Insight Exchange: Point of Care
Several distinguished experts from pharmaceutical marketing and media descend on the offices of MM&M to discuss the evolution, effectiveness and measurement of point-of-care communications. James Chase takes the moderator's chair
James Chase: I've heard a number of varying definitions of point-of-care (PoC) media, so what does it mean to each of you?
Lynn Benzing: I can see why you're getting different definitions: PoC could be the physician's waiting room, or it could be the treatment room, it could be the diabetes nurse education room, it could be a Wal-Mart that has a doctor in the store… PoC is evolving and it's not that mature as a media outlet.
Debra Sangiuliano: I would say it's targeted communications that focus when touchpoints occur. I see it as educational and self-selected, but it's much more of a pull than a push.
Meg Columbia-Walsh: So you don't think of it as a place where care is occurring?
DS: Yes but then they select a brochure or they look in a magazine. They're selecting their pharmacy, they're choosing to watch the video screen. So it's targeted, but self-selected.
Mike Boken: I see PoC as the main place that a healthcare decision is being made. And oftentimes, I think we look at the PoC as just the interaction between the doctor and the physician. But I think there are other healthcare decisions being made, online for example. And frankly, I don't usually confine it to consumers, because there's a lot of great PoC marketing to be utilized with physicians as well, to remind them when they're seeing certain types of patients that there are products available.
MCW: I think one of the very important things now is the peer-to-peer. In certain categories, consumers are going to each other. I mean, lactating moms are absolutely we know talking to each other before they're going to any physician, and that's more so I think when you look at the Boomer population. It's a very powerful group of people, and they become experts themselves. If a company or a product is not in the “ambassador system,” if we are not showing up where they're talking to each other, if we are not in that point of discussion around care…(it's not just point of care, it's point of discussion around care) we are missing something. We need to figure out how to partner with those ambassadors and those curators and influencers. That's really critical.
Traver Hutchins: Traditionally, when we think about PoC, it's in the proximity of the learned intermediary. It could be in a pharmacy or in a doctor's office, but it also doesn't mean that you aren't working through a nurse practitioner, it doesn't mean that you can't be out in a church organization where they have a health clinic. So for us, our definition has been that there is somebody there that has accredited health experience who is educating or has the opportunity to educate. And, therefore, there's a heritage of trust that comes along with it, that this information is in fact better than just a mom across the way. So, I do see much more of a pull than push, a lot more targeted. As the consumer in PoC, you traditionally have the opportunity to engage in education when you want it—on your terms—and to therefore have a more intelligent discussion with your learned intermediary.
The patient-physician dialogue
DS: To me it also starts with the physician. You can help influence them whether you're doing script-writing or PDA programs…get them aware of things. You can have gray areas too, like the appointment cards. Do you surround-sound it with the patient and the physician? To me that would be the best mix, so you get the physician and the patient thinking the same way, whether it's an in-office television, magazines, brochures, and for the physician it's PDA, script-pads, just more tactical type PoC media.
MB: If we're talking about traditional PoC, you have a localized patient that's coming in to see their healthcare provider, and PoC in the traditional sense… it's a last-ditch effort to say, “Hey, you might have seen my other ads in leisure magazines…” You have one last time to stimulate them before they go in there and have that healthcare conversation with that physician. And it may be around a product or a disease, but that's your opportunity, again, while they're localized. So it's like the 11th hour opportunity when they're in the office.
MCW: Vox (a CommonHealth company) has been filming doctor/patient visits for seven years, and I was absolutely astonished at what I witnessed and saw. I think now, something you see that is really important particularly in the siege of traditional DTC and marketers going to their consumers is the dialogue. We went from “go to the shelf” to “ask your doctor” as a call to action. Now, what we're suggesting is “present your story.” When the doctor begins to ask “How does this migraine affect your life, how does this ADHD affect your life?” we're seeing an unbelievable response at the PoC in the traditional sense. We've educated them but I still don't think we've empowered consumers. I really feel like if we can do a better job there, we can get them to finally understand why they need to stay on a medicine.
JC: So how do you convey that information to both the physician and the patient then?
MCW: You have to go to the influencers who've actually been doing some work around testing. “How much time does it take to get the context? Can the doctors actually ask more open-ended questions and then provide the materials?” You put out something that they're supposed to hand the patient but the tips for them are on it as they hand it to the patient. I think relevance is key here all over the place. Whatever medium we're in, if we're in the internet, then that's where we're hooking them up together. In the exam room, in the waiting room, I don't think it can be passive. I think it has to be some way that we're enabling them to improve that dialogue. 90% of our products stop in three months. How do we get past that magic number? We've been working here a long time to try and fix that.
LB: I think today PoC media is really about achieving awareness that is relevant at this moment in time, because it's right before they're going to go talk to their doctor: maybe they forgot the product name and then they see it and remember, so it's very much a key moment. But I think this notion of truly reaching the patient at this teachable moment…you can't do it all in seven minutes. It's almost like you have to provide a jumping-off point for the dialogue to become rich. And over time you have to get them past the 90 days, so it's the beginning of a journey.
TH: What we try to do as marketers is to make it a better seven minutes. What's the best seven minutes? As a company, we have for over a year been selling the doctor discussion card. We go into the market and say, “Look, let's develop the five things for your category. If you know that you can get the patients completely, ask these five questions then you will convert the best script to the most appropriate patients.” And I am shocked and disappointed to tell you all that not one said, “And I will do this through my detail effort.”
MCW: I do think this really talks of one thing, which is innovation. I think that we have gotten comfortable in a regulatory environment to say, “Oh, it's not going to go through.” I cannot tell you how many clients I went to that got furious in the room, insisting that the patients are asking for their drug, that the doctor does say, “Here it is, you can have it.” I don't know how we get there, because everybody is all pitching and selling their marketing plans, but we have to come up with a forum where we begin in our own industry to challenge that. We're happy to talk about innovation—I can get a client to think about avatars and social networking—but what about our traditional (communication)? I just think that's really critical, that PoC becomes something that matters.
TH: …Overall DTC works generally, and there's a sense that things aren't really broken. That it's OK, I agree. But you can do studies that show the effectiveness of what we're talking about here. Everybody talks about tying in the professional and consumer…why aren't they doing it?
LB: It's funny how an industry 10 years old could become set in its ways. I just want to throw out a question: Have we become too fixated or too focused on the patient/healthcare provider dialogue? Because that's the point at which the script is
MB: A lot of our focus has been on the brand and the doctor…we talked a lot about persistence and compliance, we talked about how little the patient has time to spend with a physician, and it gets to be a problem, because the patient walks out and thinks, “Well, I've got this diagnosis and I'm supposed to take this medicine,” but they don't understand the “whys.” We talked about that too, like, “Why are you taking Lipitor?” “Oh, it's going to get my cholesterol down and prevent stroke and heart attack, and if you control it you're going to live longer.” Some consumers are making that purchase decision, like, “Jeez, it's $30-$40, and it's back-to-school time so I'm not going to take it.” One thing I think when you examine PoC that we haven't really talked about yet is like samples. I think there's a big opportunity that's missed explaining the “why”… We are fortunate because our drugs are controlled substances so you can't give away samples. So we had to get a starter card that's activated, but with that you have a CD-ROM and a whole information kit. To activate the card the person has to opt into our CRM program— 95% of them do. Unfortunately, I think a lot of the other products are missing that.
TH: What would be your premise for if you're managing staff and you did a cards program where you didn't get the samples right there and you had to go to a pharmacy? Do you think that would increase or decrease non-compliance? Getting that first script is a thing we've all seen, and half of all of these prescriptions never even get filled. Would CRM programs help that?
MB: That I don't know the answer to without researching it, but let's say you give them a 30-day supply that's built into the sample instead of the doctor handing a couple bottles over to the patient, he hands them whatever those punch-plastic things are, and then there's information that's part of the sample that's given to the patient, at least you take one more step to say, “Hey, here's information as to why you want to stay on it.” I think that opportunity's missed a lot of times.
MCW: I mean some of the things we've seen in the statin market, because of course that's really one that's being studied very much so, is if you look at the language between the doctor and the patient, it's all about numbers. Patients don't want or understand numbers, and the conversation is six minutes of numbers. We need a re-definition of “success,” because the physicians always say “let me give you this” instead of “why did you fail?” or “Let me show you how we can improve your…” and not switch them off the product.
Scale and ROI
DS: Mass distribution DTC as we've kind of termed it means “television…” One of the reasons that brand and consumer don't really talk much, is because if you're a brand that doesn't really do DTC, they don't have the communication to talk to the consumer because that's not what they have done. I'm a professional marketer, so I sell professional materials. So if the opportunity comes up to do some PoC, I don't even have the materials to even consider it. That's not what my budget is built on. There's a lot of these little PoC providers, there's no mass reach. I think that's been one of the biggest barriers to PoC, is the ability to actually have mass reach, to really influence a large group of people.
TH: We see the same thing. There are always great industry programs, they all have different widgets, they're all very effective on scale. Anytime, in any other business category, what happens when that's the situation? Consolidation, and because each of those types of companies are innovative, they're all good in their own way. The mass media can't really drill down into pharma, because pharma is just one of 40 categories they're in and they're not in to impact DTP. So if we're talking about moving away from 50% of the budget automatically going to go to DTC on day one and then the rest gets split up, that's a perfect mix, and in five years from now, I guarantee you that you'll see consolidation.
DS: And that would be exciting, because to me this notion we touched on of this idea of patient empowerment by having a comprehensive strategy is getting great success in the market. So if we had a market solution like you said (with the CD-ROM and the kit), and they're surrounded by information at the point that they need it, so now you're really empowering the patients to understand their own health condition, and then if you could have consolidation so you have scale, then maybe it would all come together and that'd be great. I don't think we have enough options. Traditional media planners know how to plan television, print, interactive, but then you go into this clinic, and it's so down the road for them… now you have to go to five suppliers to do basically one type of channel to get the scale.
TH: You have to drive consolidation because there is that opportunity and that will be taken care of.
DS: But what if people didn't end up doing those planning things? They buy that media; the media people don't buy that media.
TH: If you look at it differently in terms of what makes the cash register ring, wouldn't that sort of change the dynamics and interest levels of all interested parties? In other words, if we started to verify script activity as a result of the DTC or DTP activity, like, “I spent this much money, how many Chevy's do I sell?” We've gotten away without doing that in mass media. You can absolutely track relative to activity if there was some sort of engagement, some sort of ROI tool. There has to be something where the consumer raised their hand in that program. If that was the new client of the realm, would that make it more worthwhile to the buyers and to the clients? My ROI on TV has been well reported to be $2.20. That's what it is. Not bad, you put in a dollar and get $2.20 back. On PoC, on average, I'm seeing 10 to 1. It's more work; you've got to buy 20 programs.
MCW: But the less you spend, the better your ROI will always be.
TH: If we're not there, we're very close in terms of actual script movement. I feel it is there, all the PoC opportunities that we have on an ROI basis. If you use the same criteria with mass DTC I think you might be surprised, you might find it more efficient, better things, actually moving more script. Because this isn't about mass, it's about mass clients, more people on script. It's smaller but there's more people coming in…
MCW: We are in a world right now where scale can be achieved through viral communication pretty significantly. In brands outside of our industry, this is just daily business and in ours it hasn't been. But our consumers, particularly Boomers, are more sophisticated. It takes a lot of work, a tremendous amount of work. I'd venture to say we lose money as a result of it in the short-term, but in the long-term I don't think that's true.
DS: I think that's where it becomes difficult. I'm not saying one's better than the other, I'm not saying you definitely need both, but I'm just saying it's just more difficult, and that's why people haven't taken advantage of it, for a couple reasons: A) they don't have the creative, and B) it's viewed as a one-off, because a brand person brought it and it's not draft… It's not viewed as media either.
TH: We've seen the benefits of both working together. Specifically we've seen it in DTC, TV and print working together, and now with the internet as well. The mix is going to change. It's been 50% broadcast, general media gets around 27%…so do you think that that's going to be optimized in a different way? Or do you think that five years from now the mix will be the same that it's been?
JC: Is it easy to put your money into TV and print?
MB: It is easy. I think a lot of times, especially in big pharma, the rule of the room is you have the DTC guy making a campaign, and by the time you make the campaign you've got all these beautiful pictures and these nice-looking people and this nice commercial, and you buy the media, and you think, “Oh, my money's spent.” Part of it is just thinking about it differently, and coming to your senior management and saying, “Look, there's a different way to do this that we want to pursue.” If the people are in a space long enough to digest what tools you have, they will come back in the next brand planning cycle and say “OK, we did that last year, now I have a better understanding of all the tools in my bag to more align things, I think I'm going to mix it up a bit.” What I've seen is that the project management teams aren't in place long enough to really start to think about things…you just don't have that professional, true understanding of everything that's out there that you can attract the consumer with.
TH: Not only do you have to build scale, but you have to build snapshots, so that within real-time, you show success so that the brand manager has perspective and doesn't have to wait two years to see it. He or she can see snapshots and build the relationship based more on a banking relationship—a guaranteed outline. So maybe that type of thing could help with the perspective: The idea of selling products as opposed to just doing faith-based marketing to the masses. I think that's what's causing the political issues out there. It's all about markets for people who have no ailments or don't know anybody who does. It's wasteful. In PoC, if something's amis, it's an aperture to serve up educational solutions first.
JC: Looking ahead, at what point are we going to divert some of those “faith-based” dollars away from the few blockbuster brands that are left on TV toward more PoC-type marketing plans?
DS: It goes back to metrics. There are some PoCs that have metrics, but a lot that don't. So I think they lose out. They don't have validation to actually say “we're putting them in the office.” Where is the distribution, who is looking at it? What are the metrics and how do we agree what they should be?
MB:With the future of the industry not being based on blockbuster drugs but more on speciality kind of disorders, you get to a point where the broad awareness isn't affordable, and it's not necessary because you're looking at such a small slice of America that has a disorder, it's got to be more important to delivering effective PoC marketing. That's getting the message right to the patient at a critical time so that they understand, they stay on their drug because getting to the patient any other way through broad media just isn't going to deliver any return.