Working with Washington

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The president of the United States fired the CEO of General Motors. Depending on your ideological leanings, you may cheer or groan at the news—but the facts are plain to see and the reality has been evolving for some time now:  the federal government is going to be increasingly in the middle of business—especially businesses that are heavily regulated by the government.

Pharmaceutical and medical device companies are clearly affected by this new reality. While they are not asking for any bailouts, they are nonetheless dependent on policymakers, regulators and a small cadre of influential individuals (as a tribute to the last administration, let's call them “deciders”) to approve reimbursement, set clinical guidelines, determine risk-benefit tolerances, approve risk mitigation plans, set liability standards and design a health system that encourages appropriate utilization of their products or services. The decisions made in Washington, DC, will echo out across the private healthcare sector.

One familiar with the healthcare sector might ask, “So what's new?” After all, these “deciders” have long held a prominent role in clinical approval and reimbursement. Is anything really that different?

Yes. It is different. We've reached a tipping point. For example, whatever guidelines are constructed in Washington about comparative effectiveness research will ultimately pit products and services against each other based on cost or value.

The selection and design of these comparative studies will often end up being more important to a product's success than all of the marketing efforts behind the product. And under healthcare reform, government and other payers will be even more pressured to set limits on what they will and won't reimburse. Decisions about reimbursement will become inherently more political and based on many factors beyond clinical effectiveness.

The questions for those in the private sector are: How are those decisions going to be made? Will there be meaningful public input? History would suggest that advocacy and communications play a critical role in the way policymakers ultimately evaluate particular products and therapeutic areas and whether there is supportive policy and regulation in place to further their development.

For product communicators, this poses a new challenge—they will now have to work through the labyrinthine layers of bureaucracy and deal with murky and often hard-to-quantify success metrics, rather than devoting all of their time and energy to informing patients or physicians.

But product managers and marketing communicators cannot simply pass the buck to their government relations colleagues or ignore the new advocacy needs because it's not part of their traditional marketing portfolio. 

In fact, put simply, it is now incumbent on product communicators to take responsibility for building their communications plans around these deciders as much as around their more traditional target audiences.

The reason is obvious: As we look to the next few years, we know that the policies emanating from Washington will be critically important in determining what products are accepted and successful and which are not, because they do not meet the standard set by the policymakers.

Product communicators must integrate public and regulatory affairs, marketing, communications and other disciplines to inform the system and to ensure that all considerations, beyond just the apparent cost of a product, are taken into account by payers, regulators and other deciders.

Here are some specific actions product communicators should consider taking:
  1. Build communications around the value proposition for your product. In the long run (or increasingly the short run), payers will not pay for products when they don't understand the value proposition. This isn't simply a job for your payer group armed with clinical data and price charts – it's your job to communicate with payers, policymakers and patients about how your product is solving their problems. Doing this in a disciplined way builds brand strength.
  2. Make product communications a multi-directional conversation. The rise of social media is the harbinger of a different kind of dialogue—one that is multi-directional rather than uni-directional. In practice, this means activating others to help you get your message out. Partnerships with payers, enlisting patients and physicians as advocates and leveraging the microphone of policymakers are to your advantage.
  3. Embed genuine patient advocacy in your communications. Active patient support for your product is critical. Too often, building patient advocacy is an after-thought or is neglected until there is a problem. This is very different than traditional marketing partnerships that are more focused on delivering a defined set of metrics. These “transactional” relationships have value, but increasingly the non-transactional relationships with patient organizations and patients themselves will prove most productive.
  4. Think about the intersection of policy and your product.  What's the value of better compliance? Of greater quality of life? Are there disease categories where expedited review or higher reimbursement will fit into the agenda of controlling healthcare costs? In a world of limited resources, these are the types of questions that will be increasingly addressed by policymakers. On the positive side, there may be real opportunities to grow market share by effectively engaging with the system.

For example, perhaps a portion of the money spent on product promotion aimed at individual patients could be better spent creating policy-level demand for appropriate incentives for early diagnosis, adherence, counseling, etc. In some cases, it is easier to change a system (even as difficult as that may be) than it is to change the individual behaviors of millions of patients through a communications program.

Conclusion
While there will be winners and losers, there may be a bright side as well. The “deciders” addressed through this kind of program can have a profound effect on the success of the product and can help create an environment of acceptance and support for a product that would be much more costly to create through traditional means.
In the words of President Obama: “Change has come to America.” The time to get out in front of that change is right now.

Robert Schooling is the chair of APCO Worldwide's healthcare practice
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