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.

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.

Why price increases will no longer work-a thought for the CEO's of life science companies.

So this article in FiercePharma on Friday (5/13) caught our eye.  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 way to engage with customers.  Regardless of the marketplace conditions, we believe that treating a customer as you would like to be treated as a person is the best approach. But why has the industry through the years continued to see things differently, then when faced with the patent cliff the drug industry faces, we seem to be out of answers.


Our advice, start to manage the expectations of your boards that lower earnings and revenues are going to be a way of life.  Look to BRIC nations for your future growth and develop harvest strategies for Europe and the US.   Several are still looking to research and development for the answer, but we believe the best thing you can do is to ensure you keep the business you earn.


Ask your senior leadership team what they are doing to make sure refills, re-orders and customer complaints are managed more effectively than the constant focus on creating demand for your products/services.  We realize you have a big number to fill every year!  It seems we spend a lot of time (and money) doing some of the same things.  Medication adherence programs work!  Why not mandate that all your products and brands make them an integral part of their marketing plan. 

Industry-Physician Education: Walking in Patients' Shoes

Some industry critics have railed that any contact between physician and drug makers is akin to a mortal sin; the very thought sullies the purity of medical practice. We think extremism, in any form, shows poor judgment and lack of logical thought. Transparency is excellent, but contact between industry and physician is still necessary for medical advancement.

So we loved the piece we read in Pharmaceutical and Medical Packaging News about the pharmaceutical consulting firm that set up booths at a rheumatology conference which allowed physicians to experience what their RA patients deal with every day. The point: education for all stakeholders, and that includes the use of biologics. A Web-designed program also stresses the need for exercise and the importance of medication adherence.

The booths were equipped with a working faucet and sink; a laundry detergent container; and working taxi cab door. A pharma sales rep guided each physician through the booth, who was asked to turn on the faucet, and so on. The physician, who was measured on how difficult it was to perform the tasks, generally had no problem doing so.

Then the HCP put on specially made gloves (made by folks at George Tech University) that simulated the challenges the RA patient goes through; the physicians' decline in functionality was significant.

The doctors who went through the booth loved it; 92% said they would go through it again – 98% said the demonstration helped them understand what their patients dealt with every day.

Just think: Maybe the consulting firm that developed this tool, OneWorld, can design similar booths for neurologists, so they can appreciate what migraineurs live with, and for pulmonologists, so they can understand what it’s like to live with emphysema.

$4 Generics and Medication Non-Adherence

Let’s face it – the business of healthcare is enough to make anybody nuts.

Take the recent study, conducted in 2007, showing only a handful of people, relatively speaking, who took advantage of their healthcare insurance provision to buy $4 generic drugs. If all the people who could buy $4 generics did so at that time, society would have saved nearly $6 billion. A lot of money, no question. The study included 31,000 people; fewer than 6% bought $4 drugs.

It’s tough to imagine that 93% of these people hated society, so maybe there’s something else going on here. They didn’t know? Perhaps. They don’t like generics? Unlikely. According to the Kaiser Family Foundation, 72% of all scripts written in 2008 were generics, and sales of generics grew 8% from 2005 to 2006. The percentages wouldn’t have changed that much from 2007.

In that same study, “Over half of physicians say they frequently talk with patients about the out of-pocket costs of medicines they prescribe, 62% say they switch patients to less expensive drugs, and 58% say they give patients office samples.”

It's anybody guess why those patients chose to spend more money. But, none of the above is the good-grief part. The following is.

Back in November, the New England Journal of Medicine ran a piece about the possible damage that these $4 generic sales can do to long-term improvements in healthcare.

Normally, when a patient purchases a prescription with insurance, that purchase generates a claims record. The pharmacy sends the claim to the pharmacy benefit manager. These claims can be used for healthcare management, including medication safety, verifying clinical trial results, and ensuring medication adherence.

But, with the $4 generics, patients often pay in cash. The authors say the pharmacies often do not submit the claim information “since they have no incentive to do so.” The result: patients are classified as non-adherent or non-users. And, because these drugs are often prescribed for chronic diseases, “the consequences of these missing claims are not insignificant.” This is also important to the topic of medication adherence because it already suffers from a lack of awareness. With almost 80% of the prescriptions today being dispensed as generic, medication non-adherence will become more of a silent disease.

The authors, Niteesh K. Choudhry, M.D., Ph.D., and William H. Shrank, M.D., M.S.H.S., aren’t labeling the pharmacies as bad guys – their actions are unintentional, they say. But, as they point out, new systems need to be devised to make sure the claims are filed. 

ACOs and Fierce Communication

So here’s a question to ponder while you’re reading our carefully honed prose: How do you attract patients to sign up for an accountable care organization?

Last week, Cigna announced that its two ACO pilots were doing, at least preliminarily, what they should be doing: improving patients’ health and saving money. The giant insurer is so happy with the results that it is planning a national expansion of its ACO program this year.

Here’s why they’re happy: At its multi-specialty medical group practice division in Phoenix, the average annual savings per patient was $336; ambulatory surgery was down 11%; preventive care visits, overall, were up 3%, and up 12% for adults. And, its partner in New Hampshire is “closing gaps in care 10% better than the market.”

A few years ago, Cigna jumped on the ACO bandwagon. The goal: “Achieve the ‘triple aim’ of improved quality, lower medical costs and improved patient satisfaction by creating a care model anchored in the principles of the patient-centered medical home that also builds in accountability by rewarding physicians for results.”

In its press release Cigna says its collaborative ACO model is big on communication. Its doctors and nurses speak frequently with its customers’ doctors and nurses, “to help with coordination of patient care.” Cigna’s program also includes disease management programs and lifestyle management programs, including stress management.

Cigna doesn’t say how its customers reacted to the idea of participating in an ACO. That notion is even more interesting for Medicare patients. How will Medicare—by law, mandated to start pilot programs by next January—attract its seniors, normally an independent, privacy-loving lot? According to the new healthcare law, the pilot ACOs will take care of all the healthcare needs of at least 5,000 Medicare patients for three years, minimum.

FierceHealthcare says the success of these ACOS will require “fierce communication strategies,” like physicians doing things they don’t normally get paid for—contacting patients by e-mail, instant messaging and so on.

But as usual, it comes down to communication. We somehow doubt that it will matter what the medium is: word of mouth, Twitter, radio, smoke signal. If the ACO healthcare providers are communicating among themselves, sharing information about a patient’s well-being, and that patient’s health is improving, along with his quality of life, then that patient will spread the word.

And that can be pretty fierce, don’t you think?