Digitally enabled solutions have and continue to transform the way that healthcare is monitored and delivered, leading to better patient outcomes and efficiencies in the delivery of healthcare.
Digital has transformed the way the pharma industry engages and communicates with some of its key customers. From disease awareness websites, to discussion forums, to self-detailing, the industry is increasingly incorporating digital platforms as a critical component in the commercialisation of a medicine.
However, when it comes to payers, it seems that one of the industry's most important customers has been largely excluded from this 'digital evolution'. While the industry is always being told how much time key customers are spending online, and educated about their digital behaviours, there is little to inform payer digital communication programmes.
The use of digital in support of payer engagement and communication is in its infancy and early adopters are coming across significant, and at times, insurmountable challenges. However, as with all good digital programmes, understanding an audience's digital profile is an important pre-requisite to the development of any activity.
Just how do payers use digital
Digital is hugely empowering for payers. It provides a range of unique tools and information sources that support them in discharging their duties. This includes information seeking, performance management, expenditure control and responsibilities associated with their day-to-day activities, such as contract management and tenders.
Commenting on the use of digital, Allan Karr, pharmacy business services manager, University College London Hospitals NHS Foundation Trust, UK, says: “Digital has revolutionised the way payers work. In addition to streamlining processes and procedures, digital supports our informed decision making on many levels, including support for effective collaboration and communication. However, that being said, payers are not as digitally savvy as many of our clinical colleagues”.
Doctors were early adopters of digital, with a large percentage accessing the internet for health information in an office and clinical setting. While there is much to be learnt from healthcare professional programmes, what works well with clinical customers may not resonate with payers. An example is self-detailing. The ability to direct doctors to what is of interest to them within a self-detailing context, does not provide the granularity of information payers need.
Payer digital communication programmes need to be based on a superior understanding of their information needs, and their individual and collective digital information-seeking behaviours.
How do payers look for information?
In forming an opinion about a particular medicine, payers assimilate a 'portfolio of information' from a variety of online sources. Critical to the validity of this information is its quality and the credibility of its source. It is on this latter point that payers are most wary of industry-sponsored information sources. Indeed, key payer decision makers will rarely access information from an online industry-sponsored source.
There is a general feeling that the information is subjective, incomplete and also perhaps biased. The European Medicines Agency and the UK National Medicines Information Centre are often preferred sources of basic drug information. This is not to negate the significant contribution of the industry to payer decision making, but this contribution rarely extends to online.
The role of non-market specific information sources
The use of online information sources naturally differs between countries, with a clear payer preference for local information.
Michael Schlander, chairman and scientific director at the Institute for Innovation and Valuation in Health Care, Wiesbaden, Germany, believes that when it comes to information seeking behaviours: “In addition to sources such WHO and OECD, German payers also seek information from UK authorities, such as NICE and the Cochrane Centre. This is reflected across much of Europe, as the UK is well known for the high quality of its information”.
However, it's interesting to note that the same is not true for UK payers, many of whom tend to have a healthy scepticism regarding the quality of data from other country sources. This is because they understand the UK governance processes that go towards the development of their information sources and there is a suspicion that the same robustness may not apply elsewhere.
Payer sources of online information
Irrespective of country and role, payers consistently rely on a number of key information providers. These include:
While key payers will take it upon themselves to source online information personally, given the extent of their activities, delegation is key. Yet, the information seeking behaviours of those to whom they delegate does not always reflect that of more 'industry-sceptical' payers.
“While I don't often access industry sites, I am aware that some of those that I delegate to, do,” says Mike Sobanja, former chief executive, NHS Alliance, UK.
When creating a portfolio of information, a 'typical' payer course of action would be to brief public health colleagues to research topics such as local demographics and disease prevalence, and pharmaceutical advisers to look at areas such as current drug utilisation in a targeted therapeutic area. In addition, they seek the opinion of a clinical specialist network, in all its many guises. In some markets, patient advocacy groups also provide a rich source of information.
“Typically I would consider patient advocacy group sites if I wanted to better understand the impact of a condition or management approach on patients” says Sobanja. “Indeed, when it comes to the patient advocacy group sector, there is the opportunity to gain a unique real-world insight”.
The use of digital in monitoring and assessment
While ease of access to digital information has bought significant advantages to payers, it is the ability to use digital in support of monitoring and assessment that offers payers the greatest benefit in terms of their informed decisions around medicines.
Dr Harald Herholz, head of quality assurance, Kassenärztliche Vereinigung Hessen, Germany, believes: “With the support of the G-BA, local Doctor Associations in Germany monitor and assess healthcare utilisation within their region. While there used to be a reliance on input from companies such as IMS, Doctor Associations now have access to their own diagnosis and treatment datasets that can be used to inform our medicine's management decisions”.
The implications for industry
Payers invariably pull information from sources and are not at all receptive to information pushed at them. This presents a real challenge for the industry if digital communication is to be deployed to support payer-informed decision making. One approach to overcoming this challenge is to ensure that all those information sources accessed by payers have appropriate, credible and balanced information on a company's assets.
This may appear a hard task given the independent nature of many of the information sources, but effective outreach programmes to all those who input and manage these is a good first step to ensuring the voice of industry is heard. However, if the industry is unable to support informed decisionmaking directly through digital media, what can it do?
Effective account management and truly understanding the need of payers is key. Beyond repackaging the value dossier and other well established activities, this necessitates having a good understanding of local needs, and tailoring all communication by payer type to reflect this. With the availability of longitudinal health utilisation data almost at payers' fingers tips, arguably it may not be long before payers know more about a company's drugs in clinical practice than the company themselves.
“There will come a time when IT solutions will provide unique insights into local health outcomes as a result of a particular pharmacological intervention. This has the potential to alter the dynamics of any discussion with a company about a particular asset. It is digital that will enable this particular aspect of medicines cost control,” says Sobanja.
Where to next?
Digital should focus on how the industry can enhance lives and not be based upon any assumption that just because the information is out there in the digital space, it will be accessed. Indeed, for payers the opposite rings true.
Pharma investment should focus resource on enhancing the personal interaction to add additional value to payer dialogue. This will necessitate a greater focus on how a treatment fits into local priorities, reflects the local demographics and improves community based outcomes, as opposed to an emphasis on clinical trial data.
But it doesn't stop there. As part of any integrated programme, it is behove on the industry to ensure all stakeholders – whether payers seek their opinion or not – have access to relevant, accurate and transparent information through both on-line and off-line means. In the absence of this, no-one can make a truly informed decision about the value of the industry and its medicines.
Carsten Edwards is managing director of Ogilvy Healthworld Market Access and Caroline Howe is managing director of Ogilvy Healthworld Digital. They can be contacted at firstname.lastname@example.org and email@example.com