January 7, 2009
While there are uncertainties in forecasting what health IT will look like in 2009, one force is already undeniably influencing the health IT market: American consumers.
Health IT has gone mainstream and in 2009, consumers will help decide where exactly it fits in the stream. President-elect Barack Obama has said health IT will be part of a stimulus package to help revive the country's ailing economy. But even without the government's help, 2009 will be a crossroads kind of year for health IT.
In the second half of my annual iHealthBeat end-of-one-year, beginning-of-another look at health IT, we'll examine the consumer drivers shaping the industry.
Health Financing and Medical Banking
In this era of economic downturn, employers continuing to sponsor health insurance for workers are looking for ways to manage costs. This past year saw growth in health savings accounts coupled with high-deductible health plans. These are tools that help employers compel workers to put more financial skin in the game of health coverage. And the consumers who opt into these plans have, in aggregate, serious monies to manage in the funds.
In 2008, HSAs amounted to about $6 billion in the second quarter of 2008, according to Information Strategies. We'll see expansion in medical banking functions that manage this business. Besides UnitedHealth (OptumHealth Bank), WellPoint (Arcus Bank), and the BlueCross and BlueShield Association (Blue Healthcare Bank), other plans will create banks that will be FDIC-insured to manage the HSA balances.
These funds, along with other consumer-facing health monies, will add up to at least $40 billion by 2013.
Telehealth Takes Off
The growth of broadband to the home, consumers' comfort with IT and health providers' need to extend caregiver resources beyond their institutional walls will converge in 2009 for telehealth applications to move into the home. Here's an instance where recession will be the mother of innovation for patient self-care and home care.
Hospitals need to staff even more efficiently during this economic-conservation era. Institutions can add volume without adding significant cost by adopting telehealth approaches to help patients with chronic illnesses avoid entering the hospital.
FDA's approval in 2007 of Intel's health device, the Health Guide, is another market signal that technology is available to provide real-time telemetry from the home to the provider by a major trusted market player. With aligned incentives between provider, payer and patient, the home could begin to become a central node for chronic care in 2009.
Online Search vs. The Doctor
Americans now favor the Internet as the source for health information compared with their doctor, based on Manhattan Research's latest Cybercitizen survey. 2007 was the first year that more consumers went to the Internet for health information than to their doctors.
"We've seen the Internet continue to grow," Manhattan Research's Meredith Abreu-Ressi said, adding, "Consumers are a lot more comfortable than they were in 2002 and are more satisfied with the content they're finding."
The top health portals looking to 2009 will be stalwart WebMD and EverydayHealth, the latter of which gained a lot of momentum in 2008 through its acquisition of RevolutionHealth and content expansion.
What's driving online searching now is consumers increasingly facing growing health care costs and decisions. For example, 40 million people didn't fill their prescriptions in 2008.
A big part of online use is essentially health shopping. Consumers are driven online to ask questions about drug information: A physician might mention a drug by name and a consumer will decide whether filling the script would be 'worth it' based on perceived value, price, and convenience. Another consumer who is in a workplace drug plan might be faced with a formulary decision for a drug that's not on a list, comparing it with an over-the-counter medication.
There's also evidence of consumers' growing interest in researching ratings for prescription drugs online. Key sources for this information are Daily Strength and WebMD as of late 2007.
In times of uncertainty, which is the watchword for 2009, it helps to get informed and engaged. My first recommendation on getting smart is to read Tom Daschle's book, "Critical: What We Can Do About the Health-Care Crisis." If you want to read more, check out David Cutler's "Your Money or Your Life."
These two influential health intellects will inform the Obama health reforms that will be rolled out over several years. Pay-for-performance, value-based health care and clinical effectiveness will be features of a new-and-improved U.S. health system.
But don't just read. In the Obama version of Government 2.0, ideas will be coming from all kinds of places -- from social networks and mothers and kids, from the 50 states and overseas. This is no time for disengagement. In 2009, health IT professionals, policymakers, payers, suppliers and patients especially need to be fully engaged in health, and the empowerment that health information can bring.
Return to In the News
Med Ad News
November 1, 2008
For the second year, Med Ad News has chosen four Pharmaceutical Marketing Ventures to Watch from a variety of young, creative venture companies that could change the way pharmaceutical products are marketed and sold.
This past August, Med Ad News began the now-annual search for the future of pharmaceutical marketing. We sought out young companies to profile that are providing the most innovative and interesting products, services, or marketing opportunities to pharmaceutical companies and the healthcare community. After reviewing dozens of nominations, many of which were provided by our own readers, we were able to narrow down the list to just four.
Each of the four companies chosen by Med Ad News is very different in business model and products and services offered. All of the companies do share one singular characteristic: that spark of creativity that makes frustrated entrepreneurs say, "Why didn’t I think of that?" Here are Med Ad News’ four Pharmaceutical Marketing Ventures to Watch for 2008.
3FX is a three-dimensional animation facility that focuses entirely on the pharmaceutical and healthcare industry. The company has been around since 1995, but its most innovative offering, the 3FX Immersive Theater Experience, launched just a year ago. The Immersive Experience is the delivery of 3-D animated content in a 360-degree portable enclosed environment – a collapsible, transportable dome with a wrap-around screen on the inside. When played, the content visually and audibly surrounds the audience, creating the impression of actually being inside a part of the human body.
The idea behind such an unusual offering had its roots in a more traditional form of immersive theater – the planetarium. But only in the last two years could the company actually find someone to manufacture a portable planetarium, presenting 3FX with the opportunity to create an offering that pharmaceutical companies could take to trade shows or other off-site locations.
"When portable domes became available, 3FX saw an opportunity to marry the portable planetarium concept to our 3D medical content, merge the two together, and then create the brand – thus the 3FX Immersive Theater Experience," says Rich Kushner, VP, sales and marketing, 3FX (3FX.com).
Moving from more traditional flatscreen animation to an immersive environment was a challenge. But after surviving the learning curve and producing their first dome content for AstraZeneca (astrazeneca.com) in November 2007, 3FX’s leaders are confident that they have the jump on the rest of the marketplace.
Creating dome content is an involved process, even more so than the traditional flat animations that many pharma companies have produced for trade shows and other presentation opportunities. Mr. Kushner estimates that animating 3FX’s portable immersive environment adds another 20% to 30% to the usual one-minute-per-month time line of a typical medical-animation project.
3FX is a full-service 3D animation facility that can do full script-to-screen content creation. The company works closely with clients in the development of a script, during that time developing all the characters and environments that are going to be in the show. Once a script is approved, all of the 3-D elements are ready to be storyboarded and animated. Professional narration, custom music, and sound effects will be designed and developed. The production process typically goes through about three work-in-progress reviews to reach a finished product stage.
3FX covers the same territory as many medical animators, but in a radically different presentation style. 3FX specializes in unbranded and branded 3D visualizations of disease states, mechanism of action, medical devices, broadcast spots, and healthcare-related imagery.
"A great benefit to our clients is that a single project can be cost-effectively incorporated into many display formats, including plasma screens, interactive applications, Websites, large group projection, PowerPoint presentations, and anywhere a digital display can be presented," says Cory Resh, partner and creative director, 3FX.
The idea of the dome presentation is to give the viewer the feeling of being inside of and surrounded by the animation. The work 3FX develops for all of is clients is medically accurate. Highly detailed characters and environments are presented with dynamic camera movement and visual effects.
"Our goal is to create visuals that viewers will want to watch again and again, enhancing the retention of the information presented," Mr. Resh told Med Ad News.
Each of the 15 members of 3FX’s staff are highly skilled at their craft, with at least 10 years of medical animation experience. Some of the animators even have medical degrees – one has a master’s degree in cellular biology. Others are degreed medical illustrators.
Already, the dome-animation concept has generated considerable interest. One client is touring one of 3FX’s domes around Latin America, showing different 3FX-generated content for different brands at a variety of medical shows.
The idea behind every dome animation is to take advantage of the special opportunities that a surround, immersive environment can offer to give the audience an educational experience that differs fundamentally from the traditional flatscreen animation.
"You have so much more space surrounding, and you want to use that space in an effective and designed fashion," Mr. Resh says. "There are little tricks that we like to use to surprise the viewer and draw them in to the full experience. It’s not like sitting in a movie theater and looking straight ahead and watching the visuals. You must use the space to your advantage and force viewers to look completely around. That’s what an Immersive Experience is all about."
Aptilon enables biotechnology, pharmaceutical, and medical-device companies to reach and interact with physicians via the Internet through its AxcelRx Live video detailing platform. Launched in 1999, the company started out in e-detailing and later transitioned to doing live video detailing for Merck & Co. (merck.com). In 2007, Aptilon began commercializing its video detailing offering with other companies. Company leaders claim that seven top pharmaceutical companies have already adopted the service in its first year of general availability.
"We have spent years developing this with Merck, who has made a commitment to building alternative channels for marketing and sales efficiency and effectiveness," says Mark Gleason, senior VP, corporate development, Aptilon (aptilon.com). "About two years ago we were ready for ‘prime time’ and took it out publicly to other major pharmas. Very quickly, we’ve added six of the most effective pharma sales forces. In every case we’re helping drive coverage and access for multiple brands. With virtually everyone, we’ve renewed contracts and are in the process of working with their teams to look at a more expansive new commercial model for a sales force of the future that is providing new strategic options."
One of the fundamental principles behind Aptilon’s video detailing platform is convenience for physicians. Rather than having to make time for sales reps whenever they happen to appear at a practice, the physician can schedule a video detail with a rep at any time that is convenient. If schedules do not match up, the physician can make an appointment to speak with a rep in one of Aptilon’s call centers, who are on call during evenings and weekends in addition to regular business hours.
Aptilon’s platform goes well beyond the traditional detail in other ways. The company wants physicians to look at its service as a complete information resource, for everything from a quick question to an in-depth clinical review.
Doing live detailing online also opens up the opportunity to offer additional services and have them at the physician’s fingertips.
"Physicians can get ‘concierge-level’ services," Mr Gleason says. "If you need patient-ed materials, samples, access to some of the key opinion leader reviews of clinical data, off-label discussions with medical-science liaisons, we’ve basically made it one-stop shopping. High-value physicians can get anything that the pharma company can make available, all hubbed around that live rep, including high-quality educational presentations at their convenience, not just when a rep drops in to the practice uninvited."
Aptilon executives believe that anything and everything that can be made available online can be wrapped around the sales rep who uses AxcelRx, who can then open up Webpages while talking to physicians and teach them how to register for sample ordering, guide them to information about the formulary in their state, or access any number of other online educational opportunities.
The idea for Aptilon was born out of a series of circumstances that have made getting in to see doctors increasingly difficult in the last several years. Physicians are overwhelmed by the number of patients they see in their practice each day, as declining reimbursement requires them to see more patients to meet the financial needs of the practice. At the same time, younger physicians have been trained to believe that reps are not an effective source of education, but these physicians are technology-savvy and are quickly replacing the retiring baby-boomer physician population.
"We’re seeing an evolution in the physician population, both in the circumstances of reimbursement and the patient obligations as well as the profile of the typical physician," Mr. Gleason says. "The time-pressured physician with patients waiting in examining rooms and waiting rooms is unlikely to have time for drug reps – the rep is becoming the odd person out in the practice setting."
To find a way around these challenges, Aptilon placed the scheduling power in the hands of the physician. Perhaps not surprisingly, the company has found that many physicians prefer to talk with reps outside of office hours. Most interactions are happening during nights and weekends.
Physician interest in live video detail from sales reps is growing, according to Manhattan Research’s ePharma Physician v8.0 physician market study. About 45,000 U.S. physicians meet via online video with their sales reps, and more than 300,000 more have shown interest in interacting with sales or other company representatives online.
Physicians already engaged in video detailing with sales reps are, for the most part, highly satisfied with their experience, according to the study. This sentiment may explain why these physicians are consistent users – physicians already participating in live video detailing sessions do so with an average of seven reps per month.
"Incorporating live video details in the physician-sales rep relationship can be a win-win for both groups," says Meredith Abreu Ressi, VP of research, Manhattan Research (manhattanresearch.com). "Depending on the company, it can be a cost-effective strategy for sales forces looking to reach physicians spread out over a wide territory, and physicians enjoy the flexibility and interactive features the sessions offer. Pharma companies should pay close attention to rep call centers that give healthcare professionals access to company representatives via telephone or Web chat at any time, as many physicians express interest in this type of service."
Not only are more doctors going online for details, but the doctors that do are staying on for longer interactions. According to Aptilon executives, the company’s live video details average more than eight minutes in length among primary-care physicians, and about 15 minutes for specialty physicians.
December 30, 2008
Did you wake up with pinkeye? Or maybe a painful sore throat or a nasty rash? You want relief and you want it now. Well, good luck getting it.
Nearly a third to half of consumers have trouble getting a doctor's appointment when they want one, and more than three-quarters report long waits once they're in their physician's office. Fall ill at night or on a holiday or weekend and your only option may be the emergency room, where you could wait hours for treatment (sicker patients get to jump the line) and pay $75 to $300 or more for the privilege, depending on your insurance coverage.
At least that's what your health-care choices used to be. Recently there's been a boom in nontraditional medical facilities that aim to deliver fast, easy-to-access care, often for a lot less than the cost of a regular doctor visit.
Over the past two years, the number of retail clinics in pharmacies, supermarkets and big discount stores has jumped from 200 to 1,100. Freestanding walk-in clinics, also known as urgent-care centers, have become more prevalent as well, with an estimated 8,000 nationwide. Meanwhile, a slew of employers are now providing health care at the office, hoping to save money and boost productivity. And a small but growing number of physicians are even offering Web consultations, typically for less than half the cost and a tiny fraction of the time of an in-person appointment.
The big draw for patients: convenience. With most of these health-care options you don't need an appointment, you don't have a long wait once you're there, and you can get care in the evening and on weekends. They're cheaper than going to the E.R. and may also cost less out of pocket than regular doctor visits, especially if you have a high-deductible insurance plan and pay the full price, not just a co-pay.
Consumers so far have expressed satisfaction with the treatment these facilities provide, and physicians groups have acknowledged that they afford better access to health care. That said, these options aren't suitable for every medical problem, and they're no substitute for "the kind of continuous care that comes with a doctor-patient relationship that's been cultivated over time," notes Families USA, a health-care advocacy group.
So don't give up your family doctor. But do use these services for what they're good at. Read on to learn where to go when.
Flu shot on the go
Last fall Kristin Baker, a yoga and Pilates instructor, received the flu vaccination for the first time. A few students were heading after class to get it in a nearby grocery store, so Baker tagged along. "It was great," says the 37-year-old Texas resident, who had never visited a clinic before but plans to return. "We waited in line maybe five or 10 minutes, and I actually picked up a few things at the grocery store at the same time." Cost of the shot: $25, but because Baker had a coupon, her flu vaccine was free.
Peruse the health aisles of a national pharmacy like CVS (CVS, Fortune 500) or Walgreens, (WAG, Fortune 500) a supermarket chain like Publix or a big-box superstore like Target (TGT, Fortune 500) or Walmart (WMT, Fortune 500) and you're increasingly likely to stumble upon the kind of clinic where Baker got her flu shot. Often only two rooms, these health centers are limited in scope: They treat about 25 common ailments, from rashes to sinus infection, in addition to providing immunizations and screenings for, say, blood pressure or cholesterol.
"We provide care for simple conditions, a very focused, episodic kind of care," says Donna Haugland, chief nursing officer for the national chain Minute Clinic, owned by CVS. And you'll get that care fast - the clinics don't require an appointment, they have weekend and extended weekday hours, and they claim you'll be in and out in less than 15 minutes - no waiting-room reading materials required.
The limited services (and prices) are posted in the waiting room as well as on the clinic's Web site. Fees typically run $50 to $75 (plus lab costs, if necessary) vs. $55 to $250 for the same services at a physician's office, according to a 2008 Deloitte report. All of the national chains now accept most major insurance policies, including Medicare. If your plan is accepted, you'll typically be charged the same co-pay as you would be at your doctor's office; high-deductible plan members may pay the full cost - but it will likely be cheaper than a regular doctor's appointment.
You usually won't find a doctor at a retail clinic. Treatment is more often provided by nurse-practitioners and physician's assistants. The medical community generally agrees that such health-care providers are qualified to handle the basic services offered.
"A retail clinic with a nurse-practitioner is okay as long as it has this limited scope of practice and an in-state physician on call who can be contacted if necessary," says Ted Epperly, president of the American Academy of Family Physicians. He adds that centers should send records of patients' visits to their regular M.D.s; as a patient, you should confirm that happens.
It's up to you to do the initial triage to determine if a retail clinic is appropriate for your symptoms. Sore throat? Sure. But a sore throat accompanied by dizziness or shortness of breath? Probably not. Also understand you won't get follow-up care. If your symptoms persist or return, go to your family doctor.
One last caveat: Don't use these clinics for routine care or checkups. That's what your family doctor is for. "We want our patients to have a primary-care provider," says Haugland. "We're not a medical home."
Find a nearby clinic at the site of industry group Convenient Care Association, ccaclinics.org.
Staying healthy on the job
The workplace health center is making a comeback, with nearly a third of companies having a clinic or planning to open one by 2009, according to benefits consultant Watson Wyatt. The 21st-century version of the old company clinic usually provides a broader array of medical services than retail clinics do but may not be equipped to do everything your regular doctor's office can. The centers emphasize prevention and wellness, often offering chronic-disease management programs for conditions like diabetes and obesity. You can typically get some immunizations and screenings as well.
Altruism isn't the motive. Healthy employees are more productive employees, the reasoning goes, and don't have to take as much time off from work as sickly ones. Plus, the companies expect to shave money off their health insurance bills, says Watson Wyatt senior consultant Marne Bell.
But in this case, at least, what's good for the boss is also good for the employees. You usually pay nothing for the services the company clinic provides; at the few companies that do charge, costs are usually lower than at the doctor's office (you may have a co-pay of $10, for instance). Prescriptions may be discounted too. Typically, all benefits-eligible employees, even part-time workers, can use the centers. A quarter of companies open the door to covered dependents, and 20% extend access to retirees.
Moreover, nothing beats the convenience. The centers are usually on-site. You can generally get an appointment within a day or simply walk in and be back at your desk in less than 30 minutes. As with retail clinics, you'll generally see nurse practitioners and physician's assistants, although some companies employ a doctor. If you do use the company clinic, just be sure to keep your regular doc in the loop about the care you get there.
Jennifer Walker, 44, an insurance claims quality reviewer at Prudential, knows firsthand the benefits of having a health center where she works. About a year ago, Walker developed a serious blood clot in her arm, and for six months after she had to have blood drawn regularly for monitoring. So every other day she went down two floors to Prudential's health center to have the check done. The process took 10 or 15 minutes, hardly interrupting her workday, and cost her nothing. Best of all, says Walker, "the staff there helped me understand the whole thing and made me feel like I wasn't going through it alone."
Medical care without the bumps
One day back in 2007, Marshall Alston's son Justin, then 14, started developing large bumps on his legs. That evening, rather than wait to get a doctor appointment or sit for hours in an emergency room, Marshall took his son to a walk-in urgent-care center near their New Jersey home. The doctor quickly determined Justin suffered from a staph infection. "My son got the appropriate medicine, and I was reassured to learn it was nothing more serious," says Marshall, a human-resources executive. They were in and out in just over an hour, and Marshall paid only his regular $25 co-pay, less than the $100-plus he'd have paid in the E.R.
Urgent-care clinics fill a health-care middle ground: They're a step up in level of care from the retail clinic and a step down from the emergency room. Unlike typical retail and company clinics, these centers employ physicians. Thus they can treat more serious injuries and illnesses. Appropriate injuries include minor burns and deep cuts that require stitches, and you can also get treatment for ailments such as bronchitis and ear infections. (More serious symptoms, such as chest pains, still belong in the E.R.) The centers usually do not track and coordinate care, meaning you have to see your primary doctor if you need follow-up treatment. These services aren't meant to be a replacement for a family physician. Bottom line: Choose urgent care "when your primary-care physician is unavailable or you have an injury that's more severe than your primary-care office or retail clinic is equipped to take care of but not severe enough to belong in the emergency room," says Lou Ellen Horwitz, executive director of the Urgent Care Association of America.
Like retail clinics, these centers are typically open weekends and late on weeknights, and patients can walk in without an appointment. The wait is longer than at a retail clinic- patients are usually out in 60 to 90 minutes- but still a lot less than the three hours that's standard in the E.R., says Horwitz. You can expect to pay more than you would at a company or retail clinic, but it's still cheaper than the E.R. For example, your co-pay may be $30 at urgent care vs. $20 at a retail clinic and $75 at the E.R.
To find a facility near you, start by searching at ucaoa.org. Not all centers are listed, however, so also try doing a Web search for "urgent-care center" and your town. Since most centers are not nationally accredited, verify that the physicians are board certified in a primary-care specialty or emergency medicine; you can find the most up-to-date list at abms.org.
No office visit required
Just as technology may have helped you slash the number of trips you take to the bank or mall, it may also help keep a lid on the number of trips you take to the doctor. Although a relatively small number of physicians currently offer "Web visits"- 8%, according to health-care data firm Manhattan Research - the ranks are growing. That's in part due to the creation of secure messaging programs, which alleviate concerns about patient privacy. What might be even more influential in bringing doctors to the Web, says Manhattan Research vice president Meredith Abreu Ressi, is that some insurers, including Aetna and Cigna, now reimburse doctors for online consultations.
Ask your doctor if he or she is one of the online messaging pioneers, and then understand how this service can help you. Online messaging is intended for simple maladies and follow-up care that do not require your doctor to see you. It's a good way to ask your doctor about prescription issues such as side effects and alternatives. You can ask how to best treat a sore throat, allergies or a recurring rash. If you are monitoring your blood pressure or a chronic disease, you can send your doctor regular updates. What these visits are not meant for: treating more serious complications such as chest pain or requesting a prescription for an ailment you've diagnosed yourself online.
When you go for a Web visit, you log in, type in your symptoms and are then prompted to answer specific questions based on those symptoms. "It is the usual questions that we would ask a patient in the office," says Karon LoCicero, an internal medicine physician in Tampa who began consulting with patients online about a year ago. The doctor responds within, say, eight business hours by e-mail or phone or requests that the patient come in. LoCicero says that it cuts the time wasted playing phone tag with patients. "The patients really like it," she says. "It is convenient for them; it is also convenient for us."
Of course, you may not actually need to rely on e-mail as the only hope to reach your usually-booked-solid doctor. In response to the rise in urgent-care centers, retail clinics and company clinics, many M.D.s are trying to give patients better access to care, extending hours and scheduling time for last-minute appointments. So don't assume that the old-fashioned appointment isn't still an option.
December 14, 2008
Manhattan Research, which studies how consumers and physicians gather healthcare information and the impact of technology, recently released its US study of consumers - Cybercitizen Health v8.0.
The study surveyed the health search habits of 8,000 US adults over the age of 18 by telephone and online during August and Sept 2008. The survey examined how consumers are using media, the types of sources users are exposed to and how all of those different sources ultimately influence their treatment decisions.
Setting the scene
According to Meredith Abreu-Ressi, vice president of research at Manhattan Research, a lot has changed in a short time. In particular, the media mix is than even ten years ago when Google had just launched.
“Back then life as a pharma marketer was a little simpler,” Abreu-Ressi says. “Marketing teams were primarily tasked with TV and print commercials, but the focus was still primarily on getting their message out to doctors through representatives. But a lot has changed – as a pharma marketer, there are hundreds of different channels available and figuring out which way to go is increasingly difficult.”
The key struggle that many companies face today, she says, is making sense of today’s landscape with all of the different channels available. The new media, Abreu-Ressi explains, is not just the internet, but dozens, if not more, channels within a channel embedded within the internet.
Companies, she says, must know how to get information to different patients groups or categories of consumers. And that’s an increasingly difficult challenge that relied on fully understanding your therapeutic category, because the relevant media mix varies drastically, depending on the group you’re targeting, she says.
With all of the available data and resources now available, the challenge, Abreu-Ressi says, is determining how to tweak the various allocations to the different sources to make the most effective marketing plan you can.
The group’s research finds that since 2002, health information seeking online has more than doubled and pharma information seeking has more than tripled. Today, Abreu-Ressi says, the vast majority of consumers are e-health consumers; it’s no longer just early adopters online.
“It’s the new norm for consumers to be looking for health information online today,” she says. “Pharma information seeking has grown even more than predicted over the past two or three years.”
Consumers are going online in a wide variety of circumstances:
And, Abreu-Ressi says, we see consumers using different resources at each of those different points of the treatment continuum. It’s not a one size fits all approach.
“Sometimes you want to be targeting consumers who are switch opportunities, sometimes you need a media plan for those coming online after seeing a DTC advertisement,” she explains. “So, it’s really important to be able to parse out within the internet channel how consumers are using all of the different sources that are available to them.”
According to this year’s study, the internet actually surpassed the physician in 2008 as a source of health information. Healthcare professionals, Abreu-Ressi says, are still the highest in terms of relevance, but have lost the “reach” race. The internet, she reports, is the only thing even close in terms of relevance.
Back in 2004, the physician was the number one source consumers relied on for health information and was also very high in relevance. Now, the physician is relatively equal in terms of relevance, but has decreased in reach. There are a number of contributing factors in the trend, Abreu-Ressi says.
The first is cost. As co-pays have increased, medical treatment is less affordable and consumers are being much more selective about when they’re seeing a physician. Since 2004, the internet has gained significantly in reach and relevance and speaks to the trend of the “empowered consumer” that’s emerging, she says. Patients are increasingly being tasked with managing their own healthcare and the internet is a key tool in how they’re doing that.
Catching up with the trends
TNS data, Abreu-Ressi reports, shows that TV represents the vast majority of pharma’s advertising budget.
“Among the measured media, the internet is only 3% of overall ad expenditure, which is still really out of tune with the types of shifts we’re seeing,” she says. “Gone are days when consumers were sitting around the TV as a captive audience and really tuned in and not wanting to miss a second of their favorite show. Ads were a necessary part of that whole experience. But what we see today is that’s not really the case for most anymore."
Abreu-Ressi says less than half of consumers are watching all of their TV live; most are watching some sort of time-delayed or alternative channel format, including shows available directly online, on mobile phones, downloaded to iTunes, and on demand with TiVo and other digital recording devices.
“The era of being tied to commercials is past, which again really speaks to empowered consumer,” she says. “They have more control than ever over the content they watch and there have been huge moves by a lot of the networks and advertisers to embrace this market."
Depending on therapeutic category, it could mean be a “wildly different” media mix in terms of how patient groups are watching television, Abreu-Ressi says.
“It is, however, almost a limited opportunity to really get in on the ground floor with some of the advertising opportunities that are coming out of these formats,” she says. “We’re seeing some of this effect not only at the increasing relevance of the internet or consumers, but at the decreasing value of TV advertising being mirrored in some other industries. Kellogg, whose cereal market was almost made thanks to TV advertising, has announced that their online ROI is beating TV by a factor of two. And even the kind of beleaguered auto industry is reporting they’re going to be increasing their digital spend because of some of the positive ROI that they’re seeing. So, they’re really seeking refuge in digital during a very difficult time – which should probably sound familiar for a lot of pharma companies.”
Abreu-Ressi says that although we’re seeing a lot of shifts within many pharma companies, there have not been a lot of big announcements like those by other big companies. One of the big things holding pharma back, she says, has been ROI analysis.
“It’s not as easy as it is in CPG, but many other industries have figured out how to do it,” she stresses. And many groups are working with pharma clients to do it; it’s not impossible. If that’s what’s holding you back, it’s time to get some metrics to prove this to yourself.”
The other thing that’s really driving the “death of TV,” she says, is that as many companies move away from blockbuster drugs, the precision targeting that’s available online is a really unprecedented advertising opportunity.
“TV is quite a blunt and costly instrument if you’re targeting an increasingly smaller segment of the population,” she explains. “The internet offers a completely new approach to segmentation. You can actually go out and find consumers looking for information on a certain condition or even on your treatment and target them specifically, rather than having to advertise to everyone on the six o’clock news, at a mere fraction of the cost of a TV advertisement. Many companies are starting to recognize this as a really compelling way of doing things.”
Channels within a channel
But just when you thought it was enough to simply have an understanding of the internet and everything that’s going with that, she says, we’re seeing the mobile web starting to change the landscape as well. Some segments are not turning on their computer when they go home at night, she explains, because they have it in the palm of their hand and that makes it an even more “on demand media” than it was when you sat down at your laptop and logged on.
“We’re really trying to understand these consumers more, Abreu-Ressi says. “It’s an audience that’s really projected to explode over the next few years. In some cases, they’ll even get rid of that “landline” internet connection and almost exclusively use their phone. Today, there are about 10 million people using their phones to find health information on the internet.”
For now, these consumers are certainly early adopters - much younger than average consumer, male, more likely to be college educated and also more likely to be caregivers to someone with a chronic condition. These are very busy, on-the-go people who have a lot going on in their lives, she says. The conditions most likely to be accessed this way include IDD, bipolar, psoriasis, ED and migraine – always active segments in terms of adopting new technologies.
Some really interesting opportunities have opened up, for instance, with the iPhone, she says. We’ve already seen some blood pressure charting, asthma symptom charting, and reporting of prescription drug interactions for consumers.
“These are going to be really interesting disease management and compliance tools,” Abreu-Ressi says. “You must understand at a very detailed level where your therapeutic category falls in the overall landscape of online adoption. We work with our clients to understand in detail how consumers differ when it comes to channels and within a channel, and when it comes to the internet by therapeutic category. You have to understand how they differ, among therapeutic categories, in terms (of where they’re going and how they’re getting information online. This is really critical to understand as clients go through their brand planning process. You have to really work out where the needle has moved and how they should be spending online.”
She says we’re also seeing another “channel” emerge as a critical resources that consumers are relying on beyond the physician and advertisements – Web 2.0 – social networking.
“We’re seeing consumers going in mass to drug rating sites and reading about others’ experiences with products before going and filling that prescription, Abreu-Ressi says. “Communities are a key support networks for many conditions. Even for conditions such as COPD and cancer that affect primarily older consumers who are less likely to be online, Health 2.0 and user generated content sources are extremely important new channels. It kind of debunks some of the conventional wisdom. I’m not sure many clients would predict that COPD and emphysema would be one of the best targets for a health 2.0 community focused initiative, and yet that’s what we’re seeing in the data.”
How can companies start to address Health 2.0? J&J and GSK, Abreu-Ressi says, have actually created YouTube channels with video content and Abbott and Merck have created FaceBook groups to create patient communities. And many companies are monitoring content online to stay aware of what’s going on in these conversations.
The possibilities, it seems, are truly endless.
January 28, 2009
HealthCentral Network is buying Wellsphere in another sign of the consolidation in the online health world, where too many sites are fighting for scarce ad dollars.
Last fall, two of the most popular sites, Revolution Health and Everyday Health, merged to surpass longtime leader WebMD as measured by unique visitors.
HealthCentral Network, which set up a partnership last year to sell advertising to pharmaceutical companies with its minority investor IAC/Interactive Corp., has a host of condition-specific portals ranging from acid reflux to erectile dysfunction. Wellsphere, a San Mateo, Calif. aggregator of over 1,500 health and wellness bloggers, also offers interactive tools that allow users to send themselves reminders like “go to the gym” and log progress on their fitness goals on their mobile phone.
While comScore’s Andrew Lipsman estimates the merger would increase unique visitors to HealthCentral’s main content site to nearly 3.1 million from 2.3 million. HealthCentral claims the merger adds four million monthly unique visitors to its total reach of ten million, which includes all of its affiliated online communities and partners.
“While scale certainly matters, it is the quality of the scale,” HealthCentral’s CEO Christopher Schroeder tells the Health Blog. As traditional ad budgets come under pressure, “advertisers are looking to put the right messaging in front of the right audiences.”
As for the thousands of bloggers HealthCentral picks up with the merger, there is already grumbling in the blogosphere that Wellsphere built its business on health bloggers who don’t benefit from the deal. “But most are happy and we hope with all our resources and quality-content background we will really strengthen these engagements,” Schroeder told us.
Health Web sites have been taking steps to improve their offerings and provide better personalized services to consumers, as the WSJ’s Informed Patient column recently reported.
Manhattan Research’s Meredith Abreu Ressi says her company’s latest survey of 8,000 consumers found that more of them went online for health information than went to the doctor last year. While healthier people tended to opt for looking online for information over visiting a doctor, many said costs were leading them to cut down on routine visits and diagnose themselves or seek advice online from other patients.
Pharmaceutical marketing has come a long way since the days when television or print ads were the only options available for promotional messaging to consumers. In fact, today’s marketers have it harder on all fronts: they have to do more (in terms of ROI) with less (in terms of budget), while also mastering the new language of marketing in an age of increasingly splintered consumer channel mix.
The smart marketers are taking the time to step back and re-evaluate the role of digital in their overall marketing spend. It takes time to learn the new e-landscape – since it is different for each target segment – and the ROI models are more complex. But there are compelling reasons why it’s critical to re-evaluate the role of digital for success in 2009 and beyond.
According to a recent study by Manhattan Research, more U.S. adults used the Internet than doctors to obtain health and medical information over the past year. As healthcare coverage, and even routine visits to the doctor, become less affordable to many Americans, the Internet has emerged as a first line of defense for consumers seeking to manage their healthcare independently.
With more than sixty percent of U.S. adults turning to the Internet for health information, eHealth Consumers are no longer a group of early adopters – they are the new norm for how Americans manage their healthcare and the health of their families.
Television advertising was a powerful tool when you had a captive audience sitting around the television tuned in and not wanting to miss a second of their favorite show. But this is far from the reality for most consumers in our increasingly on-demand world.
In fact, less than half of consumers watch all of their TV live today. That means that most consumers are watching television programming in some sort of time delayed or alternative channel format, such as TiVo, streaming online, downloaded from iTunes, or watching on their iPhone.
As a result, many of the networks are rethinking the model to embrace this rapidly growing segment. However, many advertisers have been slow to follow suit – but they will be forced to in the coming months. With most pharmaceutical companies spending the vast majority of their budgets on television advertising, it will really be time for them to rethink how they allocate to this evolving channel.
Many industries are finding that online has an even better ROI than television. Kellogg’s recently announced that they are finding that online marketing beats television in ROI by a two-to-one margin. Even the beleaguered auto industry is seeking refuge in digital by ramping down television budgets and ramping up online advertising.
Another factor that is making digital increasingly relevant to the pharmaceutical industry in particular is the shift away from the big blockbuster drugs to focus on more niche markets. Television advertising is a blunt instrument – and a costly one if you are seeking to target a small segment of the population.
The Internet, by comparison, offers a completely new approach to user segmentation: You can find consumers who are looking for information about your condition, and target them specifically – for a fraction of the cost of a television ad. Many companies are finding this to be an incredibly compelling way of doing things.
As much as digital marketing offers substantial returns and opportunities for precision targeting, the world of emarketing and online ROI measurement can be difficult to navigate for the uninitiated. However, it will be critical in the coming months and years for companies to rethink the traditional approach to channel mix and promotional targeting and update the models accordingly.
Decision Resources, LLC. companies:
Copyright 2012 - 2013 Decision Resources, LLC. All rights reserved.