Pharma's Patient Support: Stuck in the 1950s

Why isn't pharma investing to increase patient support effectiveness?

In the 1950's, when pharma companies first started visiting physicians their approach was simple:

1.      Find a doctor

2.      Tell him about your products (back then, almost all doctors were "him").

That was about as sophisticated as it got.  Today, this is scoffed at, no one tries to manage a sales force without an approach including segmentation, targeting, multi-channel strategy, closed-loop marketing system, etc.  Customers are closely analyzed and sales forces are managed via the above strategic elements as well as all kinds of tactical approaches and selling systems, all based on careful study and developed over the years to provide impact.

That's no news to anyone.

At the same time, these sales forces are fighting to get patients that are providing only half their prospective value and that other half can only be unlocked with increased adherence, so why are isn't pharma investing to increase patient support effectiveness?

But now think about patient programs.  What's your strategic approach?  Do you have a company-wide planning process for putting together patient programs?  Do you try to make them as effective as possible?  How do you even measure their effectiveness?  Some pharma companies (very few) do indeed have international as well as local executives whose job title is "patient support manager" or "patient innovation manager" (congratulations!) but most don't and I don't know of anyone who thinks along the lines of "PSE": patient support effectiveness.  Yet just about everyone has dedicated teams to deal with SFE ("sales force effectiveness") and maybe others for "marketing effectiveness" and perhaps they work for "commercial effectiveness".

Why is that?  At the risk of repeating myself (repeatedly), the commercial model is pretty much broken, we all know that, and your sales forces simply are not providing the return they used to.  In some cases, they are providing no return at all.  Yet the industry invests heavily in effectiveness efforts to make them more sophisticated.  At the same time, these sales forces are fighting to get patients that are providing only half their prospective value and that other half can only be unlocked with increased adherence, so why are isn't pharma investing to increase patient support effectiveness?

This will  come.

When it comes to patient programs, in Europe at least, pharma is still in largely in the 1950's, with reasoning pretty much limited to:

1.      Create educational support for patients

2.      Give it to doctors so they can give it to patients

Of course, many programs go beyond this, and there are many variations on the theme (create an app, use pharmacists, get nurses to call) and just as sales forces in the 1950s had a very real impact, such simple programs can likewise have a real impact, but since the industry has learned how to get much more sophisticated much more quickly, why not jump ahead?

So what would that look like?

For one thing, it means understanding exactly what you're trying to do with patients.  As I've pointed out in the past, there are two major reasons for putting together patient support programs: first, it's the right thing to do, it increases the value of your products to the patients and helps them be healthy; two, it has the potential of dramatically increasing your results.  Both of these benefits come about through increased adherence, therefore what you are trying to do in any support program is increase adherence.

In order to do that, you need to understand why people don't adhere and then investigate how you can get them to adhere.  All of this can be examined through the study of behavior, notably, consumer behavior.

I'm suggesting quite the same thing - patient support programs should be based on consumer behavior theory to influence behavior regarding adherence to therapy".

I know, there's something that sounds vaguely disturbing about applying consumer behavior theory to patient support programs, but think about it... we are trying to change consumption behavior.  For decades, marketing researchers have studied consumer behavior in an effort to get people to consume more toothpaste, automobiles, insurance, shoes, wrist watches, toys... you name it.  They have discovered a whole lot about what drives consumption and have developed all kinds of techniques to do so. If these techniques are so regularly used to promote things like soft drinks and french fries, well let's use them to adjust behavior surrounding the consumption of the diabetes drugs that these same consumers end up needing.

In 2009,  Richard Thaler and Cass Sunstein published the book "Nudge: Improving Decisions About Health, Wealth and Happiness".  I recommend it.  Essentially, what they suggest is exactly what I'm suggesting here, policy makers should use consumer behavior theory to "nudge" people into making healthier, more rational decisions.  They base their suggestions largely on consumer behavior theory (although they tend not to call it such).  I'm suggesting quite the same thing - patient support programs should be based on consumer behavior theory to influence behavior regarding adherence to therapy.  After all, pharma's sales force efforts are based on behavioral theory to influence physician prescription behavior (if you deny that, you're really being disingenuous), and the techniques used are carefully designed.  Patient support programs should be the fruit of just as sophisticated a design process.

I find it somewhat ironic that the vast majority of the research on adherence behavior and the ways to influence it come from the medical community.  Of course, it's the medical community that most directly feels the impact of non-adherence, both in terms of direct clinical results and the overall cost of treatment, but from the perspective of underlying theory, it's really the world of marketing that has the most to say about the consumption patterns of human beings and how to affect them.

Those of you who know me are probably thinking: "wait a minute, he's bound to say that, after all, he's a marketing professor who founded a company specializing in patient adherence."  My reply is simple.... you're absolutely right, which is why the next few columns will be devoted to examining exactly those underlying theories that should be considered when studying patient adherence.

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