The Age of Engagement

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Patient marketing—as a catchall phrase for engaging patients with a brand—is extremely varied and diverse in practice. Patient marketers utilize everything from traditional TV and print DTC to online social communities, unbranded disease awareness websites and product sites, to elaborate adherence programs across scads of media outlets. 

In considering the phrase itself, it has become evident that the former term, patient, is where the singular emphasis lies. The latter term, marketing, is increasingly shaped, not by product managers and account directors, but by empowered consumers no longer satisfied by brand soliloquies and one-size-fits-all content. Being able to first identify individual patient needs, and second, pinpoint how, when and where to meet them, is crucial in designing and executing a successful patient marketing campaign. 

“It's all about customer needs defining the brand experience, especially since the number of voices that are weighing in and impacting the dialogue…have multiplied,” says Ann Friedman Ryan, SVP, director of CRM and interactive at CommonHealth's consumer group EvoLogue. “What we really need to do is be able to be an active part of that dialogue and to engage our consumer base on their terms—to make sure that we understand their needs.”

Therein lies the challenge of patient marketing: patients have different needs based on diverse personalities, and ultimately, different lives. So, how can marketers effectively engage a target audience of insomniacs, for example, since individuals comprising that group can be as different as night and day? A state-of-the-art online campaign won't reach the Luddites among us, just as a 15-second TV spot might not impress the most tech-savvy connoisseur of online healthcare content. On top of that, patient classifications—age, gender, astrological sign—aren't necessarily good indicators of how an individual makes decisions about health. “There isn't a cookie-cutter solution,” says Ryan. “Emerging channels are proving themselves effective for certain brands, depending on how well they're done,” adds Shelagh Brooke, EVP, chief strategic officer at EvoLogue, but there isn't any one approach that's effective on its own.

In terms of content, health literacy is an important area to consider, according to Susan Eno Collins, SVP, health education, at HealthEd. “In order to drive any kind of action or change, [patients] have to understand the information that's in front of them,” said Collins during an MM&M webcast on patient education. In that respect, explains Ryan, it's necessary to provide diverse content so that patients can access the information that's relevant to them on an individual level. “A brand journey and a customer experience is not a linear experience. All of our messages and all of our content and education are going to be relevant at some point to all of our customers.

In addition to tailoring educational content and branded messaging to patients' needs, generating awareness for a specific condition and facilitating the conversation patients have with their physicians are two key areas in a successful patient marketing initiative. Brooke cites Lilly's campaign for Cymbalta as a good example of driving awareness for a differentiated problem. “[Lilly] launched ‘Depression Hurts' unbranded, and it focused on the problem and the patient experience as a way to connect with what people were feeling and noticing. They executed it in a way that allowed them to send those patients to content either online or offline, where [Lilly] was able to tell a larger story about depression in a way that led to their differentiation,” she says. “If you present a differentiated problem—which you can do well with an unbranded campaign—it leads to a differentiated solution. Cymbalta is for depression as well as aches and pains associated with depression. Now, Cymbalta is also indicated for fibromyalgia, and pain is certainly one of the most pressing symptoms that people feel. That was very successful for Cymbalta.” 

Brooke says Sanofi-Aventis is doing something similar with its “Know Your Rooster” campaign for Ambien CR. “They're creating a different problem, and they're doing it in a way that's very engaging and that grabs people's attention. It's not that you just have trouble going to sleep. It's that you have trouble staying asleep, that you wake up in the middle of the night, says Brooke.

Online social networking and user-generated content is an important part of the new media landscape, according to Ryan. “It allows us to go where our customers are, and to integrate into their lives, as well as to benefit from a halo of credibility just by the nature of the medium,” she says, citing “friends” in a social network or relevant content in a contextual placement. “By using those kinds of channels, we're able to keep our finger on the real-time pulse of what's going on with our target audience, and not just as it relates to them as patients, but their lives—the context in which their condition may affect their needs,” says Ryan. 

Both Ryan and Brooke underscore the complementary role of DTC in providing initial contact and interaction with a brand. Brooke offers the example of Wyeth's “Know Menopause” site. Once online, women are then able to have a full discussion. “That's where you get that engagement and interactivity—but [Wyeth] still did traditional unbranded DTC to drive people to the site,” says Brooke. 

Drugs don't work in people that don't take them
Believe it or not, some people just don't like taking medications. That can be dangerous not only for a patient's health—as evinced by former US surgeon general C. Everett Koop's quote—but also for a manufacturer's bottom line. 

Stanley Wulf, chief medical officer at InfoMedics, a service provider offering self-reported patient feedback to improve patient-physician communications as well as provide brand insight to manufacturers, describes the situation as a leaky bucket syndrome. “For the last decade or two the pharma industry has had such a healthy, robust pipeline, that the amount of water coming in the bucket—income from new drugs and blockbusters—has been so much greater than the loss due to non-compliance, that in a way there hasn't been a need to look at what is being lost through the holes at the bottom of the bucket,” says Wulf. “Now, as the pipeline has been drying up, suddenly the losses through the holes in the bottom of the bucket are depleting the bucket. That's one of the reasons pharma is saying, ‘hold on a second, it's not good enough any more that one-third of prescriptions are never filled, it's not good enough any more that 50% of chronic medications end up non-compliant. Half of the time the sales are lost to non-compliance. Those are huge losses.”

In order to drive adherence and compliance, it's important, again, to understand patients as individuals. According to Wulf, 20% of patients will be adherent no matter what kind of hoops they're made to jump through. Conversely, another 20% are stolid non-adherents regardless of what measures are taken. The remaining 60% “is where you really can influence a change in behavior and adherence,” says Wulf. 

Wulf identifies the barriers to adherence in several ways. “Reveal barriers” are barriers that can be directly addressed with a patient. “You can say to a patient, ‘Do you sometimes have problems remembering to take all your medicine?' and that's very clear and it's easy for a patient to say, ‘You know, I do,” and you can deal with that,” says Wulf. “Derived barriers,” on the other hand, are barriers such as the denial of a condition, mistrust of a medication, and comprehension issues. 

Another division to consider when promoting adherence is whether a condition is symptomatic (asthma) or asymptomatic (high cholesterol). “When you have symptoms that drive adherence, your issues are when the symptoms get a little bit better, people start forgetting,” says Wulf. “With an asymptomatic condition, you can scare people—‘if you don't take your cholesterol medication you have a higher chance of having a heart attack'—and that lasts for a while but then it dissipates.” These patients need a flexible adherence approach, for when adherence starts to wane between the third and sixth month, says Wulf. 

A dialogue is at least a two-way street
In order to comply with and adhere to a medication, it must first be prescribed. “Our point of view,” says Brooke, “is that all communications should be working toward modeling and making it easier for patients to actually present the story of their lives, whatever it is, to their physicians.” A product site is a great place to start in facilitating patient/physician dialogue. “If you look at a brand like Detrol LA, they make the point about the importance of talking to your doctor and having a Detrol discussion,” says Brooke. “[Detrol LA's] campaign directs people to a website where there's an actual dialogue tool of ‘here's how to talk to your doctor.” 

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