Do you see the Volkswagen coming?

In Barry Levinson's wonderful film Tin Men, there's a great recurring symbol of the coming future (the film is set in Baltimore in the fifties). Every so often, in the distance, a Volkswagen Beetle is seen driving along — the harbinger of the coming Sixties, which would change everything forever.

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Every once in a while, I see the same thing in pharma. Today, I saw it in a post in the Pharma 2.0 blog. The post is about a company called Sensei (which is a Japanese word meaning "teacher" or "mentor") Here's what the author, Bunny Ellerin (great name) wrote:

Sensei, a mobile tech developer better known for its weight loss tools,
launched My Diabetes Guide, an iPhone app to help patients manage their
condition. It focuses on the basics helping people remember what To Do,
To Eat and To Ask. Available for only 99 cents, it will be interesting
to see how many people buy and use it.

It sure will.

Healthcare, like law, has become an industry in which patients are expected to conform to the system. The system doesn't really conform to them. Doctors no longer make house calls — patients have to go see them. Billing is incredibly complex and patients are expected to just figure it out. It's also an incredibly expensive service, and patients are expected to just swallow hard and pay up. In most industries, this is the kiss of death.

Consider the music industry. Records (and later CDs) were available on pieces of plastic and consumers had to travel to a store to find them. As soon as a more convenient alternative arrived — one that better suited the consumer's actual needs — CD sales fell off a cliff.

As we have repeatedly written in this blog, compliance is a huge issue in pharma. The core problem is that the actual patients who need to take a drug are forgetful, distracted, and disinclined to keep taking a drug that gives them no immediate, obvious benefit. What everyone is looking for, or should be, is a compliance aid that complements the way patients actually live their lives.

This seems like one. Apple has sold over 21 million iPhones worldwide. Besides design, one of the keys to the phone's popularity is the library of third-party applications that developers can write for it. This is one of them.

Basically, for a dollar, you can add a little program to your iPod that will help you remember to take your meds if you're diabetic. Since the normal location of the iPhone is your pocket, there suddenly is an incredibly intimate, tight link between something that's part of your daily life and compliance.

For the first time it seems, compliance has been turned from an outside force trying to get into consumers' lives to an inside force, and it's all powered by the rapid expansion of smartphone use. If you can do this with the iPhone, why not Twitter? Facebook? I think this is only the beginning.

EHR vs. SOC + RM. Or, if You Can’t Beat Them, Service Them

We all should hate acronyms. Acronyms are evil. Yet, there's something about humans that makes compressing a bunch of words down into a bunch of letters irresistible. We make fun of acronyms, lambaste them, then, of course, use them with hypocritical ease. Well, I 'm going for the Acronym Trifecta in this post, which you usually have to be a government bureaucrat to pull off. I've listed three of them to refute a point I made a few weeks ago and instead present a very real opportunity for pharma marketers.Yes, folks, I was mistaken.

Electronic Health Records, I wrote a few weeks back, were not going to be good for agencies who do digital, direct or RM work. The only upside for pharma/biotech would be that more of the patient population would fall into "health seeker" category. They would be more knowledgeable, and  probably have better health literacy than we have today. That part is good — but EHR will, I think, lower the degree of patient engagement with your brand. Your patient's share-of-time online will be more focused on EHR — coordinating with physicians, reading result reports and so on.

But this shift portends something really exciting:  pharma/biotech companies could answer this challenge in a few ways. Actually, so could the Big Health Portals like Quality Health and Everyday Acquire – I mean Everyday Health.

Forget digital, forget mail, forget DTC, forget channels…you have to put all that aside no matter what your budget process is; it is like forcing people into specific bowling alleys – you can't do it. Stop thinking about the Where. Think of the What. And that What you really should think about is service.

As a patient, EHR will be all about MY health. But it will be all information. Cold. Useful, but cold. Linear, in showing a time-based path through your condition. And I am sure the user experience will be extremely smooth and well thought out. Ever use the Medco site? It's one of the highest-trafficked online destinations for those over 65, and much of the reason is the comprehensive, efficient design of the site.

IStock_000004397935XSmall To a lot of people, this is not news. For example, in the print version of MedAd News for March 2009, Erika Fishman of Manhattan Research makes some great points about pharma needing to adopt an online model of service equal to that of retail and banking.

But service alone is not enough. It is an engine without a body. You can provide all the service in the universe, but what ultimately determines outcomes is patient behavior. This reminds me of what Martin Amis wrote about the British railway system — it would run perfectly if it weren't for those troublesome passengers.

The body is built on the Stages of Change behavior model (SCM). Developed by James Prochaska and Carlo DiClement, the model characterizes the stages individuals progress through in making substantive behavioral changes. When thinking through what EMR has to do with pharma marketing, we need to apply SCM, but not in its pure form — in its practical form SCM is the framework we use to map out questionaires, brochures, call center scripts, online surveys, and all other kinds of content. Dr Cynthia Willey Temkin of Rhode Island University, is a great source for how SOC can be applied in a straightforward manner.   

And the best outcome of integrating SCM and service is adherence. This is money, and as the Quakers say, you did good, and did very well doing it. Let's explore this a little further.

By applying the very humane and sensible logic of the model across ALL communications channels,you have an ideal vehicle for identifying both customers and pre-customers.  Why "pre-customer"? Because one of the most profound truths of the SCM model is that unless people "accept" they might have a condition, and unless they "accept" they need to something, they will NOT adhere to medication. Or at least a majority. The Manhattan Research study observed that 40 million diagnosed patients have not cashed in their scripts; I have seen studies that claim 30% of people never turn in that first Rx after a new diagnosis.

As an educational tool for patients, EHR holds tremendous promise, especially since Google will be a big player. It will engage patients with a holistic view of their health and it will be great for a lot of reaons. Given this, pharma/biotech marketers need better prepared and thus more profitable patients (and hopefully cure the "leaky-bucket" syndrome called non-compliance). Even better, if you make your DTC spend about disease education and sponsored directly from your brand, and drive people to call you the minute they think about your drug or try it, then hit them hard with the best most patient-centric, segment-based service. Invite engagement, answer questions, at the highest level and with the most impact.

Think, for example, of DTC TV applying the rigors of the Q&A approach that is inherent in Stages of Change. To determine if a patient is ready to accept adiagnosis,  you would not end the commercial with "speak to your doctor," but instead with, "Call us now and evaluate whether you really are ready for Brand X."

There are so many ways to service a patient or prospective one. One of the cardinal rules of patient-centric marketing is to make sure you've covered all the different media the patient may want to use. The same goes for servicing patients. Call center, dynamic content Web sites, avatars, guided email experiences, Twitter calls-to-action all through the TV spot — these are innovations waiting for a behavioral model to give them form and meaning. For another example, imaging speaking to your pre-customers and tell help them decide that they may NOT be ready. Which, of course, means that when they are ready, you are top of mind. Thus, you would be working with the medical system, enhance the helpful nature of DTC-TV and to make it all work, create a relationship with medical societies, like the American Academy of Physicians to certify your call centers and content. The opportunities are endless, it just requires coming out of the Pharma castle a little.

This really is a forward-looking formula. It addresses credibility, honesty, helpfulness, and not wasting doctors time or your profits with poorly qualified customers. Who wants a poorly adherent patient anyway? As a business model or an ethical matter, it makes no sense.Just as banks really want to sell you a mortgage, and are not that interested in marginally profitable checking accounts, so the stages of change model can be used to focus marketing dollars on the patients who are likely to be most profitable.

You want a well-informed patient, one who has had the chance to really weigh their options and become aware of whether they really believe or are just being told they are"sick"; this is a model that answers many of the nagging marketing and reputation issues in pharma.

SOC + RM = Service = Happy adherent customers who respect you. Wait, that would be an acronym…HACWRY. 

On the other hand, maybe not.