Until the start of this decade, the buying and selling of health media was an old-school, relationship-driven operation. Marketers and publishers would position themselves on opposite sides of the table and joust about pricing and placement. They’d strike a deal, then move on to the next one. If science informed the process in any significant way, you’d be hard-pressed to tell from the decidedly analog back-and-forth.

So when programmatic technology came to healthcare, it was inevitable that every stakeholder constituency — the buyers and planners who traditionally led the charge, as well as publishers, behind-the-scenes strategists, and brand overlords — would have complicated feelings about it. On one hand, automating the buying and selling of media real estate would force-feed efficiency into a notoriously inefficient process, especially in the digital universe and its almost limitless advertising canvas. On the other hand, cue the “robots are here to replace us” fears of media execs.

You could forgive health-media firms for becoming complacent. Until programmatic came onto the scene, they rarely had to make a case for their utility. Pharma marketers turned to them for all their buying and planning and tactical needs, because who else in the marketing ecosystem was qualified to handle the assignment?

This changed in a hurry, leaving any number of media purists staring down a technology that, at least in some minds, poses an existential threat. Even as programmatic has come to dominate health media — “I haven’t seen a media plan in some time that doesn’t include at least some programmatic,” says CMI/Compas EVP, managing director, growth and innovation Justin Freid — many execs have yet to fully accustom themselves to the new technological world order.

“There has definitely been some systemic anxiety, particularly at those organizations that are less tech-focused,” explains Justin Chase, EVP, head of innovation and media at Intouch Solutions. “We still hear a lot of, ‘So I can’t just be a pharma media expert anymore? I have to be a pharma media tech expert now, too?’ For a lot of traditional media folks — great, smart, seasoned pros, but without that tech background — it’s been a little bit imposing.”

Publicis Health Media president Andrea Palmer agrees, to an extent. “Everybody bought into [programmatic] as a concept, the idea we’d use an arbitrage model to figure out ways of buying audiences rather than websites, right off the bat. But there are still people who think it will end the [media] business as we know it.”

For a lot of traditional media folks — great, smart, seasoned pros, but without that tech background — it’s been a little bit imposing.

Justin Chase, Intouch Solutions

But first, some context. In the beginning, there was print. And as Amy Levinson, president of A.L.L. Global Media Solutions, jokes, “Three whole places to advertise to physicians. We had journal ads, direct mail, and prescription pads.”

CMI/Compas COO Eugene Lee, who deadpans he “gets blamed for bringing [programmatic] to CMI,” recalls the pre-programmatic era as almost the health-media equivalent of the Dark Ages. “We used content and editorial as an analog for the HCP audience,” he explains. “In buying an ad, we had no other way to determine if the person seeing it was a physician, other than, ‘Oh, this is physician content. Who else would it be interesting to?’ Usually, I just bought medical content.”

That changed when Lee attended a conference in the mid-aughts that tracked programmatic’s emergence in other verticals. When he inquired about its potential utility in health, Lee was dismissed with a wave.

“I heard, ‘Health is too small. The professional health audience is too small,’ stuff like that. But the ability to eliminate waste [with digital buys] and target HCPs without hitting anyone else, these were things everyone wanted to do,” he says. “When you presented [programmatic] that way — not as a threat, but as another tool in our toolbox — clients got it right away.”

When you presented [programmatic] that way — not as a threat, but as another tool in our toolbox — clients got it right away.

Eugene Lee, CMI/Compas

Most of the true evolution occurred during the few years that preceded programmatic’s emergence in health media. During that period, which roughly coincided with the start of the current decade, pharma learned to love data and took its first, perhaps overly cautious steps into channels such as social media.

“Pharma found ways to be creative and to participate in the contemporary media landscape in a manner that wouldn’t have been possible prior to that,” Palmer says. “It set [the industry] up for what we’re seeing now. The norms shifted.”

The health-media landscape shifted along with them. As data became the coin of the realm, media execs wanted in on the quantify-everything action. Given the rapidly changing environment, programmatic was received far more warmly than it would have been even a few years prior.

Not everyone is on board

Which isn’t to characterize the overall response as warm. Levinson, for one, didn’t buy into the initial hype on either a theoretical or practical level.

“To me, programmatic flies in the face of ‘fish where the fish are,’” she explains. “With programmatic, what you’re essentially doing is following the fish. Why am I going to chase them from here to there when those fish are watching ESPN on a Friday night and not exactly thinking about Parkinson’s?”

Levinson is just getting started. “Here’s another comparison: the idiot Uber drivers who don’t know how to drive across the city and rely on an app to tell them how to go,” she continues. “That’s what I think of when I think of programmatic: You’re relying on the technology to lead you.”

Publishers also had their concerns. Lee recalls the most intense and “tug-of-warish” conversations about health and pharma programmatic came with publishers who weren’t all that keen to accept outside valuations.

“We didn’t come in aggressively. It was more along the lines of, ‘Some of this [space] has X value, some has Y value, some has no value,’” Lee explains. “We said that when we could identify the value of an audience, we’d pay a premium. Before they may have been underselling themselves by attaching a single cost to all [their space].” This issue, Lee adds, continues to rear its head.

To me, programmatic flies in the face of ‘fish where the fish are.’ With programmatic, what you’re essentially doing is following the fish.

Amy Levinson, A.L.L. global Media Solutions

The worry among health-media execs was, and to an extent still is, that the industry would fall in love with the efficiencies programmatic promises and automatically assign it pole position in the digital media mix. Indeed, pharma’s history suggests organizations are often quick to embrace the next big thing, to the detriment of all that came before.

To illustrate this point, Chase refers to that most obvious of health-marketer analogues: the NBA’s Houston Rockets. Under GM Daryl Morey — basketball’s “Nerd King,” per Michael Lewis’ The Undoing Project: The Friendship That Changed Our Minds — the Rockets embraced the information/analytics era in a manner so all-encompassing that “enthusiastic” doesn’t do it justice. As part of the team’s analytic deep-dive, Morey tapped a card-carrying quant to break down at a granular level the precise times and places on the court at which superstar James Harden was most effective.

“What types of moves and shots are resulting in the best outcome? Where on the court and at what point on the shot clock should he get the ball? Those are the questions they answered,” Chase says.

The problem came when Harden bought into the program without hesitation. “He became too focused on the data. He trusted his instincts less than he did what the quant guy told him.” Harden adjusted, claimed the 2017-2018 MVP award, and is the favorite to win another for the 2018-2019 season. Meanwhile, the Rockets have made the playoffs six consecutive years.

The lesson here for pharma media types: Don’t go overboard with your embrace of all things programmatic. “There will always — always — be a need in this business for great creative, strategy, and thinking,” Chase notes.

‘Both art and science’

Indeed, if there’s a single thing upon which the health-media world agrees, it’s that programmatic buying in a vacuum is a disastrous idea. “Media is both art and science,” Levinson explains. “You can’t take one out of the mix, especially when you’re dealing with HCPs. As another supportive placement strategy, [programmatic is] fine. On its own, it doesn’t drive conversions.”

Palmer warns marketers against overcorrecting to what she calls “pure-play programmatic,” which she says is mostly useful for providing an impetus to take another action. “It’s like TV that way. You hope the audience goes to a website at some point. Response rates from pure plays are still low and are always going to be low.”

At the same time, Palmer believes healthcare marketing in general has a longer tail than programs in and around other verticals, which means programmatic can play a valuable part by planting the proverbial seed.

“Our role is to provide the right information in the right place for people to make better healthcare decisions and ultimately achieve better outcomes, which can mean being there for [patients or caregivers] for months or years until they’re ready to make a decision,” she continues. “If I see an ad for tacos, I might think, ‘Oh, that sounds good for dinner tonight.’ But the likelihood that somebody is in the market for a pharmaceutical product, and that any ad can break through the clutter, is really low.”

Whether or not the health-media community is sold on programmatic’s virtues, its continued adoption is all but assured. When Chase joined Intouch nearly two years ago, he was told to expect “hockey-stick-shaped growth” from the firm’s programmatic arm. That prediction has been borne out: Intouch did around $3 million to $4 million in programmatic buys in 2016 and will likely do $25 million this year.

The programmatic community needs to iron out some existing issues around fraud (for example, counting non-human traffic as human), and brand safety will continue to pose headaches. As hard as the technologists have tried, they’re still unable to guarantee that a programmatically bought ad won’t pop up next to content that’s off-brand or off-putting.

Another question that seems likely to arise is ownership of and access to coveted media data. “There’s been a little bit of Oklahoma land-grabbing going on when it comes to the data component,” Lee says. “The default model should be that everyone should have a view into the data.”

Along those lines, boosters and skeptics alike hope to get more of a glimpse behind the curtain. Chase points to one company, Ad/Fin, that is reportedly trying to make programmatic a totally open marketplace, complete with full visibility into how much a given ad sold for and who bought it. In other words, the current New York Stock Exchange model.

That detailed understanding of who the audience is and their preferences is what every marketer is looking for

Justin Freid, CMI/Compas

Whatever tweaks to the technology lie ahead, programmatic’s rise ensures a prominent place at the table for media people, be they buyers, sellers, strategists, tacticians, technologists, or quants.

“A couple of years ago, brands would come up with these plans and say, ‘Here you go, media agency. Go follow our strategy.’ Now, media agencies are leading those conversations,” Freid says. “Media organizations can tap into data about how audiences operate across devices on a daily basis. That detailed understanding of who the audience is and their preferences is what every marketer is looking for.”