Analyzing an empowered patient
Editor’s note: Dinesh Sharma is associate director, health economics, at Forest Laboratories, Inc., Jersey City , N.J.
Health care consumers are changing the face of health care delivery1. As active members of the health care process, consumers are adopting innovative technologies to gather information, building their own health records, expressing their demands and preferences through multiple channels and shaping health care policy decisions.
Pharmaceutical clients have traditionally focused on the physician markets but are now beginning to see the value of consumer research. Driven by the emergent possibility of combining consumer trends with prescription and claims databases, and, more importantly, due to the changes in the managed care laws effective in 2006 that make it mandatory to provide prescription drug coverage to seniors and low-income families, pharmaceutical companies are gearing up to better understand the targeted consumer segments.
As the public becomes more involved, health care informatics - a hybrid discipline of health sciences and information technology - is giving the industry greater access to data on consumer behavior. Using both primary and secondary data sources on health care products and marketing efforts, linking consumer and physician behaviors and attitudes dynamically and interactively, health care informatics allows the analysis of health care consumers through all stages and phases of life, from well-being to acute episodes of illness and chronic or terminal diseases.
Number of trends
The empowerment of health care consumers has been driven by a number of trends. Aging Baby Boomers, who want to maintain their current lifestyle at any cost and are willing to experiment with alternative modes of therapies and health care systems, are becoming more involved in making health care choices.
The growth of generics is another important factor2. A positive environment in the U.S. has led to intense competition and commoditization of generics, and left major pharmaceutical players seeking growth opportunities with existing blockbusters and specialty pharmaceuticals. Meanwhile, global regulatory reform in generics markets is increasing generic usage, attracting attention from multinational players and bringing with it new challenges. As more drugs go off-patent, how consumers choose generic drugs over branded drugs will be an important issue for health care marketing research.
In addition, health care Web portals are giving consumers an active role in their health care decision-making. Multiple stakeholders within the health care industry have invested in interactive Web portals, which allow patients and physicians to communicate online and provide diagnostic tools, treatment algorithms, educational materials and access to physician networks3.
Health care consumers appreciate the convenience of access to multiple services in one place. According to recent estimates, 16 million consumers used a hospital Web site last year, while another 30 million used portals associated with their health plan4. This represents a significant step forward following the dot-com boom-and-bust cycle, firmly establishing a multi-channel, interactive marketing device for the health care industry.
And finally, the arrival of direct-to-consumer (DTC) advertising has changed the nature of the patient-doctor relationship. The evidence on the impact of DTC ads may be mixed, but there is no doubt that they are driving consumers to doctors’ offices and to pharmacies more often5.
IT revolution
All of these market forces are coinciding with the IT revolution, as even the Department of Health and Human Services (HHS) has mandated that an integrated health delivery system is necessary for building the nation’s health and security. By providing greater access to various consumer demographics; institutionalizing data warehousing in hospitals, managed care organizations (MCOs), pharmacy benefits managers (PBMs) and chain pharmacies; providing electronic health records (EHRs), personal health records (PHRs) for utilization and review, IT will change the access to and delivery of medicine6.
While still heavily reliant on primary research methods, the migration to large-scale databases and warehousing in most of the large MCOs, PBMs and third-party payer organizations has generated new ways to analyze claims and prescription data on almost all of the major therapeutic areas. The challenge remains how best to analyze consumer behavior and attitudes in conjunction with prescription and claims-level behavior.
The merging of DTC campaign databases with script and claims-level databases raises unique opportunities and challenges for marketing research, especially in light of HIPPA, which bars the sharing of certain undisguised patient-centric data.
Importance will grow
The importance of being able to mine these multiple data sources will only grow, especially in light of the following factors.
- E-prescribing: There has been significant excitement about digitizing the billions of prescription orders written every year7. As expected, the barriers to adoption include standards and usability. Physician groups are unclear about its economic benefits across the health care delivery system. How will digitizing save money, time and improve quality? Perceived benefits are tied to investment levels. For example, if the physician groups receive limited economic value from e-prescribing, consumer initiatives may be needed to further systems integration.
The role of the government in promoting adoption can not be underestimated. Pilot programs and matching grants are building an e-prescribing network within the National Health Service in the U.K. Business limitations on pharmaceutical companies to make investments in physicians and their practices must be understood within the current climate of tightening revenues and a tough regulatory environment. Perhaps the value proposition is the access to population-level or practice-level data through processing hubs, which companies such as IMS, NDC and Verispan heavily rely upon. Pharmaceutical clients of course use this type of data to make critical business decisions.
- Electronic health record: The electronic health record is on a rapid adoption curve, particularly since it was mentioned in the presidential State of the Union address in January 20048. HHS is taking a lead on this technology initiative and feels that an interoperable EHR-based national health infrastructure can be built within 10 years. An industry consortium is developing EHR certification standards for all major stakeholders.
How rapidly will an integrated health care network emerge from the adoption of the EHR and other technology initiatives? This is contingent on many significant players, such as hospital networks, payer organizations, pharmacies, MCOs, PBMs and other health care service providers. However, it is not inconceivable that a systems integration of this magnitude can be completed within 10-20 years. After all, the U.S. public school system universally adopted the Internet within less than 10 years. Even as we await the next wave of changes in health care informatics, customer relationship management (CRM) technology is significantly changing the marketing research landscape within pharmaceutical companies, managed care organizations and hospital networks.
Health care PRM informatics
Some pharmaceutical companies and health care providers have built databases and specific analytic functions to develop better relationships with patients and to deal with the growth of the patient-centric information9. The framework is CRM, built on the principles of one-to-one relationship or loyalty marketing. The analytic challenges for market researchers and marketers will be to demonstrate how best to utilize the abundance of health care information to gain greater insight into physician and consumer behaviors and attitudes, especially in terms of combining consumer trends and prescription databases.
Managed through integration of diverse databases, CRM has certainly moved health care marketing away from mass marketing techniques and towards patient relationship management (PRM), which focuses on an organization’s or pharmaceutical company’s existing patient database, with capabilities to generalize to the entire market.
The PRM process is driven by an interactive database that manages and measures customer loyalty and profitability. As a business intelligence tool for strategic market planning, the PRM database presents a complete view of patients’ activities and attributes. Once the relational database is functional, the PRM process and market planning drive it forward, employing online analytics, market segmentation and communication strategies.
Online analytics consists of advanced data analysis on promotional detailing, market share, patients’ demographic backgrounds, diagnoses and treatment. Marketing segmentation predicts individuals in the database most likely to seek specific health care programs or services and respond to promotional incentives. Communication management not only manages campaigns but conducts ROI analysis.
A step forward
Health care PRM informatics represents a step forward, beyond traditional pharmaceutical and health care marketing research, which has traditionally been heavily physician-focused. Integrating both primary and secondary databases on health care products and marketing channels - ideally juxtaposing consumer behavior and preferences with physician behavior and attitudes - PRM informatics can give health care providers and pharmaceutical firms the tools to better compete in an industry that is increasingly consumer-driven.
References
1 www.healthcare-informatics.com/issues/ 1998 /04_98/spotlite.htm
2 www.bioportfolio.com/reports/ Datamonitor_DMHC1954.htm
3 http://infosolutions.mckesson.com/ answers/Fall04/06technology.htm
4 www.healthcare-informatics.com/issues/2005/ 02_05/cover.htm#portals
5 www.ftc.gov/ogc/healthcare/findlay.pdf
6 www.health care-informatics.com/issues/ 2005/ 02_05/cover.htm
7 www.health-itworld.com/enews/03-15-2005_542.html
8 www.fcw.com/fcw/articles/2004/1206/web-ehr-12-07-04.asp