the person visits a doctor either in private clinics or in any health center for treatment of any disease condition, or even for preventive measures.

Health profession bodies in various countries have articulated what should get included in the health record of individuals. Let me draw an example from one of the BRICS nations. The Health Profession Council of South Africa (HPCSA) defines health records as “any relevant record made by a health care practitioner at the time of, or subsequent to, a consultation and/or examination or the application of health management”. Since, over any person’s lifetime a massive health data gets generated, the current trend is to capture and store such medical data electronically and is, therefore, called ‘Electronic Health Record’ or EHR.

Laudably, India also formally notified its detail intent to make EHR system work in the country. In this article, I shall deliberate on what is the current status of EHR in India, and the key barriers that need to be overcome to make the process gain momentum, in the days ahead.

What EHR can do:

Before zeroing on to India specific initiative on EHR, let me recapitulate what it entails, quoting from a credible global source. According to Health IT- the official website of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, being real-time- patient-centered records, EHRs make health information available instantly, “whenever and wherever it is needed”. As this process brings together in one place everything about a patient’s health, EHRs can:

  • Contain information about a patient’s medical history, diagnoses, medications, immunization dates, allergies, radiology images, and lab and test results
  • Offer access to evidence-based tools that providers can use in making decisions about a patient’s care
  • Automate and streamline provider’s workflow
  • Increase organization and accuracy of patient information
  • Support key market changes in payer requirements and consumer expectations

Let me reiterate at this point, a person’ EHR can bring together all health information from all the doctors visited at private clinics, hospital, health centers, school and workplace clinics, pharmacies and diagnostic facilities. In many countries, EHRs can be created, managed, and consulted by authorized providers and staff across more than one health care organization. This process has been followed, though in a very limited way, in India, as well.

EHR initiative in India:

In sync with Prime Minister Narendra Modi’s Digital India initiative, India reconfirmed its EHR initiative, just as ‘Aadhar’. By a notification, it explained how a cloud-based hospital application system will receive real-time health data of all individuals generated during any clinical encounter or events. Interestingly, EHR standards were first notified by the Indian government in 2013.

Be that as it may, with a fresh vow to popularize EHR in the country, especially among the health care providers, the Ministry of Health and Family Welfares revised the 2013 EHR standards and notified the same on December 30, 2016. A paper titled ‘EHR Adoption in India: Potential and the Challenges’, published in the Indian Journal of Science and Technology in September 2016, presents some interesting findings. Some of these are as follows:

  • Adoption of EHR has been significantly less in India as compared to other developed nations. This is despite the government’s enhancing the budget to US$ 19.2 billion for HIT for its greater acceptance and influence returns.
  • The reason may be attributed to the fact that EHR is not yet mandatory in India. (In my personal view, this is quite unlike what was Aadhar, for a plethora of government and private services, till the Supreme Court verdict came.)
  • In many countries implementation of EHR in the health care system is working very well, benefiting both healthcare providers and the patients, immensely.

The key barriers: 

The above paper identified the following as the key barriers to EHR implementation in India:

  • Legacy System: Most of the patient records are paper based documents. It’s challenging to convert the paper-based records to an electronic format.
  • Cost: High cost of implementation.
  • Policy: Absence of coordinated policy of Government. Lack of clarity in the existing policies of HIT.
  • Funding: Current actual funding of the government for HIT is grossly inadequate, besides lack of well-trained medical informatics professionals.
  • Standards: Most systems don’t adhere to standards, besides usage of multiple local languages by patients and staff.
  • Computer Literacy: Low Computer literacy among government staff and private hospital community, and lack of adequate system training on proper usage of the HER.
  • Coordination and Infrastructure: Lack of coordination and supporting infrastructure (including the hardware and software) among both public and private sector hospitals.
  • Privacy Concerns: Privacy concern on the confidentiality of patient health record needs to be properly addressed.

That’s a 2016 report, what’s happening in 2018?

One may justifiably comment and ask – the above details are of 2016, what is happening today – in 2018?

Even after 2 years since then, EHR still remains at a nascent stage in India, with the keep barriers refusing to get dislodged. The July 16, 2018 media headline – ‘Adoption of e-medical records facing infra hurdles’ clarifies it. It says: “The government is facing serious challenges in its efforts to adopt an electronic health record (EHR) system.” This news report quotes the latest report prepared by the ministry of electronics and information technology (MeitY), titled ‘Adoption of Electronic Health Records: A Roadmap for India’.

This paper highlights that the government is still facing serious challenges in adopting (EHR) system for every Indian’s medical record that can be accessed by doctors and hospitals – transforming the speed, quality and cost of healthcare in India.  Intriguingly, the challenges, continue to range from infrastructure creation, policy and regulations, standards and interoperability to research and development.

The report also emphasized: “With more than 75 percent of outpatients and more than 60 percent of inpatients in India being treated in private health care facilities, it is necessary for the government to bring these establishments on-board for using EHR. In view of the size of the country, there is a need to take a Free and Open Source Software (FOSS) approach to make good quality software available to hospitals and individual practitioners.”

EHR in the United Staes and other countries:

According to the ASHP National Survey of Pharmacy Practice in Hospital Settings: Prescribing and Transcribing – 2016, ninety-nine percent of hospitals across the United States now use EHR systems, compared to about 31 percent in 2003. Computerized prescriber-order-entry (CPOE) systems with clinical decision support are used by 96 percent of hospitals.

As indicated in the above September 2016 article of the published in the Indian Journal of Science and Technology the EHR implementation rate in China is 96 percent, Brazil – 92 percent, France – 85 percent, and even in Russia the same is at 93 percent.

EHR, in various form is working in many other countries of the world. Let me cite an example from nearer home. As captured in the Accenture paper titled “Singapore’s Journey to Build a National Electronic Health Record System,” Singapore government has articulated the essence of EHR with its vision that is easy to understand and remember by all – “One Singaporean, One Health Record.” To improve health care quality for all residents, increase patient safety, lower health care costs and develop more effective health policies, Singapore’s MOH created this vision that enables patient health records to be shared across the nation’s healthcare ecosystem.

Conclusion:

Borrowing the concept of Singapore, I reckon, EHR should also mean to all Indians: “One Indian, One Health Record.” I fully agree that this process isn’t easy. Many barriers require to be overcome in pursuit of this pathway – successfully. No country found this process easy, neither it is expected in India.

That said, the key question is, can India do it successfully in a relatively short period of time? My answer undoubtedly will be an emphatic yes. This is because India has the world-class IT service providers, such as Infosys, TCS and Wipro, to name a few. It means, India has the capability. Does India have the financial resources, as well? Going by the incumbent government notification on the implementation of the revised EHR standards in India, together with what it says about the country’s economic robustness – I would again say – yes, the country possibly has the financial resources too.

It seems very much possible, also considering what the last two successive governments could conceptualize, structure and implement – a massive project of similar nature and magnitude for all Indians – ‘Aadhar’. When ‘Aadhar’ could so quickly be linked with all services – provided virtually by all public and private organizations, why can’t EHR be linked with all health records of every Indian, backed by appropriate infrastructure, human resources, laws and policies?

If a new law is required for addressing privacy and ownership concerns on health data generated for all, so be it! Doesn’t this initiative need to be visible to all – just as ‘Aadhar’ project, with a priority tag attached to it?

Thus, from the perspective of ‘One Indian, One Health Record’, government notification on EHR standards in 2013, and then revising and notifying the same in 2016, appears to be no more than a tentative intent. It has been happening to several important public health care initiatives for long, and continues to happen even today.

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.