Last Post Review
In my last post I described what Evidence-Based Medicine (EBM) is, but didn’t mention much of its impact to the business. Coming back to my summary of EBM:
Evidence Based-Medicine is a systematic approach that attempts to answer a medical question by considering the best available clinical evidence and applying strong medical expertise to maximize the value for the patient.
One can easily start inferring implications to the business, and I believe nothing is more correct than it. There are several ways in which EBM impact the Health Care market but I will focus on what I consider the most strategic aspect: Evidence-Based Marketing.
Have you heard of it? No? Great! You’re in the right place, then.
Evidence-Based Marketing
I assume you know what Marketing is and how it works in Health Care. Just in case you need more background, read my post “Creating a Multi-Stakeholder Approach” to understand the new Health Care market arena. You may also be interested in my post “The (New) Health Care Market Professional”. Enjoy it.
If you have enough expertise in Health Care Marketing, or not enough time to go over two others posts, let’s focus on Evidence-Based Marketing.
I have already mentioned that the Health Care market is used to target physicians and patients with their products. Therefore, the product/brand message is prepared in such a way to speak either the physician or patient’s language. Nothing wrong with this, but the issue remains in the fact that we have more stakeholders (a.k.a. Targets) to our Health Care Marketing Strategy. And I find it difficult to argue that Health Plans are one of the most relevant (if not THE most relevant) of all stakeholders, simply because they pay the bill.
If you believe money is power, than you should immediately start considering Health Plans as your clients. Yes, clients! Not payers, partners or anything else. After all, clients pay for our products.
Actually, you should not invest much time thinking if Health Plans are clients or not; it is the same as thinking if the Sun will rise tomorrow. Some people won’t like it, but regardless of what they think, Health Plans are already considering themselves as clients and want to participate more than simply paying the bill. If you don’t accept it, maybe you should visit Monster.com and look for good opportunities in other industries.
Health Plans are not primarily interested in clinical benefits, quality of life, coupons, relationship or many of other aspects that we use to target physicians and payers. Our new clients react differently: they want to 1) save money; 2) make sure the money they invest generate results. And, to demonstrate results you need evidence.
When you base your Marketing Strategy on evidence, you bring measurable results to the market. Health Plans will then have a perfect tool to compare your product/brand with others and take a decision based on the best ROI ratio.
But, if you don’t bring any evidence to the table and compete against other brands chances are Health Plans will probably be skeptical about paying for your products. Imagine it:
a) Company X has a product that costs $300 a dose and has demonstrated clinical results in 90% of the cases with strong and real-world data. The results are expected to decrease other costs.
b) Company Y has a similar product that costs $250 a dose. Physicians recommend it and patient associations support it.
Well, it takes one second to see that Company Y product is cheaper than Company X’s. After a second look, what makes us sure that Company Y really works? That turns the situation in:
a) Pay $300 and be 90% sure certain costs will decrease.
b) Pay $250 and expect to have good results based on the market’s opinion.
Correct me if I’m wrong, but these are very unbiased statements. Now put your Health Plan’s hat on and answer: honestly, which one would you choose?
Evidence-Based Marketing is Marketing Strategy clearly based on strong evidence. To base your Marketing on Evidence is very different from using evidence to support your strategy.
Small Word, Big Difference
I hear people proudly saying they “support their strategies with evidence”. Then I ask how they do it and get the same answer 90% of the time:
1) Focus on physicians and patients
2) After the message is in the market, use evidence to support the message
This is the main difference: Evidence-Based Marketing uses evidence to create the message. This is very different from creating the strategy and then seek ways to fit evidence in.
Evidence comes before Marketing. Remember it and you’ll get a huge portion what I’m trying to say in this blog.
If you cannot generate evidence (again, strong and measurable evidence) you cannot and shouldn’t market your product. On the other hand, once you have the evidence, then you may start planning your strategy.
Implementing Evidence-Based Marketing
Let’s say you have a vaccine that has a 80% effectiveness ratio in the first dose (that’s why we get several doses of the same vaccine, BTW). With this information in hand you realize:
1) Your vaccine may be useful for difficult-to-reach individuals.
2) These difficult-to-reach may simply mean the largest (untapped) portion of the market.
3) There are several competitors, but none is using the effectiveness ratio, or even targeting the untapped segment.
This is the same situation I found in 2005 when I was having my MBA internship with a major global pharmaceutical company. In three months, I was able to create a whole new Marketing Strategy that after implemented generated an ROI of above 2,000%. Several months later, after I had concluded my MBA, my manager at that time wrote me an e-mail saying that they had won a Global Marketing Excellence Award based on my recommended strategy.
This is the best real-world example I could think of to demonstrate the benefits of starting the development of your Marketing strategy with the available evidence. Had I started the Marketing strategy looking at something else, results would be completely different.
Final Words
Evidence-Based Marketing is a new concept within the Marketing framework. We have heard of Green Marketing, Guerrilla Marketing, Defensive Marketing and now Evidence-Based Marketing. Everything relates to a basic understanding: how to differentiate yourself in the eyes of the client.
I am a Marketing professional currently working in Health Economics. Marketing professionals should always be cross-functional, and this means having the opportunity to work in other areas such as Health Economics, R&D, Sales and others. Had I not have had the exposure to Health Economics, I would have been developing Marketing Strategies only for physicians and patients.
There is still much to be explored and discovered about Evidence-Based Marketing until it becomes so natural that we call it part of the overall Health Care Marketing Strategy. Until then, keep your eyes and ears open to the market, attend events (such as ISPOR and HTAi) to understand the latest clinical trends and challenge yourself to create a comprehensive strategy to the market.
See you next time!
Ernesto M. Nogueira
Monday, April 14, 2008
Saturday, March 15, 2008
Evidence-Based Medicine
Last Post Review
Evidence-Based Medicine
Last time (actually, a long time ago) I related a few points of what I consider a strong Health Care Marketing professional. The market has changed; or, even better, it has evolved and thus requires a different kind of professional. As Health Care develops into a more result-oriented business, the more we’ll see the demand for a new type of strategic and commercial approach.
Thank you all for your feedback. Feel free to use this blog, as well as my personal e-mail (click the “Send me an e-mail” link located at the side column).
Evidence-Based Medicine
I’ve seen many colleagues afraid of the EBM concept, “what is this thing?” and “how does it impact my business?”. Well, let’s try to analyze the concept and how to translate it into Evidence-Based Marketing. After all, Marketing is something we can control, while Medicine is not.
But before I start my text, I just want to reemphasize the fact that this blog is focused on the business aspects and implications of Health Care. Therefore, I’ll approach EBM as a Marketing professional and not as a researcher. For more information, I recommend you ask your local Medical Board to understand their perceptions around the theme.
The concept
EBM is, first of all, a methodology created to answer a medical question. This question may represent a problem (i.e. how to reduce the complications associated with a certain surgery) or not (i.e. to determine the best approach to treat a certain condition in a specific type of patient).The concept was created to bundle three main aspects: 1) Clinical Evidence, 2) Medical Expertise; 3) Value for the Patient. In other words, with EBM we are not only trusting a physician’s individual decision nor saying that everything published is the true.
Clinical Evidence
The main sources of clinical evidences are studies that, once finished, are usually modeled into articles and then made available in renowned publications and databases such as JAMA, Cochrane and BMJ. However the problem is that the vast majority of articles have methodological flaws, placing serious questions around the conclusions and results. The implication: never, NEVER trust an article just because it is published!
How to assess the accuracy and value of an article? How to identify clinical evidence from biased or erroneous statements? Well, first we need to understand that nowadays the part that describes how the study was developed (methods, methodology etc) is much more important than the results part. To illustrate this better, according to a famous Clinical Publication it is estimated that thousands of articles are published every day globally, but just around 10% of them have no basic methodological mistakes. By all means, I’m not saying articles are useless; on the contrary, we need to filter the ones we can apply.
Another step is to classify the article according to its Level of Evidence. Basically, the more sources generate data and the less the researcher intervenes on the results, the better the study. Classifications such as “double-blinded”, “multi-centered” and “randomized” signal strength of a study. But again, it doesn’t mean it is 100% good, we need to first apply a methodological filter
(above paragraph) and then classify it according to its level of evidence, such as the one below.
Medical Expertise
Physicians, Nurses and other Medical professionals have studied for several years and are constantly updating their knowledge in the field. An approach that ignores the academic and professional expertise of these medical professionals cannot be considered a serious method. On the flipside, those days when the doctor’s opinion should be respected and never questioned are gone.
The idea is simple: Health Care is strongly based on technology, and since technical advancements are happening everyday, we cannot apply judgments from 5 years ago into current situations. Or should we use large cassette walkman radios when there are MP3 players available? The problem is when certain professionals feel themselves as more important than the comments they make.
Careful if your KOLs are too much confident to change ideas or to even consider other options. Chances are, you are getting an ego statement rather than a medical opinion.
Also, theory without practice turns into nothing. Ideally, medical professionals apply their existing knowledge to evaluate new evidence and make their decisions. But there is still one last pillar, and the most important one.
Value for the Patients
OK, we have theory (Clinical Evidence) and practice (Medical Expertise), but why are we making a decision? What do we want to accomplish?
This is, by far, the most important aspect of Evidence Based-Medicine. The main goal is always the value for the patient; simple as that. If you don’t know what I mean with the term “value”, then check one of my previous posts.
Note that the patient word is in singular, not plural. Although the current guidelines may demonstrate that the gold standard for Diabetes treatment is XYZ, EBM may focus on specific patients (i.e. Type I Diabetes patients) to reach a different conclusion. Value for patient is not value for all.
In one sentence: Evidence Based-Medicine is a systematic approach that attempts to answer a medical question by considering the best available clinical evidence and applying strong medical expertise to maximize value for the patient.
Final Words
“But aren’t you going to discuss how EBM applies to business, and what Evidence-Based Marketing is?”
Absolutely, and I’ll do that in my next post. Actually, I hope to make you curious about how this methodology can turn a simple statement into a clinically supported Marketing strategy.
Overall, I urge you to understand and recognize the importance of EBM to business. EBM is a trend that recently gained much strength and will impact the way we do business and promote medical technologies.
See you next week with Evidence-Based Marketing!
Ernesto M. Nogueira
Saturday, February 9, 2008
The (New) Health Care Marketing Professional
Last Post Review
In my last post I analyzed the implications and particularities of the Public Health Care market. What I have seen in 5 different countries during the last years is that partnership can be described as the best relationship model with public agencies. Note that I’m using relationship, not business model.
Companies should aim to make long-term and continuous businesses in the public arena. This means seeking win-win situations that may be totally contradictory to the “low-hanging fruit approach” in some cases, but will certainly generate an outstanding pay-off in time.
The (New) Health Care Marketing Professional
Since this blog was created to generate strategic discussions around Health Care Marketing, nothing more logic than focus on the #1 strategic asset: people.
Based on my perceptions and conversations with innumerous other professionals, I have listed the most commented items companies are looking for in Health Care Marketing Professionals nowadays. I don’t have the intention to create a definitive description of how should a successful professional look like (BTW, this is not my core skill); on the contrary, my idea is to list a few major assets that in no way make a complete list by themselves. However, they might serve as a valuable compass to one’s career map.
Not Products Nor Solutions; Sell Health Care
I remember one of my former Marketing professors showing a drill to our class. Next, she asked what consumers were actually getting when they bought that drill.
Convenience, a powerful tool, the drilling itself and a hammer (!) were a few answers we all gave. All wrong.
When consumers buy a drill, my professor said, they are getting holes. Likewise, when consumers buy movies, they are actually purchasing entertainment. Of course, it varies depending on the product/service itself and the consumers: used cars may represent transportation while a Porsche may bring status. The fact is, we never buy things for what they are, but for what they can provide us.
When a patient buys a medicine, that patient is not buying a chemical compound. Well, based on the above paragraph we can infer that the patient is buying a solution for a certain condition (relieve for a headache, for instance). However, this is a particularity of current Health Care business: because of the limited resources and need for efficiency, products should not provide solutions. They should provide the best solutions.
A headache relieve may cause indigestion the next day. Although the solution was achieved, we created a new problem. In that sense, any health care product may lead to any possible complication, ranging from simple discomfort to severe complications. Companies that sell simply health care products are focusing on the activities and not on the value they should generate to patients.
Strong marketing professionals quickly realize this doesn’t mean shrinking your market to a few “ideal” individuals. On the contrary, there is an opportunity to reinforce the Marketing strategy by demonstrating to all stakeholders (not only patients) the benefits of a certain product in terms of health care.
Remember that headache? How about measuring the positive effects of employees’ productivity once they get rid from the pain? Same with lower drug costs to health plans.
In summary, health care marketing professionals should be focusing on the long-term effects of the product to patients, not on the product features to physicians or simply lower costs to health plans. Focus on Health Care is the same as focus on value for patients.
Value for patients, and nothing else, is the ultimate goal of our business. Any questions?
Multi-Stakeholder View
As previously described in my posts, the market is more than simply companies – physicians – patients. Other participants such as government, health plans, regulatory agencies, other medical professionals and employers are also equally involved in the health care cycle.
Marketing 101 again: STP: segment, target and position your message. Since we have multiple participants in the system (like it or not), the logic conclusion is that each stakeholder has a different value proposition. The cost-savings for health plans is different than the reduction in Operating Room Time for Hospitals.
“OK, but you just said that the business is all about value for patients!”
Indeed! And that is why once we determine the real value for the patient, we need to walk backwards and assess the specific value for each stakeholder. If you cannot do it; either you need some Marketing insight, or your product is not that good. Usually, the first option is what happens.
Health Care Marketing professionals should understand the fragmentation and dispute for power among the system’s participants. Successful strategies focus primarily on the patients and link secondary value-propositions to each of the participants.
As in investment, we should not put our eggs in just one basket. There is no single participant (physicians, patient, health plan, hospital etc) that is strong enough to deserve more than 50% of your product strategy.
Cross-Functional Work
Although this is not a new concept, it has gained a lot of importance lately. And if you want to know a little bit more about me, this is also the reason I temporarily left the “pure” Marketing area to work in a Market Access division.
Marketing campaigns should not start the moment products are launched in the market. The Marketing part should be involved since the beginning, during the product development phase. And I’m not referring to only Market Research.
Taking me as example, my Market Access experience taught me how to assess and estimate clinical and economic benefits of products in development. Later, I can validate those assumptions and estimations in the market, which will significantly increase my product’s chance of success after launch.
In order to better analyze a diversified and changing market, you should invest a couple of years working in or at least closely with different areas. Marketing professionals need to understand the major implications for their products, from regulatory aspects to health plans reaction. Once more, this is not a threat but an opportunity to be head and shoulders above others who only dare to use the Marketing perspective.
The great Marketing Professional is more than just a Marketing guy. He understands the market as a whole and how to apply cross-functional knowledge to shape the market.
Final Words
As I said, my intention was not to make an HR guide, but to focus on those personal skills that are among the strongest ones for a Health Care Marketing professional. There are others, and I invite readers to list them as well.
Hope you’re enjoying this blog as much as I am. Suggestions and critics are always welcomed!
Ernesto M. Nogueira
In my last post I analyzed the implications and particularities of the Public Health Care market. What I have seen in 5 different countries during the last years is that partnership can be described as the best relationship model with public agencies. Note that I’m using relationship, not business model.
Companies should aim to make long-term and continuous businesses in the public arena. This means seeking win-win situations that may be totally contradictory to the “low-hanging fruit approach” in some cases, but will certainly generate an outstanding pay-off in time.
The (New) Health Care Marketing Professional
Since this blog was created to generate strategic discussions around Health Care Marketing, nothing more logic than focus on the #1 strategic asset: people.
Based on my perceptions and conversations with innumerous other professionals, I have listed the most commented items companies are looking for in Health Care Marketing Professionals nowadays. I don’t have the intention to create a definitive description of how should a successful professional look like (BTW, this is not my core skill); on the contrary, my idea is to list a few major assets that in no way make a complete list by themselves. However, they might serve as a valuable compass to one’s career map.
Not Products Nor Solutions; Sell Health Care
I remember one of my former Marketing professors showing a drill to our class. Next, she asked what consumers were actually getting when they bought that drill.
Convenience, a powerful tool, the drilling itself and a hammer (!) were a few answers we all gave. All wrong.
When consumers buy a drill, my professor said, they are getting holes. Likewise, when consumers buy movies, they are actually purchasing entertainment. Of course, it varies depending on the product/service itself and the consumers: used cars may represent transportation while a Porsche may bring status. The fact is, we never buy things for what they are, but for what they can provide us.
When a patient buys a medicine, that patient is not buying a chemical compound. Well, based on the above paragraph we can infer that the patient is buying a solution for a certain condition (relieve for a headache, for instance). However, this is a particularity of current Health Care business: because of the limited resources and need for efficiency, products should not provide solutions. They should provide the best solutions.
A headache relieve may cause indigestion the next day. Although the solution was achieved, we created a new problem. In that sense, any health care product may lead to any possible complication, ranging from simple discomfort to severe complications. Companies that sell simply health care products are focusing on the activities and not on the value they should generate to patients.
Strong marketing professionals quickly realize this doesn’t mean shrinking your market to a few “ideal” individuals. On the contrary, there is an opportunity to reinforce the Marketing strategy by demonstrating to all stakeholders (not only patients) the benefits of a certain product in terms of health care.
Remember that headache? How about measuring the positive effects of employees’ productivity once they get rid from the pain? Same with lower drug costs to health plans.
In summary, health care marketing professionals should be focusing on the long-term effects of the product to patients, not on the product features to physicians or simply lower costs to health plans. Focus on Health Care is the same as focus on value for patients.
Value for patients, and nothing else, is the ultimate goal of our business. Any questions?
Multi-Stakeholder View
As previously described in my posts, the market is more than simply companies – physicians – patients. Other participants such as government, health plans, regulatory agencies, other medical professionals and employers are also equally involved in the health care cycle.
Marketing 101 again: STP: segment, target and position your message. Since we have multiple participants in the system (like it or not), the logic conclusion is that each stakeholder has a different value proposition. The cost-savings for health plans is different than the reduction in Operating Room Time for Hospitals.
“OK, but you just said that the business is all about value for patients!”
Indeed! And that is why once we determine the real value for the patient, we need to walk backwards and assess the specific value for each stakeholder. If you cannot do it; either you need some Marketing insight, or your product is not that good. Usually, the first option is what happens.
Health Care Marketing professionals should understand the fragmentation and dispute for power among the system’s participants. Successful strategies focus primarily on the patients and link secondary value-propositions to each of the participants.
As in investment, we should not put our eggs in just one basket. There is no single participant (physicians, patient, health plan, hospital etc) that is strong enough to deserve more than 50% of your product strategy.
Cross-Functional Work
Although this is not a new concept, it has gained a lot of importance lately. And if you want to know a little bit more about me, this is also the reason I temporarily left the “pure” Marketing area to work in a Market Access division.
Marketing campaigns should not start the moment products are launched in the market. The Marketing part should be involved since the beginning, during the product development phase. And I’m not referring to only Market Research.
Taking me as example, my Market Access experience taught me how to assess and estimate clinical and economic benefits of products in development. Later, I can validate those assumptions and estimations in the market, which will significantly increase my product’s chance of success after launch.
In order to better analyze a diversified and changing market, you should invest a couple of years working in or at least closely with different areas. Marketing professionals need to understand the major implications for their products, from regulatory aspects to health plans reaction. Once more, this is not a threat but an opportunity to be head and shoulders above others who only dare to use the Marketing perspective.
The great Marketing Professional is more than just a Marketing guy. He understands the market as a whole and how to apply cross-functional knowledge to shape the market.
Final Words
As I said, my intention was not to make an HR guide, but to focus on those personal skills that are among the strongest ones for a Health Care Marketing professional. There are others, and I invite readers to list them as well.
Hope you’re enjoying this blog as much as I am. Suggestions and critics are always welcomed!
Ernesto M. Nogueira
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