Fixing Noncompliance

It is considered as a black mark on a patient’s chart.  Being labeled as a noncompliant patient basically sends the message that no matter what medical instructions a physician gives you, you will not abide.  A recent post by Dr. Danielle Ofri, associate professor of medicine at New York University School of Medicine and editor in chief of the Bellevue Literary Review, discusses what it truly means to be noncompliant and how the issue of noncompliance could be better handled. 

Dr. Ofri quotes the example that a hypothetical medical chart was constructed for a 67-year-old patient with diabetes, hypertension and high cholesterol.  In order to remain truly compliant, the patient would have more than 3,000 behaviors to tend throughout the course of a year!  These include anything from taking medication as prescribed to exercising three or four days a week to attending recommended checkups.  Day in and day out (for some reason medical issues do not like to take time off), the patient must turn instructions into habit so that they may remain compliant.

The question needs to be asked, what can we do as Healthcare and Pharma professionals to improve medical adherence?  This could potentially be a multi-billion dollar question as improved medical adherence would directly impact prescription drug sales and provide new avenues for healthcare companies to facilitate and monetize physician-patient dialogue.  Now that smartphones and apps seem to be within arms length of almost everyone, we believe one key strategy will be to develop apps that allow patients and physicians to monitor key stats such as daily caloric intake and provide the ability to set reminders to adhere to a prescribed plan (see Prescription Smartphone Apps for Medication Adherence). 

However, this is just the beginning.  Improving adherence will require input and effort by everyone involved.  It is important for the Healthcare and Pharma industries to understand that adherence can be a “complicated balancing act” for patients.  Particular issues in a patient’s therapy may trump others and professionals in Healthcare and Pharma need to recognize this so that a prioritized plan can be developed.  Together we can develop strategies that improve medication adherence, and with this improvement, everyone will be better off.

Ferry from "Statin Island"

Statins have become some of the most widely prescribed drugs of all time.  Atorvastatin calcium (the artist formally know as Lipitor) is prescribed an estimated 50,000 times a year according to the FDA and is by far, up until it lost patent protection in November 2011, the best selling statin of all time (see graph).  And to make them even more spectacular, statin benefits are not limited to simply lowering LDL cholesterol levels.  Recent studies have shown that statin use could potentially treat or prevent cancer as summarized by John LaMattina, a contributor to Forbes. 

Image courtesy of Pharma Marketing News

Even with the extensive benefits and proven efficacy of statin therapies, adherence to prescribed therapies is still an issue.  PMPNews.com recently summarized the results from the USAGE survey, which was the largest cholesterol survey ever, tracking treatment adherence and physician-patient communication of 10,100 statin users. 

With 75% of all newly prescribed statin users discontinuing their therapy by the end of the first year, we believe it is essential that healthcare providers uncover the reasons behind this trend in their patients and do not assume the patient is "compliant." We further encourage healthcare providers to develop strategies and leverage support tools that encourage treatment adherence.  

Studies show increasing the adherence rate will result in improved health for patients, higher revenues for drug manufacturers, and reduced future healthcare costs.  The USAGE survey shows that side effects (62%), cost (17%), and lack of treatment efficacy (12%) lead the way for reasons why statin users discontinue prescribed therapies.  However, revamping physician-patient dialogue and education techniques will help address adherence issues because part of good adherence counseling includes discussions about how to manage potential side effects.    

For more information about the USAGE survey, please visit www.statinUSAGE.com.

Monitoring Consumer Sentiment in Pharma

Sifting through social media sources is one of the best ways to find information regarding new technology.  While perusing Twitter, we came across this article written by Jennifer Zaino of semanticweb.com.  With today’s world of constant data streams, managing it all and applying it in a meaningful way is a priority of successful companies.  Effectively utilizing this data requires semantic technology and sentiment analytics, and in turn, a user or business can continuously adapt their social customer relationship management (CRM).  Gartner, a leading information technology research and advisory company, recently released its Magic Quadrant for social CRM. 

Several players exist in the semantic technology arena that work with companies to develop business strategies and social experiences that generate improvements for sales, marketing, and customer service, while also benefiting online communities.  Gartner has divided these players into the following four quadrants based on completeness of vision and the ability to execute that vision: niche players, visionaries, challengers, and leaders.  On this spectrum of social CRM players, it is evident that the leaders, such as salesforce.com, are the ones that effectively utilize social and sentiment analysis strategies that are evolving with today’s world of social media and ever developing  “emotional state” of the Internet.  Learning from the leaders of this area of information technology will allow for better overall consumer experiences across industries.  Going beyond keywords for developing a sense of consumer sentiment will be the new normal, and those who effectively utilize this information technology, will be the leaders of their respective industries going forward.   

With regard to pharma, noticeable improvements will be necessary in the future regarding the consumer experience.  Developing efficient methods of monitoring consumer sentiment of various biopharma products will allow companies and healthcare providers to adjust quickly (assuming they are willing to) and provide necessary support for patients in times of non-compliance.  

Prescription Smartphone Apps for Medication Adherence

When it comes to embracing new technology, we like to think that we are ahead of the curve.  However, our approval is only bestowed upon technology that provides a substantial benefit, especially given costs or numerous unavoidable advertisements. As illustrated in a recent article by Pamela Lewis Dolan at American Medical News, a new wave of technology will become the norm in healthcare by way of smartphone and tablet apps that will allow physicians to closely monitor many aspects of patient compliance. 

There are a few questions however for the future implementation of these “prescribed apps”:

1. Does the app serve a utility that is worth the cost/adherence?
2. How much data will the app produce for the patients?  
3. Will the physician have the time/man power to properly utilize the data?
4. How will physicians monetize the use of the apps?
5. With data being retrieved without office visits, will this mean decreased revenue?
6. As with any prescribed therapy, how does a physician ensure patient compliance?
7. Will health-related apps be regulated by the FDA?

Physician-patient communication desperately needs creative improvements to ensure therapy compliance and persistence.  With the growing use of smartphones, using healthcare apps and the field of mobile health is only expanding in the coming years. The FDA has already approved a select number of apps to deal with clinical care and bills are currently in place to create an FDA Office of Mobile Health.  For a fraction of the cost for an office visit, patients can purchase an app that allows them and their physician to monitor health progression, collect critical health outcome data between office visits that may reduce visits to the office.  

We know medication adherence and health outcomes can be improved by allowing healthcare professionals to track metrics that normally are not monitored, such as heart rate, glucose levels, and calorie count.  This is not driving the conversation out of the exam room, but extending the reach of the physicians diagnostic and treatment capabilities.  With 10% of smartphone users having downloaded health-related apps, the practice of “Prescribing an app” will continue to catch on.  Generating a large market from the almost 1 billion smartphone user base will be as easy as posting that picture of dinner to Instagram. 

Message to Pharma CEOs: Forget prices increases, retain customers first!

This may be an older article from May 2011 by FiercePharma but it caught our eye and is still very relevant a year and a half later.  What is the moment when reality and perception converge for the Pharma industry?  What will happen when the CEOs of all the top life science companies need to tell their boards there is no more room for growth?  We hope someone in these organizations is spending some time on this subject, because the time is now.

We have always suggested there is a new era of engaging with customers.   The media for connecting with your customers is constantly evolving, and today, these methods of customer interaction are changing faster than ever.  But the majority of industries are slow to catch up, especially life science companies.  Yet, regardless of the marketplace conditions, the pace of change or current technologies, we believe in maintaining focus on the golden rule.  Treat customers as you would like to be treated as a person!  Through the years, the industry has continued to see things differently.  And then, when faced with events such as the patent and fiscal cliff, the drug industry seems to be out of answers.

This leads us to our current advice.  Do more with the business you currently earn! Our advice is to start managing the expectations of your boards that lower earnings and revenues are going to be a way of life if you do not take this focus.  Of course, this is unless you plan to revamp your research and development efforts to be wildly successful, but that discussion will require its own post. 

Firstly, look to BRIC nations for your future growth and develop harvest strategies for Europe and the US.   Secondly (and possibly more importantly), focus on making sure refills, re-orders, and customer complaints are managed more effectively rather than the constant focus on creating demand for your products/services.  It is evident that you have a large number to fill every year.  Globally, pharmaceutical companies lose an estimated $564 billion annually in revenues due to failed medication adherence (see study by Capgemini Consulting).  And with stats like the finding that 75% of first time statin users discontinue use within the first year of therapy, the focus needs to be retaining customers. It seems that much time (and money) is spent working on the same insufficient “brand-building” strategies.  Medication adherence programs work!  Why not mandate that all your products and brands make them an integral part of their marketing plan?  Let’s change the focus going forward and recoup some of that $564 billion.