Strategic Change, Value Innovation and Drimpy.com – Interview with Rob Halkes

Rob Halkes has been working as a consultant in healthcare and pharmaceutical marketing for 20 years. He gained experience in the industry focusing on strategic change, professional development and innovation in pharma. He is also part of the development team of the integrated healthcare platform, Drimpy. We asked him to share his insights on the changing environment of the pharmaceutical industry and healthcare.

You have been urging strategic change in the pharmaceutical industry. Why is this issue important and what kind of specific changes do you think pharma companies should consider?

Because of the current economic situation, the trend in healthcare will be “more care for less money”. For all governments in healthcare in Europe, it is easy to cut costs on pharmaceutical products. So we see an enormous pressure in a lot of countries, not only in the Western countries, but in the Eastern countries of Europe as well. We see a lot of pressure on cutting and reducing prices and on the replacement and substitution of premium and specialty products with generic pharmaceutical products. To the pharmaceutical companies it will mean that they are trying to sell their products in the context of a commodity trap. The commodity trap is an economic phrase that implicates that prices for premium products will be inflated by upcoming generics or cheaper products. If you go along with the trend to make cheaper products or to sell your products for cheaper prices, you will find yourself in a downward spiral. The pharmaceutical companies have no tradition in trying to innovate their marketing approach other than just creating new products, submitting those to the market and introducing those at a higher price. And now premium innovative products are being replaced by generics. So although you may have made or developed very good innovative pharmaceutical products, those will tend to be replaced by generic ones. The market of specialty products merges with the market for OTC or generic products. The only solution to escape the commodity trap is to innovate your marketing approach.

That can be done if you are willing and competent to make a strategic change towards helping the doctors to treat their patients better. Helping means a two-step process: not just helping doctors to prescribe your product, but helping doctors with your product to be able to help patients better. Then you can convince the prescribers that there is more to your product than just the product itself, that you are also actively supporting the doctors to innovate their caring for the patients to support them better.  This added value could be the reason for a higher price instead of going down with the commodity trap. This is difficult for pharmaceutical companies because for 20 years now they have been on the same business model of promoting new products for higher prices – that will come to an end now. That is only one issue of all difficulties that present themselves to pharmaceutical companies.

More strict regulation of promotion, lesser access to prescribers, upcoming generics and new stakeholders – these are other issues in the pharmaceutical industry that need to be mentioned. Governments, healthcare insurance companies, payers and patients are all new stakeholders that will come to the market with a clearer voice that they want better products for a better care. Hence, strategic change is necessary when it comes to changing market conditions and the way the conditions and caring for health are changing in different countries. Adapting to the conditions in specific countries will become relevant. The European affiliates will have to design their approach according to the local conditions of care.

You also developed a new business model called “value innovation” for the pharmaceutical industry. Could you describe this concept?

The approach of value innovation that I developed in the Netherlands has very clear results. We can show graphics of the outcome and how obvious the changes and results are. Through these results the model speaks for itself. The approach of value innovation is based on two principles:

The first is that as a pharma company you have to support your healthcare providers – doctors, specialists and pharmacists – to help their patients better by improving their way of caring for the patients. There are two concepts for this kind of care: integrated care and participatory care. That’s the first principle: innovate for your healthcare providers to help them improve the way in which they are performing their care for health. It might look as though you are mingling with their business. But in our experience healthcare providers mostly don’t have time to reflect on how they are providing care. When you help them with expertise, training and other services, you will be appreciated as someone who is caring for their interests and is acting on their behalf. When you do so with integrity, you will gain a different market position: a trusted one. It will reimburse you through the attention that your product is getting from them as being your partners in the business of caring for patients. For a lot of companies this will be a change in their selling approach. They have to learn how to submit and propose those services, because it differs much from just detailing.

The second principle is based on the necessity to differentiate between your targeted doctors: between those who will readily appreciate what you are doing, and those who will not. Most of the pharmaceutical companies already segment their priority doctors as to their individual potential for business. I propose to extend this to differentiate between those who have an innovative stance to healthcare development and those who don’t. In a changing landscape of healthcare, those who do want to improve their way of caring for patients will often collaborate with colleagues to approach innovation in care cooperatively. We see examples in health care groups, like “Zorggroepen” in the Netherlands, the Policlinics or medical centers in Germany or the GP consortia in the UK. We developed a segmentation procedure with which you can target the GP centers that are the most influential and have the most potential to cooperate with as a pharmaceutical company. The benefit for those that do want to work with you will be that patients and other stakeholders in care will notice that by working together in a co-creative way, it is possible to create better outcomes of care with less cost. It will lead to a higher satisfaction for patients and for a lower cost of patient per year in specific care programs, especially for chronic care. And if you can demonstrate, that you as a pharmaceutical company are helping the healthcare system in this direction, you will get a lot of attention that will lead to a position of preference that will help your business as well.

So actually the change will be from a purely product-oriented approach toward a patient- and healthcare-oriented position. And that is an orientation that healthcare providers and doctors will recognize as a change from selling toward helping.

Last October you showcased Drimpy.com at the Health 2.0 Europe conference. Could you tell us about this project and its aims?

This particular project is two years old now. We started it with the founder and owner of Drimpy, Arnold Breukhoven in the Netherlands. He had the idea of a health platform for integrated care in which patients could communicate better and have a better relationship through the online network with healthcare providers. We did see this not only as a necessity from the patients’ point of view but also from doctors’ perspective. Data and information from the patient is relevant for the doctor to act upon. Doctors often want to get information from a patient that the patient isn’t able to generate readily. He hasn’t been tracking his health parameters before the consult, doesn’t know precisely how often he has suffered from certain conditions, is not aware of the medication he actually uses, etc. With Drimpy the patient is able to collect and monitor his health parameters like blood pressure, sugar level, daily complaints, pain sensations, etc. and record his health-related information, medications, conditions, allergies, as well as store his health related documents (documents made by the patient himself, documents received from the lab or from the hospital, for example an x-rays). So a lot of data and information can be added and tracked on the platform that will help a doctor to diagnose the patient and implement a therapy in a much more effective and satisfactory way. Furthermore, the platform not only functions as a personal health record, but also as a communication device in which the patients and caregivers can communicate and interact privately.  Naturally, Drimpy also facilitates specific applications to support the patient and his/her loved ones with adequate and reliable information to help them understand and better cope with their conditions. It supports them in compliance-related activities as well. In doing so Drimpy works as an Ehealth platform, safely and reliably.

The site is firstly based on the principle of being an integrated care platform: activities from the different caregivers like doctors, pharmacists and hospitals come together to the patient’s benefit. Secondly the platform is patient-based. The site is designed from a participatory point of view. Anyone who registers on the platform can do this. Thirdly, and that is the most interesting feature, the patient has a private network that he/she can develop for people to be a part of his/her healthcare team, and to give them access to certain personal health information. The platform is set up like a private Facebook so the patient can select people that he wants to share information with and add those who want to help him in coping with his conditions. Drimpy.com is thus an integrated healthcare platform that is managed by the patient himself being in the position to select and keep the data that he wants to track and to invite and work with those caregivers who he wants to work with. Drimpy puts the patient in the position to set up his healthcare in a participatory way.

The digital ways of setting up a network like you just described in connection with Drimpy.com seem to work for patients and doctors. How do you see the pharmaceutical companies in this mix? How do they usually react to these digital solutions in your experience?

First of all, when it comes to Drimpy we see the site as a platform with which it is possible to organize the processes of care, to organize the caring for health itself. Making it clearer for the patient what the doctor is doing during the treatment is important because the patient has to work with the doctor to set up and complete his therapy. This will result in a better understanding between both parties about what they are doing, why they are doing it and how they will proceed. So it enlightens all the processes of care and makes telemonitoring and telecare possible. That will at least reduce the time spent on unnecessary face-to-face consults. It will enable them both to be efficient with face-to-face time. As a result the doctor will have more time to attend to difficult patients rather than to routinely work through consults that are actually not needed. The doctors and patients can reserve consults for those situations where they are necessary to optimize the therapy. This makes everything more rationalistic and more efficient. The point of course, is to have doctors and patients learn about how they can do this, and to customize the platform towards the specific needs of chronic conditions like diabetes or COPD, etc. The pharmaceutical companies can offer this facility to the doctors as a service from their side. With Drimpy they have a very distinguishing service to deliver to doctors. When they do, I’m sure doctors will be surprised and thankful to get help with implementing this version of telehealth in their practice, so they can help their patients with more satisfaction.

We talked about a lot of new trends: strategic change, new business models, new platforms and ways of talking to doctors from the pharmaceutical companies’ point of view. How do you see all these trends changing in the next year?

I presume that healthcare providers – doctors, hospitals, and pharmacists – will be quicker to adopt social media for the benefit of improving care and their relationship with patients. And pharmaceutical companies will be next. That is because healthcare providers – as we see in the Western countries – will understand that social media is relevant to their practice. Social media, integrated in healthcare processes will become more and more popular. In the near future one will not be able to work without them. Social media will help doctors to distinguish their position and help them in reaching out to their patients. They will first adopt social media in a web 1.0 and then 2.0 fashion, and then in a more integrated way as we have seen it with Drimpy. Drimpy itself facilitates healthcare providers to quickly integrate social media into their practices.

Pharmaceutical companies have to cross a threshold to change their business. That is a huge task for them, and to also look at the internal condition of the pharmaceutical companies. Because it is still very tricky for them – as they perceive it – to change in ways in which they are actually delivering services to doctors to help their patients better. Providing service in this way is a way of doing business that they are not accustomed to. They will be reluctant because they see that it will be a big change. As one of our pharmaceutical affiliates in the Netherlands said: “The hard thing is not so much to change towards the local conditions of the Dutch market, it is more difficult to get an approval to do so from the European headquarters.” It seems that changing the internal conditions of a pharmaceutical company is harder than to just change into a country-based marketing approach. But luckily we are in a position to work with pharmaceutical companies to show them how they might embark on this adventure and we can also learn from examples in other countries, like the UK or Germany. We can show them how they can present themselves in difficult situations and how they can move further towards solutions that would help their business as well.

You mentioned that pharmaceutical companies are reluctant to change their ways of doing business. In your experience what are the main obstacles that they mention when it comes to implementing a new model or new marketing solutions?

Well, the main obstacle is to adopt the vision that you can do your business in a different way than you have been doing until now. The pharmaceutical industry has one of the most traditional ways of doing business in the Western world. These companies have not changed in the sense of adapting their businesses according to the market conditions for the last 10, or maybe 15 years. And the pharma rep model in which they are promoting the product in detail conversations with doctors is the most sustainable business model that we have seen. They are so accustomed to it, that it is very hard to implement any change. So this is where we provide assistance. We have a concrete and specific way in which we can guide them step by step to change their ways of marketing in order to change in a manageable way instead of changing overnight in a troublesome way. Guidance is important to change, so that the development of the business doesn’t disrupt the outcome. The most difficult steps are to learn how you should do these things differently, to try to experiment with it carefully and to build up a new company and new sales force.

Change is a very difficult thing to do, not only for pharmaceutical companies but for doctors as well. Local market conditions will show them that past performances will not sustain their business for the future automatically. You have to implement the changes that are necessary in the framework of the system of healthcare and its renewal. When these changes emerge, pharmaceutical companies either get lost in the market or they adapt to these changing conditions, partner with healthcare providers and help them to provide better care in their countries. The ones that are daring to take the first step towards the changes are the ones that learn how to change and provide this specific support. This very competence will be strategic in the years to come. The first ones to move will have this advantage over their competition. If you wait until others have changed, you can only pick up what’s left over in the market. The first ones have the benefit of choice and of learning how to proceed. Going on with following a routine is easy, making the changes, learning how to do things differently is however one of the most difficult things for people to do.

(You can connect with Rob Halkes on Twitter.)

Mobile Medical App Regulations – Are They Necessary?

As I mentioned before, the FDA seemed to be moving faster with proposals to regulate medical applications than with the ever-dragging process of creating guidelines for social media in healthcare. Helthcare IT News surveyed 50 of its readers on what they thought of the sudden urgency the FDA addressed the issue of non-regulated mobile apps.

As you can see on the chart below, 46% of respondents thought that regulations are important for different safety reasons. But the rest of the readers, 54% said that too much regulation could be demotivating and problematic for developers. My question is: can one think both of these statements are right? I think you can agree that some sort of regulation is needed so an app doesn’t offer a band aid for a broken arm (excuse me for the simplified example), but it is also important that the developers can still be innovative and creative.

The article also mentions a concern that is not addressed in the survey. Mainly, that regulations are offered for doctors, so they don’t become too reliant on these applications. First of all, what do you call too reliant? Where do you draw the line? A recent study showed that in the United States every 2 in 5 doctors use mobile apps during a visit. Would you consider that too high? And second of all, isn’t it more of a concern that patients become too dependent on these tools? The doctor has a medical degree to help him/her decide what app to use and how. But what about the patient that follows any advice on a mobile device without seeing a doctor?

(Source: Healthcare It News)

Medicine In The Digital Era

With new devices constantly appearing on the market at a new speed, it is safe to say that the digital era has arrived. It also consumed the medical field with physicians enjoying the perks of having mobile access to the enormous amount of knowledge required while practicing medicine. While it was long obvious that mobile applications and devices influenced doctors in a major way, a recent infographic about U.S. hospitals and healthcare professionals included surprising numbers to prove just how much they became an integral part of practices.

According to the data below, more than 2 in 5 physicians go online during a patient’s visit mostly for drug references, new publications, disease associations or to look for a support group for patients. The most convincing fact was the high rate of doctors using consulting applications with 94% of them turning to these for information. The infographic also suggests that other mobile based technologies are welcomed as well. For example 86% of physicians are interested in accessing electronic health records, while 83% of them would like to use these devices as prescription tools.

The data also highlights the fact that more and more doctors go on social sites for professional reasons. At the 1188 hospitals observed Facebook seemed the most popular with 1018 pages created. These healthcare facilities shared overall 548 Youtube channels, 788 Twitter accounts and 458 LinkedIn profiles. One thing that stood out was the relatively low number of hospital blogs with only 137 listed for all 1188 hospitals. Despite the fewer blogs in these organizations, the infographic states that blogs are actually favored by doctors compared to private online physician communities.

The numbers once again show the significance of the “mobile movement” among healthcare professionals. Maybe this magnitude is why the FDA, while usually slow in similar cases, felt the urgency to address this phenomenon with its draft guidance for mobile medical applications.

 

(Source: Spinabifidainfo.com)

Non-Adherence – There’s An App For That

I was very surprised to read a blog post the other day about how mobile applications to increase compliance are “intrusive” and how the whole concept is shortsighted. After stating what an enormous problem non-adherence is, I think the only reasonable conclusion could be to try every possible tool to help patients stay on the right medicine regiment. When non-adherence causes 89,000 deaths and $100 billion dollars every year in hospital costs only in the United States we simply cannot turn our backs on a solution because of some negative reaction without further observation.

The post also mentions a study about an application for patients with Type 2 diabetes, that reportedly failed to provide help and was rather annoying in the eyes of the participants. There are no numbers or percentages to really measure how unsuccessful the experiment turned out to be, only a few examples of negative feedback to prove and emphasize how “aggressive” these applications are.

I however agree with the statement, that there isn’t one solution that is going to magically solve the problem of non-adherence. It has to be a very balanced mix of different components, that in the end help patients (and their physicians) with the dosages and tracking of medications. But I also believe that a smart and easy-to-use application could be a complimentary element in the mix. The article quotes the New England Journal of Medicine and its list of tools that could help increase patient compliance: tracking prescriptions, paying providers based on outcomes or having lower co-payments. As I said before, the fight against non-adherence has to combine different but equally important elements, so an app wouldn’t make these changes unnecessary. But all fails if patients don’t remember to take their medication.

The blog post includes a list of automated pill dispensers as the possible solutions to increase compliance. Here is one example:

The SIMpill Medication Adherence System text-messages the patient’s mobile phone if the patient does not take their medication or takes it at the incorrect time. If the patient still does not take their medication, an alert can be sent to their caregiver or healthcare provider. The system also monitors prescription refills and alerts the pharmacy when the patient is running low.

While I think this is a complex and wonderful solution of the problem, I can’t understand how a mobile application could be more “intrusive” than this. How can one state that an app is too aggressive and poorly perceived and then list automated tools with alarms, messages and alerts not only to the patients but to their providers. We can’t just say no to a possible solution because it didn’t work for a group of people. With adherence different methods work for different patients. That is why there is a great need for the invention of several complex applications and solutions, so everyone could choose what fits them best.

(Source: World of DTC Marketing)

Twitter – The Social Site Without Innovations And Marketing Potential?

The recent blog post of Phil Baumann about the future death of Twitter on Health Is Social made me think about what grabs our attention and what makes us “addicted” to different social platforms. Do we need constant upgrades, new features, redesigned platforms? Do we really care about the advertising potential of a social media site or we are happy to just use them?

There are two very different approaches if you look at Facebook and Twitter about the frequency of introducing new features. If you are on Facebook for a couple of years now you remember many occasions when the platform was remodeled, new features were introduced. There is a trend of creating a Facebook Group against these changes. “We want the old Facebook back” and “We hate the new Facebook”. Managing your news feed, your settings, your pictures is always a challenge after these innovations get realized. But somehow we always get used to the new way of facebooking. We enjoy the new chat features, the check-ins, the numerous applications for page administrators. And at the end, we get used to a constantly changing online experience.

Over at Twitter the picture looks very different. Except one major redesign, the social networking site is the same as it used to when first introduced. We have our tweets, mentions, retweets and Twitter feeds. And although the application originally created features that changed our communication habits for good, the new ideas stopped coming. Until the third-party applications like Tweetdeck and Hootsuit appeared. So the option for fun features and user-friendly solutions were there, only people outside the company came up with them. With Tweetdeck for example (other than integrating all your other social media accounts) you can schedule tweets, monitor all Twitter action at the same time, you can follow specific feeds using hashtags. You can also automatically shorten links which as a feature is a “no-brainer” considering the 140 character limit. So the new features are there, Twitter just had to buy them to make them its own.

So when it comes to the experience the necessary new features are there on both sides (Facebook and Twitter) to keep the users entertained and interested. The only difference is that people use Facebook and its numerous applications on the actual site, while 42% of Twitter users turn to third-party solutions and rarely visit the original Twitter portal.

The second major difference about the two social sites is their advertising potential. Facebook was able to create an advertising system that in my opinion is easy to navigate and effective. Other than that, Facebook Pages can operate fully as advertising machines. In the meantime we have seen Twitter struggling with this issue for a long time now. Most recently implying that future user feeds would contain paid advertisements. The idea resulted in a lot of negative feedback and at least for now, Twitter is left with sponsored tweets, trending topics and recommendations. But there is two sides of this story: one for the individual user and one for the brands. And looking at this subject from these two different point of views we have two different answers. One says it is probably good that Twitter hasn’t figured out a way yet to clog its feeds with ads, and unless it finds a way for integrating  advertisements without interfering with user experience, it should leave the platform ad free. But obviously for marketing and financial goals this position would be insufficient.

So on the long run is it enough to satisfy the users or you have to come up with solutions to please advertisers also? For a great user experience the first would be enough, but to stay alive on this market you would probably (well, definitely) have to consider the second.

And to get back to the point where we started: when we are comparing Facebook and Twitter, are we comparing apples and oranges? And is it really not enough for Twitter to be just … well, Twitter?

(Source: Health Is Social)