Market with Me, Not at Me: A Patient’s Plea for Inclusive Strategic Marketing in Healthcare

For the month of April, I will be sharing things I’ve written in the process of obtaining my MS in Health Care Administration which I finished up this past fall.

In the last thirty years, the healthcare system in the United States has started to shift from a paternalistic (top-down from doctor to patient) view to a more participatory (doctor and patient as equals) model.  This has resulted in great changes to the healthcare system at large, including changes from the Affordable Care Act requiring more participatory medicine.  However, there is still a long way to go in order to reach an ideal state in healthcare marketing.

While participatory changes in medicine itself may have come a long way, the same cannot be said for the pharmaceutical industry.  As healthcare systems move towards patient engagement, healthcare marketing – especially in pharmaceuticals – needs to follow suit or be left behind.  This paper will examine the current state of healthcare marketing and examine what steps organizations need to take in order to reach the ideal states according to patients, pharma, and system viewpoints.

Healthcare Marketing

Strategic marketing is a “plan for getting from a point in the present to some point in the future in the face of uncertainty and resistance” for businesses and organizations (Zuckerman, 2005, p. 3).  Creating an effective strategy involves planning, sustainability, performance improvement, quality, direction, focus, scheduling, analysis, connection, and importance (Zuckerman, 2005).

In the 1980s, healthcare advertising began to grow (Thomas, 2015, p. 13).  In the next decade, marketing within healthcare grew to include the “direct-to-consumer movement” (Thomas, 2015, p. 14).  This led to the rise of consumerism in healthcare, something that had started a few decades earlier.  By the time the 2000s came around, business and marketing practices from other organizations in the pure profit world began to stick in healthcare (Thomas, 2015, p. 16). The use of social media and internet-based marketing also began to rise.

Portions of the Affordable Care Act have “ushered in a new era of strategic planning” (Zuckerman, 2005, p. 7).  This will require a major shift strategic marketing processes for many organizations, some of which is already in the process of happening.  In combination with the ACA, the Precision Medicine Initiative from the White House, released in 2015, has helped to push the envelope in medicine.  The goal of this initiative is: “To enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward the development of individualized care” (The White House, 2015).  The world of medicine has not done a fantastic job of staying ahead of the curve without mandates, but the pharmaceutical world has done worse.

Current State of Pharmaceutical Marketing

Profits in the pharmaceutical industry are incredibly high, up to “three times the average of all industries” (Thomas, 2015, p. 86).  This often leads to a demonization of those in pharma, especially when some medications cost “upwards of $100,000 for a full course, and with the cost of manufacturing just a tiny fraction of this, it’s not hard to see why” (Anderson, 2014).  The costs of medications are often rationalized due to the low number of medications that pan out in the long run and become profitable (Anderson, 2014).  Additionally, pharma companies want to make as much money as possible before medications are able to be reproduced as generics or biosimilars (Anderson, 2014).

Pharma has failed to keep up with demands, let alone staying at the front of innovative ideas (Brozak, 2013).  Pharma seems to rely on their background of creating a handful of one-size-fits-all medication and marketing those as cure-alls.  Just as in marketing, these companies don’t focus on the development of new ways to deliver previously developed medications (Brozak, 2013). As Steve Brozak elaborates:

Companies using new technology and evolving marketing techniques to capture markets and displace predecessors, like Wal-Mart in retailing, Zappos in footwear, Volkswagen in cars, and others, were late entrants into existing markets but eventually surpassed their competitors.  Big pharma, beware, the same could happen to you. (Brozak, 2013)

The vast majority of money spent within the pharma industry is on marketing and not research and development (Swanson, 2015).  Even more troubling, the bulk of these marketing funds are “directed at the physicians who do the prescribing, rather than consumers” (Swanson, 2015).  More than 50% of pharmaceutical expenses, roughly $13 billion, were related to contact with healthcare providers with an additional ten billion through advertisements and other contact (Thomas, 2015, p. 86).  Companies, including big names like Glaxo Smith Kline, have committed bribery in the not-too-distant past in order to get their medications prescribed (Anderson, 2014).  With pharma barons like Martin Shkreli who will price gauge life-saving medications, the reputation of pharma employees and companies continue to take hits.

There is a lot of debate in the pharma industry on whether or not direct-to-consumer marketing is effective – and if this type of marketing is truthful versus convincing the consumer they need a medication.  Unfortunately, this can lead to a number of issues within the patient-health care professional relationship – just as much as it can empower patients by encouraging them to seek treatments and diagnoses (Thomas, 2015, p. 89).  The American Medical Association, in conjunction with a number of other medical associations, has even called for an end to DTC advertising (American Medical Association, 2015).  It’s important to note that the only other nation in the world that allows DTC advertising is New Zealand (American Medical Association, 2015).

There is, of course, a unique set of ethical and legal issues associated with marketing in both pharmaceuticals and medicine in general.  Limitations have been put into place by organizations like the Federal Trade Commission in order to halt improper advertisements (Thomas, 2015, p. 26).  There has also, from a pharmaceutical point of view, been a history of inability to communicate directly with patients or patient groups as a result of some of these limitations (Coe & Deverell, 2015).  This can certainly cause issues even when these barriers have, for the most part, been eliminated as the pharma representatives aren’t used to this line of communication being open (Coe & Deverell, 2015).

Ideal State of Healthcare Marketing: Patient Viewpoint

At the time of writing this paper, Kristin Coppens was the social media lead for Spectrum Health in Michigan.  She is also a renowned patient activist, working with organizations such as Stanford University.  She had this to say:

Often, the communications and marketing industry as a whole struggles with marketing AT people versus engaging WITH them.  The same can be said about healthcare.  I understand physicians and other healthcare providers have a level of education and expertise that the patients often do not have, but I think we [patient activists] are also not saying they don’t know what they’re talking about.  Unlike the flip side of the coin, patients are not pushing an ‘us versus them’ agenda.  We just want to be included and work WITH healthcare professionals.  Some of the ways the industry could do this would be to simply bring patients into the conversation, i.e. health systems using patients as patient advocates/patient experience.  Fill those positions with actual patients.  Or you could even have a patient-led board that regularly makes patient engagement enhancements and decisions.  Another way starts in medical school.  Teach these physicians to engage with patients instead of just talking AT them with jargon.  I think it all boils down to getting patients in “positions of power” so to speak. (Coppens, 2016).

As Ms. Coppens expands on, there is a lack of recognition of patients as experts in their own experience.  In medicine in general, this can lead to the perpetuation of the paternalistic attitudes that medicine as a whole has been trying to move away from.  In marketing, this leads to a lack of connection between the product/brand and patient/consumer.  This is especially true in pharma when commercials depict unrealistic activities for someone with, say, Rheumatoid Arthritis to participate in – no matter what medications they are on.

This lack of connection adds to the demonization of those working in the pharma industry.  Patients like Ms. Coppens often believe that these companies are not focused on their wellbeing as a result of this disconnect.  If pharma doesn’t understand what it’s like to be a patient and handle the symptoms of certain illnesses, how can they display a realistic version of improvement in their advertisements?

Realistically Moving to the Ideal State

As Ms. Coppens mentions, one of the biggest barriers between patients and others within the healthcare system and pharma is how we overcome the ‘us versus them’ mentality.  One of the common occurrences in the pharma world is hiring a third-party organization to conduct market research (Coe & Deverell, 2015).  While this may be best practice in some situations, the removal and seemingly refusal of pharma reps to interact with the patients they serve contributes to this mentality.  It is great to have pharma interested in obtaining reactions of patients, but this is often done through focus groups on already-produced materials instead of including patients in the development of advertisements or other materials (Coppens, 2016).

A bonus of ensuring better brand management and interaction with patients is that there is less need for the urgent use of relationship management personnel and resources.  Obviously, though, the biggest bonus is that these changes would help to contribute to a general sense of working together and removing the demonization of each party for the other.  From a marketing standpoint, these changes have the potential to increase profit while decreasing over-prescription of these medications and, therefore, any potential lawsuits and settlements related to such medication.

Having patients involved with the pharmaceutical marketing process also has the unique opportunity of addressing a variety of quality-of-life issues while promoting medications in very pointed groups or diagnoses.  It has been proven that patients’ individual health improves with an increase of their engagement in their own care (Greene, Hibbard, Sacks, & Overton, 2015).  This can also lead to fewer admissions and readmissions to the emergency room or hospital, fewer complications, and lower healthcare costs overall (Greene, Hibbard, Sacks, & Overton, 2015).  Having patients at large involved in improving healthcare for groups of patients can have an enormous effect on the lives of patients involved as well as patients, healthcare providers, and others who are reached with this information.

One pharmaceutical group already accomplishing this is Jansen, the pharma wing of Johnson & Johnson.  Through their group Joint Decisions, a partnership with arthritis-based site Creaky Joints, they aim to educate others about what it’s like to live with rheumatic diseases, ways patients can empower themselves to become better partners in their care, ways to handle life events such as travel with illness, and more (Joint Decisions, 2016).  Patients involved with Joint Decisions are among the leading rheumatic patient activists in the Western Hemisphere and are compensated for their involvement, something that is not the norm in patient activism (personal communication, June 2015).  Through this partnership between a non-profit organization, pharma, medical professionals and patients, better materials are being released for patients living with types of arthritis.

Conclusion    

As highlighted in this paper, there has been quite a lot of change within marketing in the last several decades.  However, there is still a lot of work to be done.  This is especially true in the pharmaceutical industry.  Patients are often left out of the marketing process or only brought in on the back end after materials have already been developed.  Organizations will need to include patients more in the front end of development, which will become especially important in the future as the United States focuses more on pointed care and inclusionary medicine.  If organizations within healthcare want to follow an example, investigating the partnership occurring with Joint Decisions – pharma, healthcare professionals, and patients – will lead to new best practices for inclusionary medicine and marketing.

Works Cited

American Medical Association. (2015, November 17). AMA Calls for Ban on Direct to Consumer Advertising of Prescription Drugs and Medical Devices. Retrieved from American Medical Association: http://www.ama-assn.org/ama/pub/news/news/2015/2015-11-17-ban-consumer-prescription-drug-advertising.page

Anderson, R. (2014, November 6). Pharmaceutical industry gets high on fat profits. Retrieved from BBC News: http://www.bbc.com/news/business-28212223

Brozak, S. (2013, May 25). Big Pharma Learned The Wrong Marketing Lesson. Retrieved from Forbes: Pharma & Healthcare: http://www.forbes.com/sites/stephenbrozak/2013/05/25/big-pharma-learned-the-wrong-marketing-lesson/#7060824346c4

Coe, J., & Deverell, C. (2015, March 23-24). Amgen. (P.-e. Wrap-up, Interviewer)

Coppens, K. M. (2016, June 17). Healthcare Marketing. (K. Schultz, Interviewer)

Coulter, A. (2011). Engaging Patients in Healthcare. Maidenhead, Berkshire, England: McGraw Hill/Open University Press.

Greene, J., Hibbard, J., Sacks, R., & Overton, V. (2015). When Patient Activation Levels Change, Health Outcomes And Costs Change, Too. Health Affairs, 34(3), 431-437. doi:doi:10.1377/hlthaff.2014.0452

Joint Decisions. (2016, May). Joint Decisions. Retrieved from Joint Decisions: http://www.jointdecisions.com/

Ouschan, R., Sweeney, J., & Johnson, L. (2000). Dimensions of Patient Empowerment. Health Marketing Quarterly, 18(1-2), 99-114. doi:doi:10.1300/j026v18n01_08

Sanchez, P. M. (2003). Refocusing Website Marketing. Health Marketing Quarterly, 20(1), 37-50. doi:doi:10.1300/j026v20n01_04

Swanson, A. (2015, February 11). Big pharmaceutical companies are spending far more on marketing than research. Retrieved from The Washington Post: https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-pharmaceutical-companies-are-spending-far-more-on-marketing-than-research/

The White House. (2015). The Precision Medicine Initiative. Retrieved from The White House: https://www.whitehouse.gov/precision-medicine

Thomas, R. K. (2015). Marketing Health Services. Chicago, IL: Health Administration Press.

Weber, L. J. (2006). Profits Before People?: Ethical standards and the marketing of prescription drugs. Bloomington: Indiana University Press.

Zuckerman, A. M. (2005). Healthcare Strategic Planning. Chicago, IL: Health Administration Press.