The Patient Marketing Report: Group Therapy

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It doesn't take several years of post-graduate studies and a degree in medicine to describe what it's like to live with a disease. From a patient's perspective, the practical wisdom available in an embarrassing anecdote, or a triumphant description of a breakthrough, can sometimes provide more value than any discussion to be had inside a doctor's office.

Additionally, direct-to-consumer advertising, for all of its patient-centered emphasis and messaging, doesn't necessarily affect the behavior of real patients, at least in terms of requesting brands from doctors. Data compiled by Verilogue, a company that records and studies physician-patient conversations, found that DTC advertising drives patients to request specific brands during in-office visits only 3% of the time (out of a study of 12,500 interactions). “Notably, physicians are more likely than patients to reference DTC ads in these conversations,” says Jeff Kozloff, Verilogue's CEO.

For marketers, harnessing the value of patient-to-patient disease communications online can be a ticklish endeavor. The importance of perceived authenticity—regulatory requirements notwithstanding—can present a challenge for even the most transparent educational campaign, branded or not. However, new strategic partnerships with a loud focus on meeting patients' needs, and a quieter focus on meeting business objectives, are accomplishing both.

For other patient groups and their caregivers, point-of-care models, direct mail and email, mobile applications, video and TV continue to be invaluable channels in a successful patient marketing campaign.

Social Media & Patient Communities
To effectively engage patients, and keep them engaged, marketers need to understand what kinds of information and services are needed at the individual level. To that end, Novo Nordisk, through a partnership with the International Diabetes Federation, the International Society of Pediatric and Adolescent Diabetes and experts in the field, sponsored the Diabetes Attitudes Wishes and Needs (DAWN) Youth WebTalk Survey in 2007, an extension of the DAWN initiative beginning in 2001. The findings, culled from 6,500 participants from nine countries, “indicated that the psychosocial aspects of coping with diabetes are particularly important to address for youth and young adults…and their parents,” according to Susan Rago, director, patient services and professional relations at Novo Nordisk.

When the Juvenile Diabetes Research Foundation (JDRF) approached Novo Nordisk in February 2008, the organization “had done its homework, by proposing a concept that was in alignment with Novo Nordisk's focus on empowering an important patient and caregiver segment,” according to Rago. Through an “unrestricted educational grant” from Novo Nordisk, JDRF launched Juvenation.org, a social networking community for type 1 diabetes patients.

Though Juvenation.org does not allow manufacturers to send product-specific messages to its user groups, Novo Nordisk (manufacturer of Levemir and NovoLog insulin products for type 1 diabetes) and other corporate partners are able to maintain a presence via corporate logo placement and visibility. JDRF monitors site page views, unique visitors and membership growth, and also acts on the insights gleaned from group discussions, in order to stay relevant and keep patients engaged, says Rago. JDRF is responsible for site content and operations, and monitors conversations for “appropriateness and approval of online content, safe-guarding of audience and meeting regulatory guidelines,” says Rachael Lewinson, national manager, online communications, JDRF.

“To create win/win partnerships…it is essential that the initiative creates mutual and relevant value to each partner and targeted patient/stakeholder groups, leverages the strengths of each partner, aligns with respective business objectives and delivers upon pre-agreed performance metrics,” says Deno Syrios, national director, marketing and corporate relations at JDRF.

Juvenation.org, built by marketing agency Ignite Health, features member blogs and groups including parents of children with diabetes and diabetic athletes, a college life group, a poetry and funny stories group, and a “sick of diabetes” group, among many others. Forum topics cover blood sugar readings to “the worst diabetic crime you've ever committed,” and everything in between. Banner ads sponsored by Medtronic direct visitors to a free webinar on the subject of insulin pump therapy, or a registration form for a free glucose monitoring system.

Through another unrestricted educational grant, Shire Pharmaceuticals partnered with Dialysis Patient Citizens (DPC), a patient group for dialysis and pre-dialysis patients. DPC Classrooms, the Shire-sponsored portion of the website, offers virtual “classrooms” for dialysis patients. The first classroom, launched in late summer of 2008, focuses on nutrition, from “kidney-friendly diets” to the role of phosphate binders—such as Fosrenol, a Shire product—in managing one's health. The classroom, created by MicroMass, is the first of many other classrooms that will eventually comprise an entire school of health, according to Bill Leinhos, director, dialysis clinics, at Shire. A second classroom focused on building heath networks—including caregivers, nurses, renal dieticians and others—is currently in the works. “Dialysis patients can be on 12 different medications, while also balancing socioeconomic issues. It's important for Shire to bring in materials and tools outside of the specific core condition,” says Steve Carickhoff, product manager, Fosrenol. The community of dialysis patients is fairly small—around 350,000, according to Leinhos, so the wisdom in partnering with a pre-existing group like DPC was self-evident.

According to Manhattan Research, the most frequented patient community sites encompassing multiple conditions include DailyStrength.com, PatientsLikeMe.com and CarePages.com. In June, UCB announced a partnership with PatientsLikeMe.com for an epilepsy-focused patient community expected to launch in early 2010. Maureen Malloy, manager, strategic marketing and corporate communications at Manhattan Research, pointed to a study from late 2008 that found over 60 million US adults using health blogs, online support groups and other health-related social media applications. Over 20 million adults in the US have posted health content online, according to the Manhattan Research study.

Online Video & iPhone apps
With the sheer amount of video online increasing exponentially by the second, being in the right place at the right time—with the right video—is more important than ever. Raj Amin, CEO and co-founder of HealthiNation, an independent producer of health videos, says online video is a great way to engage patients—if the context is right. “If we're looking for women in a very specific demographic, they could be on a gaming site,” for example, says Amin. HealthiNation partners with over 50 web affiliates spanning condition-focused sites to lifestyle and nutrition properties, in addition to providing cable television subscribers with video-on-demand options.  

Beyond location, another important consideration is a consumer's motivational stage. While some patients may be looking for straight facts without the gloss, others need a stronger entertainment hook to be engaged. For the latter group, HealthiNation creates video content dubbed “edutainment,” or educational health videos developed by a team of doctors and media experts designed to provide informational content in a snazzy format. “Pharma is understanding that it is high quality video that engages consumers,” says Amin. “Viewers spending a longer amount of time on a video have expectations of higher quality.”

GirlTalk, an edutainment-based video series that included advertisements by Schering-Plough in support of the contraceptive Nuvaring, features episodic discussions between young women hosted by Annabelle Gurwitch, an actress, author and activist. Topics include stress, dating, relationships, diets and body image, and are spliced with long-form video advertising for Nuvaring—usually close to three minutes—that resembles the Girl Talk format. Viewers can skip over the Nuvaring ad at any time and continue with Girl Talk, although a stationary Nuvaring banner remains just below the video player. Amin says the company is able to measure how much time is spent viewing a brand-oriented message, as well as click-through rates and unique viewer numbers. On the back-end, clients can measure those conversion rates with product sales, he says.

GirlTalk content, which targets women in their early twenties to mid-thirties, is somewhat broad in terms of audience, but that was appropriate for Nuvaring. HealthiNation can create video with a tighter focus—for diabetics pre-insulin, as an example, says Amin, as well as video for conditions that require a more inclusive educational campaign, such as fibromyalgia.

Additionally, HealthiNation offers targeted email programs that serve up videos focused on compliance, such as motivational stories. “Most pharmaceutical companies have their own email compliant platform,” acknowledges Amin, adding that HealthiNation's platform is integrated and can work with internal programs. In April, the company announced a partnership with A.D.A.M., a health information and technology solutions firm, for the launch of Medzio, an iPhone application linking smart phone users to HealthiNation and other content suppliers. Amin says only a small percentage of HealthiNation's overall viewership is currently watching videos on mobile devices, although the company is testing iPhone capabilities.

In other online video news, Merck and Allergan have both recently launched celebrity-helmed video series. Merck's unbranded HIV/AIDS education series, titled Living Positive By Design: Creating Positive Conversations, stars Jack Mackenroth, a designer on Project Runway. The series premiered on Myspace (www.livingpositivebydesign.com) in September, and was created by M-Street Creative. Allergan coupled actor Michael Welch of the Twilight movies with High School Musical-themed online video in support of Aczone, an acne medication. The campaign, titled Aczone the Musical and found at www.aczonethemusical.com, was created by Indelible.   

In addition to online video, a panoply of health-related iPhone applications have launched in recent months, allowing on-the-go patients to keep records of their health as it relates to a condition in real-time. Some of the apps deliver sponsored messaging and reminders to patients as well. For $4.99, patients with Crohn's disease can purchase an iPhone app called GI Monitor, to record their symptoms and transfer the information to doctors. A Humana subsidiary called Sensei launched a $0.99 app last April for patients looking to manage their diabetes in real-time. The app also includes a checklist to help facilitate patients/doctor conversations, and the company is in discussions regarding “customization opportunities for other stakeholders,” which could “enhance compliance and brand loyalty,” said CEO Robert Schwartzberg in April. Lifescan, a Johnson & Johnson subsidiary, is currently testing an app that would sync glucose meter readings with the iPhone.

3D models, direct mail and point-of-care
Buried beneath the hubbub of Web 2.0, iPhones and social media, innovative patient tools and materials continue to be created and used by most pharmaceutical manufacturers. However, Marc Sirockman, general manager at ArtCraft Health Education, a New Jersey-based supplier of patient education materials, says all models and illustrations are not created equal. “We see patient education materials all the time that are clearly medical illustrations,” and thus not appropriate for patients, says Sirockman. “There are [depictions of] kidneys out there that would scare the crap out of you…the idea isn't to scare the patient, but to educate him or her.” Sirockman says new PhRMA guidelines in 2008 destroyed budgets as companies scrapped old materials. However, things are picking back up now, he says.

At the doctor's office, materials for patients have to enter with sales reps, and that won't happen if they don't have value for the rep. “The healthcare provider is the next shareholder, with the ultimate destination being the patient,” explains Sirockman. For patients, models are a vital means of orientation within the body—a key in the learning process, which leads to better adherence and compliance, says Sirockman. An attention to detail is crucial when developing models or illustrations. “We test our patient education materials with healthcare providers and nurses to ensure optimal size, color and font sizes,” says Sirockman. The 3D models are used at the point-of-care, and some are created as demos for patients to take home. Other models and stand-alone pieces are more traditional, with universal slots for brochures or other materials, says Sirockman.Shire's direct mail campaign for Fosrenol, a tablet for dialysis patients, consists of five communications over four months, according to Carickhoff. Call centers staffed with renal nurses communicate with patients as a part of the program, and ask patients if they're still taking Fosrenol, explains Carickoff. As a result, patients have been shown to adhere to Fosrenol regimens at a rate of 37% above patients not enrolled in the program, says Carickhoff, when measured using IMS prescription refill data.
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