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Patient power

Achieving stakeholder satisfaction in the midst of change
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A decade ago, pharmaceutical companies could navigate a comparatively simple stakeholder landscape with ease. They joined the sales force 'arms race' then reached out to high prescribers in the primary care physician population and worked with hospital teams on gaining formulary acceptance. They then made sure their marketing teams interacted with regulators every so often. As long as they ticked all these boxes, they could more or less assume their share price would travel in the right direction.

As market pressures started to bite, we saw primitive steps forward in stakeholder communication; more emphasis on engaging payers to help with market access, for example. However, the communication was still pretty much one way and limited. The big sea change recently has come, not only because of market factors, but also massive power shifts. Huw Tippett, head of global commercialisation at Novartis, summed the situation up: "Today, sales forces seem bloated, rep productivity is falling, market access is more difficult, cost containment pressures are greater, shifts in stakeholder power are substantial and competition from generics is formidable. Taken together, these changes constitute an inflection point for the industry."

GlaxoSmithKline (GSK) banged the final nail in the coffin for the traditional sales force army approach when it announced in 2010 that it was developing a system for compensating its sales reps based on customer satisfaction not prescription sales volumes. The emphasis for these sales people would now be on performance not just on engaging with physicians, but with multiple stakeholder groups, with an end objective of not just retaining their custom but of getting positive recommendations from them. According to IMS, only 43 per cent of rep calls internationally led to face-to-face meetings in 2010, those visits on average lasted less than two minutes and only a third of visits were thought to be useful. An ongoing Kantar Health survey, The Changing Pharma Commercial Model, was set up to determine the strength of companies' relationship with primary care physicians and GPs in the US and Europe. It shows that when sales reps get through the door there is a tendency to mistake physician complacency for retention and that this tendency has become even more of an issue. Primary care physicians (PCPs)no longer have real control over what they write on the prescription pad and therefore are not the only stakeholders that need satisfying. Specialists and even payers are the primary influencers; the PCP typically does not change the therapy prescribed without direction from the specialist and the payers control the funding, or not.

Although the power is likely to shift back and forth, the message is clear: it is no longer enough to deliver just what the doctor ordered. Companies need to tap into a complete sphere of influence and influencers and measure the impact their actions are having on them. Kantar Health's Stakeholder Ecosystem listening/monitoring dashboard shows how many stakeholders pharma companies have to satisfy and the complex relationship between each of these stakeholder groups. This research shows that there is so much more emphasis on the patient than there ever was before. So what has promoted this change of direction?

Social media
Although it has been slow to embrace the power of social media, the pharmaceutical market has been greatly impacted by its phenomenal rise. As Proctor & Gamble veteran and Intuit CEO, Scott Cook, said: "A brand is no longer what we tell the consumers it is, it is what the consumers tell each other it is."

More than 95 per cent of consumers internationally are engaging in healthcare conversations online and sharing often strong opinions about treatments and drug company performance. This was highlighted in a study Kantar did with patients with Crohn's Disease or Ulcerative Colitis asking for feedback on their biologic therapy. The results pointed to some similarities in patient views, as well as differences in particular attributes, eg manufacturer support of patients was perceived as higher among patients on one of the drugs. The fact that they can talk about this in an online space has given them a great deal of power.

Social media has also had a big influence on physicians; 66 per cent of international physicians are actively involved online. They score higher than spectator level on the socio-technographic scale because it gives them access to the peer-to-peer discussion that they value highly as a means of gaining feedback. If those peers include key opinion leaders (KOLs), so much the better. Add a therapy emphasis to the online KOL discussion and it becomes even more enticing.

For example, more than 75 per cent of oncologists get their information online from peers. Therefore it would be immensely powerful to be able to direct their efforts towards those influencers that have the most impact on actual prescribing and dispensing behaviours. The challenge of PCP/KOL online communities is that few let pharma companies participate in their conversations. They have tried to test online communication with doctors through physician-only portals, allowing them to download samples, hold video conferences with company representatives and find information on clinical trials and patient education. There are also numerous company-sponsored product and disease portals aimed at doctors. However, these sites do not normally allow doctors to talk to each other because they are usually unable or reluctant to monitor comments that refer to off-label prescribing and/or adverse events about their products.

In the past year, the survey has shown that almost a third of physicians were negatively influenced in their choice of diabetes products by discussions and comments on social network and community sites. It also showed a much smaller sample for depression and more reliance on community groups, feedback from patients and carers and also discussion with sales reps. Finding an appropriate means of communicating on a subject that is more taboo, connecting and measuring the strength or otherwise of the engagement is the important thing. Monitoring that conversation is also key. Combining reputation performance measurement tools with listening tools gives companies a powerful measure of performance.

The future
Patients can only become more powerful as companies deliver 'whole products' and personalised solutions, including training and information to add value and deliver better outcomes in a bid to differentiate themselves. There will be a new breed of speciality and service reps, the former specifically trained in a therapy area and the latter more of a general educator, both of whom will have to have more of a partnership with doctors, helping train them and offering different support packages to them. The role of payers will vary by geography, but they will always be important in a market access scenario, particularly in the emerging markets of Brazil, Russia, India and China (BRIC). Joining the online conversation will become key for companies as each major therapy area will have a global online community, including HCPs, carers, providers, patients, who will drive decision-making.

Education, the transparent flow of information and a more customer-centred product development process will help relationships between big pharma and patients. Regulatory affairs people will face a large task as online communities are created where people with particular conditions can get together and where companies can respond in a way that is both legal and useful. If financial services companies, another highly regulated group, can innovate in this way, pharma can too. It just needs to work out how to do it within the rules and have an eye to a more liberated future where regulators will require active monitoring and listening.
Now they can see patients tweeting about the side effects of their drugs and they can choose not to listen or to delete the comments; that won't be an option in future.

The Author
Mark Sales
is head of global brand & stakeholder management, Kantar Health

To comment on this article, email pme@pmlive.com

4th May 2011

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