R. J. Lewis, founder of the healthcare marketing company E-Healthcare Solutions on Bear Tavern Road in Ewing (U.S. 1, January 10, 2007), is a contributor to the new book, “Results — The Future of Pharmaceutical and Healthcare Marketing.”

Lewis grew up on Long Beach Island, where his father was a principal and his mother a teacher. He majored in marketing at the University of Delaware, Class of 1990, and later earned an MBA from NYU and worked at the medical education division of Grey Healthcare Group, and as vice president of sales for Physicians Online.

Lewis co-founded Ad-Juster, a San Diego-based tech company that specializes in online discrepancy management and reconciliation. In the book, Lewis describes how there are great challenges and equally great rewards in an industry that is rapidly changing towards a “pay for results” paradigm. Below is an excerpt:

Both the healthcare market and the practice of marketing communications are in flux. Customers are rapidly shifting their media consumption habits. Once, they received their information from radio, TV, and newspapers, and they networked at dinner meetings. Today they are spending more time on the Web, using mobile devices, and engaging with online social networks, which all involve consuming more digital content. Highly fragmented media has led to multitasking and limited attention spans.

In spite of the regulatory environment, the politics, internal challenges, and all the other countless excuses, pharmaceutical and healthcare marketers must face the realities of a new digital age.

The Affordable Care Act is here to stay. The payment dynamic is changing, with payments now tied to outcomes. Clinical trial data alone does not support the negotiation process with payers as it once did. Payers want data that reflects the “real-world” use of products. To be effective going forward, all participants in the healthcare ecosystem must work together and leverage digital technologies that support outcomes in order to deliver patient results.

In every industry, over time, inefficiencies are eliminated. This is the essence of the Affordable Care Act. Government is trying to pay for outcomes and results instead of for procedures and transactions. Ironically, pharmaceutical marketers themselves have done this for years with their own vendors, funding only those programs that deliver meaningful return on investment.

In digital media, for example, there are various ways to pay for advertising. There’s CPM-based advertising or cost per thousand impressions delivered. There’s CPC advertising, cost per click. Then there’s CPL, cost per lead. There’s even CPA advertising, which I refer to as cost per “anything” because payment is tied to any “action” mutually agreed to, such as viewing a video or signing up for a newsletter.

Over time the trend between pharmaceutical companies and their vendors has been to push the pricing model down that continuum and pay less for the unguaranteed result and more for the guaranteed result. But now the pharmaceutical industry finds itself, uncomfortably, on the receiving end of the “prove-your-results” conversation and is being asked to prove real-world results despite having limited control over many aspects of what drives an outcome in a complicated system with many participants.

Payers are press for results, the actual efficacy of a course of therapy as opposed to simply paying for the number of prescriptions written. So if patients don’t improve or fail to take their medications, pharmaceuticals are being asked to share the risk. Pharmaceuticals’ typical clinical-trial-backed-marketing approach touts the efficacy of their drug. But managed care is pushing back on clinical trial data because, by definition, trials are highly orchestrated and conducted in a near-perfect environment where the patients are evaluated and qualified and the drug regimen enforced to a specification.

Payers today want to see supporting real-world data addressing how these medicines perform under actual conditions in which some patients take medicine incorrectly or simply stop taking them. When a company produces the ­real-world data, the payer will say, “We want to see the clinical trials.” If one is positive, they want to see the other, and if both are good, they want to do their own testing instead. Successful marketers will learn to expand their influence of control and align with other constituents on delivering improved outcomes.

While publishers of medical print journals are often reducing their frequency of circulation, by contrast, high-quality digital influencers now publish multiple times each day, including on weekends, or better yet, they pursue real-time user engagement that drives community and loyalty.

Some examples of the newer disruptive Internet services that attract physicians and healthcare professionals include WebMD/Medscape, MDLinx, Doximity, QuantiaMD, Diabetes in Control, Drugs.com, and Doctors Lounge. There are also audience aggregators who deliver niche audiences at scale, such as my company, eHealthcare Solutions.

In the digital world, when one venue breaks a story, others often repurpose it for their own niche audience. The same or similar information is available in hundreds of venues now. It is hard to be the single source for information anymore. As rapidly as privacy is changing, so are the acceptable standards of fair use under the copyright laws. The balance of enforcement for a publisher is challenging because publishers want links back to their content.

So, by vigorously enforcing copyrights, they also isolate themselves, which does not necessarily work well in a networked world. Competition is intense. People’s readership habits are changing. We ingest and consume information differently today. Nowhere is this more magnified than in the rapid shift to mobile devices. Customers tend to catch up on their news when they are standing in line at a CVS, device in hand with two minutes to spare, or while sitting in the waiting room at their doctor’s office.

People prefer bite-size information today. Content has to be portable for all channels, not just websites and mobile but also for social media, e-mail, and other frequently consumed channels. The need for headline shock and attention-grabbing, as well as the need to write copy in a search-engine-friendly way, in order to win the love and respect of the search engines, is changing our language, style, and skill set. Unfortunately, to be successful today, writers write first and foremost for the machines, then for shock value to attract a short attention span, and then finally for purpose. Media knows that if they win the love of the search engines, the people will follow.

The sheer number of machines crawling the Web has unintended consequences as well, such as false ad delivery being generated by “nonhuman traffic” (NHT) and the subsequent questions that arise as to was my advertisement ever viewed by a real person? Was the ad impression “viewable:” a challenge the industry is only beginning to address and reconcile.

“Results: The Future of Pharmaceutical and Healthcare Marketing,” Advantage Media Group. E-mail RLewis@EHSmail.com.

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