Four New Ideas—
And How Public Relations Helps Make Them Real


“In Pharma 3.0, companies will not be selling pills as much as managing entire patient experiences…companies will need to build the long-term relationships with patients that will become increasingly integral to their brands.
Ernest & Young “Progressions” Global Pharmaceutical Industry Report
2010

Yes, yes, there are a welter of change agents affecting the pharmaceutical industry and the larger health care enterprise. Many of them have been talked into the ground by industry observers, politicians and members of the health care communications community.
Ernest & Young recently published Progressions, its 2010 Global Pharmaceutical Industry Report. The report is full of good observations, but I was most interested in four seismic changes that they predict are having a profound and for the most part positive influences on health care and health communications.
1. Patient Empowerment Transforms to Patient Responsibility
Kind of sounds like a Republican Party catcall, but it’s a pretty accurate description of where the patient movement is going. Fifteen or twenty years ago we were talking about how the patient was becoming a partner in his or her health care and how the doctor was no longer the god in the white coat.
The democratization of information brought on largely, but not entirely by the Web, accelterated this. But just as the patient now has a voice in treatments, his responsibility towards risk-sharing is also rising. Just look at your drug co-pay scheme. You can receive the latest and greatest medication, vaccine or antibiotic, but you may be asked to contribute $40 or event $80 a month from your pocket for the treatment. Contrast that with a generic medication which may cost you just $10 or $20 dollars.
There are often extremely good reasons for using a newer medication. But as costs rise, the patient (and the doctor) will need to weigh its value versus older generic drugs.
Some predict patient responsibility may become even more urgent as some health care plans and companies consider rewarding employees practicing healthy behaviors or imposing higher insurance rates on over-weight employees or employees who smoke. For a number of reasons penalizing obese employees is bad public policy, but the idea is certainly on the table.
Public relations can help companies explain the relative benefits of branded medications and who should most profit from them. We can also work with companies outside of the health care arena on employee wellness initiatives.
2. The Transformation to Pharma 3.0.
This is Ernst & Young’s term, but the notion is not theirs alone. Pharma 1.0 could be considered “the good old days” in which a blockbuster drug would put wind in a company’s sails for years. A billion dollar molecule could contribute ten, twenty even forty percent of a company’s income. The problem was that as the patent ran out of gas, the company desperately had to refuel with another blockbuster or two. If was much like a treadmill, with its speed constantly increasing.
Pharma 2.0 was the diversification model: sell lots of drugs, but sell other things too, from over-the-counter brands to sutures. Abbott and Baxter led the way with this model, but others caught on as well.
Pharma 3.0 (which nicely merges with patient responsibility) is a new way of looking at the core business of the drug company: rather than simply selling medicines, it is selling health outcomes. So if company X is in the diabetes business, sure, it is developing a glucagon-like peptide analog, but it is also offering disease management programs for physicians and patients, drug persistence programs and other tools to help get the patient to where he or she needs to be.
Public relations plays a integral role here, as we are in a great position to help companies increase patient compliance and persistence through educational programs such as interactive learning modules and other tactics.
3. The New Players and New Partners
Health care companies are enlisting usual and not so usual partners in helping achieve Pharma 3.0. For instance, Bayer Healthcare has linked with Microsoft and the National Multiple Sclerosis Society to create “MyBrainGames” an online mental games center for people with MS.
Bayer has also partnered with Nintendo to create “Didget” a glucometer for kids with type 2 diabetes that can be plugged into a Nintendo game console. Novartis, Vodafone and IBM have created “SMS for Life,” that uses mobile phones and other technologies to manage supplies for people with malaria.
Relatively simply technology is allowing us to do great things. Johnson & Johnson, the federal government and other partners have launched Text4Baby, a service that sends SMS messages about nutrition, health and other important topics to pregnant women, based on their due date. A simple but effective service for women with limited access to other resources.
With so many potential partners in the greater health care space, public relations has far more opportunities for client partnerships. As many of these initiatives are centered on communications, who is better to help out than our industry?
4. The Value Proposition & Value Mining
It doesn’t take a health economist to figure out that in a cost-conscious environment, finding the relative worth of a medication will be the price of entry. There are many ways of looking at comparative effectiveness, far more than we can review here.
There’s a new spin on the value proposition, however. It’s called value mining.
In the old days, clinical trials and outcomes data were the private property of pharmaceutical companies. Outsiders, even clinical investigators, would get information only when the company thought it was time. Not so anymore.
According to Ernst & Young, regional health companies such as Partners in Boston and Intermountain Health in the west are using historical, empirical data to determine effectiveness of drugs already approved by the FDA. Armed with outcomes on thousands of patients, and computers capable of scrutinizing dozens of variables, these companies are running “parallel universe” clinical trials by simply and cheaply examining historical data to see which drugs work best on which patient groups.
Yes, this is turning clinical trials on their heads, looking backward instead of prospectively for outcomes. But how can biopharmaceutical companies deny the value of reams of data on thousands and thousands of patients? Communicating precisely the meaning of these retrospective trials and their implications for payers will be a massive challenge.
Patient responsibility, Pharma 3.0, new players and value mining are four change agents that cannot be ignored. They may not sound as sexy as the profound changes we are seeing as a result of the digital health transformation, but their impact, I believe, will equally great.

2.75 Cheers for Kaiser

2.75 Cheers for Kaiser Permanente

I spent last weekend on the San Francisco Peninsula, primarily attending to my mother, who spent the prior week in the hospital. Mom is 13.75 dog years old, and at that age, well, age becomes a conspirator, and you become its plot.

This becomes relevant since her care at the Redwood City Kaiser Permanente facilities is emblematic of how we can deliver good health care, at a reasonable price, even for those in their late, late years.

Part one. She complained about breathing troubles and scheduled a physician’s appointment at Kaiser. In quickly, diagnosed with chronic obstructive pulmonary disorder and hospitalized all within an afternoon. It helps that the walk-in clinic is a stone’s throw, or wheelchair ride, from the Kaiser hospital.

I am not writing here about her transitory mental confusion, the concern over whether she can continue living alone in a retirement community and the need for at least temporary round-the-clock attendants. We’ll save those for another day.

Part one and a half. The attending physician phoned me and spent all the time required spelling out her medical diagnosis (guarded) and various living arrangement options. I decided to check out the situation myself, hence the visit to the Bay Area.

Part two: the follow-up. I accompanied mom on her follow-up visit, about a week after she was discharged. American Airlines thoughtfully contributed to the drama by cancelling my late evening flight back to New York; my rescheduled return gave me just four hours from Kaiser visit to wheels up. Being a New Yorker, I anticipated the horrors of waiting and waiting for her appointment and grinding teeth trying to get back to SFO on time.

But the nice surprises started the minute we entered the clinic. A short line in a comfortable reception area; the request to pony up $10.00 for her visit (I couldn’t get my blood pressure read for ten bucks here in the Empire State), then a short elevator ride up to “clinic F.”

Clinic F was nicely furnished, with magazines from this century; pictures of the physicians staffing the clinic and their bios nicely displayed on the walls. Moments after arriving, mom’s name was called and she was led to her physician, a woman who’s treated her for several years. I am watching the clock. Not bad.

Thirty minutes later I am called into the exam room, where the attentive physician reviews mom’s chart with me, discusses with both us her medication schedule and answers both our questions with alacrity and no sense that she has to make way for the next patient.

All in all, the report is positive and her health improving, though it’s doubtful there are triathlons in her future.

Kaiser Permanente some time ago computerized its medical records, so everything the physician needed to know is at her fingertips. Oops--one problem: the computer crashes, making it impossible for her to e-mail the on-site pharmacy mom’s new prescriptions. So we move to another exam room and a more cooperative computer.

Time elapsed: ninety minutes; seventy of which were with the physician. Then down to the pharmacy, where an electronic display chimed that mom’s prescriptions were ready. The pharmacist threw in one of those weekly pill dispensers for free.

Outside, we passed through the pleasant gardens soaking in the California sun. Then to the street where the Redwood City policewoman waived the red “no parking” regs, so mom could have an easier time getting into my rental care.

Back to her retirement community, a bid farewell, then off to the airport with plenty of time to make the flight.

How does Kaiser manage great patient care, fast service and pleasant surroundings all wrapped in a $10 co-pay?

Medicare helps and don’t let anyone tell you seniors don’t like it.

The medications Kaiser dispenses are not best in class. When have you been prescribed lovastatin, the first “statin” drug, approved about 25 years ago? But lovastatin works pretty well if you don’t have galloping dyslipidemia.

You won’t find Kaiser doctors in Castle Connolly’s “best doctors in America.” Don’t expect Johns Hopkins or Stanford Med graduates. But they are thoughtful, caring and in mom’s case know primary care medicine as well as anyone you could hope for.

Kaiser’s medical information system is seamless, electronically linking departments, clinics and the pharmacy. But if the computers don’t work, you gotta move.

These points contribute to “how does Kaiser do it,” but they don’t fully answer the question. I’d really like someone to enlighten me.

Someone critical of President Obama’s enacted Patient Protection and Affordable Care Act said that sooner or later all of us will be going to Kaiser-like facilities.

If so, we could do a lot, lot worse.