A Community Approach

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Kim Ribbink

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As many pharmaceutical companies are finding, healthcare begins within the community, and a regional program, with health information that helps patients at a local level, might just win a company the hearts, minds, and ultimately buying power of those community members.

For an industry confronted with heavy regulations and intense competition, finding ways to develop market share is a key priority. Pharmaceutical, biotech, and medical device companies use numerous tacks to approach product expansion — from physician detailing, to direct-to-consumer advertising, to brochures, literature, and conferences.

Many in the industry also are starting to broach campaigns with a more regional focus. It’s an approach that makes sense since health care is, at heart, a local issue.

“Healthcare really takes place on a level between a healthcare provider and a patient, and there are lot of people who influence decisions on a local level,” says Kate Maguire, president of Dorland Solutions.

Regional marketing essentially involves targeting an audience by geography or community. To reach that audience, companies, agencies, or market research organizations are developing tactics to get their message across, be that through locally respected advocacy groups, hospitals and physicians, charity drives, festivals, or health fairs. Dorland terms this approach as regional convergence, characterizing it as a way to maximize local impact of thought leaders, clinical trial sites, and other early product or procedure advocates.

Such programs present a creative way for companies to have their voice heard by potential customers, be they physicians or patients.

DOING THE HOMEWORK

Before launching a regional campaign, companies need to gather data relevant to the disease state — that is, find out where, or in which communities that condition is most prevalent, and, if approaching a hospital or local health group, uncover those that provide extensive treatments or health programs for that condition.

“Companies are always trying to find ways by which they can increase the demand and awareness for the product,” says Ajit Baid, pharmaceutical research analyst at Frost & Sullivan. “As the pharmaceutical industry becomes more competitive, companies are enacting a variety of strategies to help create awareness and improve market share.”

One approach, Ms. Maguire says, is to start by looking at where the prescribers are, or where the majority of procedures for a particular condition are being carried out.

“For instance, when we launched the Thin Prep Pap Test for Cytyc Corp., we started by looking at where the prescribers for oral contraceptives were and we went after the top markets,” Ms. Maguire says. “The reason being is we know doc tors will not give patients a prescription for an OC without giving them a pap test. So our leads got us into the top five markets so we could get the biggest bang for our buck early on.”

In the case of identifying a suit able regional hospital market for a campaign, companies such as HealthMarketInsights provide data and software solutions to pharmaceutical companies to help them pinpoint which hospitals perform the most volume for a particular disease state, or particular procedures.

“That way companies can send their sales team into particular regions, and to the most attractive hospital prospect within that region,” says Maureen O’Brien, director of marketing and client relations at HMI. In addition, HMI provides detailed information at the ICD9 or DRG level, including cost and charge drivers and outcomes data, which helps to identify and segment the patient population for a selected disease state.

Understanding the specifics of the community is paramount to a successful campaign. “The very first step is understanding the needs of the group you’re going to be working with,” says Jodi Devlin, general manager of the antiviral franchise for the U.S. at Abbott Laboratories. “Then the second step is identifying who would be most appropriate to address that group, what the topic should be, and the best vehicle to address that group.”

Abbott has several drugs for the HIV positive community, including Kaletra, an antiretroviral agent for the treatment of HIV and AIDS, and Norvir, a protease inhibitor for the treatment of HIV and AIDS.

In its work with the MSM community, men who have sex with men, the vaccines division of Glaxo SmithKline administers surveys to that community, through third par ties, to gather some basic market research information. That includes the attitudes and practices of gay men, what they know about hepatitis A and B, where they are likely to seek immunization services, and what the immunization rates in the community are.

Caption
CHARLOTTE KROFT, RONAN GANNON, AND JORDAN RUBINSON
The vaccines division of Glaxo SmithKline administers surveys to the MSM community, through third parties to GATHER BASIC RESEARCH INFORMATION.

Caption
KATE MAGUIRE
START BY LOOKING AT WHERE THE PRESCRIBERS ARE, or where the majority of procedures for a particular condition are being carried out.

“Every year we go back to the community using the same format and forum to evaluate just how many people have become immunized or are immunized at that point in time,” says Jordan Rubinson, senior product manager for Twinrix. “And by having the different data points over the years, we’re able to demonstrate whether or not our programs are reaching the community and having an impact. And fortunately for us, they are.”

Twinrix is the only combination hepatitis A and hepatitis B vaccine. GlaxoSmithKline’s other adult vaccine products include, Engerix B for hepatitis B, and Havrix for hepatitis A.

Another important part of the puzzle is to pinpoint the objectives of the campaign.

“We start by working with a brand team to identify what the objectives are to determine what the educational efforts need to be,” says Celeste Cafiero, VP of strategic development at HealthEd, a health education agency. “Are they trying to merely raise awareness of a particular condition? Do they want to educate healthcare professionals on a particular treatment or proto col for handling a particular disease? And then we look at the demographics — is there a particular part of the country where the condition is more prevalent? Or if we want to study a large number of people in a short amount of time, can we start to target the high prescribers of a particular drug?. That way we try to get a significant enough pool of people with the condition that we can then evaluate results of the program.”

After a region has been selected, companies need to continue to evaluate the effectiveness of a campaign.

“We conduct perceptual mapping on how we’re changing and influencing opinions,” Ms. Maguire says. “We do some qualitative and quantitative research that tracks how we’re doing with these programs. But early on it is most important for us to make sure we are appropriately influencing our target audiences and changing their perceptions about our client’s product. For all our clients, the greatest measure of success is share gains and sales gains.”

SELECTING THE MARKET

Markets are selected based on several criteria — disease prevalence, community responsiveness, as well as market size.

“The first targets are the big cities where patients have more paying capacity, and greater awareness,” Mr. Baid says. “There are big hospitals in major cities, more physicians, more patients, more reps. But if those markets have been exhausted, companies might decide to tap other markets that haven’t been approached. By being the first in, a company can get patients in that area on their medication first.”

While smaller companies often are trying to get a foot in the door with these types of programs, for the larger pharma companies it is just as important to maintain a leadership position.

GlaxoSmithKline has made huge strides in building on its market leader ship within the hepatitis A and B vaccine market through its regional programs in the MSM community. The choice of the MSM market was clearly associated with the increased risk within the gay community for hepatitis A and B.

“There are very strong CDC recommendations for this group that they be immunized against hepatitis A and B,” says Charlotte Kroft, product manager for GlaxoSmithKline adult vaccines. “These are longstanding recommendations, but it wasn’t until we put into place regional programs that immunization really started to take off.”

Racing off to a local nonprofit group, or healthcare center without researching those groups’ willingness to embrace such projects is costly and counterproductive.

“Once the market has been identified, it’s necessary to look even deeper — at pre scribing patterns of physicians, the sales data, and the geographics of the city that we want to focus on,” says Nancy Bacher Long, president of Dorland Public Relations. “If the heavy prescription area is in the southwest corner of the city, we don’t want to do an event in the north east corner. We’ve even gone so far as to overlay that knowledge with demographic information about the population. If the program is targeted at young men, we wouldn’t want to go to an area where there were a lot of older women.”

Careful planning is paramount before selecting a market for a regional program. “The markets really have to be representative of broader populations,” Ms. Long says. “If a regional market provides artificially good results, based on a skewed aged population or some other factor, then the larger rollout may be anticipated to have inflated impact.”

Quote:
MAUREEN O’BRIEN
There’s LESS MONEY WASTED BY TARGETING those hospitals that a company knows are doing the greatest volume of certain procedures or certain diagnoses.

Quote:
NANCY BACHER LONG
Once the market has been identified, IT’S NECESSARY TO LOOK EVEN DEEPER — at prescribing patterns of physicians, the sales data, and the geographics of the city.

All these are important considerations since companies have to know the level of financial return on investment they are likely to receive from these regional programs.

To assess the value of doing such a program, GlaxoSmithKline looks at what it terms readiness factors, such as the size of the MSM community, their partnerships in those communities, as well as the support of public health departments in those areas.

“Ultimately the vaccine has to be paid for, and whether it’s through public health initiatives or through programs like Medicaid support within these communities and states, we look to see whether there’s going to be adequate funding to pay for these vaccines,” Mr. Rubin son says. “We also gauge the sensitivity of our salesforce, whom are very understanding of the special needs of the gay community.”

Abbott executives say data from the CDC helps them to identify metropolitan areas that have the highest prevalence of HIV.

“We then try to identify and partner with advocacy groups, educators, social workers, nurse practitioners, or anyone who may have contact with those who are either already HIV positive and know they are, or groups that may be at risk,” Ms. Devlin says.

The company’s goals are threefold. “One is to increase awareness overall of HIV,” Ms. Devlin comments. “Two is testing — this is something that we’re trying to encourage at a regional level through consumer programs. Then three, for anyone who is HIV positive, we really try to communicate that there is hope. The treatment is very effective, it can improve overall quality of life and people with HIV can live very long, productive lives.”

LINKS TO THE COMMUNITY

A regional, or community-based program, by definition requires a sound working relationship with respected community leaders, and local health organizations.

“We recently did an all-day program dedicated to HIV with Rainbow/Push and the Chicago Department of Health,” Ms. Devlin says. “Abbott was just one part of it. Among those at the event were a pediatrician, a physician from the South Side Health Center, the mother of a young man who had died of AIDS and who has written a book about the experience, and the producer of a video on HIV in African Americans, which was put out by the Chicago Department of Health. That program was an example of what Abbott is trying to do. We’re really trying to find a base of organizations that are already present and find out what their interests are. And this is something that the Department of Health and Rain bow/Push felt would be important.”

Rainbow/Push, based in Chicago, is a multi-racial, multi-issue, international membership organization founded by Rev. Jesse L. Jackson.

For its hepatitis A and B vaccine program, GlaxoSmithKline has sought to build partner ships within the MSM community. These include groups such as Callen Lorde, a grass roots nonprofit organization that serves the gay community in New York, as well as a similar group, Howard Brown, based in Chicago. Those partnerships are the basis of much of the success GlaxoSmithKline has had with the MSM community, Mr. Rubinson says.

“When we began our research for the vaccines campaign, one of the consumer insights we got from the MSM community is that their local LGTB (lesbian, gay, transgender, and bisexual) organizations were the most credible authority to them, more so than CDC, local health departments, or even the pharmaceutical companies,” says Ronan Gannon, director of adult vaccines at GlaxoSmithKline. “It’s that insight that really made us tailor a region al focus to this campaign.”

In addition, partnering with local public health departments has helped the company to drive orders.

“Many of our large orders for vaccines come through the public health departments, many of which are destined and designed to be delivered to the MSM community through various STD programs and other public facilities,” Mr. Rubin son says. “We’ve realized some very large orders from the states in which we’ve been very active.”

LOCAL VERSUS NATIONAL

A localized program has advantages for both large and small companies. For big pharma, the advantage is obviously to build both market share and corporate goodwill at a grassroots level. For smaller companies, regional programs represent an opportunity to roll out a product or service without incurring the heavy costs of a nationwide campaign.

The effectiveness of a regionally focused campaign was clear for the Dorland team following its work for Cytyc.

“Cytyc went from a base of $0 to more than $250 million in sales for the Thin Prep Pap Test and now has more than a 65% market share,” Ms. Maguire says. “That didn’t happen because the company did a big national launch, it happened because Cytyc started at the ground level, market by local market. The company began influencing and tapping into all the key influencers in the market to make the market switch.”

A marketing campaign that actually reaches the appropriate audience makes financial sense for any company.

“There’s less money wasted by targeting those hospitals that a company knows are doing the greatest volume of certain procedures or certain diagnoses,” Ms. O’Brien notes.

That scenario played out for HMI with data research the company conducted for a pharmaceutical company seeking to introduce a cardiac drug into as many hospitals as possible. HMI helped the company identify which markets would be the most attractive prospects for their drug, and then which hospitals within those regional markets would be the most attractive prospects.

“That company expected to realize $45 million in sales over their expectations,” Ms. O’Brien says.

Often, companies might test the effective ness of a marketing campaign at the local level before taking that message to the broader community.

“Sometimes we use local marketing programs to prove a concept,” Ms. Long says. “If a client wants to try a certain program we will test it on a regional level, evaluate the return on investment and some payout. This makes it easier to move on to a broader level — potentially multiple regions or multiple locales, or potentially nationally.”

With the aging population and the growing instance of chronic diseases, such as cardio vascular disease, diabetes, cancer, and stroke, the value to companies reaching out to local patient populations becomes more evident.

“Any company involved in managing or providing treatment for these chronic diseases definitely will have some kind of a budget for regional campaigns,” Mr. Baid says. “And more and more companies are likely get into regional activities.”

VISIBLE RESULTS

Partnering with local hospitals and health care providers, with nonprofit groups, or community centers gives companies positive visibility, giving them an opportunity to get recognition. The campaigns themselves are usually unbranded, which helps companies get their message about the disease state across more effectively.

Quote:
JODI DEVLIN
The goal is to make sure that the people who we are trying to reach out to understand the importance of being in care, and working with their physicians.

“Our activities with these regional events and the partnerships we’ve established are unbranded, in the sense that we talk about the diseases themselves — hepatitis A and B — and there’s not really any mention of either GSK or the vaccines that we have within these programs,” Mr. Rubinson explains. “This gives us a much higher degree of credibility and level of support with our partners, and ultimately the credibility within the communities.”

For many of the companies undertaking such programs, the results speak for themselves.

Last April, Frost & Sullivan awarded its 2001 Marketing Strategy Award to Glaxo SmithKline for its vaccines program with the MSM community. Analysts noted that vaccination rates had risen within the community due in part to the campaigns. In addition, a survey conducted by the Gay and Lesbian Medical Association demonstrated that vaccination for hepatitis B rose one third from 35% in 1999 to 46% in 2001; similarly, hepatitis A vaccination almost doubled from 23% in 1999 to 45% in 2001.

Regional programs, such as the ones con ducted by GSK, can translate into improved sales for a company.

“I can confirm that this regional program resulted in increased sales to GSK Vaccines and was well worth the efforts invested,” Mr. Gannon says.

Others executives working in the regional marketing arena have found success in helping companies gain more of a presence, but a lot of that depends on the way the message is portrayed.

“One of the things that we have experienced is that by setting up very specific objectives in terms of the kinds of coverage we want to get, we’ve been very successful in reaching all of the key daily papers, the key television health programs, and so on,” Ms. Long says.

“We often evaluate — before starting a program — what percent of the coverage there is on a specific disease state, and in what percent is our client represented. Then we set an objective to double that, or triple that percentage, and we’ve been very successful in increasing the client’s share of voice in those markets. We’re in the process of doing a program for a client where we’ve increased their share of voice in the targeted markets fourfold in less than six months.”

 

Sidebar:
Taking it to the Streets

THE PHARMACEUTICAL INDUSTRY’S FUTURE GROWTH DEPENDS ON ITS ABILITY TO REPLACE EXISTING PROD UCTS WITH NEW REVENUE DRIVERS. To do this, pharmaceutical companies must build the next generation of blockbuster drugs through smart, effective prelaunch marketing.

Blockbuster Pharmaceutical Launches, a new study by Cutting Edge Information, high lights the pharmaceutical industry’s need to focus on regional product awareness and product credibility. According to the study, there are several key regional groups that pharmaceutical companies must target to achieve successful block buster launches:

  • REGIONAL KEY OPINION LEADERS — Strong opinion leader relationships are vital to decreasing the time to peak sales for new drugs and achieving blockbuster status. While almost every major pharmaceutical company engages in thought leader management activities, many are focused on national and international opinion leaders. Regional thought leaders play a critical role participating in advisory boards and providing valuable research. Regional thought leaders eventually become nationally recognized, so it is important for pharmaceutical company brand teams to engage them early in the development process.
  • ADVOCACY GROUPS — Companies can prepare the marketplace years before launch by developing relationships with patient advocacy groups and professional organizations. These relationships have proven to build product awareness and lifetime customer value, as well as drive rapid product uptake.
  • COMMUNITY PHYSICIANS AND PHARMACISTS — Marketing teams must work with influential community medical leaders to drive product uptake. Medical affairs teams and scientific liaisons interact with local physicians on new research projects and communicate their findings through medical publications, which drive prescriptions.

Pharmaceutical companies must also incorporate regional sales management into the marketing processes to build product awareness and drive future blockbuster success at launch. One of the major challenges that Cutting Edge Information discovered is that brand teams under resource their promotional efforts. Brand teams must provide sufficient staff and budgeting to proven tactics that drive prescriptions and long term compliance.

For example, local and regional sales teams found free samples extremely effective at promoting product awareness. In both offices and hospitals or clinics, doctors dispensed an estimated $7.9 billion of free samples to patients in 2000, an increase from $7.2 billion in 1999, and $4.9 billion in 1996. Patients are more likely to take a free sample and then fill a prescription when given the option.

Lastly, regional direct to consumer advertising spending has jumped in recent years. For example, Merck spent 117.7% more on DTC ads in 2000 than in 1999. Likewise, Pfizer’s DTC spending almost doubled, from $126 million to $250 million.

According to Cutting Edge Information, brand teams that develop strategic region al DTC advertising plans typically benefit from rapid uptake and higher sales.

 

Chart:
ACTIVITY IMPORTANCE RELATED TO PRODUCT LAUNCHES
1 = Low Importance 5 =High Importance

EFFICACY                                                                     4.75
PUBLICATION                                                             4.5
SAFETY STUDIES                                                       4.25
REGIONAL KEY OPINION LEADERS                 4
GLOBAL KEY OPINION LEADERS                       3.75
MARKET RESEARCH                                                3.75
PHARMACOKINETICS                                             3.5
ADVISORY/ADVOCACY MANAGEMENT        3.5
INTERNAL COOPERATION                                     3
HEALTH OUTCOME STUDIES                                2.25
PHARMACO STUDIES                                               2.25

Source: Cutting Edge Information, Durham, N.C.

 

Sidebar:
Health Lessons at a Local Level

EFFORTS TO IMPROVE HEALTH STAN DARDS SHOULD BEGIN AT THE MOST BASIC LEVEL — conversations between a doctor and his or her patient — then through efforts by local healthcare centers or nonprofit advocacy groups.

Hospitals might sponsor a health fair to raise awareness about certain chronic conditions, such as heart disease, cancer, or diabetes, in an effort to encourage people to come in for tests. Local advocacy groups might try to encourage members of a community most prone to a certain condition to get tested, follow diet and treatment regimens, and remain compliant. The goal is to reach out to people who don’t normally go to their physicians for screening.

Several companies have been working with these groups, providing resources to community driven organizations, to help drive awareness and change behavior.

HealthEd, a patient education agency, works with patient advocacy groups to develop their educational materials.

“Advocacy groups are often used as partners in the development process to make sure that the content is not only accurate, but credible,” says Celeste Cafiero, VP of strategic development at HealthEd. “Frequently, we will work with a target part of the country, depending on whether or not the condition has the demographics that lend itself to that area.”

In its efforts to improve diabetes awareness within the Hispanic community, Aventis Pharmaceuticals has been reaching out to grass roots organizations with a grant program, carried out in conjunction with the Latino Influencer Network (LIN), a partnership of Latino health and diabetes experts.

“Four organizations are selected to receive the award of $10,000 each,” says Melissa Feltmann, U.S. Product Communications at Aventis Pharmaceuticals. “At the end of the program they provide the LIN with their results. Based on those results the LIN will select the most effective program among the 2002 grant recipients and that organization will receive an additional grant of $5,000.”

Quote:
CELESTE CAFIERO
Frequently, we will work with a TARGET PART OF THE COUNTRY, depending on whether or not the condition has the demographics that lend itself to that area.

The winners are selected based on several criteria, says LIN member Andrea Zaldivar, M.S., A.N.P., C.D.E., Internal Medicine Associates of Mount Sinai Medical Center. “Creativity is one of the criteria that we use, as well as a company’s ability to continue the program past the time for the allotted amount of money,” Ms. Zaldivar says. “We evaluate if the programs have some evaluation process in place, and their record within the community. We’re interested in groups that partner with other groups within the community.”

Once the recipients are selected, Aventis and LIN leave how those resources are allocated and how the programs are conducted to the local group. It is, Ms. Feltmann says, an unbranded program with no discussion about Aventis products.

“Our focus is to give money or resources to communities because they have established a trusting relationship with their constituents and they have a sense of what needs to be done within their own communities, as opposed to our reinventing the wheel, and coming up with a new program ourselves,” Ms. Zaldivar says.

Both Ms. Feltmann and Ms. Zaldivar say the goal of all diabetes education programs is to encourage patients to control the disease.

At the heart of such programs is the hope that education will drive greater health aware ness, community-by-community across the U.S.

While HealthEd’s goal is to roll out its educational programs on a national level, regional efforts often provide an opportunity to pilot a program to determine its value to the patient and doctor populations.

Quote:
ANDREA ZALDIVAR
We evaluate if the programs have some evaluation process in place, and their record within the community. We’re interested in GROUPS THAT PARTNER WITH OTHER GROUPS WITHIN THE COMMUNITY.

“One of our programs was a journal and tracking diary for colon cancer patients,” Ms. Cafiero says. “The program was rolled out nationally. The qualitative results from the evaluation showed that 86% of the individuals who received the educational piece felt that it gave them a greater sense of control in their treatment plan; 78% said it helped them to manage their treatment more effectively; and 86% said it enhanced their interactions with their healthcare providers. It also was included in a research study at a cancer center in one part of the country to evaluate the results using targeted patient-centered resources in conjunction with chemotherapy versus chemotherapy alone.”

Aventis’ programs have had similar success. “Last year, the additional $5,000 award went to Latino Health Access, in Santa Ana, Calif.,” Ms. Zaldivar says. “Between July 2001 and January 2002,Latino Health Access was able to accomplish more than 131 eyecare screenings, they had 34 podiatry visits, they had more than 103 nutrition visits, and they were able to provide two cataract surgeries to individuals through this effort.”

 

Sidebar:
Experts on this topic

AJIT BAID. Pharmaceutical research analyst, Frost & Sullivan, San Antonio; Frost & Sullivan provides strategic market consulting and training. For more information, visit frost.com.
CELESTE CAFIERO. VP, strategic development, HealthEd, Westfield, N.J.; HealthEd specializes in creating easy-to-understand, culturally sensitive communications programs. For more information, visit healthed.com.
JODI DEVLIN. General manager, antiviral franchise for the U.S., Abbott Laboratories, Abbott Park, Ill.; Abbott is a global healthcare company devoted to the discovery, development, manufacture, and marketing of pharmaceuticals, nutritionals, and medical products. For more information, visit abbott.com.
MELISSA FELTMANN. U.S. product communications, Aventis Pharmaceuticals, Bridgewater, N.J.; Aventis is dedicated to improving life by treating and preventing human disease through the discovery and development of innovative pharmaceutical products. For more information, visit aventis.com.
RONAN GANNON. Director, adult vaccines; JORDAN RUBINSON. Senior product manager, Twinrix; CHARLOTTE KROFT. Product manager, adult vaccines, GlaxoSmithKline — GlaxoSmithKline vaccines team, Philadelphia; GlaxoSmithKline is a research-based pharmaceutical company, with a leadership in anti-infectives, central nervous system, vaccines, respiratory and gastrointestinal/metabolic. For more information, visit gsk.com.
NANCY BACHER LONG. President, Dorland Public Relations, Dorland Global Health Communications, Philadelphia; Dorland is a full-service healthcare communications agency. For more information, visit dorland.com.
KATE MAGUIRE. President, Dorland Solutions, Dorland Global Health Communications, Philadelphia; Dorland is a full-service healthcare communications agency. For more information, visit dorland.com.
MAUREEN O’BRIEN. Director, marketing and client relations, Health Market Insights, San Francisco; HMI provides solutions and healthcare information to assist healthcare organizations. For more information, visit healthmarketinsights.com.
ANDREA ZALDIVAR, M.S., A.N.P., C.D.E. Internal Medicine Associates of Mount Sinai Medical Center, New York; LIN is a partnership of Latino health and diabetes experts established by Aventis Pharmaceuticals. For more information, visit aventis.com.

PharmaVoice welcomes comments about this article. Email us at feedback@pharmalinx.com.

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