The Change Managers

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The Change Managers
BY DENISE MYSHKO

COMPANIES ARE FINDING THAT USING behavioral science IS AN EFFECTIVE WAY TO MOTIVATE EMPLOYEES, DOCTORS, AND PATIENTS TO CHANGE INGRAINED BEHAVIORS. ABOVE ALL, AS SOME PHARMA COMPANIES HAVE FOUND, BEHAVIORAL MANAGEMENT CAN INCREASE PATIENT COMPLIANCE.

QUOTE:
By applying tried-and-true behavior change techniques to the conversation between the constituents — payers, doctors, and patients — we can accelerate the adoption of brand preference, loyalty, and compliance. DAVE BULGER

Pharmaceutical companies always have reached out to their customers — doctors and patients — to build relationships and create awareness about their products. They’ve worked to increase patient compliance and educate consumers about diseases and treatment options. Now, they have an opportunity to take that one step further, to customize these programs for specific segments within these audiences as the rapid growth of the Internet makes the development of such programs easier and less expensive.

Whether the strategy is called behavioral marketing or relationship marketing or even developing lifetime customer value, the goal is to motivate people to shift their thinking and change their habits. What is required is a greater focus on, and understanding of, behavioral science, which is defined as a science that deals with human action and seeks to generalize human behavior in society.

“The point is to motivate and influence both adoption and compliance behavior, whether it be directed at patients, physicians, pharmacists, other healthcare professionals, or even pharmaceutical enterprises and their salesforces,” says Keith Yagnik, vertical practice leader for retail and pharmaceutical/life science markets at HarteHanks. “The contemporary use of behavioral management really started with the salesforces in terms of making sure they knew who they were calling on and understanding the script behavior patterns of the physician.”

Pharmaceutical companies now are trying to position themselves as healthcare partners rather than simply product manufacturers. As such, they are trying to construct a triangle where they are at one point, the patient is at another point, and the patient’s physician is at the third point, says Eric Bolesh, senior analyst at Cutting Edge Information.

“By facilitating communication between the patient and physician, the pharmaceutical company is providing a service to both,” Mr. Bolesh says. “The company has stepped out of the realm of just selling a drug into being a real healthcare provider. It wants to be seen as more of a service provider than just a distributor of products.”

Because improving compliance is an ongo ing challenge for the lifescience industry, Mr. Yagnik says there is growing recognition that just presenting facts in the form of patient education does not motivate people to change their behavior.

“A company that just tells people what it wants them to do rarely gets patients motivated,” he says. “Repeating unwanted advice alienates people. One of the weaknesses of the oldstyle monologue education efforts is that they do nothing to help the physician, the salesforce, or patients get past the natural human resistance to change.”

And behavioral change, Mr. Yagnik says, is not a single event, but a process enabled by dialogue where certain behavior patterns need to be unlearned and replaced with new ones.

Compliance with prescription drugs is a serious concern. As many as 30% of patients on medications for chronic conditions don’t refill their prescriptions, according to the Consumer Health Information Corp. About 10% to 20% of patients never get the initial prescription filled. And even if the medications are filled and refilled, up to 50% of all medi cations — more than 1 billion — are not taken correctly.

A well-constructed behavioral management program includes many of the elements of a traditional patient education program, with one significant difference: it contains messages and information on how individual patients can make positive changes in their lives.

“At the end of the day, this is health education being delivered via marketing channels,” says Dave Bulger, executive VP and behavioral strategist at DVC ActiveCare. “Marketers need to think in terms of patient wellness to adequately develop relationships with patients. We need to be health motiva tors first; brand lift will follow healthier patient behaviors.”

Traditional disease management programs, he says, are too heavily focused on patient education that doesn’t provide patients with tangible suggestions for changing unhealthy behaviors. “The assumption is that if patients read all the patienteducation materials, they’ll follow all the recommendations,” Mr. Bulger says. “That’s not necessarily true. Traditional pharmaceutical marketing has been focused on delivering enough information to impact the first script.”

Instead, he says, pharma companies have to reach individual patients and solve individual problems to create a compliant patient. Creating compliant patients in turn creates compliant doctors — and better returns for the brand.

BOX:
Lifetime CustomerValue: Five Principles for Success

1. Launch and measure lifetime customer value programs. Not having formal objectives in place undermines customer initiatives. After the company and its employees embrace a customercentered focus, they must begin enterprise data collection, dissemination, and action.
2. Build better customer relationships through disease management programs. Diseasemanagement programs drive compliance while creating longterm relationships with customers. Integrated healthcare services empower specific customer populations over time, improve clinical outcomes, and lower costs — and also build loyalty to the company providing services.
3. Build a customer-focused corporate culture. Cultivating a corporate culture that appreciates the intangible benefits of stronger customer relationships is a chief challenge in realizing lifetime customer value.
4. Provide medical resources to support non sales physician relationships. Physicians and nurses still make up a pharmaceutical company’s largest and most valuable direct customer base.
5. Cultivate relationships with nonchronic endusers through healthmanagement and educational resources. One of the biggest challenges facing the pharmaceutical industry is its episodic interaction with nonchronic patients.With tools to pre serve customer relationships, pharma companies will drive compliance before shifting patients to health management tools.

Source:Cutting Edge Information, Durham,N.C. For more information, visit cuttingedgeinfo.com.

QUOTE:
We would like to find a better way to communicate the idea of a tailored program to people. SAUL SHIFFMAN,PH.D.

BOX:
In April 2003, Datamonitor released a new study that found that the over 55 population is becoming an increasingly attractive group for healthcare companies to target with online health information. Because of increasing life expectancy and the booming senior population in the United States and Europe, senior consumers are a highly desirable marketing group for healthcare companies.

Datamonitor’s consumer research, covering 4,500 consumers across the United States and Europe, shows that Internet use among seniors is continuing to grow, with more than 50% of seniors in the United States and United Kingdom having accessed the Internet.

Many seniors are taking an active interest in looking after their health, with up to 40% having looked for health information in the last 12 months.

Furthermore, seniors are far more likely to visit a physician than younger age groups.

High levels of Internet access among the current generation of 35 year olds to 54 year olds will drive Internet levels among seniors over the coming decades. Among seniors who are already using the Internet, about 50% are online for at least one hour per week for personal reasons such as email; in the United States this figure increases significantly to 68% among online seniors.

The booming senior pop Older Americans Heading to Internet for Health Information ulation will require longterm healthcare treat ments.With average life expectancy rates in the United States and Europe set to increase by up to two years during the next 20 years,and with the overall senior populations forecast to rise by as much as 40% in the same period, healthcare companies are gearing their marketing efforts toward the lucrative seniors market.

The strong relationship between age and the preva lence of diseases such as hypertension and type II dia betes, together with the increased risk of seniors devel oping other conditions, mean that seniors have a wide and growing range of information needs. Healthcare companies have the potential to forge long-term relationships with seniors in manag ing their healthcare requirements.

Many seniors take online heath information with them when visiting the doctor. Seniors visit a doctor more frequently than younger generations. Research shows that the average number of doctor visits per year in the United States increases steadily with age from just two per year among 15 year olds to 24 year olds to more than six per year in the over 75 age group.

The opportunity for senior patients to take an active role in their own health management is reflected in the numbers who are already asking their doctors about symptoms or treatment information for a disease because of something theyhave readon the Internet. In the United Kingdom, more than 25% of online seniors who are interested in health care information havediscussed information found on the Internet with their doctor.

Among those seniors who have looked for health information in the last 12 months, more than 50% are interested in information about living a healthy lifestyle. While interaction with a doctor remains the preferred channel for collecting health information among offline seniors, health information Websites now rank highly among online seniors as a popular source of information.

“There are already numerous Websites aimed at providing the senior population with healthcare information,” says Virginia Winters, healthcare strategy analyst at Datamonitor. “The aim of the majority of these Websites, in particular those provid ed by pharmaceutical companies, is to build a relationship with consumers, with the intention of raising awareness and cre ating a strong brand presence. In building relationships with consumers, successful Websites must develop marketing strategies around three stages: first, attracting consumers to the Website; second, encouraging consumers to use the information; and finally, to encourage consumers to return to the site on a regular basis.”

Source: Datamonitor report: Targeting Seniors: Strategies to Promote Online Marketing Relationships in Healthcare. For more information, contact Elisabeth Freeman by email at efree man@datamonitor.com.

QUOTE:
Successful Websites must develop marketing strategies around three stages: first, attracting consumers to the Website; second, encouraging consumers to use the information; and finally, to encourage consumers to return to the site on a regular basis. VIRGINIA WINTERS

GRAPH:
HIGH INTERNET USE AMONG 35 TO 54 YEAR OLDS WILL DRIVE THE FUTURE ONLINE SENIOR POPULATION
100% 80% 60% 40% 20% 0%
Germany UK US
18 34 35 54 55 and over Age (years) Internet penetration among seniors is set to rise sharply over the next 10 years as the 35-54 generation ages
Source: Datamonitor

IMPORTANCE OF THE WEB
The increased use of behavioral science as a way to motivate patients is a function of the digital world, consultants say.

“There are several attributes that make the digital world really attractive for this applica tion, one being a lower incremental cost,” says Craig Douglass, partner at the Cadient Group. “The legacy is that early diseasemanagement programs were done through direct mail and phone. But this is expensive. The margins just aren’t there for this type of tailored program.”

The Internet has allowed companies to cus tomize programs and target patients more precisely, Mr. Douglass says.

“Print is very expensive; it costs too much to have 50 different versions of a message,” he says. “But in the digital world, marketers can really hone the message to an individual patient.”

This is important, he says, because the triggers that eventually motivate a patient to change behavior vary depending upon personal preferences, beliefs, and history.

“Without the Internet, mar keters couldn’t possibly launch these types of programs on the scale that they are being launched,” Mr. Bolesh says. “It is so much easier for the average person to go online, sign up for a program, find out more about the product that they might be taking, enter their information, and actually get involved proactively in the program that the pharmaceutical companies are providing. This type of involvement allows the pharmaceutical company to provide a mass customized approach to patient management.”

The online population continues to grow. Research by Harris Interactive shows 67% of adults (140 million people) are now online, of whom 57% go online at home, 28% use the Internet at work, and 18% do so from a college, library, cyber-caf, or other location. Those adults going online grew from 17.5 million in 1995 to more than 50 million in 1997 and to more than 100 million in 1999, according to Harris Interactive. Latest data show that 140 million adults now go online.

And, according to the Pew Internet and American Life Project, consumers increasingly are using the Internet to find reliable health information. When the Pew Internet Program first inquired in March 2000 about online healthcare, 46 million Americans had used the Internet to find healthcare information. By October 2002, that number had grown to 73 million. Most look for information about specific illnesses, weight control, and prescription drugs.

Additionally, in April 2003 independent market analysis company, Datamonitor, released a report that found that the over 55 population is becoming an attractive group for healthcare companies to target with online health information. Increasing life expectancy and booming senior population in the United States and Europe combine to make senior consumers a desirable marketing group for healthcare companies.

While pharma companies can track prescription sales, assessing the impact of specific programs on patient behavior can be difficult. “Because of the speed of the Internet, by the time the question is asked about whether there is a return on investment, that moment in time is gone,” Mr. Douglass says. “To us, ROI is about accountability. It’s akin to port folio management. Portfolio management is much more appropriate because companies make an investment in these programs and then work to optimize the yield. It’s an ongoing process about optimizing.”

Mr. Bolesh says Merck and Lilly have successfully developed behavioral-marketing programs on the Internet.

Merck has developed Websites for both physicians and patients. MerckMedicus.com provides a medical library that includes Dorland’s medical dictionary, The Merck Manual, and best practice information; news and information, including a scan of medical journals; information on professional development, including CME information; patient resource; as well as information within various specialties. The news section can be customized to allow for individual preferences.

Merck also publishes an online news source for consumers. Merck Source.com contains a health library, resources for patients, and lifestyle management tools.

Lilly’s Website, LillyDiabetes.com, provides patients and their doctors with information and tools about diabetes and nutrition. Tools, including meal diaries and bloodsugar monitors, can be personalized for individual patients.

QUOTE:
What the Internet provides, which isn’t available anywhere else, is timeliness, privacy, convenience, and the ability to handle complexity very simply. KEN NEHER

QUOTE:
Because of the speed of the Internet, by the time you ask, “Did I get a return on my money?” that moment in time is gone. The online world is highly accountable and is a great place to play. CRAIG DOUGLASS

CHANGING PATIENT BEHAVIOR
Mr. Bulger says one of the best and earliest examples of a successful individually tailored behavior change program is GlaxoSmithKline Consumer Healthcare’s Committed Quitters. The program, begun in 1996, seeks to address the psychological and behavioral aspects associated with smoking. For instance, many smokers develop daily smoking rituals such as having a cigarette with morning coffee, socializing with coworkers during a smoking break, or lighting up after dinner. Helping smokers overcome their personal hurdles via tailored support materials offers an important behavioral adjunct to the nicotine replacement therapy’s weaning of the physical addiction.

The healthcare expenses associated with smoking cost the economy more than $150 billion a year in expenses and lost productivity between 1995 and 1999, including $81.9 billion in mortality-related productivity losses and $75.5 billion in excess medical expenditures, according to a report by the American Lung Association in June 2002. Although 70% of smokers want to stop smoking and 34% attempt to quit each year, only 2.5% succeed, according to the association.

Committed Quitters is a 10-week or 12-week individualized behavioral support program used in conjunction with the nicotine replacement products NicoDerm CQ, Nicorette, or the company’s new product Commit Lozenge. Participants can enroll by phone or email and respond to questions about their motives for quitting, risky situations that tempt them to smoke, and their personal barriers to quitting. That information is used to personalize a plan to quit smoking.

The company has worked with MicroMass Communications Inc., a relationship marketing agency founded by Mr. Bulger, since the inception of the Committed Quitters program to develop individualized materials that address a person’s own specific hurdles.

“The program has proven its worth in trials,” says Saul Shiffman, Ph.D., professor of psychology at University of Pittsburgh. “The program has an effect equal in magnitude to the nicotine replacement products themselves.”

In 2000, Dr. Shiffman published a report on the efficacy of the Committed Quitters Program for Nicorette gum. He found that those who participated in the GSK Consumer Healthcare program reported a 47% higher quit rate at 6 weeks and a 56% higher quit rate at 12 weeks than those who only used the smoking cessation product.

One challenge for the company, however, has been in getting consumers to take advantage of the Committed Quitters program. GSK Consumer Healthcare has found that less than half of those who buy a nicotine replacement product participate in the Committed Quitters program, says Ken Neher, associate director of relationship marketing and compliance at GlaxoSmithKline Consumer Healthcare.

“From a marketing perspective, we are working on ways to get involvement in the Committed Quitters program even higher than it is today,” he says.

Dr. Shiffman points out that it is difficult for consumers to understand that these programs are tailored to their individual needs.

“Consumers are used to mail-merge types of programs and so when they receive a program that is printed nicely they incorrectly assume that it is a standard program and we’ve just stuck their name in there,” he says. “We would like to find a better way to communicate the idea of a tailored program to people.”

To address this need DVC ActiveCare this February introduced a “virtual interview” buddy system to be featured on GSK Health care’s Website quittingsupport.com. The site provides an integrated behavioral support system to help smokers address the issues to quit smoking.

Still, feedback suggests that those who do participate in the program have favorable responses. Mr. Neher says this knowledge helped the company to launch Quit.com last December, a nonbranded portal Website that provides information about what the quitting process will be like.

“With information from a pharmaceutical company, there is always skepticism about what we are trying to do,” Mr. Neher says. “We are trying to educate people about the need to quit smoking and orient them about the process to do so. Quit.com is based on a model called the stage of readiness, which helps people be more prepared to stop smoking.”

“The Internet has several advantages for a program such as Committed Quitters,” Mr. Neher says. “What the Internet provides, which isn’t available anywhere else, is timeliness, privacy, convenience, and the ability to handle complexity very simply and less expensively.”

These programs present real opportunities for the pharma industry, Mr. Neher says. “Building compliance programs is not only the right thing to do for consumers, but ultimately these initiatives provide consumer healthcare companies with increased revenue,” he says.

GSK Consumer Healthcare has created similar compliance programs, including one for OsCal, a calcium supplement (oscal.com), and Remifemin, a herbal supplement for the symptoms of menopause (remifemin.com). The Website for Remifemin includes tools for track ing symptoms, news on menopause, and expert opinions. The Website for OsCal includes news, information, and other resources.

BOX:
Real Time Interview Feature with Arnold Palmer Hopes to Inspire Smokers to Quit

DVC ActiveCare, DVC World wide’s consumer health care marketing practice, in February 2003 introduced a “virtual interview” buddy system to be featured on GlaxoSmithKline ConsumerHealth care’s quittingsupport.com Website. The site, developed by sister practice area DVC Inter active, provides an integrated behavioral support system to help smokers address all the issues related to quitting smoking. The promotion combines DVC Active Care’s insight into con sumer behavior as it relates to smoking cessation and clinical research that shows that quitting with a “buddy” is more successful than quitting alone.

“DVC ActiveCare uses consumer behavior to create programs that will be effective for consumers and brands alike,” says Joseph Poggi, managing director at DVC ActiveCare. “A virtual interview enables the user to interact one-on-one with a buddy who is not only a celebrity, but also someone who knows what it’s like to quit smoking. This creates a more beneficial and effective outcome.”

DVC ActiveCare worked in partnership with DVCi, DVC Worldwide’s digital marketing practice, and Eidoserve, a spinoff of CarnegieMellon University, to execute the virtual interview technology.

It allows users to interface “real time” with Arnold Palmer, who had formed a similar support network to help win his battle with smoking, and Saul Shiffman,Ph.D., a leading expert in the field of smoking cessation. A customized question and answer format addresses issues about quitting smoking, health, golf, or which nicotine replacement therapy (NRT) product they recommend. The questions asked are then matched up to the answers from a previous interview and the “correct” or most appropriate answer is then video streamed for the user. This site marks the first time a virtual interview is being used in a consumer setting with an over-the-counter product.

“Quittingsupport.com features information on how to build-a-buddy system, including the best way to find a buddy, methods of keeping in touch with a buddy to keep them smoke-free, and triggers that could cause someone to relapse,”Mr. Poggi adds. The site, quittingsupport.com, was recently relaunched as part of the “Success Begins with the Right Support” promotion created by DVC for GlaxoSmithKline’s NRT portfolio of products: Nicorette Gum, Nicoderm CQ Patch, and the new Commit Lozenge.

QUOTE:
A virtual interview enables the user to interact one-on-one with a buddy who is not only a celebrity, but also someone who knows what it’s like to quit smoking. JOE POGGI

QUOTE:
The company has stepped out of the realm of just selling a drug into being a real healthcare provider. It wants to be seen as more of a service provider than just a distributor of products. ERIC BOLESH

BOX:
Experts on this topic
ERIC BOLESH. Senior analyst, Cutting Edge Information, Durham,N.C.; Cutting Edge Information is a business intelligence firm providing primary and secondary research reports on a wide range of business subjects. For more information,visit cuttingedgeinfo.com.

DAVE BULGER. Executive VP, behavioral strategist, DVCActiveCare, Morristown, N.J.; DVCActiveCare, a practice area of DVC Worldwide, uses behavioral marketing to create programs that accelerate brand performance, targeting consumers, patients, and healthcare professionals. For more information, visit dvcworldwide.com.

CRAIG DOUGLASS. Partner, Cadient Group, Conshohocken, Pa.; Cadient is an online pharmaceutical marketing company that develops programs that address the behavioral patterns of consumers and healthcare professionals to move them to try, purchase, prescribe,and remain loyal specific brands. For more information,visit cadient.com.

KEN NEHER. Associate director, relationship marketing and compliance, GlaxoSmithKline Consumer Healthcare, Pittsburgh; GlaxoSmith Kline is one of the world’s leading research based pharmaceutical and healthcare companies,with headquarters in the United Kingdom. For more information, visit gsk.com.

JOSEPH POGGI. Managing director, DVC ActiveCare, Morristown, N.J.; DVCActiveCare, a practice area of DVCWorldwide, uses behavioral marketing to create programs that accelerate brand performance, targeting consumers, patients, and healthcare professionals. For more information, visit dvcworldwide.com.

SAUL SHIFFMAN,PH.D. Professor of Psychology, University of Pittsburgh, Pittsburgh; the university’s 9,600 employees, including 3,800 faculty members,serve more than 32,000 students through the programs of 18 undergraduate, graduate, and to professional schools. For more information, visit pitt.edu.

VIRGINIA WINTERS. Healthcare strategy analyst, Datamonitor Plc., NewYork, London; Datamonitor is a business information company specializing in industry analysis for six industry sectors: automotive, consumer markets, energy, financial services, healthcare, and technology. For more information,visit datamonitor.com.

KEITHYAGNIK. Vertical practice leader for retail and pharmaceutical/lifescience markets, HarteHanks, San Antonio; HarteHanks is a worldwide, direct, and targeted marketing company that provides direct marketing services and shopper advertising opportunities to a wide range of local, regional, national, and international consumer and business-to-business marketers. For more information,visit hartehanks.com.

PharmaVoice welcomescommentsabout this article.Email us at feedback@pharmavoice.com.

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