Go with the (patient) flow

Editor’s note: Sharon S. Paik is vice president at Ipsos Marketing - Healthcare Practice, a Norwalk, Conn., research firm.

An increasingly dynamic and interactive health care marketplace has necessitated an equally dynamic evolution of research tools to help today’s brands succeed. In the past, physicians were the dominant influencer of a brand’s success. Patients were highly trusting of their caregivers, there were fewer barriers regulating a physician’s prescriptions and pharmaceutical brands were aimed at large patient populations (i.e., depression, hyperlipidemia, hypertension, osteoporosis), treated by physicians who were generalists. Accordingly, pharmaceutical companies primarily focused marketing activities toward physicians via heavy detailing by sales reps. Brands such as Prozac, Lipitor and Fosamax became blockbusters in the 1980s and 1990s through this relatively straightforward approach.

As the industry evolved and health care shifted from a primarily physician-focused and product-centric environment, changes occurred in market that included involvement of other key influencers, particularly among patients. The consumer awareness movement and resources on the Internet have encouraged patients to manage their health more proactively. Other changes also occurred: managed care organizations are more prevalent and influential, nurses have taken on greater responsibilities and the ranks of health care players have been expanded to include caretakers and family.

Additionally, while it has become increasingly more difficult to get me-too products approved, new technologies have reinvigorated drug discovery in less common therapeutic areas. Personalized medicine has become a viable aspiration. Amid this environment, progressive pharmaceutical marketers are beginning to assess their marketing objectives using a more comprehensive approach. They need to gain a greater understanding of the market, their customers and their customers’ motivations.

These emerging trends create a need for new research tools to support pharmaceutical brand decision-making. One such tool is the buying process approach. Though it is referred to by other names, such as patient flow mapping, patient dynamics, market mapping and market flow modeling, it is most commonly known as the buying process. Irrespective of its name, we strongly believe the analytic process behind it is critical, as it provides insights to help marketers prioritize their resources in a complex health care system. It is also flexible enough to identify how to reprioritize in the face of new market developments.

Full range of factors

With fewer product launches, it is more important than ever to maximize brand potential with targeted marketing strategies. In an increasingly dynamic external environment, marketers must adapt their brand strategy to the full range of factors that can influence the success of their brand. These factors may begin with traditional notions of brand features and benefits but need to go further and include characteristics of physicians, patients and the full range of the environment in which they interact to achieve effective health care.

As shown in Figure 1, the “360º customer experience” is an approach to research that addresses the changes in the health care market. It helps marketers understand the multiple customer types who impact the success of a brand and their “balance of influence.” Many of the research techniques are interrelated with the buying process, since both have a common goal: to provide a comprehensive understanding of the customer experience.

The buying process is a key component to the 360º customer experience. The model is designed to uncover key decision points in a given market, as well as the critical actions and perceptions that drive behavior at each point. In this way, one can understand how patients come to use a brand.

The central player in the buying process is the patient. At the simplest level, the buying process aims to outline the series of events that a patient goes through as they move through the health care system. The model aims to provide a blueprint of the process for any brand to map its opportunities by following the patient, remembering that patients seldom think in terms of products or services but rather in terms of their personal needs.

Why they do it

Through the application of primary research methods, we can explore what patients do, why they do it and how we can predispose them to the appropriate use of a product. The buying process is systematic and structured in that it explores the cascade of events that a patient experiences as they cope with their disease - from the first time they recognize their symptoms to their evaluation, diagnosis and, ultimately, fulfillment and compliance of the treatment they are offered.

The common steps (leverage points) through the buying process are:

Perception: Will a person perceive a problem exists?

Origination: Where do they begin to solve their problem?

Evaluation: Who do they talk to about their problem?

Diagnosis: How is the product identified and confirmed?

Treatment: What treatments are available?

Delivery: Do patients fill their prescription?

Compliance: Will the patient comply with their treatment?

Follow-up: Is the treatment successful or does the problem still exist?

When patients make a buying decision - that is, to take a therapy - that decision represents the culmination of a process. It may take place almost instantaneously or stretch out over a long period of time, but it is a process, not an event. Time is a very important element here, given that it’s never uniform, and each patient goes through the system within their own time frame. This provides an opportunity to understand how long it takes a patient to go through the various points in the process, including where especially lengthy periods of time elapse, so that we can help the patient move through the system efficiently.

No matter how long the process takes, the buying decision always begins when a patient becomes aware of a need. Once they have identified that need, they begin to search for and explore possible avenues for meeting that need. While gathering information, they refine and evaluate all of the buying criteria that will affect the decision to purchase and narrow the field of choices to the best few alternatives.

Mapped out in detail

The discernable steps and sequences that the patient takes through the process can be mapped out in detail using the common leverage points as the primary anchors. Patient flow-mapping provides marketers with a graphical flowchart of all key stages throughout the process, quantifying the number of patients who take a specific action or step at each stage from the perspective of the various stakeholders, including patients. The flowcharts allow marketers to identify the most common path taken by patients and determine where and how this path can be changed to facilitate greater brand use.

Each patient is considered to be unique and has their own path through the health care system. For that reason, patients provide their individual experiences, while physicians provide information for specific patients or patient types. While patient experiences are the basis for analysis, these kinds of experiences need to be evaluated not only from a patient perspective but also from the perspective of other key players in the market, including physicians. Obtaining both the prescriber and patient standpoint allows for pinpointing differences in customer perceptions. Frequently, identifying which issues patients and physicians see differently provides significant insight into appropriate allocation of marketing dollars to maximize returns for the brand. Moreover, these perceptions are not limited to physicians and patients but can also include pharmacists, payors, nursing professionals, caretakers, etc.

Let’s consider a hypothetical patient, Tom, a typical, middle-aged male, who has a stressful job: a market researcher on the vendor side. How does Tom progress through the health care system?

Despite “eight hours of sleep every night,” Tom is always tired and has been complaining about it incessantly to everyone. His symptoms have started to make an impact on this life, and like most men, he doesn’t go to his doctor until pushed or nagged.

After his wife makes the appointment to see his primary care physician (PCP), Tom finally goes for the annual physical, the first time in five years. His PCP determines that all systems are fine with Tom, with the exception of general fatigue.

Therefore, the PCP recommends behavioral and lifestyle modifications, such as getting to bed at a regular time, reducing job-related stress, and to return for a checkup in six months.

About a year-and-a-half later, Tom falls asleep at the wheel and almost gets into a car accident. Again, his wife pushes him to see his doctor. So, Tom returns to his PCP, and he is even more tired and run down, despite changing to a job that he says is less stressful: a market researcher on the client side.

What’s next for Tom, now that his PCP could not help him with his symptoms?

Tom’s PCP refers him to see a specialist. It takes his PCP office over a week to complete his referral paperwork. Once he receives the referral, Tom calls the specialist’s office to make an appointment for a month later. Tom postpones his appointment twice. He finally sees the specialist nine months after the referral.

The specialist diagnosed Tom and told him to schedule a follow-up appointment to discuss treatment options. (The specialist is identified as a key influencer in the buying process system.) Tom agrees, but it takes him three weeks to call for the follow-up.

Tom postpones his appointment once and eventually sees his specialist 12 weeks after the first consultation. (Further delays in the process.) The specialist provides him with two prescriptions, four educational booklets and information about patient-support groups.

The specialist thinks he did a thorough job explaining the treatment options. However, Tom is overwhelmed and fear sets in after he walks out of the office. He is concerned about the side effects of the medication and how they will affect him.

Tom needs time to digest all of this and think it through. Tom is frustrated with the specialist’s treatment recommendations and he takes the initiative to look for alternatives and possibly get a second opinion.

In the end, Tom doesn’t continue on in the health care system. He falls out at the treatment and delivery points in the process.

The buying process was able to identify the points of opportunity to intervene, including moments in the timeline that can be shortened in order to help Tom continue through the system. Also, you could have the specialist be a key influencer in the process by providing education to encourage desired behaviors from both him and Tom.

Provide an understanding

The buying process can be used for both new and in-line products. For new products, the model can provide an understanding of a new category, including insights into areas that may not have yet been covered extensively. This approach should be executed two to three years pre-launch in order to have adequate time to initiate any necessary strategic initiatives prior to launch and to aid in the development of targeted marketing. Conversely, for in-line products, the buying process can help assess fundamental changes in the market (such as new competition, generic/therapeutic substitution and/or policy changes) and provide an integrated perspective on the health care market. Once a product is introduced into the market, the tool can be used to track a brand’s performance post-launch. The buying process can also measure the impact of major market events that can improve a brand’s success (see Figure 2).

A graphical representation that highlights the market leakages at various points (Figure 3) can provide a visual snapshot for the areas of priority and opportunity. In Figure 3, the entire width of the horizontal histogram represents the total theoretical market potential. We can see a numerical snapshot that depicts the cumulative and actual market leakage - where, at each step, we lose some portion of the market’s potential patient population - and what potential remains. Thus in this hypothetical disease process, there is only a realized market potential of 8 percent that actually follow through to the end of the buying process and are being successfully treated.

Examination of these leakage points show targeted prioritization of needs and opportunities. To determine which marketing efforts should be pursued, we consider the largest areas of market loss, the feasibility of impacting change and the cost of initiatives at each level. Subsequently, we can determine where marketing efforts should be focused to increase the optimal realized market value and the subsequent number of prescriptions. Once the priorities in the health care system have been identified (leverage points), it is critical to influence desired behaviors among targeted customers at these points to achieve the maximum business opportunity. Behaviors need to be reinforced or changed at these points in order to move the patient through the system. Each strategic action must be tailored to the relevant customers and to the specific behaviors that address the key business opportunity.

Regularly monitored

Behaviors and preferences are constantly changing, and this has been both complicated and accelerated in recent years by the vast increase in product choices and new product entrants. Therefore, the market must be regularly monitored for these changes. The blueprint of the health care market will shift as customers are offered new benefits that enhance their experiences. If you have developed a sound model, it will constantly feed into the brand development process, helping to identify, understand and react to any shifts that occur. Drastic changes can be implemented for every shift, but only for those that will provide the best business opportunities. Understanding which ones are worth the investment and time will be essential to maximizing marketing dollars.

Furthermore, the analysis of the buying process helps boost brand potential in a volatile market by understanding patient actions within the marketplace. In a market where brand growth is slowing, the patient becomes a key player. By increasing the depth of understanding of patients and their experiences within the health care system, pharmaceutical marketers can demonstrate the distinct value of their brand to consumers. Through targeted marketing, relationships can be built with patients, enhancing their lifetime value.

The systematic analysis of the buying process can help determine how to interact with patients in a way that will increase compliance, persistence, and brand loyalty. It can help increase the total number of prescriptions by identifying and quantifying the size and feasibility of targeting niche populations. The identification of niches with unmet needs in the market serves to maximize the total number of patients who can benefit from use of the brand. Moreover, market obstacles can be identified and overcome, helping provoke change in consumer actions and increasing fulfillment rates.

Not be enough

For a brand to be successful, it is generally agreed that it must possess a significant competitive advantage, such as an improvement in treatment outcomes, a cost benefit or improvement in compliance. But the presence of such advantages may not be enough. Marketers need to fully understand the range of internal and external market environments that may impact the customer today and in the future. The buying process identifies current actions and helps to facilitate positive customer actions, thereby linking all the key players to a mutually-beneficial goal: satisfying the patient’s needs.