In my last blog post, I used the pharmaceutical industry’s quest for patient centricity as a jumping-off point to discuss how pharma companies need to focus on customer centricity, rethinking their commercial strategies to better address their many stakeholders in the evolving healthcare ecosystem. But since patients’ wellness is the pharmaceutical industry’s reason for being, patient centricity should remain pharma’s North Star.
To get a sense for what’s truly possible for pharma’s patient-centric efforts, and what progress is being made, I recently called my colleague, Hensley Evans, who leads our consumer and patient marketing practice. Hensley has worked with a plethora of biopharma and healthcare companies, and she also brings her expertise in B-to-C companies’ customer-focused initiatives, having previously worked with consumer packaged goods organizations. We had a spirited discussion about patient centricity’s challenges and opportunities, and, amidst it all, the need for pharma to keep its eye on the ball. Here are some excerpts from our conversation.
Pratap Khedkar: Everyone in pharma—and in healthcare more broadly—is talking about patient centricity, but even if the patient is at the center, pharma finds itself at the periphery. Can pharmaceutical companies truly be patient-centric when they’re so far from the patient right now?
Hensley Evans: The primary challenge that’s preventing pharma from being truly patient-centric—in the way that companies in other industries are customer- or consumer-centric—is the fact that pharmaceutical companies are at an arm’s length from patients. Several intermediaries directly or indirectly control the decisions that patients make about the medications they take. Pharma has to pay attention to who is paying the bills. Although patients are paying a larger portion of their overall healthcare costs, seven payers and pharmacy benefit managers are controlling 70% of the drug spend.
Healthcare providers are the intermediary between patients and pharma on the therapy choice side, and payers and PBMs stand between pharma and patients on the payment side. If I’m pharma and I’m only paying attention to the patients, I could wind up serving the needs of a small percentage of patients because I haven’t paid attention to the people making the payment decisions.
PK: Yes, pharma needs to work better with other stakeholders—with payers, employers and the government. How can companies design effective programs that both include and reach patients while keeping those stakeholders in mind?
HE: Unfortunately, there’s not much transparency around the partnerships that pharma is creating with payers and employers—and, in some cases, state governments—to provide services. One pharma company recently partnered with a Fortune 500 corporation to drive better diabetes screening and diagnosis among the employee population. It’s an example of a large employer having a vested interest in keeping its employees healthy.
If those employees are diabetic or prediabetic and undiagnosed, it’s obviously in the corporation’s best interests from both an employee productivity and a healthcare cost standpoint to get them screened and diagnosed or into preventive care as quickly as possible. And it’s in the pharma company’s best interests to get the patients diagnosed so they can theoretically get on the pathway sooner and start treatment. It’s a good example of a partnership that’s serving the financial interests of both companies while also serving the patients because it’s providing earlier intervention and better education to employees.
PK: In effect, both of the companies are saying, “Let’s go around the payer,” which is a provocative approach. Could pharma appeal directly to employers more often to get closer to the patient without the key stakeholder who controls the money getting in the way?
HE: Yes, but it’s obviously only reasonable with the largest employers. You’re not going to do that at scale, but it’s possible with companies that have 50,000 or more employees. It’s a pretty compelling proposition. From what I know of the program example in this case, the pharma company was in negotiations with the corporation for more than a year to get the program in place. You’d have to create a model that allows you to scale it more quickly.
PK: For instance, one collaboration that might be interesting is the Healthcare Transformation Alliance. Although the HTA is in its formative years, 20 big employers have gotten together—Macy’s, Coca-Cola, Verizon, etc.—to pool their healthcare data. If there were some sort of consortium or aggregation like that, maybe pharma could act directly with them or through them as opposed to trying to go to each company, which, I agree, is a nightmare because of the fragmentation. It’s interesting to consider the institutional approach with payers, but let’s get back to the patients.
One challenge that stops us, as an industry, from getting closer to the patient, besides HIPAA and other things, is just sheer trust. A 2016 Gallup Poll found that no other industry is held in lower esteem by U.S. citizens than pharmaceuticals. The only thing that came in below pharma in the survey was the federal government. [Laughter] In order to be patient-centric and walk the walk, pharma has to do something to reverse the trust deficit. Any ideas on how to repair the trust gap?
HE: That’s an excellent question. Some pharma companies are starting to do more work around reputation marketing.
One of the best examples of reputation marketing historically is the BASF campaign: “We don't make a lot of the products you buy. We make a lot of the products you buy better." It’s about trying to humanize a big chemical company to say: “Hey, we really are a consumer company. You just don’t know about all of the things we make that make the things you enjoy better.” Whether you think that campaign worked for BASF or not, the awareness of that campaign was high.
Pfizer is doing that with their “Get Old" campaign [a content-focused initiative on aging that launched in 2012], and a few other companies are looking to shore up their reputations directly with consumers. Johnson & Johnson has been a leader in the space for a long time through social media and other broad corporate communication initiatives.
Then there are loads of companies that have just ignored the problem and hoped it would go away. How is anyone going to hear a different story if we aren’t telling it? The pharma failure to tell their own story effectively is a big miss. Consumers aren’t just going to figure that out.
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PK: Yes, it really is a big miss, and pharmaceutical executives agree, although they do so privately. The biopharma industry is trying to address this collectively through efforts like PhRMA's "Go Boldly" campaign, but individual companies should consider investing in reputation marketing initiatives to start changing negative perceptions—or even to bolster positive perceptions.
When pharma does actually get into conversations with patients as opposed to communicating with them through ads plastered on TV, is that proving to be something valuable to the patient? Can pharma build on the conversation idea?
HE: Pharmaceutical companies are anxious about having direct conversations with patients. There’s been so much concern about adverse event reporting, and compliance and regulatory issues.
Pharma is finally trying to create more of those direct relationships through patient advisory boards, especially in the specialty and rare disease space. One avenue is co-creation programs between pharma and patients to gather insights on services and interventions for patients. Who knows better what will and won’t work in supporting patients than patients, themselves? You could argue that patients don’t know everything about what they need, but they know a lot.
PK: Does the approach require a third-party intermediary so that a pharmaceutical company can be completely patient-centric and not tied down by the legal risk? Essentially, is there a need for another layer so that pharma gets insulated but not too much because creating more distance from the patient is hardly a good idea? Has someone found a way that’s, perhaps, not so onerous?
HE: I don’t think anyone has found a perfect solution. It seems like creating advisory boards that have pre-built approaches to compliance and monitoring adverse events is one possible solution instead of having random pharma employees talking to patients.
PK: Whenever I go to a conference, the panel usually includes a patient advocate, especially in the specialty areas like oncology. They speak passionately and they chide pharma, saying, “You guys need to partner with us more.” The patient advocacy people certainly have influence, but it’s unclear as to whether their agendas truly represent the whole patient population’s interests. Is that a channel you feel is worthwhile?
HE: Nobody knows how to partner with advocacy organizations, and they don’t always have the same goals and objectives as pharma when it comes to patient care. Associations and advocacy groups have long looked to pharma to fund programs, but true partnerships are a bigger challenge. The advocacy group might say, “We’ll partner with you, but we don’t want to promote anything that’s branded that might feel like marketing.” And, of course, pharma says, “What am I trying to achieve with this partnership?”
PK: We discussed the challenges in every direction, whether it’s trust or stakeholders and partnerships, whether it’s cooperating with other emerging platforms such as advocacy or technology firms. Is there also a central mindset issue? Do we need a new generation of marketers to come up and ease into the new way of thinking?
HE: It’s a real pendulum. I see organizations that have developed conviction that the patient is critical to the decision-making process, as well as more and more companies committing to providing broader patient services, listening to patients’ needs and working to provide something of value. On the promotional end, companies are also investing in patient education and advocacy, but when companies are looking to cut budget, that’s often one of the first things to get cut. Some organizations are swinging away from the patient as the key decision drivers.
On the other hand, categories like oncology are starting to understand that the patient plays more of a role than they had given the patient credit for in the past. Overall, the market is becoming more patient-focused and acknowledging that patients have decision-making abilities, but it still swings backwards occasionally. Two steps forward, one step back.
Hensley makes a good point. When the pendulum swings like that, it damages trust in the long run. It communicates to the marketplace that the patient is the last thing added to the priority list and the first thing to be cut when times are tight. The pharmaceutical industry’s focus on patient centricity has to become more consistent and holistic, and must be sustained. Companies have to start doing a better job of positioning patients at the heart of their strategies, their R&D and their go-to-market models—and communicating that patients’ wellness is, in fact, the pharmaceutical industry’s reason for being.