Seeing people, not pixels

The iPad has been one of the most anticipated gadgets to come about since the iPhone in June, 2007. To quote the Wall Street Journal, "Last time there was this much excitement over a tablet, it had some commandments written on it." This weekend, the iPad will launch with all of the excitement and more of the original iPhone. The device has many critics who point out that its lack of Adobe Flash, multi-tasking and camera will make it Apple’s next failure, similar to its now infamous Newton PDA. Other’s are more optimistic about the device and see it revolutionizing how we consume media. As an ex-Apple employee and admitted “fan boy” - I’ve already pre-ordered mine and eagerly await its arrival. While I’m very excited about the new product and the catalyst it's sure to be for the current “tablet” marketplace, I’m wondering how it fits into the Pharma marketing mix. Whenever new platforms or technologies come along, we get lots of interest from our clients. The question we have to ask back is if it’s right for their target audience. We are not resistant to innovation and change, but sometimes it’s not the right fit for a demographic even if it’s the coolest thing in our minds. For now, I feel that the iPad has a lot of potential in the Healthcare Professionals (HCP) sphere of promotion. I think that in time, Direct to consumer (DTC) marketing will find its place in mobile advertising and the iPad specifically. For HCPs, there is no doubt that they are aware and interested in using the iPad. In a recent survey by Epocrates, the medical software company found that almost 60% of doctors are considering the iPad for their work, with a third of those ready to buy. This presents a great opportunity to reach HCP audiences who already have the device, as well as leverage their existing interest in the device. The iPad or devices like it could become the most valuable tool in a Sales Reps detailing kit. Only a few months ago Pfizer armed their sales force with $1500 tablet PCs. For half of that, they could have purchased the cheapest 3G model at $629. In addition to the hardware costs, imagine the savings of not having to print and drop ship sales aides when a regulatory or marketing change is needed. Available for download from the Apple iTunes App Store, AT&T WorkBench helps extend existing enterprise application services to iPhone / iPad through secure web apps hosted in a managed environment. It enables companies to deploy enterprise applications in a highly-secure manner – even on mobile devices purchased by an individual. With this tool, a technician can securely update an online interactive sales aide to all reps within just a few hours. For the physicians that have an iPad, medical reprints might become a thing of the past. Instead, companies could offer a custom ePub version of a journal article for HCPs to load into their iBooks App. There are plenty of other ways the iPad can help save time and money while putting a far more interactive marketing platform in an HCP or Reps hands. A few more ways it could be applied include:

• Medical Meeting Booth Touch Points
• In-Office Patient Medical Device Training
• On-Demand Detailing / CME

For patients, there are a few obstacles ahead before the iPad or any other “smart” devices can be utilized fully. The main concern is the open “review” feature for Apps. It’s a regulatory person’s worst nightmare - an open text field. This means potential Adverse Event reports and potentially negative comments in general from consumers. To place a patient focused “App” on the iPad, Pharma will need to go the “Web App” route. In place of “Native Apps,” more companies are turning to optimized “Web Apps.” Web Apps offer several advantages over Native Apps. Web Apps remove the open review field, as well as cut out the developer channel step of submitting to Apple. This way you gain the ability to instantly update your Web App, just like you would for a brand website. I’m very excited to see how the iPad will be used among marketing teams across different brands, both Pharma and Consumer. Whether you think the iPad is just another flawed Apple product or the next great thing, it’s sure to spur innovation and creativity in new ways of reaching physicians and patients. Top of mind for each of our clients is achieving a high-value result that is both timely and delivered within ever-tightening budget constraints. At Compass, we are constantly evaluating our delivery process to uncover ways to increase our efficiency and timeliness. We also do our best to educate our clients on how they can help. The following are three quick tips I can offer from experience in managing the delivery of interactive programs for nearly 15 years. 1. Be realistic about what you can achieve. Have you ever found yourself in the middle of a great meal at a favorite restaurant when you suddenly – and regrettably – realize that your eyes were bigger than your belly? Project bloat causes that same queasy feeling. When new project enthusiasm morphs into to a mile-high stack of manuscripts, wireframes and design concepts on your desk, you know you’ve ordered more than you can comfortably swallow – and that you’re not going to meet your deadline. The cost of extending your project’s budgeted duration can lead to significant cost overruns. Time is a silent budget killer. Not only is it costly to keep your team (and your agency’s team) engaged in a project that’s beyond its planned duration, but you’re delaying ROI and missing opportunities to engage those teams on new projects. Even worse, delays can result in missing the window of opportunity to capitalize on the market insight that led you to invest in the project in the first place. To avoid these hazards:

• Be honest about how much time you can carve out of your schedule to work on each program or project in your marketing plan. Share this with your partners so that they know what to expect and how to engage you.
• Be aware of the effort and timing impacts of other projects in your pipeline on your staff and your organization.
• Launch content and features in phases. If launching a new site, start with a placeholder site or HCP-focused content to establish a presence and then follow up with additional content and features.
• Avoid “over-socializing” your project within your organization in the early stages – which can lead to scope additions and time drag from stakeholders not directly invested in your project goals.
• Come to terms with the reality that it’s probably going to take longer than you think – and budget accordingly.

By setting bite-sized, realistic goals you give yourself and your team an advantage in delivering a successful, timely program on schedule and on budget. 2. Make regular, clear communication with partners and vendors a top priority. You want the best-of-the-best working on your brand for each thing that you do. But what happens when you can’t remember if you told the PR agency or the branding agency or the offline agency or the interactive agency about the new market research insights you received last week? This is an issue with which nearly every busy brand manager struggles. Clear and consistent communication can help to avoid the extra time, effort, churn and rounds feedback. As a start:

• Take the time to talk with your partners each week. If a weekly “status report” format feels like a root canal, be open with your partners about what format works for you.
• Get your agencies and partners together on a regular basis and encourage inter-agency collaboration. Insist on inter-agency cooperation.
• Conduct all-agency calls at least quarterly to ensure that everyone is on the same page.
• Ask for feedback from your partners regularly. Invite them to tell you what they need from you to deliver their best work.

Excellent communication ensures that all of your partners are working as efficiently as possible, with the most current brand and company insights, to deliver a cohesive and impactful brand experience. 3. Schedule an early stage concept review with your med-legal team. At Compass, we’ve had the great fortune to work with clients that have a passion for innovation and exploration. We’ve delivered some of our best work as pioneers in uncharted territory (see www.pku.com). Key to our success has been early partnership with our clients’ medical / legal / regulatory (MLR) teams. People support what they help to create. Early concept reviews help to:

• Provide insights that can put your marketing program on a path to “approvability”.
• Save time and budget dollars that would otherwise be spent on creating potentially troublesome program elements.
• Minimize costly rounds of review.
• Foster a relationship of trust and collaboration with your MLR board that makes them want to find ways to help your program succeed.

Whether we’re sharing a strategy deck, storyboards, wireframes or an interactive prototype – at Compass, we believe early support from MLR is essential to successful innovation. Behavioral and demographic targeted ads in the world of online advertising are nothing new to marketers, but for the average consumer and internet user, the reasons why they are seeing a particular ad is somewhat of an enigma. It all comes down to your internet history, or at least your history since the last time you cleared your cache. The sites you visit, the pages you view and in Gmail's case the words you type in an email are all captured, and that information is used to display ads that are more relevant to your personal interests. I was first introduced to the use of behavioral targeting in Gmail. For anyone who uses Gmail I’m sure you are familiar with the column of paid search ads running down the right side of your conversations. One day, I noticed that the ads for beach house rentals was particularly relevant to an email exchange with my friends over our pending long weekend at the beach. The coincidence stumped me for a moment, but then the realization came. Gmail was using keywords in the text of my conversation to display relevant and targeted paid search ads to me. And if this was momentarily baffling for me, it must be for others not so internet savvy, especially when it is used in display advertising and not in something as obviously personal as Gmail. So when I stumbled across the recent New York Times article discussing a new icon meant to inform consumers about the use of behavioral targeting I felt compelled to put fingers to keyboard. The use of targeted ads is on the rise. Government criticism to the practice is becoming louder. More and more consumers are questioning the “why” behind the ads that they are seeing. A little icon, an “i”, developed by the advocacy group, the Future of Privacy Forum, is supposed to help. The idea was to create a symbol that would become as synonymous to information about targeted ads, as the three-arrowed triangle is to recycling. The “i”, within a circle on a blue background, will direct users to a page explaining how their web history and demographic profile was used to determine that they would see this particular ad.¹ More marketers plan to utilize behavioral targeting in their media buys, but face resistance over using that data from consumers and the government. In a recent eMarketer report, it was estimated that behaviorally targeted advertising is expected to rise at a steady growth rate of approximately 20% year over year from 2009 to 2014, topping off at $2.6 billion in 2014.² Marketers view behavioral targeting as an effective way to cut through the ad clutter that consumers are increasingly getting bogged down with and therefore have a tendency to ignore. The “i” is meant to be an important step towards making consumers and the government more comfortable with the practice. So what does it all mean? For marketers, as the use of the “i” becomes more ubiquitous, creative will need to be developed or adapted to accommodate the symbol (and creative folks will need to get used to a little icon interfering with their aesthetic). Education will need to be given to clients and to other internal stakeholders within their organization, about it and what it means. Also, it’s yet to be determined if the web page explaining the “i” and the use of behavioral targeting will be a standard link, or if each company will be responsible for developing and hosting their own page. It’s still debatable whether or not all consumers will embrace targeted advertising as it grows in usage. Providing an informational tool to increase the transparency between consumers and advertisers is certainly a good step, but I have to question if it will truly alleviate any unease that some consumers may feel at having examples of their captured behavior staring them in the face. Personal privacy, especially online, is a growing concern for many. For every user that doesn’t like it, I’m sure there will be many others who already do welcome targeted ads and will continue to welcome them even more as they grow in prominence. If you have little control over the fact that you will see advertising online, almost equivalent to the amount of control you have over exposure to television ads, why not embrace ones that will be much more meaningful to you? In my opinion this is a win-win for both consumers and advertisers. At the very least, targeted ads will translate to increased brand awareness, if not click through rates, while consumers will be exposed to new products, services or messages that are much more meaningful to them.

1. Clifford, Stephanie. “A Little ‘i’ to Teach About Online Privacy.” New York Times 26 January. 2010. Media & Advertising. 2 February. 2010
2. “Privacy Restrictions May Open Ad Targeting Doors.” eMarketer 1 February. 2010. eMarketer Daily. 2 February. 2010

Pictured on right: Wardendyffe Tower in Long Island was planned by Nikola Tesla to provide the whole world with wireless electricity. It may seem like an uphill battle. How could a patient change the way a physician prescribes? Believe me, I’ve heard it many times before. “We don’t focus on patients,” and “Our only real target is physicians – patients don’t matter.” Really? That sounds like a great strategy – for 1997. Let’s keep up with the times, people. Consumers are hungry for information. It doesn’t matter what the category. My dad used to choose whatever the local mechanic recommended, but now he won’t even buy a new headlight without searching ratings, reviews, and shopping engines. People want to be fully informed before making a decision. Show me the CARFAX! So why would we think healthcare is any different? People want to make the right decision when it comes to health and safety, and they will do the research. So why fight it? It isn’t hard to give people what they want. It doesn’t require a multi-million dollar ad campaign. You just have to be there when they are looking for you (even if they don’t know they are looking for you). 1-800-flowers can run commercials all day long and I may never feel the need to order flowers. However, a search ad is very likely to get my attention when it appears for the term “same day flower delivery” on October 7th (my Mom’s birthday). This is exactly how it works in pharma. Consumers develop symptoms/are diagnosed/need a refill and immediately start searching. These are the opportunities you must pounce on. They are looking for you. They want your help. Encourage them to seek diagnosis. Prompt them to ask questions. Help them save money. If you don’t, your competitor will. I have a great case study, but first something I stumbled upon while writing this post. I asked a coworker to pick a random disease and then I started searching. “how can I stay awake?” “narcolepsy treatment.” “ghb coupon.”All roads should have led to Xyrem. But they didn’t. They led to Nuvigil. Even a search for “xyrem coupon” led me to Nuvigil. The icing on the cake – Xyrem.com won an eHealthcare Leadership Award in 2008 for “best website.” People want to be empowered, and they will use the tools you make for them. But only if they can find them…having a great site does nothing for you if people can’t find it! Let’s get back to my original question. Can patients influence prescribing habits? Well, I work with a smaller brand in a marketplace dominated by several blockbuster drugs. This smaller brand can’t afford a big consumer campaign, but they do make sure they reach the right people at the right time. Year after year they continue to prove that smart paid and organic search campaigns get results. Results that are driven by patient requests. Patient requests for a brand that those patients had never heard of before they started searching. This brand dominates natural search, continually being the only brand on the first page for key disease-state terms. This natural search presence plus a strategic paid search campaign has resulted in highly qualified patient traffic that continues to increase every year. More than 20% of their traffic in 2009 printed a coupon and 30% of those prints were redeemed. Need more proof? The brand did a 3rd party study and found this interesting stat: In 2009, 10% of their prescriptions were driven by patient requests. Not bad for the annual cost of a handful of sales reps. The audience for online video is proving itself insatiable, offering opportunities for sharing and connection on a global level previously unimaginable. With viewers “tuning in” to watch video online, the consumption of broadcast content will continue to morph dramatically. Pepsi opted to skip advertising in the the most widely-viewed sports events to focus on social media efforts. Soon, Hulu could become more of a threat to traditional television than DVRs. Some companies continue to use long-form video, such as GlaxoSmithKline and the Alli-themed documentary, but brief, serial clips may yield an advantage for continued engagement. In pharma, the opportunity is yet to be fully seized. Nearly half of online physicians in Western Europe reported watching Web videos for professional purposes. At the FDA social media hearing, we learned physicians watched instructional videos online the night before performing an orthopedic surgical procedure. And this doesn’t change translating from professionals to consumers. Video can be extremely effective in communicating with patients and caregivers beyond simple text. Video can communicate complex ideas, such as mechanism of action, more easily than the written word. Patients telling their own stories in their own words yields greater emotional engagement. And, very often it becomes viral. This should encourage brand managers to recognize the unique benefits of video and leverage these assets online – whether on corporate, unbranded or products sites, or shared on social media channels. As we have been discussing on our blog, many pharma companies have been contemplating the implementation of HCP RM programs, although very few have made any concrete progress. The initial steps companies have been taking are all too familiar, however, and I am concerned that the industry may follow the same path that they followed in the adoption of interactive marketing back in the late 90s/early 2000s. The path goes something like this:

• Identify an emerging trend that presents a new marketing channel opportunity (ie, the Internet)
• Research and purchase a large, comprehensive system or platform that is a “best in class” solution for highly sophisticated marketing campaigns (think BMS and Broadvision)
• Pay an enormous sum for an outside consulting firm to determine the best way to implement the platform and train the organization…and then spend a year+ doing so
• Attempt to force brands to use the resource by mandating platform usage as well as providing partial funding and man power
• Do all this before the solution has been proven successful to brand marketers, or before they understand how to integrate it into their marketing plans

What then follows, of course, is that the platform is under leveraged and usually deemed obsolete three years later, after millions of dollars have been invested and much time wasted. Finally it took some “Cowboy” brand manager on an overlooked brand (See Famvir at Novartis, circa 2001, the first brand to utilize an online coupon) to be the first mover, which the company then used as a model for the rest of the organization. Why didn’t this path work for “e”, and why won’t it work for HCP RM? Two reasons:

1. The company failed to follow a simple business rule – fulfill market demand. In this case, the “market” is their brand management, and no one in brand management was clamoring for a sophisticated, enterprise-wide solution. They wanted to dip their toe in, follow the guidance of their agency partners and test different solutions, different approaches. They didn’t want the 500 lb gorilla solution, and they weren’t prepared to leverage it so early in the adoption lifecycle (Neither was MLR or the rest of the organization).
2. The company tried to circumvent evolution – the most effective form of natural selection. Innovative brand marketers (aka, the “brand cowboys”) will see the new channel opportunity and find a way to test it out, to start small, to move in the right direction. If successful, this effort will grow and evolve and eventually become something comprehensive that can be replicated across other brands. Think of the early brand adopters of paid search, and how that spread like wildfire once the ROI was demonstrated! If unsuccessful, the solution will fail, without undue time or budget waste, and it will be up to the next brand or partner to do better. By starting with a massive and mandated solution, this process was overridden and platforms that did not serve the needs of the brands or the end customers were mistakenly chosen.

I certainly understand that HCP RM is complex, more complex than internet marketing, and involves many groups across the organization. Thus, no one brand cowboy can likely implement a true RM program without a lot of internal support and collaboration. However, let’s pick a cowboy on a brand that has much to benefit from RM; start small and simple, and scale up from there. Once success has been demonstrated and processes have been worked out, then consider what larger platform or system might be needed, and what other brands can be added. At the end of the day, it will have taken just as long to get the whole company on board, but the solution will be far more suited to the needs of the company/brands, it will have been proven successful in driving business and there will be meaningful support and adoption throughout marketing and the rest of the organization. Everywhere in the industry these days, you hear talk about Healthcare Professional Relationship Marketing (HCP RM), Non-personal Promotion (NPP), and Channel Preference Marketing (CRM). Nearly every company has these programs on their “to do” list, but few are actually implementing them. Why is this? On November 4, 2009, Compass Healthcare Communications hosted its Innovation Lab Series workshop in Princeton, assembling a team of participants and expert panelists to discuss this very topic. HCP RM: Why Now? The old model for how to target and communicate with healthcare professionals has been turned on its head. The time physicians have to interact with sales forces continues to diminish and access to physicians is becoming increasingly difficult. Up to 35% of all physicians are now considered “no see” docs and some states such as Massachusetts are imposing restrictions on sales rep activities. Add to this the fact that pharmaceutical companies are drastically cutting their sales forces and you have an environment that’s ripe for new and more effective ways to reach HCPs. What HCP RM Is Not Before exploring HCP RM programs in more detail, it helps to establish a few things that HCP RM programs are NOT. They are not newsletters or mailers or phone calls created in a remote conference room and then force-fed to a recipient. They are not comprised of generic content that makes no provision for how the recipient wants to be communicated with, what his or her level of knowledge is with the brand, or where the recipient resides along the brand adoption continuum. They are, instead, customer-focused programs, delivering the right message to the right audience segment at the right time using the right channel. The right message is one that is meaningful to the HCP. Figuring this out means understanding who the HCP is—what their needs and interests are, what motivates them—so that you can truly service their needs, not just sell them stuff. Where To Start When many pharma marketers hear the term relationship marketing, they are quick to think of patient relationship marketing efforts such as compliance programs. But given that some physicians either cannot or do not want to meet with reps and that many prefer other and more varied forms of contact, it’s clear that HCPs want to engage with the brand through several communication channels. Building a successful HCP RM program is no easy feat. It all starts with understanding the different segments of your audience and delivering tailored, meaningful communications to them in the form, method or vehicle they prefer. Every disease state and therapeutic class is different. Organizations will have to adopt a different mindset beyond just a rep knocking on a quickly closing door. And there are no simple formulas that will guarantee success in any given specialty. But there are some best-practices tips we discussed over the course of the Innovation Lab session that can help overcome common challenges in the HCP RM space.

1. Identify leadership, budget, and resources: One of the biggest challenges to implementation, especially in larger pharmaceutical companies is: Who is going to lead the initiative? Who owns this “new” program? The brand? The sales force? Another party? Who will pay for it? And what changes will need to be made to the technical infrastructure to support the program? This may prove to be the biggest obstacle. A truly effective RM program should be thought of as an infrastructure investment; not a mere campaign. By its very nature and considering the many departments that an effective RM program impacts, this initial step has the highest likelihood of derailing or significantly delaying the entire project. Our advice is to pilot a program with one or more brands that share the same specialist. Do not go “enterprise wide” right out of the gate. Learn from the mistakes that were made with the adoption of online programs in Pharma. (See sidebar)
2. Devise the right segmentation strategy: Who are the right and wrong physicians for your program? What are the best messages to deliver to your different audience segments? To succeed in this area, you’ll want to work with outside resources to “really” understand your audience segments. Successful programs are based on segmentation that’s psychographic rather than segmentation that’s demographic, script-driven, or decile-driven. It’s important, too, not to forget the nurse segment, as nurses perform most of the legwork and patient interfacing. By first effectively segmenting HCPs and determining your goals, you can then move onto choosing the appropriate tactics and channels for those various segments.
3. Build the right databases. Having a database that meets your RM goals is key to delivering customized communications to each specific audience segment. Successful and strong relationships can only be attained when the database can continually “learn” and react over time. Pharmaceutical companies are notorious for having physician databases that are anything but robust. And many lack the capability to appropriately design, build, and maintain the right kinds of databases. Unfortunately, many vendors who excel in this area have proprietary databases that pharma companies can only rent, preventing the pharma companies from truly owning, mining, and leveraging its own data. Still, there are tips for creating an effective database. It’s essential, first of all, to set up your database correctly from the beginning, ensuring that the data fields you collect are indeed the right ones and that the right people are using the database. It‘s critical, too, that the database be designed to acquire and decipher incoming information—eMails opened, poll questions answered, site pages visited, rep observations—so that the database continually learns where each target is on the behavioral continuum and what is required to move them further along. This ensures that your communications meet the specific information needs of each segment, reflects their knowledge of the brand and where they are on the continuum. Your budget and technical requirements must also be able to support the data to be collected and stored.
4. Abandon political silos. Beware the turf battles that may ensue, although this may be easier said than done. Chances are, a lot of hands will be touching your RM program, and there will be many interested, affected and vested parties—from individuals in multiple internal departments to a network of outside vendors. This is not the time to retreat to political silos. These different teams need to work together and complement each other’s contributions. Pick the core competencies of each group and have them focus on the task at hand. Everyone needs to know how to play well together in order to deliver the best program results.
5. Address sales force fears. Nearly everyone would agree that the in-person relationships developed by the field force are the number one relationship marketing vehicle available. However, it’s not uncommon for sales reps and their management to view HCP RM programs with resentment. In reality, these programs aren’t intended to replace the sales force—ideally, these programs should serve to assist and augment sales force efforts. A successful RM program must be integrated with all the efforts put forth by the sales group, and be developed with their involvement at all levels. To do so, it is imperative that all parties see the value of the program from the beginning and be allowed to not only participate in the upfront design but also have direct access to all ongoing reporting and results.
6. Measure results. It’s amazing how many companies budgeting for HCP RM programs fail to invest in proper metrics. ROI strategies are key to analyzing which strategies and tactics worked, which didn’t, and which audience segments are worth investing in. It is hard to predict which tactic will work, and which path is most successful for each segment. There are no easy formulas for determining all this. At a minimum, everyone needs to identify and agree to specific measurement criteria before ever launching a single program. Given the pioneering stage of HCP RM programs and the number of variables involved, pre-program ROI analysis is difficult. Many times, a combination of models, formulas, and basic trust among your partners and internal measurement team is all that will suffice. You take your best collective guess ahead of time, implement a pilot of your program, and then closely measure the results.
7. Develop a program of tactics. This is not about eMarketing or Interactive Marketing, but about giving your targets another opportunity to engage with your brand. It’s less about selling and more about customer service. There is seldom one singular tactic that you can pursue at the expense of all others. Tactics should be regarded as an entire program. Thinking multimodal is key. We have to give physicians a chance to respond to determine their preference for not only the tactic but also how it is delivered. The good news is that physicians are already accessing some of the technology you’ll be using. An estimated 80% of all physicians under the age of 45 carry smart phones and nearly 1 in 4 participates in eDetail programs . There are many vehicles at your disposal—take the time needed to invest in the right ones.
8. Don’t lose sight of the message. If you’ve been delivering the same message to your audience for a while, changing the medium in which you communicate that message is not likely to have much of an impact. Concentrate instead on delivering information that’s new and meaningful to physicians. Translate those hours and pages of physician insight research into meaningful content that can result in behavior change. Find a balance between branded and unbranded communications. Focus on providing needed services to your audience versus simply selling yourself and you just might find yourself becoming the de facto expert in an area.

Clearly, HCP RM programs are growing in prominence. Finding success in this area requires understanding your customers like never before in order to offer them meaningful information and tools that they actually want to use. By integrating these tactics and resources so they all work well together you can successfully shift from the mindset of physician “selling” to one of physician “service.” Making that shift will strengthen your relationships with all your key targets—a critical requirement in moving HCPs closer toward ultimate brand loyalty.
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