Patient centricity: From commitment to effective MC implementation

Beverly Smet, VP Business Development Sander Speleman, Sr consultant Patient Engagement

View recorded webinar: http://bit.ly/1IByvRk

Across Health Webinar

Patient centricity: From commitment to effective MC implementation

© Across Health Webinar 1

http://bit.ly/1IByvRk



AH key numbers 2015


• Focus on enhancing customer

engagement through an integrated

channel mix (“fusion”) in healthcare

• over 70 consultants

• Physical presence in 10 markets

• Over 500 projects (40% in customer

insight & strategy)

• Channel affinity of 10.000 HCPs and

Patients

• 35+% CAGR since 2007


What we will cover

• Patient centricity in pharma: the landscape

• How to engage with patients using a multichannel approach - methodology for channel mix selection - validated patient segmentation model - case studies

• Measuring impact

• Q&A

It’s changing weather …

…Market wise …Customer wise

…Strategy wise

© M

SO

ffic

e C

lip A

rt

4 © Across Health Webinar

Payers Government healthcare spending pressure More proactive management of formularies Legislative support for lower- cost generics

Specialists & GPs Prescription monopoly under erosion Access increasingly crowded Interest is decreasing Purchasing consortia taking on negotiation role

Pharmacists Expanded generic substitution power (Fr, Ger) Consultative role

Nurses From passive to active influencing role Extended prescription formulary

Patients No longer rely on guidance from physician alone

Focus is shifting from HCPs only to multiple stakeholders in pharma marketing



We spend around 95% of our budget on finding the next patient and then probably

less than 5% after we found them”

(Gary Walker, Sr Director, Customer Innovation, Eli Lilly)

Still, relative budget spent on patient-centric initiatives very low…


74%

60%

57%

54%

42%

34%

33%

31%

25%

22%

21%

18%

14%

11%

8%

6%

6%

18%

29%

15%

27%

28%

43%

27%

24%

51%

41%

37%

37%

15%

29%

23%

26%

23%

4%

7%

18%

13%

19%

17%

28%

34%

20%

25%

37%

38%

43%

46%

51%

50%

53%

5%

4%

10%

6%

10%

6%

12%

11%

5%

12%

5%

7%

28%

15%

18%

18%

19%

Pharma-owned website*

Email marketing

Direct marketing

Web Banners

SEO

Mobile marketing

SEA

Outbound call centre

Integrated cross-channel campaigns

Patient adherence tools

Social media marketing

Social media monitoring

e-sampling

Marketing automation software

e- or PHR** ad & promo services

Quantified self / self-tracking devices

Remote patient monitoring

Standard practice Pilot planned or ongoing Never Do not know / not applicable

This is confirmed by our Multichannel Maturometer Overview of patient tactics adoption in pharma (Across Health Multichannel maturometer 2015)

© Across Health 8

N = 223 EU scope

*Company, product, or disease website. **electronic or personal health record.

The role of the patient in the customer journey: 50% of the stages are patient-led

Mar

ket

exp

ansi

on

Sh

are

gain

Sa

les

op

t.

Origination

Presentation

Evaluation

Diagnosis

Treatment Choice

Brand Choice

Fulfillment

Compliance/Persistence

Stages of the customer journey Pharma programs


Economical consequences

10

36% loss in potential sales

Loss in brand equity as patient and HCP

view are negatively impacted

310 billion $ of avoidable medical spending

Source: WHO

Increasing the effectiveness of patient support may have a far greater impact than any improvement in

specific medical treatments

© Across Health Webinar

3 angles on creating a disruptive Patient- Centric model

11

Source: Disrupting the model: Patient Centricity ; Pharmavoice

Outcome based healthcare

360° patient

view

Open innovation

360° patient view

• Rapid prototyping (learn from technology peers)

• Outside-in, open approach (combine competencies of multiple companies)

• Flexible control (quick response to new challenges and opportunities)

• Portfolio management (learn from each other)

• Execute MC strategies and use analytics for future decisions

• Centralised data management for a holistic view of the patient

• Flexible segmentation that can change according to market conditions

• Integrated campaign mgmt to reach customers through their preferred channels with one-to-one messaging (MC surround sound)

• Realtime reporting to integrate learnings in campaign cycle

Focus of today

• Switch from volume based to outcome based payment

• Reward models based on cost savings

• Big integrated patient data : capability of measuring improvements in quality that are also clinically meaningful


Patient centricity is built up around 3 pillars

Across Health 12 9/20/12

Get deep insights into the

patient journey in order to

understand how

customers need evolve

over time

Interact with your patients

during all patient journey

touchpoints through the

channels they prefer

Offer tools and services

that add value to your

patients

Patient

Journey

Patient

Value Patient

Experience

2 key primary tools for collecting valuable patient insights on these 3 pillars, next to secondary research:

Across Health patient navigator (quantitative) Virtual patient focus groups (qualitative)


In order to assess Reach and Impact, we ask each Patient two key questions:

“to what extent do these channels influence your

health decision making?”

“which channels have you encountered in the

past 3 months?”

Across Health Patient Navigator : quantitative insights in channel reach and impact


Over 40 channels are assessed

pharma call print ad GP

DM radio ad specialist

fax TV ad pharmacist

newsletter billboard nurse/coach

pharma sms pharmacy ad family/friends

sample patient

brochure caregiver

pat adherence pat assoc

print content

TV content

eNewsletter search engine ad search engine

website banner ad online pharmacy

smartph app social media ad website health

facebook eNewsletter health

twitter online patients

youtube wikipedia

eLearning disease website pat assoc

Earned

Off

line

On

line

Owned Paid40 Channels Covered


• Performance Maps display Reach and Impact for each channel

• The GP channel is highlighted for comparison

GP

Impact

Rea

ch

Impact and reach of all channels are mapped on a performance map


Benchmark the importance of each channel vs that of a GP visit: Multi-Channel Equivalence Map

Impact is rescaled to allow direct

comparison with the GP (MCQ Doc)

The graphs and tables are similar to performance maps, but the GP is ALWAYS set at 1.00


Definition of MCQ

A MC Equivalent (MCQ) = A combination of multichannel interactions with a consumer/patient that equals the impact of 1 GP visit

For example: 1 GP visit = 1 click on a search engine ad + 1 website conversion + 1 exposure to a banner


An alternative viewpoint could be to take the patient association website as the benchmark

Website patient association is set at 1.00


Virtual Patient focus groups: understanding the Multichannel patient journey for information and services (qualitative)

Goal

Collect profound insights on how to engage with patients by offering engaging content and services in the format and through the channels they prefer for each step of the patient journey

Identifying the MOT’s along the patient

journey

(WHY)

Translating in a need for specific

services, content

(WHAT)

Looked up via different

channels/ sources

(WHERE)

Accessed via different formats (mobile,

online, ...)

(HOW)

Patient journey for information and services


Virtual Patient focus groups: Concept & approach

21

Client area Patient area

Whiteboard

area • Interactive 2hrs chat session with

8-10 patients

• Pre-approved script

• Visual cues to facilitate discussion

• Recurring if necessary

• Convenient for participants

no travel

• Company listens in realtime

• Participants can type

simultaneously, increasing the

amount of feedback

• Open & honest feedback as there

is no peer pressure (anonymous

participation)

• All feedback is scripted, no bias

Concept

Benefits

Case study

• Existing AED, newly approved indication • New indication : migraine prophylaxis • Market : Belgium

Insights • migraine prevalence : 10% of population, mainly women • 50% of migraine patients are eligible for phrophylactic treatment, but only 10 % get it


Campaign objectives

• Increase disease awareness about migraine

• Inform patients that prevention is possible

• Drive migraine patients to GP to request prophylaxis


MIGRAINE Patient seeks professional help (73%)

SPEC GP (60%)

ACUTE Medication

Others

-Block (44%) Others AD VPA

Switch (64%) EFFECTIVE STAYS ON -BLOCK

(36 %) PRODUCT X

Brand / Delivery Choice

Presentation

Origination

Evaluation / Diagnosis

Compliance

Treatment Choice

Fulfillment

Drop-out

PROPHYLACTIC Medication (38%) (62%)

5%

Patient journey

Leverage point


Impact

50%

10%

0,2 0,1

GP

Disease website

Re

ach

Pharmacist

TV

0,3 0,4 0,5 0,6 0,7 0,8 0,9 1,0

Social media

Print

Email

General health Website

Nurse

Patient association

Mobile app

Sponsored search ad

Specialist

Banner

1,1 1,2

Search engine

20%

30%

40%

60%

70%

80%

90%

100%

Reach and impact on health decision making of Belgian patients : Multichannel equivalence map

“Have you been exposed to this channel?”

“Have you been influenced by this channel?”

Doctor

Simplified chart derived from

Across Health Patient Navigator


Step 1 Creating the business case



• Cross industries, the golden rule is that you need 7 interactions to change behaviour

• In the past, the GP used to be THE source of information for patient health decision making

• How should the optimal channel mix look like today… and in the future ?

The “sweet spot” of Effective Frequency Source: http://inside-social.tumblr.com

You need on average of 7 “channel exposures” (with a minimum of 4) to be effective. Because GP’s are seen by patients as one of the most

impactful channels, we assume that a good disease awareness campaign should reach the equivalent of 4 GP visits


On average, European consumers visit their GP 2x/year

32%

28%

18%

12%

10%

None 1 2 3 or 4 5 or more

All Online EU Consumers=2

How many times have you seen or talked to a doctor for yourself for each of the following in the past twelve months?

Mean number of times (including zero)

Source: Manhattan Research


9/20/12

So a good disease awareness/ patient activation campaign should generate the

equivalent of 2 GP visits

2 GP VISITS

2 Multichannel equivalents (MCQ) +


Leverage Point Behavioral Objective Strategy

Building the business case

Awareness & Presentation

Inform migraine patients on new generation treatments in prophylaxis

Stimulate more patients to ask for prevention

Calculation of the desired number of GP equivalents

Target group Target group size*

GP visits Additional MCQ needed

Desired # MCQ’s

Avge reach top 10 channels

Possible # MCQ’s

Visits doctor (73%)

365.000 2 2 730.000 29% 211.700

Does NOT visit doctor (27%)

135.000 0 4 540.000 29% 156.600

Total 500.000 1.270.000 29% 368.300

* Target group size : Belgian population is 10mio, women 50%, 10% prevalence

Stimulate patient-physician interactions


Based on the SOV need (368.000 MC GP* equivalents), a channel mix calculation takes place

*A MC GP equivalent = a combination of multichannel interactions with a target customer that equals the impact of 1 GP visit ** 2000 pharmacists (40%) & 1500 GPs (15%) ordered the promotional kit before the start of the campaign; 73% presentation of population *** Derived from Digital ratecard Sanoma magazines (2,1 mio / month)

Channel Reach

TG Response

% Interaction

ZG Channel Weight

# MC GP Equivalents

Search engine advertising Q1 – Q4 3.000.000 5 150.000 0,4 60.000

Awareness leaflets GP Q1 – Q4 ** 55.000 25 13.750 0,7 9.625

Awareness leaflets Phamacist Q1 – Q4** 146.000 25 36.500 0,7 25.550

Banner Flair Q1-Q4*** 25.200.000 0,1 25.200 0,4 10.080

Overlayer Flair Q1 10.800.000 0,1 10.800 0,6 6.480

Banner / Overlayer Skynet Q2-Q3 40.000.000 0,1 40.000 0,4 16.000

Pharmacist 146.000 30 43.800 0,9 39.420

Poster campaign Q1-Q4 201.000 5 10.050 0,5 5.025

TV press release 250.000 100 250.000 0,3 75.000

Radio press release 150.000 100 150.000 0,3 45.000

Newspaper press release 200.000 100 200.000 0,3 60.000

Activation website (quizz /diary conversion) 150.000 35 52.500 0,7 36.750

Total 80.298.000 982.600 388.930

982,600 interactions with the target group:

ca. 389.000 MC GP equivalents (MGQ)


Data collected via 300 representative GP’s. All data are extrapolated to the national universe (=12.500 GP) – Period : Q4 / 2005 Q1 2007

Rx split - All Migraine prescriptions : preventive vs acute treatments

36,6% 38,8% 38,1% 37,8% 40,1% 43,4%

10,6%11,1% 12,5% 12,2% 10,9%

10,0%

52,8% 50,1% 49,4% 50,1% 49,0% 46,6%

Q4/05 Q1/06 Q2/06 Q3/06 Q4/06 Q1/07

Only LT Both Only Acute

Preventive treatment growth +19% in year 1

Q4/Y1 Q1/Y2 Q2/Y2 Q3/Y2 Q4/Y2 Q1/Y3

Business impact

MS more than doubled over a period of 1 year

1,2% 7,1% 11,1% 14,9% 14,7% 16,0%10,2%

9,1%8,7%

7,8% 9,2% 9,7%

45,3% 39,0%38,3%

40,1% 41,2%46,1%

15,5%23,6% 20,3%

18,8% 13,3%8,0%

27,8%21,1% 21,5% 18,3% 21,7% 20,2%

Q4 / 05 Q1 / 06 Q2 / 06 Q3 / 06 Q4 / 06 Q1 / 07

Topamax Depakine Inderal Redomex Other profylactic treatments

Q4/Y1 Q1/Y2 Q2/Y2 Q3/Y2 Q4/Y2 Q1/Y3

Product X

Rx share within preventive treatments segment - Total Belgium


35

One size doesn’t fit all…


Segmenting patients is KEY to provide tailored support that is based on their needs and thus improves adherence outcomes


A validated patient segmentation should be the foundation of your program

• Collaboration with Sjaak Bloem (Professor at Nyenrode Business university and associate director innovation at J&J) and Joost Stalpers (J&J)

• Overall functioning with chronic disease based on level of control and level of acceptance

• Correlation between functioning and adherence

• 6 question barrier assessment leading to 4 patient segments

37 37 © Across Health Webinar

Patient segments are derived from 6 questions

Please indicate the extent to which you disagree or agree by circling a number 1 = fully disagree to 7 = fully agree (presented in random order) Acceptance Q1. I am at peace with how my health condition is Q2. The way in which I am functioning physically and mentally is acceptable to me Q3. I accept my health condition the way it is Perceived control Q1. I have the feeling that I am having grip on my health condition Q2. My health condition is to a great extent in my own power Q3. I have a substantial amount of influence on my health condition

Cut-off point high vs low acceptance: avge (Q1+Q2+Q3) = 5,333

Cut-off point high vs low control: avge (Q1+Q2+Q3) = 5,666


4 patient segments, each with different needs and expectations

control

“Engaged”

Confirmation seekers

~25%

“Emotionals”

Structure seekers

~20%

“Unintentionals”

Motivation seekers

“Disconnected”

Perspective seekers

~50% ~5%


The higher the level of overall health functioning the higher the level of adherence is

Segment progression (and indirectly adherence levels) can be measured by asking these questions at regular time intervals during a patient support

programme

control

“Engaged”

++ “Emotionals”

+

“Unintentionals”

“Disconnected”

-- -


The Across Health patient navigator also looks at relative channel importance by segment

Example of relative channel importance by segment (TA not disclosed)

Source: Across patient navigator


Example of how insights from the patient navigator and virtual patient focus groups are brought into practice

Basic assumption : a movement between segments takes 3 months on average


Simplified campaign journey/ segment

27x /


Measuring ROI & other KPIs of patient-led programmes

A holistic approach of measurement

ROI = f (REACH, ENGAGEMENT,

CONVERSION, ADVOCACY, COST)

ROI = f (NEOCORTEX + LIMBIC)


Example of Impact measurement patient support programme

Leading indicators Lagging indicators

Qualitative

Feedback from stakeholders and patients e.g. Ease of patient enrolment in programme Knowledge improvement patients Brand differentiation for reps …

Patient evolution of wellbeing according to segmentation model Measure movement between quadrants

NPS Recommendation of program by patients

Morisky (self-reported adherence)

Quantitative

Operational metrics % recruitment vs. population, activity level on website, engagement and interaction with channels

Medication Possession Ratio

Cost per patient for running the program

46

Patient centric metrics / commercial metrics


Healthcare

Patient centricity: From commitment to effective MC implementation