How pharma marketers are using behavioral science

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New technology has shifted the marketing paradigm from one-way messaging and simple reminders paired with education efforts to a new set of tools including gamification, augmented and virtual reality, and online interventions tailored to individual patients. Designed right, these advances stand to have a more meaningful impact: helping foster long-term behavior change to support brand objectives.

And it's not just marketers who are recognizing that shift. Medical associations, too, are starting to better grasp the importance of addressing patients' behavior in improving health outcomes. The American Diabetes Association, in its new 2017 standards of medical care, included new guidelines on the importance of addressing patients' psychosocial needs while also looking at traditional health needs.

See also: 4 trends with the potential to change behavior in the patient journey

But more can be done. Most companies still don't allot enough of their budget to create long-term behavior change in patients. When habits can sometimes take as long as a year to form, that's a recipe for relapse, according to behavioral health psychologist D'Arcy King, EVP and chief strategy officer of Daggerwing Health.

“It's about long-term sustained behavior change,” she affirmed. “That's what is missing in many cases. We don't necessarily give programs enough time to work or see success or even measurable results coming out of them.”

And while programs with life-long goals sound nice on paper, clients need to demonstrate ROI on quarterly timelines. The key? Helping patients with chronic diseases prioritize disease management so it becomes automatic behavior and then recognize that connection, King added.

See also: 3 Lessons on Behavior Change from Pokémon Go

“It's hard for patients to say each day, ‘I will take this on and I will win,' because then they burn out,” she explained. “It goes back to, as a patient, ‘What are my priorities?' And for many who succeed in managing their disease, it's about prioritizing their condition in incremental ways so they have a better quality of life.”

This eBook, spanning both HCP and consumer campaigns, elucidates how pharma marketers can leverage behavioral health learnings to help create that connection for patients. You'll find four case studies detailing how drugmakers and their marketing agencies use behavioral change techniques — such as reframing, social learning, problem solving, and others — to keep patients adherent to their treatment regimen, better communicate their symptoms, and reinforce healthy behaviors. And on later pages, six industry leaders share their thoughts on the pharma sector's progress in making behavioral science a key part of the marketing equation.



COMBATING “AUTOMATIC THOUGHTS” TO CREATE LONG-TERM HABITS

Brand: Saxenda
Manufacturer: Novo Nordisk
Campaign: SaxendaCare support program
Agency: MicroMass

You don't have to look any farther than the rate of obesity in the U.S. — 36% among adults — to know that it is as difficult to treat as it is prevalent. And the odds of slimming down to a healthy weight once someone is obese don't look much better: 1 in 210 for men, and 1 in 124 for women, according to recent research.

MicroMass was tasked with supporting patients trying to shed pounds while on Novo Nordisk's Saxenda — a weight-loss drug and reformulation of its blockbuster diabetes drug Victoza. The agency developed a 16-week program designed to build patients' confidence, support adherence, and correct misperceptions that could pre­vent them from reaching their goals.

See also: Sharecare aims to drive behavior change with VR acquisition

The program begins with patients receiving a welcome kit consisting of a portion plate and a health and wellness guide from the Obesity Action Coalition. Those are followed by weekly emails driving them to an online platform that works to reinforce key topics and skill-building activities.

Jessica Brueggeman, SVP of MicroMass's health behavior group, explained how these activities help patients form positive long-term habits, the importance of which is grounded in science.

“A lot of times we think about skills or behaviors or things we do as physical activities,” Brueggeman reports, “but something we saw clearly in published research was the importance in combating automatic negative thoughts that get in the way of being successful, such as, ‘I messed up and ate a bag of potato chips. Now I'm just going to give up,' for example.”

See also: Changing Behavior is Ongoing, And That's Why It Requires Communications

Health coaches provided personalized support and problem-solving through role-playing to assist patients in making lifestyle changes.

“We tried early on to get coaches to recognize some of the challenges these patients have had,” says Rob Peters, SVP of strategy for MicroMass. “These patients have already tried to lose weight. We didn't want to give them a repeat experience.”

And as part of that effort to differentiate, Peters added, there's very little in the program that talks specifically “about weight loss or what they hope to accomplish by losing that weight. We tap into more of that internal motivation. We didn't have to give them that ‘OK, your goal is 25 pounds; celebrate when you get there.'”

See also: Guidemark Health's Fascetti on Ads that Change Behavior

To that end, personalized coaching works to set small, yet achievable, goals for patients. “We'll get patients to articulate why they're doing what they're doing, what's motivating it, because getting patients to voice that motivation really reinforces their internal motivation,” Peters noted.

That motivation ties into a key part of the program, according to Brueggeman: “Helping patients be successful on their own, examine their own challenges, and get past them.”



CREATING EMPATHY AND UNDERSTANDING THROUGH VR AND AR

Brand: Eylea
Manufacturer: Regeneron
Campaign: In My Eyes
Agency: Intouch Solutions

People with retinal diseases struggle to communicate symptoms. And not just to doctors, but to loved ones and caregivers, as well. Enter Regeneron's marketing team for Eylea, a treatment for three eye disorders: neovascular age-related macular degeneration, diabetic macular edema, and macular edema following retinal vein occlusion.

“It's difficult to articulate these vision changes unless you experience them,” said Regeneron senior product manager Natalie Mancuso. “Patients needed a way to get their caregivers and family members to better understand their condition.”

See also: Digital IDs become focus as drugmakers seek to track doctors' behavior online

Regeneron enlisted Intouch Solutions to help develop a virtual- and augmented-reality application — available now through iTunes and Google Play — to let patients and caregivers better understand vision changes. The branded app was designed as a visual aid for physicians so they can see firsthand how the disease affects patients.

The emphasis was on getting people with the eye disorders to take action. “When I think about a patient who is experiencing vision impairment who may either be unsure or afraid, the first step is getting to a physician and being able to describe it,” Mancuso noted. “If there is a place where Regeneron's offerings can help, great.”

To that end, the app In My Eyes gives viewers a firsthand experience of what these conditions are like. It offers story mode and live mode. The former plops viewers into a lobby with three patients, each one showcasing a different vision problem treated by Eylea. Each patient's story is meant to underscore how these conditions can affect daily life. The latter taps into the smartphone's camera to show viewers, in their current environment, how vision can be distorted by one of those three diseases.

See also: The Science and Psychology behind Patient Engagement

“The analogy is Pokémon Go,” said Brent Scholz, VP, creative director at Intouch, about the app's live mode. “You're looking out into the world through your camera, but with three overlays that resemble each disease's effects” so you can see the blurred vision, distortion, or clusters in real time.

Virtual- and augmented-reality technology doesn't come cheap, however. A 360-degree video can cost as much as $100,000, according to a recent New York Times report.

The app debuted at the American Academy of Ophthalmology's 2016 annual meeting, where doctors could see the app in action in Regeneron's booth. Regeneron then rolled out the app to its sales force at its 2017 kickoff campaign meeting for Eylea.

See also: Devicemakers eye market for drug adherence

The behavioral rationale behind In My Eyes is to change how people view and appreciate vision disorders, and that understanding, in theory, leads to action.

“This condition is more than clinical,” said Mancuso. “It's about understanding the impact on day-to-day life. The idea behind this app was to broaden these conversations and help people take action.”





USING GAMIFICATION TO REINFORCE HEALTHY BEHAVIORS

Brand: Spiriva Respimat
Manufacturer: Boehringer Ingelheim
Campaign: RespiPoints
Companies: HealthPrize and Propeller Health

Boehringer Ingelheim launched a gamified support program for patients taking Spiriva Respimat, its COPD treatment, in a bid to keep them on their medication and reward them for filling — and refilling — their prescription.

Respimat is the successor to BI's Spiriva HandiHaler. Respimat has the same active ingredient as HandiHaler, but delivers it in a slow-moving mist meant to help COPD patients better inhale the medicine.

Known as RespiPoints, the program is the drugmaker's first gamified support program, according to BI spokesperson Chris Wahlers. It's a free online system that rewards patients for reporting they took their medication, read educational information, and refilled their prescription. Those activities give users points that can be redeemed for online gift cards. It also includes weekly quizzes and surveys. BI worked with HealthPrize to develop the program.

See also: New mobile app seeks to address medication adherence

The quizzes include such questions as “What does COPD stand for?” and “What is the first step to using the inhaler?” Patients are also asked to define a refined grain and to compare calories between healthy and unhealthy foods. Participants can also be temporarily banned from earning points if they fail to verify a prescription within 30 days of registering.

The program is “the latest in a series of efforts to empower people living with COPD to better manage their health with engaging and educational tools,” Ruchin Kansal, executive director and head of business innovation for BI, stated in a press release. Another BI executive, Graham Goodrich, VP of diabetes marketing, noted in a 2016 interview with MM&M that the company sees gamification programs, such as the one with HealthPrize, as a way to keep patients engaged through “edutainment.”

“Technology affords us the opportunity to package that educational information in a way that really resonates and promotes understanding,” Goodrich added. “The next step is, once somebody has learned something, how do we keep it top of mind?”

See also: GSK and Propeller Health's smart inhaler aims to improve adherence in clinical trials

Pharma companies have increasingly looked to provide more services “beyond the pill.” These kinds of programs, often in the form of apps or connected devices, can help patients stay on their treatment regimen and ultimately improve their experiences and health outcomes by providing incentives to keep them engaged with their healthcare. These add-ons are particularly popular for products approved to treat such chronic conditions as COPD and diabetes.

This isn't BI's first effort to change adherence through incentives. BI announced a commercial partnership with Propeller Health in March 2016 to boost adherence and patient engagement.

The platform tracks how and when patients use the Respimat inhaler to create a custom view for each patient, letting them understand the disease's impact on daily life.




DEVELOPING PROBLEM-SOLVING SKILLS TO DRIVE ADHERENCE

Brand: Cerdelga
Manufacturer: Sanofi Genzyme
Campaign: The Connections Program
Agency: Atlantis Healthcare

A somewhat-common misconception laypeople may have of patients who have a rare disease is that they all arrive at their doctor's office brimming with motivation. The thinking goes that absence of information about the condition, rather than eliciting frustration (as it does in most people), would somehow forge empowered patients who require little psycho-social support to begin and maintain a treatment regimen.

However, Laura Moore, a health psychology specialist for Atlantis Healthcare, pokes holes in that theory. These patients, too, need personalized support to adhere to a treatment regimen. “Because it's a rare disease, people assume everyone is starting from the same point,” she said. “But there are differences with each individual.”

Atlantis was tasked with creating a comprehensive support program for Sanofi Genzyme's launch of rare-disease drug Cerdelga, approved for Gaucher disease.

See also: Lilly's branded app for Trulicity looks to address adherence

The six-month program uses such behavioral change techniques as reframing and problem-solving to help patients develop the long-term motivation to keep taking their medication. “No adherence plan will last forever,” Moore said. “You want to give patients the tools to continue that positive behavior.” And this one is different from reminders or a stand-alone education effort.

It's critical to leverage these techniques to create lasting change because of how varied the rare-disease patient journey can prove. “Their journey is not linear,” Moore explained. “It would be nice if everyone started at X and ended at Y, but that doesn't happen. There are things that happen to people at certain points in the diagnosis.”

And that is why it's critical that these programs be personalized, she added. To do that, patients complete a screener at the beginning of the process that helps personalize their experience. “We have an algorithm that puts patients into either a high-risk or low-risk version of the patient journey,” Moore said. That selection determines message frequency.

See also: Boehringer Ingelheim launches gamified support program

Among the behavioral techniques in the program, problem-solving helped patients anticipate obstacles and develop techniques to head them off. “One of the common problems for patients is remembering this every day or making it part of their routine,” Moore continued. “So case managers will look to find those reasons that interrupt their pattern and work to find techniques that have helped them in their past.”

The support program also employed a social-learning model for patients to emulate how others have successfully followed a treatment plan. “One way adults learn is by understanding and observing what others do,” Moore explained. “With social learning, we use stories from other patients who have Gaucher disease who overcame similar obstacles to help people in the program. It's through this modeling experience that we can show them what a good management strategy might look like.”

The program has had a significant impact on those who have opted in, according to Moore. Patients in the program were 6% more adherent to their medication over a year than those who weren't. “It doesn't sound like a tremendous amount,” she said, “but for an ultra-rare disease, that can tally up quickly. We're proud of that.”

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