Beverly Smet, VP Business Development Sander Speleman, Sr consultant Patient Engagement
View recorded webinar: http://bit.ly/1IByvRk
Across Health Webinar
Patient centricity: From commitment to effective MC implementation
© Across Health Webinar 1
AH key numbers 2015
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• Focus on enhancing customer
engagement through an integrated
channel mix (“fusion”) in healthcare
• over 70 consultants
• Physical presence in 10 markets
• Over 500 projects (40% in customer
insight & strategy)
• Channel affinity of 10.000 HCPs and
Patients
• 35+% CAGR since 2007
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What we will cover
• Patient centricity in pharma: the landscape
• How to engage with patients using a multichannel approach - methodology for channel mix selection - validated patient segmentation model - case studies
• Measuring impact
• Q&A
It’s changing weather …
…Market wise …Customer wise
…Strategy wise
© M
SO
ffic
e C
lip A
rt
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Payers Government healthcare spending pressure More proactive management of formularies Legislative support for lower- cost generics
Specialists & GPs Prescription monopoly under erosion Access increasingly crowded Interest is decreasing Purchasing consortia taking on negotiation role
Pharmacists Expanded generic substitution power (Fr, Ger) Consultative role
Nurses From passive to active influencing role Extended prescription formulary
Patients No longer rely on guidance from physician alone
Focus is shifting from HCPs only to multiple stakeholders in pharma marketing
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We spend around 95% of our budget on finding the next patient and then probably
less than 5% after we found them”
(Gary Walker, Sr Director, Customer Innovation, Eli Lilly)
Still, relative budget spent on patient-centric initiatives very low…
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74%
60%
57%
54%
42%
34%
33%
31%
25%
22%
21%
18%
14%
11%
8%
6%
6%
18%
29%
15%
27%
28%
43%
27%
24%
51%
41%
37%
37%
15%
29%
23%
26%
23%
4%
7%
18%
13%
19%
17%
28%
34%
20%
25%
37%
38%
43%
46%
51%
50%
53%
5%
4%
10%
6%
10%
6%
12%
11%
5%
12%
5%
7%
28%
15%
18%
18%
19%
Pharma-owned website*
Email marketing
Direct marketing
Web Banners
SEO
Mobile marketing
SEA
Outbound call centre
Integrated cross-channel campaigns
Patient adherence tools
Social media marketing
Social media monitoring
e-sampling
Marketing automation software
e- or PHR** ad & promo services
Quantified self / self-tracking devices
Remote patient monitoring
Standard practice Pilot planned or ongoing Never Do not know / not applicable
This is confirmed by our Multichannel Maturometer Overview of patient tactics adoption in pharma (Across Health Multichannel maturometer 2015)
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N = 223 EU scope
*Company, product, or disease website. **electronic or personal health record.
The role of the patient in the customer journey: 50% of the stages are patient-led
Mar
ket
exp
ansi
on
Sh
are
gain
Sa
les
op
t.
Origination
Presentation
Evaluation
Diagnosis
Treatment Choice
Brand Choice
Fulfillment
Compliance/Persistence
Stages of the customer journey Pharma programs
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Economical consequences
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36% loss in potential sales
Loss in brand equity as patient and HCP
view are negatively impacted
310 billion $ of avoidable medical spending
Source: WHO
Increasing the effectiveness of patient support may have a far greater impact than any improvement in
specific medical treatments
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3 angles on creating a disruptive Patient- Centric model
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Source: Disrupting the model: Patient Centricity ; Pharmavoice
Outcome based healthcare
360° patient
view
Open innovation
360° patient view
• Rapid prototyping (learn from technology peers)
• Outside-in, open approach (combine competencies of multiple companies)
• Flexible control (quick response to new challenges and opportunities)
• Portfolio management (learn from each other)
• Execute MC strategies and use analytics for future decisions
• Centralised data management for a holistic view of the patient
• Flexible segmentation that can change according to market conditions
• Integrated campaign mgmt to reach customers through their preferred channels with one-to-one messaging (MC surround sound)
• Realtime reporting to integrate learnings in campaign cycle
Focus of today
• Switch from volume based to outcome based payment
• Reward models based on cost savings
• Big integrated patient data : capability of measuring improvements in quality that are also clinically meaningful
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Patient centricity is built up around 3 pillars
Across Health 12 9/20/12
Get deep insights into the
patient journey in order to
understand how
customers need evolve
over time
Interact with your patients
during all patient journey
touchpoints through the
channels they prefer
Offer tools and services
that add value to your
patients
Patient
Journey
Patient
Value Patient
Experience
2 key primary tools for collecting valuable patient insights on these 3 pillars, next to secondary research:
Across Health patient navigator (quantitative) Virtual patient focus groups (qualitative)
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In order to assess Reach and Impact, we ask each Patient two key questions:
“to what extent do these channels influence your
health decision making?”
“which channels have you encountered in the
past 3 months?”
Across Health Patient Navigator : quantitative insights in channel reach and impact
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Over 40 channels are assessed
pharma call print ad GP
DM radio ad specialist
fax TV ad pharmacist
newsletter billboard nurse/coach
pharma sms pharmacy ad family/friends
sample patient
brochure caregiver
pat adherence pat assoc
print content
TV content
eNewsletter search engine ad search engine
website banner ad online pharmacy
smartph app social media ad website health
facebook eNewsletter health
twitter online patients
youtube wikipedia
eLearning disease website pat assoc
Earned
Off
line
On
line
Owned Paid40 Channels Covered
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• Performance Maps display Reach and Impact for each channel
• The GP channel is highlighted for comparison
GP
Impact
Rea
ch
Impact and reach of all channels are mapped on a performance map
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Benchmark the importance of each channel vs that of a GP visit: Multi-Channel Equivalence Map
Impact is rescaled to allow direct
comparison with the GP (MCQ Doc)
The graphs and tables are similar to performance maps, but the GP is ALWAYS set at 1.00
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Definition of MCQ
A MC Equivalent (MCQ) = A combination of multichannel interactions with a consumer/patient that equals the impact of 1 GP visit
For example: 1 GP visit = 1 click on a search engine ad + 1 website conversion + 1 exposure to a banner
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An alternative viewpoint could be to take the patient association website as the benchmark
Website patient association is set at 1.00
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Virtual Patient focus groups: understanding the Multichannel patient journey for information and services (qualitative)
Goal
Collect profound insights on how to engage with patients by offering engaging content and services in the format and through the channels they prefer for each step of the patient journey
Identifying the MOT’s along the patient
journey
(WHY)
Translating in a need for specific
services, content
(WHAT)
Looked up via different
channels/ sources
(WHERE)
Accessed via different formats (mobile,
online, ...)
(HOW)
Patient journey for information and services
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Virtual Patient focus groups: Concept & approach
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Client area Patient area
Whiteboard
area • Interactive 2hrs chat session with
8-10 patients
• Pre-approved script
• Visual cues to facilitate discussion
• Recurring if necessary
• Convenient for participants
no travel
• Company listens in realtime
• Participants can type
simultaneously, increasing the
amount of feedback
• Open & honest feedback as there
is no peer pressure (anonymous
participation)
• All feedback is scripted, no bias
Concept
Benefits
Case study
• Existing AED, newly approved indication • New indication : migraine prophylaxis • Market : Belgium
Insights • migraine prevalence : 10% of population, mainly women • 50% of migraine patients are eligible for phrophylactic treatment, but only 10 % get it
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Campaign objectives
• Increase disease awareness about migraine
• Inform patients that prevention is possible
• Drive migraine patients to GP to request prophylaxis
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MIGRAINE Patient seeks professional help (73%)
SPEC GP (60%)
ACUTE Medication
Others
-Block (44%) Others AD VPA
Switch (64%) EFFECTIVE STAYS ON -BLOCK
(36 %) PRODUCT X
Brand / Delivery Choice
Presentation
Origination
Evaluation / Diagnosis
Compliance
Treatment Choice
Fulfillment
Drop-out
PROPHYLACTIC Medication (38%) (62%)
5%
Patient journey
Leverage point
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Impact
50%
10%
0,2 0,1
GP
Disease website
Re
ach
Pharmacist
TV
0,3 0,4 0,5 0,6 0,7 0,8 0,9 1,0
Social media
General health Website
Nurse
Patient association
Mobile app
Sponsored search ad
Specialist
Banner
1,1 1,2
Search engine
20%
30%
40%
60%
70%
80%
90%
100%
Reach and impact on health decision making of Belgian patients : Multichannel equivalence map
“Have you been exposed to this channel?”
“Have you been influenced by this channel?”
Doctor
Simplified chart derived from
Across Health Patient Navigator
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Step 1 Creating the business case
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• Cross industries, the golden rule is that you need 7 interactions to change behaviour
• In the past, the GP used to be THE source of information for patient health decision making
• How should the optimal channel mix look like today… and in the future ?
The “sweet spot” of Effective Frequency Source: http://inside-social.tumblr.com
You need on average of 7 “channel exposures” (with a minimum of 4) to be effective. Because GP’s are seen by patients as one of the most
impactful channels, we assume that a good disease awareness campaign should reach the equivalent of 4 GP visits
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On average, European consumers visit their GP 2x/year
32%
28%
18%
12%
10%
None 1 2 3 or 4 5 or more
All Online EU Consumers=2
How many times have you seen or talked to a doctor for yourself for each of the following in the past twelve months?
Mean number of times (including zero)
Source: Manhattan Research
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9/20/12
So a good disease awareness/ patient activation campaign should generate the
equivalent of 2 GP visits
2 GP VISITS
2 Multichannel equivalents (MCQ) +
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Leverage Point Behavioral Objective Strategy
Building the business case
Awareness & Presentation
Inform migraine patients on new generation treatments in prophylaxis
Stimulate more patients to ask for prevention
Calculation of the desired number of GP equivalents
Target group Target group size*
GP visits Additional MCQ needed
Desired # MCQ’s
Avge reach top 10 channels
Possible # MCQ’s
Visits doctor (73%)
365.000 2 2 730.000 29% 211.700
Does NOT visit doctor (27%)
135.000 0 4 540.000 29% 156.600
Total 500.000 1.270.000 29% 368.300
* Target group size : Belgian population is 10mio, women 50%, 10% prevalence
Stimulate patient-physician interactions
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Based on the SOV need (368.000 MC GP* equivalents), a channel mix calculation takes place
*A MC GP equivalent = a combination of multichannel interactions with a target customer that equals the impact of 1 GP visit ** 2000 pharmacists (40%) & 1500 GPs (15%) ordered the promotional kit before the start of the campaign; 73% presentation of population *** Derived from Digital ratecard Sanoma magazines (2,1 mio / month)
Channel Reach
TG Response
% Interaction
ZG Channel Weight
# MC GP Equivalents
Search engine advertising Q1 – Q4 3.000.000 5 150.000 0,4 60.000
Awareness leaflets GP Q1 – Q4 ** 55.000 25 13.750 0,7 9.625
Awareness leaflets Phamacist Q1 – Q4** 146.000 25 36.500 0,7 25.550
Banner Flair Q1-Q4*** 25.200.000 0,1 25.200 0,4 10.080
Overlayer Flair Q1 10.800.000 0,1 10.800 0,6 6.480
Banner / Overlayer Skynet Q2-Q3 40.000.000 0,1 40.000 0,4 16.000
Pharmacist 146.000 30 43.800 0,9 39.420
Poster campaign Q1-Q4 201.000 5 10.050 0,5 5.025
TV press release 250.000 100 250.000 0,3 75.000
Radio press release 150.000 100 150.000 0,3 45.000
Newspaper press release 200.000 100 200.000 0,3 60.000
Activation website (quizz /diary conversion) 150.000 35 52.500 0,7 36.750
Total 80.298.000 982.600 388.930
982,600 interactions with the target group:
ca. 389.000 MC GP equivalents (MGQ)
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Data collected via 300 representative GP’s. All data are extrapolated to the national universe (=12.500 GP) – Period : Q4 / 2005 Q1 2007
Rx split - All Migraine prescriptions : preventive vs acute treatments
36,6% 38,8% 38,1% 37,8% 40,1% 43,4%
10,6%11,1% 12,5% 12,2% 10,9%
10,0%
52,8% 50,1% 49,4% 50,1% 49,0% 46,6%
Q4/05 Q1/06 Q2/06 Q3/06 Q4/06 Q1/07
Only LT Both Only Acute
Preventive treatment growth +19% in year 1
Q4/Y1 Q1/Y2 Q2/Y2 Q3/Y2 Q4/Y2 Q1/Y3
Business impact
MS more than doubled over a period of 1 year
1,2% 7,1% 11,1% 14,9% 14,7% 16,0%10,2%
9,1%8,7%
7,8% 9,2% 9,7%
45,3% 39,0%38,3%
40,1% 41,2%46,1%
15,5%23,6% 20,3%
18,8% 13,3%8,0%
27,8%21,1% 21,5% 18,3% 21,7% 20,2%
Q4 / 05 Q1 / 06 Q2 / 06 Q3 / 06 Q4 / 06 Q1 / 07
Topamax Depakine Inderal Redomex Other profylactic treatments
Q4/Y1 Q1/Y2 Q2/Y2 Q3/Y2 Q4/Y2 Q1/Y3
Product X
Rx share within preventive treatments segment - Total Belgium
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One size doesn’t fit all…
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Segmenting patients is KEY to provide tailored support that is based on their needs and thus improves adherence outcomes
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A validated patient segmentation should be the foundation of your program
• Collaboration with Sjaak Bloem (Professor at Nyenrode Business university and associate director innovation at J&J) and Joost Stalpers (J&J)
• Overall functioning with chronic disease based on level of control and level of acceptance
• Correlation between functioning and adherence
• 6 question barrier assessment leading to 4 patient segments
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Patient segments are derived from 6 questions
Please indicate the extent to which you disagree or agree by circling a number 1 = fully disagree to 7 = fully agree (presented in random order) Acceptance Q1. I am at peace with how my health condition is Q2. The way in which I am functioning physically and mentally is acceptable to me Q3. I accept my health condition the way it is Perceived control Q1. I have the feeling that I am having grip on my health condition Q2. My health condition is to a great extent in my own power Q3. I have a substantial amount of influence on my health condition
Cut-off point high vs low acceptance: avge (Q1+Q2+Q3) = 5,333
Cut-off point high vs low control: avge (Q1+Q2+Q3) = 5,666
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4 patient segments, each with different needs and expectations
control
“Engaged”
Confirmation seekers
~25%
“Emotionals”
Structure seekers
~20%
“Unintentionals”
Motivation seekers
“Disconnected”
Perspective seekers
~50% ~5%
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The higher the level of overall health functioning the higher the level of adherence is
Segment progression (and indirectly adherence levels) can be measured by asking these questions at regular time intervals during a patient support
programme
control
“Engaged”
++ “Emotionals”
+
“Unintentionals”
“Disconnected”
-- -
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The Across Health patient navigator also looks at relative channel importance by segment
Example of relative channel importance by segment (TA not disclosed)
Source: Across patient navigator
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Example of how insights from the patient navigator and virtual patient focus groups are brought into practice
Basic assumption : a movement between segments takes 3 months on average
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Simplified campaign journey/ segment
27x /
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Measuring ROI & other KPIs of patient-led programmes
A holistic approach of measurement
ROI = f (REACH, ENGAGEMENT,
CONVERSION, ADVOCACY, COST)
ROI = f (NEOCORTEX + LIMBIC)
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Example of Impact measurement patient support programme
Leading indicators Lagging indicators
Qualitative
Feedback from stakeholders and patients e.g. Ease of patient enrolment in programme Knowledge improvement patients Brand differentiation for reps …
Patient evolution of wellbeing according to segmentation model Measure movement between quadrants
NPS Recommendation of program by patients
Morisky (self-reported adherence)
Quantitative
Operational metrics % recruitment vs. population, activity level on website, engagement and interaction with channels
Medication Possession Ratio
Cost per patient for running the program
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Patient centric metrics / commercial metrics
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