In 2015, over 200 million U.S. citizens had a smartphone¹ and, for the first time, searches from mobile devices outnumbered desktop searches on Google.² Today, 1 in 20 searches on Google is for health-related information.³ Digital engagement is now a fundamental part of how patients, caregivers, physicians, pharmacists, and others live their lives. In this way, managing one’s healthcare is following other industries that have “gone digital”—from retail to financial services to taxi and delivery services—and has become an anytime, anywhere experience.

This new reality has many implications for the pharmaceutical industry overall, particularly for commercial strategies. More precisely, it presents both the opportunity and the imperative to evolve marketing strategies if companies want to play a meaningful role in the decisions patients and healthcare providers (HCPs) make about care. Historic mixes of advertising in traditional media combined with heavy salesforce coverage and “push” messaging are insufficient. While each of those tactics remains relevant, today’s commercial mix should reflect the fact that people are now viewing digital channels close to 50% of the time,⁴ and, even more importantly, that those people seek real engagement in regards to their care.

As a result, pharma companies need to make a mindset shift from “telling” to “listening” and then (eventually) “engaging” because patients are no longer passive recipients of care. Rather, they are active shapers of their care. The most innovative marketers today are finding ways to solve a problem, delight, inspire, or empathize with patients right in the flow of what they are doing (instead of interrupting to push a message to them). Similarly, more and more HCPs use digital tools and media to confirm facts and as a way to connect with others for clinical advice as well as emotional support.

Many pharmaceutical companies are reluctant to make full use of digital channels because they are not clear on what to do differently. Some are experimenting with new engagement models but have not yet found a good way to measure new tactics on an apples-to-apples basis with traditional approaches. As a result, they too are challenged to determine what their best commercial approach is. Others have a sense of what should change but don’t have a clear picture of how to pull off simultaneous shifts in their commercial mix, their operating practices, and (in many cases) the culture of their commercial teams.

As part of the path forward we rely on proven as well as new frameworks that can help pharma marketers evolve commercial strategies. The former includes a “3D” roadmap to help companies Discover how to effectively engage with patients and providers at the moments that matter most; Design customer experiences that align content, messages, and media to build a mutually beneficial relationship; and Deliver those experiences consistently, superbly, and efficiently.⁵ The 3D approach has helped scores of organizations across industries innovate their approaches to digital engagement. The approach is introduced in Chapter 2 and then fully detailed in Chapters 3 through 5. We also present the new concept of grounding commercial strategies in customer-specific CareFlows (advanced patient journeys) and micro-moments as a way of ensuring that tactics and offers are targeted, dynamic, and meaningful for specific patient and HCP customer segments.

As detailed in Chapter 1, the business and customer benefits and opportunities from deploying these approaches are significant. Yet we are realistic about the equally significant effort it will take to change business practices to embrace this new model. As discussed in Chapters 5 and 6, seizing the opportunity and being successful in the digital age will require many companies to transform their commercial approaches end-to-end, including technology/IT, strategy, sales, managed markets, regulatory, and other functions and dimensions. To do so, many companies will need to put in place the building blocks common to any transformational effort, such as a compelling vision for change, prominent role models to serve as change champions, targeted investments in new talent and capabilities, and a refined operating model that reflects necessary changes to organizational structures, processes, and systems.

Our hope is that most leaders of pharmaceutical companies can find new insights and approaches in this book, whether their organizations are already innovating their commercial strategies with more of a digital orientation, looking for ways to inspire their organizations to undertake that change, or investigating the role digital tools and channels should have. Further, while this book is primarily written with U.S. audiences in mind, some ideas may also be applicable to other geographies (the direct-to-consumer recommendations may not be relevant outside the United States, yet many of the physician-oriented suggestions likely will resonate).

Finally, we hope that the core content, case studies, and informative sidebars (“More than the sum of the parts” is an example) provide a broad picture of the opportunities available to pharmaceutical companies. We hope this book serves as both a catalyst for innovation in your company and a resource as you consider or plan your transformation.

Many of the sidebars were written by “Featured Partners” of the authors. These are organizations that are themselves digital experts and have shared case studies of their own work that illustrate the points made in the book. As this book is itself digital, we will continue to add to these case studies on a regular basis to further enrich the content of this book. Keep checking back for new material, and if you have a compelling case to share, please submit it to info@pharma3d.com.

More broadly, please don’t hesitate to contact any of the authors to ask questions, offer comments, or share your experiences.

It was the pharma company’s most important launch of the year, but executives knew the product faced significant headwinds entering late into an already-crowded category. Their game plan was one they had run many times before: put 80% of the direct-to-consumer DTC budget into TV and 20% into digital and other “alternative” consumer channels. It had to work.

One problem, though: it didn’t.

The team quickly learned their TV campaign was barely generating a break-even ROI. They scrambled and, working with healthcare analytics firm Crossix, were able to quickly determine that patients who saw both TV and digital elements of the campaign delivered an ROI seven times higher than that of TV alone. They rapidly doubled the digital budget and reduced the TV spend. Almost immediately, the overall campaign ROI jumped by more than 25% and delivered millions of dollars in incremental revenue. This finding, that a combination of activities was more valuable than each activity individually (that the whole is worth more than the sum of the parts), is called “interaction effects” in statistics. It also makes a lot of common sense: if you see a commercial on television and then see complementary content the next day in your web browser, that should be more powerful than seeing either alone or encountering disjointed messaging.

How is it that so much “hidden potential” for this brand resulted from shifting away from the traditional marketing spend allocation? Is this case an exception, or are there market changes that make this experience increasingly common? It appears to be the latter: Crossix reports digital programs generate lifts in sales in 69% of the campaigns it analyzes.⁷ Given how many skilled and savvy marketers there are in pharma, what causes opportunities like this to be missed? And this (shifting the media mix) is only one form of growth opportunity being missed; as we shall see, other missed opportunities are even more impactful.

Other industries (consumer products, for example) experienced these issues and saw these effects in their media mix models several years ago and then made the shift from TV to digital. Today, some sectors spend more on digital programs than they do on television.

A confluence of forces, driven by technology, is changing the landscape in healthcare and the pharmaceutical industry’s role within it. This intersection is creating unprecedented challenges and unique opportunities. The pharmaceutical companies that embrace this new world will find rewards not only in market share and profitability, but also in patient outcomes. Those that are slow to adapt risk being pulled into a race to the bottom, scrambling for market share with increased rebates and growing sales expense.

The old pharma business model worked something like this: (1) demonstrate in the controlled setting of a clinical trial a statistically significant improvement in a patient outcome related to a specific condition; (2) field a small army of salespeople equipped with the results of this clinical trial; and (3) target physician segments in force to deliver those messages and drop off sales samples. Why? Because it worked. It was effective, predictable, and fairly easy to manage.

This shift mirrors that which occurred in the retirement-planning industry about 20 years ago when pensions gave way to 401(k) plans. Essentially, the responsibility shifted to consumers to manage their retirement plans, with similar consequences as consumers sought out tools and information to help with college savings planning, asset allocation, and mutual-fund screeners. Today’s healthcare parallel is the increasing number of people who are now choosing their prescription coverage through Medicare Part D, Affordable Care Act (ACA)–driven public exchanges, high-deductible consumer-directed health plans, and/or employer-sponsored private exchanges. This has inspired, and perhaps required, more patients to act like true healthcare consumers, making more conscious choices and trade-offs about coverage, care, and costs. They are, in turn, tapping the explosion of healthcare information online to become more informed and engaged in their care.

In parallel, healthcare providers are under new pressures. Most doctors are now employed by large institutions, many of which are making changes to clinical practices. At the same time, therapies are getting more specialized; effectively prescribing them requires a deeper understanding of the treatment, the patient’s condition, and the reimbursement landscape. Payers are simultaneously getting more restrictive in formularies while reducing the prescribing autonomy of many physicians and physician assistants. All these forces make prescribing more challenging and increase the importance of tools that support decision-making by providing the right information at the right time. Healthcare providers are, as a result, also turning to digital sources for information and to engage with one another for everything from consultation to consolation, as shown in the 15% increase in health-related searches over the last four years.¹

Decision Resources Group reports that, in 2015, 43% of patients searched for medical information before seeing a doctor, and 72% of patients with preexisting conditions (such as cancer, heart disease, or diabetes) searched when first experiencing symptoms to understand what condition they might have. They also report that 60% of patients with preexisting conditions like to validate a doctor’s opinion with their own online research. Following a diagnosis, 84% of patients turned to search to learn about their treatment options.

If you believe in the “database of intentions” concept, which John Battelle coined in 2003, that “the aggregate results of every search ever entered, every result list ever tendered, and every path taken as a result ... represents, in aggregate form, a placeholder for the intentions of humankind—a massive database of desires, needs, wants, and likes,” then this massive growth in health-oriented digital activity represents a dramatic shift in how society manages its health.² And it’s a shift in which pharmaceutical companies should play a central role.

Google and Decision Resources Group conducted an online survey of more than 1,000 practicing U.S. physicians in 2015 that yielded insights into how profoundly the practice of medicine has been changed by digital tools and sources of information.³ Among the key findings:

Mobile has forever changed how consumers make decisions. We no longer “go online”; we live online. Micro-moments are those moments when we turn to a device to act on a need we have in that moment. They are the I-want-to-know, I-want-to-go, I-want-to-do, I-want-to-learn, and I-want-to-buy moments. These intent-rich moments are when decisions are made or preferences shaped. These moments have become the new battleground for brands. To win the hearts and minds of consumers, marketers need to be at every micro-moment that matters to their audience and deliver experiences that move people to choose their brand.

Thanks to mobile devices, micro-moments can happen anytime, anywhere. Accordingly, in those moments, consumers expect brands to address their needs with real-time relevance. For instance, 82% of smartphone users consult their phones on purchases they’re about to make in-store, while 91% turn to their phones for fresh ideas in the middle of a task.⁵ Here’s a guide with strategies, insights, and customer examples for mastering micro-moments:⁶

A MICRO-MOMENTS PLAYBOOK

Case study: Walgreens jumped on the micro-moments opportunity to engage consumers

In 2011, Walgreens recognized the need to appeal to customers through digital channels. Though many companies hungrily eyed the potential of smartphone apps to connect to people real-time, apps were still developing as a platform for customer engagement. Walgreens understood the power of the app in connecting with customers at the times they needed Walgreens the most, thus building brand loyalty that would maximize the value of each customer.

Opportunity
When Walgreens saw that almost 50% of people with the Walgreens app used it while shopping in-store, the company jumped on the opportunity to elevate the experience. It enhanced the Walgreens app to let customers refill prescriptions via SMS or a bar code scan and launched a “web pickup” feature that let people order items on their phones and pick up them up in-store.

Impact
Between 2011 and 2012, Walgreens doubled mobile-app downloads and saw 52% of digital refills come from mobile phones (a rate of one mobile refill per second). In addition, Walgreens discovered that shoppers who use the app in conjunction with desktop access and in-store visits spend six times more than those who don’t involve digital platforms in their shopping routine.⁸ By identifying and locking in on customers’ micro-moments of need, Walgreens was able to deepen its customer relationships and get the most out of each interaction.

As consumers rely more heavily on mobile, web sessions are getting shorter and more frequent,⁹ and, as a result, consumers make more informed decisions faster. Now that patients and HCPs rely more heavily on mobile as well (SERMO reports that 60% of its log-ins are now from mobile devices, a figure that continues to increase), their needs in those moments are even more transparent, and the signals of intent and context are more meaningful and useful. As a result, all users—consumers, patients, and HCPs—expect messages, content, and experiences that cater to their personal situation with extreme relevance—and not just on mobile, but across all devices and channels.

Compelling micro-moments deliver a better experience for consumers and drive real business results for brands. For companies to “win” these micro-moments, they must: 1) identify the moments to win; 2) deliver on consumers’ passions, interests, and needs in the moment in ways that are timely, relevant, and useful; and 3) measure every moment that matters.

The implication for marketers, particularly since few (if any) pharma marketers have developed attribution models that incorporate all types of micro-moments, is that they need to get comfortable placing lots of small bets based upon their understanding of stakeholders and their behaviors. They also need to get into a test-and-learn mode to experiment until they find what works with those stakeholders.

So it’s a digital world: always on and always connected. Who hasn’t researched online when a loved one has been diagnosed with a condition? Who doesn’t turn to WebMD or the Mayo Clinic Online to self-diagnose or understand what they were just prescribed? The reality of the people who use pharma’s products and services has fundamentally changed.

Though brands do their best to simplify and quicken customers’ purchasing decisions, the overwhelming availability of information in the Digital Age can make even the most ordinary purchase a lengthy ordeal. A poignant example from Google’s research on micro-moments and customer purchasing behavior is the seven-day online product search and research process for a customer who ultimately bought a single $200 pair of shoes after over 150 online interactions.¹¹

The robust online activity leading up to this customer’s purchase reveals some key aspects of customer behavior that are crucial for brands to investigate in order to craft digital marketing strategies that respond effectively to customer micro-moments. Teams need to look at:

Patients and medical professionals have embraced a variety of digital resources, from apps and websites to other services, to expedite and enrich the diagnosis, treatment, and delivery of healthcare services and pharmaceuticals. There are several key drivers of this adoption:

As smartphones become more ubiquitous, so too has the instant availability of information on every topic imaginable. Take, for example, this video of Giana, a consumer searching for a fever sore medication at her local pharmacy. When Giana noticed that one treatment was both cheaper and larger than another treatment, she wondered why, and immediately pulled out her smartphone. A quick search informed Giana that the smaller, more expensive treatment also worked faster, and as a result, Giana ended up buying it. This story illustrates a broader trend: more and more, healthcare consumers are using the internet to make split-second decisions about their treatment.

Given that HCPs are busy making care-related decisions and holding discussions with patients during the day, it is crucial that pharma companies deliver access to content or opportunities to engage with HCPs at the times when HCPs need assistance most. On average, physicians have three devices that they use regularly for work (smartphone, tablet, and computer) and are within reach of their mobile device more than 85% of their day. They use these mobile devices to access the internet almost half the time.¹⁶ This trend suggests major opportunities to better utilize the full functionality of mobile phones to target engagement with physicians at the precise times when that engagement is most effective and needed.

Social (whether public or private communities) is where pharma marketers can listen for expressions of satisfaction or discontent—which some pharmacos have shied away from, given Food and Drug Administration (FDA) requirements concerning reporting of adverse reactions or events. That said, even with the instantaneous nature of social media, many forward-looking pharma marketers are embracing social channels to engage with patients and healthcare professionals, offering timely responses in the moments that matter.

As the video and conversations included here reflect, patients are not just willing and able to share their healthcare experiences or post questions online, they seek out advice and want to listen and engage with a variety of resources to get the information they need. Pharma marketers should be part of these conversations, at the very least as an observer.

Example 1: The Rheumatoid Arthritis Warrior website and Facebook page are a source of information and support to the rheumatology community, presenting patient experiences, news, and discussions on rheumatology research. The website and social-media presence have been maintained by Kelly Young since 2009.

Courtesy of Kelly Young of Rheumatoid Arthritis Warrior (rawarrior.com); used with permission.

Example 2: The following image shows the wealth of knowledge that parents can access via an online community. In this example, moms share opinions about some medical centers in Montville, New Jersey.

Example 3: Emily suffers from ulcerative colitis and uses YouTube as a platform to share her story with others. In the following video, she discusses her experience with Humira injections.

Though the advent of digitalization is transforming numerous industries, its possibilities in the healthcare space stand to revolutionize the way individuals understand their health and how pharmaceutical companies, providers, and payers seek to provide treatment. Dr. Eric Schadt is the founding director of the Icahn Institute for Genomics and Multiscale Biology at New York’s Mount Sinai Health System. In an interview with McKinsey, Dr. Schadt discussed how big data in medicine, facilitated by developments in wearable technology, can fundamentally transform the way players in the healthcare system interact.

According to Dr. Schadt, big data will allow us to build better health profiles and predictive models around patients, thus improving disease diagnosis and treatment. New data will layer on existing data as we build models and iterate on them by applying them to individuals and assessing the outcomes. Gradually, the growing wealth of big data will allow us to develop increasingly sophisticated models and understanding of disease structures and behaviors.

Though wearable devices are seen largely in the recreational sphere, they are developing quickly into research and clinical-grade products. For instance, wearable glucose monitors that interface with digital apps have already been approved by the FDA. Furthermore, Dr. Schadt predicts that within the next 10 years, more accurate information about individuals’ health will exist outside of the health system (e.g., through digital apps connected to wearable devices) than within it.

Though payers, device makers, and pharmaceutical companies are all healthcare players likely to benefit from advances in wearable technology, pharmaceutical companies may stand to gain the most by using the data collection facilitated by the devices. This information will be examined not only through the lens of genomics, but also for the causes of diseases, methods of prevention and protection, and development of pharmaceuticals to fight the diseases.²³

American Express’s approach to small businesses, OPEN Forum, provides an example pharmacos could learn from in how a brand is strengthened by investing in its relationship with consumers. Through its OPEN Forum, American Express has created a meeting place where small-business owners can find digital content specifically written to help them become more successful. Through the forum, entrepreneurs can also connect with one another for advice and collaboration or to contract for services. OPEN Forum also has a social-media presence, with over 200,000 followers on Twitter who follow the forum to learn what is newly posted on its website. By creating this resource, AMEX makes small-business owners feel like the company has invested in their personal success, not just provided card services.²⁴

The shift in pharma strategy away from blockbuster drugs targeting broad swaths of the population (PPIs for GERD, statins for cholesterol) to specialty conditions such as rare diseases and oncology is also shifting the traditional TV broadcast model for marketing to one that favors highly targeted digital advertising to niche segments with very specific needs.

The large and growing body of digital content can, paradoxically, put some digital patients at a disadvantage as well, if not managed appropriately. There is so much accessible information that it threatens to overwhelm and confuse some. A recent study by IMS found Wikipedia to be the website most often used by physicians for prescribing information,²⁵ suggesting that there is a real opportunity for easily accessible prescribing information. More importantly, patients (and some physicians) can have difficulty distinguishing good from bad sources. Pharma companies can stand out from the abundance of sources by not only effectively informing their stakeholders, but also guiding their path of inquiry by participating centrally in it.

For many facing a sore throat, fever, or other ailment, it has become an immediate reaction to search for treatment information online. Unfortunately, not all online health sources are trustworthy, and patients run the risk of following advice that is ineffective at best and damaging at worst. Additionally, many credible online sources of medical advice are dry, full of jargon, and overwhelming for users with no technical knowledge of medicine.

To respond to the overwhelming (and sometimes confusing) wealth of information online, Google resolved to make it easier for people to access simple and accurate medical content on demand.²⁶ In February 2015, Google launched a new health conditions feature showcasing basic medical information about symptoms and treatments for common conditions from reliable medical sources. Since then, Google has released these curated showcases for hundreds of diseases, which have all been compiled, curated, and reviewed by the Mayo Clinic and a team of medical doctors for accuracy.²⁷

In addition to basic information such as the disease definition and a description of symptoms and treatment, the health conditions feature showcases disease prevalence and criticality, contagion factors, and susceptible age ranges, among other useful facts. Search results from well-known and reputable organizations, such as the Mayo Clinic, appear for many medical searches, ensuring that users can quickly access accurate answers to their most pressing questions. Physicians note that it is important for patients to continue to consult with medical professionals in person to ensure proper diagnosis and treatment, but have largely applauded this shift.

Example: Screenshot of Google’s health knowledge showcase on a desktop device

Courtesy of Google; used with permission.

Example: Screenshot of Google’s health knowledge graph on a mobile device

Courtesy of Google; used with permission.

1. Pharma stakeholders are already using digital and turning to nonpharma resources to find the support they need to make decisions. Half of all patients and caregivers already turn to digital channels to look up formulary or dosing information.²⁸ For now, they continue to rely on one-on-one interactions with, and the expertise and prescribing authority of, doctors and pharmacists to winnow down the options, but they also turn to social networks for advice. Pharma has attempted many times to provide data for these decisions, but often their execution has interfered with their intent.

2. Traditional sales force models in many categories are more costly and carry less impact every year. Access to physicians is more limited, and when access is granted, many sales forces report getting less face time and/or having less valuable conversations.

3. Print- and TV-advertising-based commercial strategies appear more and more out of sync with consumers’ and HCPs’ media consumption patterns and desired brand relationships, and hence less impactful than they once were. And when ad blockers, cable cutting, DVR ad-skipping technology, and ad-free premium media are factored in, even digital advertising is under pressure to reach targeted audiences.

4. The new paradigm in healthcare is outcomes-oriented and coordinated (end-to-end, integrated care that focuses on the patient’s journey across the entire CareFlow, rather than just down a funnel) and necessarily relies upon digital tools to synthesize data from multiple sources to develop and execute a comprehensive care plan, as well as facilitate stakeholders’ interactions and communication.

Given all the HCP and patient trends cited in this report, we know that more and more decision-makers are both seeking reliable information and seeking to connect with others through digital means. Because pharma budgets don’t reflect the balance of these users’ channel usage, it is likely that pharma commercial strategies are not yet optimized. Research by eMarketer in 2015 illustrates the discrepancy between how consumers consume media and where marketers spend on advertising to reach them.

Achieving success with digital marketing is challenging, dynamic, and urgent. For pharma to seize and realize the opportunity digital presents, it must approach it with a firm strategy to coordinate investments and build new capabilities. Other sectors, including publishing and retail, have tackled the promises and challenges of digital before pharma and offer some clear lessons and maps from the frontiers of metrics and analysis, ad tech, content management, and the type of leadership required to harness the power of digital and harvest its rewards. Both Progressive Insurance and Major League Baseball, for example, saw that customer behavior was changing and customer needs were not being met, spurring significant investment in digital by both organizations.

Progressive’s digital evolution involves four stages, which we believe apply to any organization dependent on digital:

1. Recognizing that the digital channel exists and starting to provide information through it.

Progressive was among the first to recognize the potential of the early internet. In 1995, when the internet was just gaining popularity, Progressive stepped ahead of the competition and became the first major auto insurer in the world to launch a website. While the site was primarily informational at first, it offered comparison rates online by 1996, and sold auto insurance policies online by 1997.

2. Listening to customers and capturing their behaviors.

Progressive began to listen to its customers and measure their actions online in the early 2000s, focusing on providing a better overall experience for every party involved in a claim, including the customer and the body shop. It re-imagined the entire process, calling it “concierge claims service,” in which customers simply dropped off their cars at a service center, and the insurer handled everything else (design thinking before “design thinking” was a buzzword).

Progressive opened its Twitter account in April 2007, again as one of the early adopters. In addition to launching marketing campaigns on social media, the company began deploying social listening to get real-time feedback for its marketing campaigns. The insurer also began to actively encourage online price and feature comparisons with its competitors. While certainly helpful to consumers, the comparison tool also was valuable to Progressive because the company could capture vast amounts of real-time customer demand data. Even if a consumer decided to go with another carrier, Progressive would know that in a year, he or she would likely need to renew the car insurance policy, and it could therefore take a targeted action to try to win the driver back.

3. Developing insights based on user-generated data and using that data for precise marketing.

The company entered the third phase of its digital evolution—finding insights from the data its users generated—to better target its marketing. In 2011, Progressive started using telematics data to personalize pricing and user experience. Drivers would place its product, Snapshot, in their car, and Snapshot would gather driving-behavior data (speed, frequency of driving late at night, frequency of breaking hard, etc.). The insurer could then use the data to better estimate risk and therefore offer the customer a personalized price and user experience.

4. Truly engaging with consumers and being responsive.

Progressive is engaging with consumers on a one-on-one basis to provide customer care and to personalize its marketing to make it more relevant to each customer. To better personalize its marketing, the insurer recently brought both data management and programmatic ad buying in-house by using the Turn programmatic platform and big data application Hadoop. They were able to improve their analytics to go beyond the last site visited before coming to Progressive: the company can now look at the combination of ads the consumer saw over a period of time to predict “what combination of ad placements might be most successful in the future,”³¹ to reach “their consumer on the right device, at the right time, with the most effective messaging.”³²

Major League Baseball was faced with other hurdles and opportunities, yet its digital journey contains the same components as Progressive’s, and it too prevailed with a successful push into digital through its incubator, MLB Advanced Media (MLBAM).

At the turn of the millennium, Major League Baseball recognized digital as an opportunity to increase industry profits and a present a new way to promote baseball as a sport. Before 2000, digital rights were held by each baseball team separately. As a result, teams in more significant media markets would have an inherent advantage. Unsurprisingly, in the late 1990s, digital capabilities varied enormously by club: some teams had advanced internet presences, while others were largely fiddling with “brochureware” technologies. Digital capabilities, however, would become very important for the future—not only to support consistent branding across MLB franchises, but also as a driver for acquiring new fans. The league thus became interested in building best practices uniformly across teams.

In 2000, MLB consolidated internet rights under a new shared organization, MLB Advanced Media (MLBAM). That move shifted the power created through the separate digital rights, creating more of a level playing field: now, through the MLB’s online services, every fan gets access to the same services, regardless of the team he or she supports.³³

Since those early years, MLBAM has grown into a wildly successful digital enterprise. Hailed by Forbes as “the biggest media company you’ve never heard of,” MLBAM has revenues expected to exceed $1 billion by 2016, and the company provides digital infrastructure for a wide range of other professional sports leagues and media companies.³⁴ How did a traditional sports league pivot so effectively to become a leading-edge player in digital that sets the pace of interactive innovation globally?

One of the reasons for MLBAM’s success is its high level of autonomy while still serving baseball’s interests. MLBAM was organized as an incubator: essentially, an internal startup geared for agile implementation and entrepreneurship. On the one hand, MLBAM shared the MLB brand, accessed MLB resources, and serviced the needs of all MLB clubs. On the other hand, MLBAM operations were separate from the rest of the MLB: while its leadership was well aligned with MLB, much of the staff were hired externally, and many of the people at the table were external technology partners. The new hires ensured that the organization fully embraced a digital-first mindset, while the separate operations insulated MLBAM from day-to-day realities that might be threatened by the promise and speed of digital entrepreneurship.

Finally, MLBAM integrated digitization into the everyday fan experience, spanning the interactive and physical domains. For example, many ballparks are now equipped with Apple iBeacons, which provide a variety of location-based digital experiences. When fans walk up to the gate, their ticket will automatically display on screen. Users can also use their phones for other features such as accessing special merchandise coupons or receiving seat upgrades. Thus, technology has become fully integrated into the core baseball experience, tailored for each individual fan and the way each fan wishes to experience baseball.

Today, MLB Advanced Media still supports team websites: it provides audio and video subscriptions for all out-of-market games (approximately 125 million games are streamed per day), creates original content, sells merchandise, and provides infrastructure for other sports organizations (such as the NHL and the WWE), traditional media providers (like ESPN and HBO), and many other types of entertainment (rock bands’ websites). The NHL deal, in particular, announced in 2015, represents MLBAM’s biggest digital-media-rights partnership, which is “expected to enhance the user experience across the League’s digital platforms,” including NHL apps, 30 team websites, GameCenter Live, NHL Center Ice, NHL Network, and NHL.com.³⁶

The impact of all of this activity has been tremendous economic success for Major League Baseball: MLBAM brought in about 9% of the league’s $9 billion in 2014 revenue, and its tech unit has been growing in the double digits.³⁷ Moneyball may have the Oscar nominations, but it was a little-publicized digital incubator that grew into a sports media giant that truly set the stage for the future of the national pastime.

The digital journeys of Progressive and MLBAM may have been different, but they both sprang from the same place: an acknowledgment that digital platforms would engage, serve, and respond to their customers in new, exciting, and lucrative ways.

Most pharmaceutical leaders recognize that their commercial mix does need to evolve considerably to adapt to the changing environments of patients and HCPs. Few could confidently say, however, that their commercial model is optimized today for either group, and fewer still that their companies are evolving their commercial approach as quickly as demand for digital content is growing.

Three big issues tend to hold many pharma companies back:

Regardless of your company’s backstory, the good news is that commercial models that are tuned for the Digital Age can and do work well for pharma and are within reach of all organizations.

To move from one stage to another, as Progressive did with insurance and MLB did in entertainment, requires pharma companies to fortify or develop new underlying capabilities, which we will discuss in-depth in the chapters devoted to each of the 3Ds—Discover, Design, and Deliver.

Leaders who embrace the digital shift in patient and healthcare provider (HCP) behavior or see current approaches plateauing in effectiveness often struggle to gain traction for these perspectives across their organizations, or they find that initial results do not meet expectations. So far, this book has focused on the primary question those leaders ask: Is change worth it?

Now we switch gears to address the leaders who believe that a new approach to engagement is necessary and are looking for ways to inspire their colleagues, preferably with an executable roadmap. The goal is to help these leaders craft a simple game plan for evolving their commercial (primarily marketing, but not limited to marketing) approaches. We will outline the key commitments an organization should consider and best practices to accelerate a smooth and effective transformation.

The most successful pharma marketing organizations do three things really well. They Discover the behaviors, beliefs, and needs of the people they are marketing to; they Design experiences relevant to the people they are marketing to; and they Deliver those experiences consistently, superbly, and efficiently. These phases are well known by experienced marketers, in pharma and elsewhere, but we refer to them as the 3Ds not only because they delineate the biggest areas of change for most companies, but also because we believe pharma needs to “think in 3D,” adding depth and perspective as the industry moves from campaigns that talk at patients and physicians to solutions that listen to and engage with them.

The 3Ds are not sequential steps, but work in parallel and constantly intertwine, supporting, informing, and improving one another. This leads to continuous delivery, ongoing discovery, and optimization done rapidly and fluidly.

Finding the confidence to move from a traditional, “analog” commercial model to a dynamic, digital approach is particularly challenging in pharma: there are inherent opportunities and constraints that are more complicated and nuanced than those in sectors where a person’s health and life aren’t on the line. Added to this are the enormous complexity and diversity of the individuals—from family members to physicians, payers to pharmacists—involved in or affected by a patient’s care. All told, responsible healthcare and the rapid rollout of new, interoperable technologies make pharmaceutical marketing uniquely difficult to get right.

The 3D framework can help pharma leaders find a more compelling role to play in the lives of their patients, prescribers, and all others who influence patient behaviors and decisions as they move through the CareFlow—the holistic cycle of detection, diagnosis, treatment, and recovery.

Whether you’re focused on making engaging connections with patients, caregivers, physicians, or other care providers, it is critical to understand that decision-maker’s experience, design a way of interacting with this individual that helps him or her make decision(s), and then consistently deliver on that intended mode of interaction. Executing consistently across all three Ds requires a shared reference point to discuss what customers (patients and providers) are going through. The CareFlow concept provides this common foundation.

There are many ways to collect and present these insights. For many years, pharmaceutical marketers have been developing, modeling, and following “patient journeys” to guide their marketing programs. While these broad frames provide value in characterizing the main phases of care and treatment, it’s now clear that consumer decision-making is rarely linear, and that many “journeys” don’t accommodate the messy, iterative nature of human behavior. The CareFlow concept, illustrated here, attempts to evolve the traditional patient journey approach into a more dynamic and nuanced one that better reflects the complexity of interaction points (digital and traditional) that influence patient and provider behavior.

Why do we need a new journey? A fundamental change has occurred in the healthcare environment that creates an opportunity to build on traditional concepts of “patient journeys” or “patient funnels.” This change is the result of two big trends. First is the explosion of easily accessible medical information online. Second is the broader trend of people engaging with this information on their phones, tablets, and PCs to educate themselves, seek the opinions of others, and ultimately make their own informed decisions. As patients and physicians often interact with the same information and brands, their relationship has become more complex, which makes broad characterizations of their behaviors more complicated.

Although the term patient journey has been around the industry for many years, even today many “journeys” that marketers reference are actually patient funnels, meaning that they don’t reflect the continuous nature of managing a condition or tend to isolate and overfocus on one part of the journey while paying too little attention to other important steps or phases. Treating decision points as endpoints risks missing insights like this: The factors that caused a patient to be resistant to seeking professional help early in the CareFlow may well be the same issues affecting non-adherence, later in the CareFlow.

For example, if mobility issues caused a patient trouble in initially seeing a doctor, an easy solution is to get that patient signed up for a mail-order pharmacy to deliver refills on a regular schedule. This kind of insight can be missed if the pharmaceutical company doesn’t look at the CareFlow comprehensively to understand why some patients fail to make appointments. The pharmacy has no visibility into the early stages of the CareFlow. Accordingly, it is up to the pharma company to generate these insights and respond to them. If this doesn’t happen, the patient suffers, and the course of care needs to begin again as the condition continues or worsens.

Funnel models highlight the patient experience but don’t sufficiently isolate all the “marketable” touchpoints or micro-moments. In addition, they often don’t isolate the channels that are influencing a choice and the messages or forces that are most influential at driving that choice. There is real value in truly taking a patient-centric view. Traditional pharma “patient flows” or funnels are really about where and how a pharmaco can interact with the patient. The CareFlow looks at things from the patient’s perspective (not caring about who the patient interacts with, whether pharmaco, caregiver, physician, or other). With that insight, the pharmaco can then isolate where it could join the conversation and add value without being disruptive.

The CareFlow is a “real” patient journey in that it profiles, holistically, the experience of the patient or HCP and focuses on the interrelation between experiences over time. The great benefit is that marketers who apply the CareFlow model will discover considerable opportunities and sources of value that were previously hidden in plain sight.

We favor the CareFlow concept as a more comprehensive and continuous framing of the process—one that reflects the complex influences at work between individual patients and all relevant stakeholders (see figures). The CareFlow model reflects the realities of actual caregiving:      

HCP CareFlows distinguish between two types of parallel provider experiences. The first is the continuous building of the provider’s “knowledge estate,” which is the accumulation of that provider’s training, experiences, and beliefs. A recent McKinsey survey of 450 U.S. physicians found that in addition to going online for their work, almost one in five use the internet regularly to learn about or engage on clinical topics not directly related to their work but for personal interest.¹  This is part of the curation of their knowledge estate.

The second type of experience is the patient encounter, a layer on top of the knowledge estate made up of the salient specifics of the patient’s condition, history, affect, etc. The patient encounter draws upon the knowledge estate while simultaneously enriching it. The patient encounter is a result of everything the multiple participants bring to it (positive and negative) and as such may be a multistage experience involving many actors. For example, HCPs often engage in peer-to-peer discussion during the “Researches potential issues” and “Researches therapies and coverage” stages, as well as during the “Monitors progress” stage. SERMO reports that a large number of doctors collaborate with other HCPs in real time about active patient cases in order to inform diagnoses, treatments, and follow-up care.²

A pharmaceutical marketer wanting to affect and influence the CareFlow must understand the patient’s and HCP’s needs, as well as the broader ecosystem in which they operate. While the moment a script is filled at the pharmacy is the singular “success event” commercially, it is just one of many critical decision points or micro-moments in the CareFlow. Earlier micro-moments include research; consultation with doctors, peers, and family; and ensuring affordability, while later events include the experience of side effects, the motivation to stay with therapy, scheduling appointments, remembering to take medications, and financial challenges. All these moments play critical roles in the patient getting care. As a result, they are potentially vital points of interaction for marketers.

A marketer that develops a well-defined CareFlow through diligent discovery can identify all the interactions customers have in their relationships with a brand or product and then zero in on the specific forces that affect choices in these micro-moments. Such a marketer is then positioned to design appropriate marketing actions to influence or reshape these choices. For example, a recent meta-analysis of 16 randomized clinical trials, published in JAMA Internal Medicine, reports that text messages to mobile phones almost double the odds of medication adherence (the equivalent of raising adherence rates from about 50% to 67.8%).³ This is one of many micro-moments that a marketer could target. Not every micro-moment will be relevant to each decision-maker or product, but they all need to be considered holistically. After examining all micro-moments from the new perspective of the CareFlow, marketers may find that their current targeting of some important micro-moments is inadequate while they may be overspending on other micro-moments.

Pharmaceutical marketers who analyze behaviors with an eye toward building a CareFlow and then designing experiences based on those insights are tracing the footsteps of behavioral marketers of the past. Retailers, for example, have known for years that the majority of retail shoppers turn right when they enter a store (one of the many findings Paco Underhill immortalized in Why We Buy: The Science of Shopping). Accordingly, they have designed their stores not only to accommodate this fact, but also to exploit it. The same opportunity exists in pharmaceuticals, now that myriad new data sources on patient and HCP behavior have emerged and ever more precise methods of reaching patients and HCPs have evolved.

This example also underscores the significant need—and opportunity—for pharma companies to partner with other organizations to meet patients’ needs and experiences and agree on measures of success beyond market share and the number of scripts written. Some pharmacos may be hesitant to get into the transportation business, and they don’t really need to. A pharmaco can work with a hospital system or payer to provide access to transportation options or perhaps identify a new entrant to the transportation market (e.g., Uber piloted doing $10 house calls for flu shots, joining a host of other start-ups aiming to deliver on-demand care services⁴). The broader point is that if a pharmaco can provide a high-value service for patients wrestling with the challenges of getting to a provider or caregiver, such a program would be valuable and memorable, and would engage the pharmaco in the patient’s ongoing treatment not only as a pharmaceutical supplier, but also as a trusted partner on the road to recovery.

The field marketing team was puzzled about why some physicians confidently prescribed a new and well-promoted drug, while others never recommended it to their patients. A research request was submitted to the corporate center of market analytics, where an analyst pulled in the data and began to rule out possible factors, including geography, health plans and approvals, and socioeconomic patient analysis. Nothing in the data seemed to indicate a reason why some physicians were either unaware of or averse to using a drug that had proven its efficacy many times over. “Then I guess we need to call them up and ask them why,” said the head of product marketing. A week later, one of the disengaged doctors obliged, barking out the reason on a short and loud phone call: “You want to know why I don’t prescribe it to my patients? Hell, that’s easy. I know it works; I read the literature. I just can’t find the right words to explain it to my patients. And if I can’t do that, then what good is the drug to both of us? You guys give the patients ‘doctor discussion guides,’ but how about one for me to discuss your drug with my patients?”

Discover is the process of searching for and identifying potential points of engagement with patients, physicians, or other critical stakeholders. Marketing in the digital age has become a search for those engagement opportunities—specifically, those tacit and overt invitations by the audience that they want something, including information about their own conditions or the possibility to connect with others who share the same experience.

Fifty percent of primary care physicians now report that they share information from online videos with patients.¹ Insights emerging from these types of intersections of new and increasingly richer data sources were inaccessible to most pharma marketers even a few years ago. Then, marketers were forced to make decisions based on a combination of syndicated prescription data, surveys, sales rep feedback, key opinion leader (KOL) panels, and experience. Now, however, the game has changed. This chapter shows how to harness digital resources and analytics to develop vastly superior marketing approaches to discover new opportunities.

Discovery in the Digital Age is the art of combining numeric and emotional views of behavior across the CareFlow. As such, it is not simply classic data mining or even “big data” number crunching that many think of when discussing business intelligence. The Digital Age Discover process recognizes that the data are coming from new sources; for example, we ourselves are often the sources of data, whether from our medical records or the Fitbits and smart watches around our wrists. Effective discovery, therefore, requires a perpetual “insights engine,” one that never stops combining these torrents of data with ethnographic and attitudinal insights. The pharma team becomes informed with the facts and perceptions needed to rapidly prototype and run experiments based upon the team’s understanding of decision-makers and hypotheses about how they are behaving. Outputs of experiments then enable the rapid adjustment of tactics, content, campaigns, and actions to better inspire behavioral change.

Past behavior by patients and physicians is a critical indicator of future intentions. To change or influence intentions, you must therefore first understand both what the underlying behavior is and why it is happening (i.e., the motivation for it). Once that insight is gleaned, the task is to construct a strategy that affects that behavior, either to change or reinforce it. Getting to the “why” typically requires a good understanding of the “what,” derived from numerous interviews with the decision-makers involved in the CareFlow about how they make decisions.

Note that observing the “what” is remarkably easy in the Digital Age. Analysis of search patterns can provide insights into people’s interests, intentions, and future actions. By simply searching on their own relevant terms, from drug names to medical conditions, side effects, and other phrase combinations, a marketer can with a cursory look identify the most frequently searched combination of words and phrases surrounding a brand or condition. In the (anonymized) case presented in this sidebar, it’s clear from search data that users are really focused on when the brand loses efficacy.² Unfortunately, the brand itself had no advertising attuned to addressing this situation.

The major search engines and third parties offer a variety of tools that can be deployed to dramatically elevate decision-making. Marketers should take advantage. The information is out there for the finding, it’s inexpensive, and it carries real impact from the insights it can reveal.

Google looked into the types of questions its users who were searching for information on breast cancer sought to answer between September 2014 and September 2015. Their range of inquiries was broad, highlighting the vast difference in experiences across patients with the same diagnosis:

Though all users are battling with the same condition, they search for answers in varying ways. Understanding the many avenues through which patients hope to obtain answers to their questions can help marketers identify the quickest and most effective ways to help them.

Similarly, analyzing search trends for schizophrenia reveals clear cycles in user interest over the course of each day. Google examined these daily trends from October 2015, as shown in the figure.

Several lessons can be gleaned from the results of Google’s schizophrenia searches:

Thus, understanding the patterns in timing, device choice, and seasonality for queries on schizophrenia clarifies when and where afflicted patients express their acute needs.

Brands need to understand what people want and how they seek it when they engage in a therapy or disease area. With this understanding, the brand can tailor its communications to be far more relevant to patients and HCPs who are searching for insights. Despite the breadth of searches on breast cancer or the variety of patterns in schizophrenia searches, many of the clear themes that emerge can be highly relevant to a marketer of therapies for these conditions. Being the brand that is most helpful when a person is in need of information usually has numerous benefits later in the CareFlow.

The Digital Age has created a flood of new types of data, and the challenges are how to integrate data from multiple digital and nondigital sources and how to develop perceptive analysis to find insights. The good news is that most companies already have a wealth of data on hand that they can use, and what they don’t have, they can purchase or collect.

For example, market access teams can contribute claims and copay data, while blinded customer-support call-center data and customer relationship management (CRM) data sets can help in segmenting customers and understanding their needs. Even electronic-medical-record information can be used to provide insights into the treatment pathways within the CareFlow and identify triggers for engagement. Internal data sets can be augmented with socio-demographic data from third-party providers like Acxiom; claims data from payers; script purchase data from IMS, Symphony, or others; digital healthcare analytics from Crossix that generate insights based on prescriptions, over-the-counter drug purchases, medical claims, and clinical and socio-demographic consumer data; clinical-trial or FDA Sentinel data from public sources; and genomic data or patient-generated data (e.g., from wearables, online community forums, or social media). Cross-industry analytics providers include Google Analytics, Amazon, Adobe Marketing Cloud, Salesforce.com, and Oracle, some of which offer free tools (e.g., Google Trends) that can provide preliminary insights.

Social media represent a valuable channel for companies to connect with consumers. Monitoring social media is also a way to identify situations where online sentiment may affect overall corporate valuation. In some cases, company performance in financial markets has been affected by the information (or misinformation) of online opinion shapers. One poignant example of this effect can be seen in the recent struggle of several foreign companies in the Chinese market for baby formula.

In the summer of 2012, a study at Hunan Agricultural University mistakenly indicated that several foreign baby formulas might contain additives that were dangerous for infants. By the time the mistake was revealed, stocks had plummeted for several players. Unfortunately, these foreign firms did not have a strong social-media presence in China, particularly on the popular Chinese social network, Weibo. As a result, they were unable to quickly recognize the risk or respond to assuage consumers’ concerns about their products.

These events showed the vulnerability of foreign companies in a market where they cannot engage the public in a quick and wide-reaching way. In this case, highlighting the safety of their products after the study’s mistake could have reduced the financial impact for these companies. The importance of social media in quickly reaching consumers highlights the importance of digital reputation management and consumer engagement in today’s world of rapidly shifting brand perceptions and information dispersion.

Sales reps’ calls on prescribers are another major source of information to drive the Discover phase. Many companies are already using this source, so the new opportunity is to combine it with other sources to create novel insights. Using IMS data and CRM tools such as Veeva, companies can collect information on and resources related to the clinical, access, and patient-support information that physicians respond to and why they respond to it. Even the content the organization designs, develops, and delivers to its various audiences is a source of insight as patients and HCPs read, download, and forward it. All of this activity can be tracked and used to refine a brand’s commercial model.

Analytics derived from the entire customer experience—digital as well as the physical world—yield insights into what is actually important to consumers and when and how consumers can best be engaged. This collection of data-informed insights can then be used to develop more targeted, relevant customer experiences that turn patients into advocates. The Discover process can help uncover unmet needs, identify linkages, anticipate future behaviors, and indicate how to best engage with the players in the CareFlow as they move in and out of the patient’s journey toward better health.

While data can fill in a lot of the “what” in the market, to explain the “why” behind the analytically-derived insights it is often helpful to ask the field sales force as well as to commission focused market research that focuses on the following objectives:

Given the options for digital channels, pharma companies have the potential to engage with their patients in all aspects of their online life, not just the commercial or health-related ones. Understanding the whole picture is important, but marketers will need to be thoughtful about which aspects of online life to prioritize as targets. We have new visibility into the broad arcs of patient behaviors, from their very first concerns, to experiencing symptoms and anxieties, to decisions to seek more information, book appointments with doctors, seek alternative treatments, and manage costs, coverage, and refilling of prescriptions. By adding predictive analytics, the marketer can move from a reactive to a proactive stance, anticipating triggers of intent versus detecting and responding to them.

Developing a comprehensive understanding of how best to treat a condition requires understanding the condition from the patient’s point of view. Conducting CareFlow analyses for specific conditions provides a unique opportunity to create this view. McKinsey recently conducted such an analysis for clinical depression, surveying over 1,200 patients who self-reported clinical-depression diagnoses to ask about their experiences with the condition over time. From this, three key opportunities were identified for pharmaceutical companies to tap into new value pools while improving patient outcomes.

1. Improve the speed with which depressed patients are diagnosed

Though establishing a diagnosis of clinical depression only requires two weeks of symptoms, 12% of patients took 3 to 6 months after first sensing something was wrong to receive a diagnosis; 12% took 6 to 12 months, and 26% took over a year. Based on further examination, the bottleneck appeared to be in deciding to see a provider, rather than in a delay by a provider in making a diagnosis once consulted: 90% of patients were diagnosed with depression within their first three visits,¹² but 58% waited over a month after first sensing something was wrong to make an appointment with a provider, with 19% taking over a year.

This points to significant opportunities for pharmaceutical companies to help direct patients to providers earlier. One such opportunity is for marketing initiatives to more intensively highlight the symptoms of depression and correlation with family history,¹³ thus helping patients and their immediate environment of friends and family to recognize symptoms and seek care earlier. Patients appeared to be amenable to earlier engagement with providers: whereas 44% of patients used healthcare professionals as their first source to gather more information upon sensing something was wrong, 57% stated that they would have preferred to have done so, suggesting a gap between experiences and desires. Upon diagnosis and medication prescription, patients typically filled their medications quickly.¹⁴ This further suggests that the delay in seeking out a provider is the major barrier to initiating antidepressant therapy.

2. Manage patient expectations regarding the duration of the therapy required to gain relief

Expectation management regarding therapy also appeared to be a hurdle to successful treatment. Literature suggests that though changes may be considered after 2 to 4 weeks of treatment, 6 to 12 weeks may be needed for an antidepressant to take full effect, and providers typically make a determination regarding effectiveness after this extended period.¹⁵ However, 18% of all prescriptions were discontinued in less than a month, and of these, 52% had lack of efficacy reported as a reason for discontinuation. Reminding physicians of the duration of therapy required before assessing potential medication changes and asking physicians to educate their patients on the topic could result in a significant improvement in medication adherence. This could subsequently increase the number of patients who ultimately experience symptomatic remission from their medication and remain on the therapy for an extended period.

3. Provide multimodal, holistic treatments

Even after treatment with medication is underway, there are still opportunities for pharmaceutical companies to continue interacting with patients. This is shown by the 63% of patients who believed that a change in lifestyle would help them manage their depression (60% reported physical activity improved their depression symptoms). Omada Health, a digital health program, provides an example of expanding treatment modalities. Omada Health partners with a variety of employers and payers to provide patients with professional lifestyle coaches, who provide constant individualized feedback (via the internet, text messages, and phone calls) to motivate and coach patients to lead healthier lives. If pharmaceutical companies partnered with such programs, it could help them expand their impact “beyond the pill,” allowing them to provide holistic treatment.

Summary:
CareFlow analysis provides an in-depth understanding of patient behaviors throughout patients’ experiences with a condition. By understanding these behaviors, various stakeholders can create targeted actions with the ability to significantly improve their impact.

One use of data analytics is to refine targeting to ensure that more relevant information gets to the right patients, HCPs, or caregivers at the right time. Some companies worry that privacy and HIPAA regulations that restrict the use of patient-level data will prevent any type of outreach activity. Despite the complexities of the privacy laws, there are compliant ways of using some types of available, non-identifying customer data to develop better commercial strategies.

HIPAA regulations dictate that pharma companies cannot store personally identifiable information for patients who have not opted into any program specific to the organization. This means that in order for a pharma team to tie together its own internal digital response data to patient treatment data or claims data, such information needs to be hosted at an outside vendor that performs the integration and anonymizes the data used by the marketing team. Furthermore, great sources of consumer behavior reside at third parties, such as Facebook and Medscape, which generally do not allow these data to be stored by the pharma organization within its own four walls.

These regulations create uncertainty for pharma companies as to what they can or cannot do with personal patient data, limiting them from optimizing how they use this valuable information in their marketing efforts. As a result, pharma companies tend to leverage personal data conservatively to avoid running into any regulatory disputes. Nevertheless, opportunities exist once a clear understanding of the relevant regulation is formed. A key part of organizing a Discover model is focusing on the hosting strategy for data so that access is seamless, linkages are possible, and compliance with privacy regulations is ensured. There are numerous third parties that can also facilitate this process in a HIPAA-compliant way.

Pharmaceutical marketers not only must understand patients, but also need to understand the different needs HCPs have and the different influences that affect their decision-making. To develop experiences that resonate with different segments of the HCP community, pharma companies can track spending patterns and prescribing behavior or look at what they are searching for online and what that implies for their goals.

Our research shows that physicians in different geographies and specialty areas are influenced by many different factors when making decisions. Some of these factors include cost, patient satisfaction, outcomes, and time management. For some HCPs, using the latest therapy is important, while for others, it is not. Marketers need to know how these prescribers cluster, so they can effectively target them. For example, in the past 5 to 7 years, many pharma companies have restructured their sales forces to focus on HCPs who still have considerable decision rights when prescribing (versus those who are constrained by payer contracts or the policies of their hospital system employers). These prescribers, who still consider the sales representative a partner, tend to cluster by region and specialty. Digital tools can be very effective complements to traditional sales force models. In a recent McKinsey survey of American physicians, 23% of respondents reported interacting digitally with a pharma sales representative at least once a month, and an additional 33% said they would like to; 70% reported that they wished they had better tools to help them communicate with fellow physicians in real time.¹⁶

In this context, marketers have the opportunity to complement these sales strategies by targeting a suite of email and digital interactions to the physician segments where the sales representatives have less access and/or influence as well as a desire to interact digitally. In parallel, a different set of digital interactions should be designed for physician segments where the sales representatives are present, dovetailing with the messages they are delivering live. In the same research, two-thirds of physicians reported using online videos to keep up-to-date with medical information.¹⁷ It seems like a clear opportunity for pharma companies to further invest in meeting this type of demand.

Discovery requires an expansive approach across different patient and HCP groups and data types. It also necessitates a balancing of quantitative and qualitative analysis, and demands that users keep the process open and alive to respond to new opportunities as they are uncovered from the sea of inputs being processed. Most pharma marketers are unaccustomed to this process (most focus on commercial touchpoints only), yet it must be wholeheartedly embraced to inform an approach that is relevant and focused, and to truly engage the patient and professionals at every stage of the CareFlow based on a broad set of touchpoints in patients’ and HCPs’ lives. It should also be constructed as an ongoing, continual capability.

There is a pivotal shift that happens between Discover and the second of our 3Ds—Design—and it is related to the selection of the goals pharma companies want to achieve and the patient and HCP problems they want to solve. The Discover phase is about understanding the inspiration for patient and HCP behaviors, and forming a clear sense of the CareFlow and the micro-moments within that CareFlow specific to the segments and circumstances of the specific medical condition. Discover reveals not only what actors do today, but also the thoughts, beliefs, attitudes, mindsets. and habits that underlie those behaviors, and the emotions and feelings that accompany those thoughts. This must be done through a combination of empirical analysis, interviews, and surveys—observing as well as calculating.

Design is the creative “building” phase, where the pharma team takes the insights gained from the analysis of patients and/or HCPs and turns those insights into the experiences, content, media, information, offers, and actions across their respective CareFlows. This engagement can, and should, go beyond a traditional, one-way advertising campaign.

What’s different about Design in the Digital Age? Traditionally, pharma marketing was primarily a “push” model, with marketers focusing on compelling decision-makers to take action based upon the intrinsic characteristics of the product they were selling. Some companies still think primarily in terms of point-in-time campaigns with a specific message for a specific product. Recently, more and more have started to take a more patient-centric approach, but few start the full breadth of their commercialization planning, marketing strategy, and message development by truly working backward from the CareFlow. In contrast, in consumer products, bringing a consumer product or food to market virtually always begins with a deep understanding of the customer’s full life context and how that affects the consumer’s desires, needs, and constraints.

The idea of Design, therefore, is to create an experience for a patient or HCP (or a tight group of patients or HCPs) that matches a stage of intent in a CareFlow. That experience very likely involves a product and leverages that product’s distinctive attributes, but it may only involve the product indirectly (e.g., it may engage a person in a way that eventually results in product usage). Importantly, that experience will very likely need to be one where there is genuine engagement—an opportunity for both parties to gain more than a transaction—between a company and its patients or HCPs. Designing for engagement in the digital age is about approaching one’s audience with an invitation to engage, not about making an (unwanted) interruption. Designing for engagement means designing for the audience’s mindset, not the marketer’s. Designing for engagement is as much about listening and responding as it is telling or convincing, and it is an inherently generous process.

Designing for engagement leads the marketer to choose relevant experiences to deliver and the appropriate content to use for each audience, based upon both the obvious and subtle insights developed during Discover. The goal is to identify and engage in select micro-moments through the appropriate channels and with relevant content, sparking discourse and developing relationships with participants over the course of their CareFlows. Although patients’ needs evolve as they progress through their treatment, there is usually an ongoing need for education and support from beginning to end. The art and science of designing exceptional customer experiences depends upon deep knowledge and a willingness to engage and keep engaging as the CareFlow unfolds. Practice makes “near perfect.”

Recently, Kleiner Perkins Caufield & Byers, the venture capital firm, held a series of panel discussions with a range of professional designers who have turned their focus to healthcare, an industry that has arguably lagged others in design.

The episode of the Ventured podcast titled “Better Health through Decision” digests those discussions and highlights the opportunity that design brings to healthcare.¹ The focus is largely on technologies (rather than pharmaceuticals directly), but it’s valuable to hear how the designers think about and approach their work. It consistently starts with a deep understanding of the user (be it physician or patient) and then transitions to imagining the experiences that they will most easily understand, relate to, and effortlessly use. With that design vision in mind, the delivery of that experience becomes a matter of execution—although, as you will hear, sometimes that execution requires communication through seemingly impermeable metal.

These themes come up repeatedly in this chapter; you’ll hear from one designer who named the persona she is designing for “Betty,” so this should be a good introduction.

While individualized plans are not necessary, we do favor a micro-segmentation approach based on how behaviors, needs, motivations/intent, emotions, and pain points cluster within the brand’s patient or HCP populations. Note the word and, which underscores that it is the synthesis of multiple behavioral and attitudinal factors that will define the best segments and strategies, rather than basic demographics or script trends.

Often, multiple issues common to a persona affect different parts of a CareFlow. Marketing to a persona across each of the parts of the CareFlow that are important to that persona, and in a way that reflects how that persona is moving through the CareFlow, is far more compelling than finding a point in the CareFlow that applies to many different personas and then trying to address that point in a one-size-fits-all way. Developing personas also helps commercial teams coordinate across tactics, keeping the customer at the forefront of engagement design. Personas also reinforce for all members of the commercial model the notion that their job is to engage customers by providing solutions to the customers’ real-world problems.

“[Name of persona] needs a way to [desired outcome], but [key problem or barrier] because [root cause], which makes him/her feel [emotional state], so instead he/she [what the persona does today].”

Using and completing this story structure clarifies the goal of engagement during Design. The name defines the alignment to a selected persona. The desired outcome delineates the hope of that individual. Does he or she want to save money? Concentrate better at work? Stop smoking? Feel better? Avoid side effects? The key problem or barrier is the impediment the pharma team promises to alleviate. Can’t find a doctor? Then add a directory of qualified, trained physicians. Too expensive? Offer payment options.

After breaking down the challenges and influences, the marketer writes the story that meets those needs and then figures out how to deliver on the experience envisioned in that story. To illustrate, consider the case of a patient named Joan and her psoriasis:

Joan needs a way to consistently take her [TNF inhibitor] to control her psoriasis, but she doesn’t consistently get injections (despite having plenty on hand at home) because she lives alone and hates giving herself the injection (it’s really painful, and she’s actually a bit scared of the whole process, particularly the auto-injector), which makes her feel both frustrated and a bit ashamed, so instead she makes extra appointments with her rheumatologist (so he’ll do the injection, although she doesn’t admit that to him) and ultimately gets only about one-third of the injections she should.

Once marketers understand the problem faced by a patient like Joan (and assuming that the Joan persona is large enough to address profitably), then they can design a solution to it. Consider first the traditional approach. The marketers find there is a cohort of women age 40–55 who have low compliance and would like injection support. The “solution” might be to put together injection trainings, printed and downloadable materials, and maybe even the ability to speak with nurses about injections. Note here that the marketers completely miss an opportunity to truly connect with their muse (Joan) and create a bond and relationship that is more than just transactional.

Conversely, the right solution for Joan doesn’t end with the obvious or the practical: “Let’s put up an injection site finder on our website,” or “Let’s post links to local visiting nurse associations (VNAs) and provide information on how to get those injection services covered by your insurance” (although few brands even go that far). The right solution truly empathizes with Joan, reflects that the brand understands her situation, affirms that it’s common and nothing to be ashamed of, and cares deeply about resolving the problem because uncontrolled psoriasis will lead to even worse complications.

Going even further, any exceptional design would start by developing a way to identify people who are in Joan’s situation. This can be done using big data analytics to develop behavior markers that strongly correlate with this patient profile yet don’t cross any HIPAA barriers, and then using that profiling information to develop outreach programs to these patients. These could be nurses calling from a call center, education targeting physicians to explain that this is indeed a common problem, and brochures for physicians’ offices and waiting rooms directing the patient to a focused website, among other possibilities.

Those outreach programs would provide the resources the patient needs, share stories of other patients who have overcome similar circumstances, provide a forum to connect with others in the same situation, and offer an “injection site finder” that locates places near Joan’s home where she can go to get an injection. (Maybe her local pharmacy is equipped to do so; maybe the pharmaco can arrange for a pharmacy to provide injection services for free, just to get the patient to walk in the door, after which she’d likely buy something she needs.) If need be, there could even be a way to facilitates nurse visits to the patient’s home to provide the injections—ideally with reimbursement in part or in full already worked out with major insurers or, at the least, with discounted rates for those paying the provider out-of-pocket. This type of initiative doesn’t need to cost huge sums of money, but it needs to be valuable and intimate, show truly personal empathy, and respect privacy.

Once the solution is designed, it must be tested and improved based on how the program is working in the field. Sure, a marketing team might pilot the program with some focus groups in a small test market, but what is really needed is to put in place the metrics and feedback mechanisms to gauge whether the brand is getting the desired improvements to the problem story. In the event it isn’t working or isn’t quite solving the problem, the brand team will know, iterate, and take actions based on the team’s test-and-learn model to improve the solution. They then learn from that and further iterate as needed.

Very few pharma marketers test-and-learn or iterate enough in their marketing execution. This may be a legacy of the fact that in-market, controlled testing was very time consuming and costly in traditional media (e.g., a split cable test for a TV spot might cost hundreds of thousands of dollars to run). Digital media, fortunately, offer the potential to test at dramatically lower costs.

Regardless of the driver, there is a dramatic contrast between the amount of testing done by pharma teams versus, for example, best-in-class retailers, who are A/B and multivariate testing constantly. In these other industries, failing to test-and-learn would be a massive competitive disadvantage. In today’s pharma landscape, those who start doing this in earnest can gain a massive advantage. Solutions that fail to meet initial goals can recover and improve; those that start strong can do even better. Ultimately, the opportunity is to deliver more value and a closer bond between the brand and the market than resulted from the one-and-done structured campaigns of the past.

When applied properly, this customer-first approach has led to some notable digitally enabled successes.

“Content” is the broad and generic term for any message, media, or digital asset that will be exposed to audiences at the various, important micro-moments in their CareFlows. The Design phase not only conceives, commissions, creates, and tests such content, but also considers the channels and platforms appropriate for reaching the right audience on the right device at the right time.

When marketers are planning communications to match up to a specific need for a specific persona, they must consider the way in which messages will be delivered (not just what is being shared). One way to test that a marketing program is designed to be as compelling to the patient or HCP as possible is to ask if it’s NOBLE:

Non-self-interested. A modern brand must be in it for the patient, not for the pharmaco. A selfless, generous, committed, and helpful brand will be trusted and sought out. It is rare today to hear the word altruism associated with pharmaceutical companies or brands, which is why it is potentially so powerful for patients and HCPs to encounter a brand that is living altruistically. Digitally fluent people can quickly smoke out phonies who are entirely self-interested. An effective brand today is authentic and clear about what it can and can’t do, as well as what its intentions are.

Open. The brand must also be genuinely interested in feedback from users and must aspire to improve based on that input. It must collect information continuously about how it is resonating with decision-makers and then adapt, redesign, innovate, and retest as needed. Said another way, its marketing learns from its experience in the marketplace and improves over time.

Bespoke. Interactions with the brand must be personalized to the user. The brand needs to recognize the differences that exist among decision-makers in not only their demographics and behaviors, but also their beliefs and emotions. By recognizing and learning this during Discover, marketers can tailor the approach to the individual, constantly adapting to their context, respecting their history with the condition and the brand, and adapting to the particular opportunities and constraints of the delivery channel.

Linked. Efforts must be integrated across multiple channels, but this is not the multichannel efforts of the past, where the goal was to push the same message across multiple formats. Instead it is a recognition of all the places people will consume information, an understanding of what those decision-makers care about when consuming that information, and an optimization of message within each channel based upon behaviors observed in other channels.

Engaging. The marketing program must be responsive. If a brand aspires to truly be part of a user’s experience, then it must be prepared to be part of a two-way conversation where it shares messages of value with the other participants in the conversation in exchange for getting insights of value. It also must conduct the conversation at a pace that reflects its interest in the views of others and feels real.

Getting the moment right is a matter of understanding the CareFlow at a detailed level and then executing effectively (which will be covered in the next chapter). Google research suggests that to get the message to strike a chord, marketers need to add value to the audience in one (or more) of three ways:

As a result, Google coaches companies to think about developing three types of content:

Patients and physicians in the digital era regularly interact with multiple channels at once when engaging on an issue or with one another. Thus, if the company wants to affect a particular micro-moment, there are typically multiple ways to enter into the person’s experience at that moment. This is a great relief: marketers don’t have just one way to get a message across or fulfill a specific need, and they don’t need to be perfect at executing on every type of marketing tactic or channel in order to address the varied nature of micro-moments. Simply put, marketers aren’t stuck if their organization just can’t get its head around certain marketing tactics or vehicles (e.g., particular classes of social media).

What is critical is to select the right blend of tactics to influence a micro-moment based on what will be most compelling to the selected persona(s) and what the marketing team thinks the company can effectively execute. Activities within the blend must also be coordinated with one another.

Unfortunately, pharma companies often struggle to achieve true coordination. Sometimes by design, commercial initiatives are siloed from one another because they’re owned by different departments, managed by different external agencies, or aimed at somewhat different objectives. Another trap pharma companies fall into is taking an operations-first approach to commercial execution. This means specialized groups are formed to focus on online initiatives, field force enablement, patient services, etc., because each of these activities requires specialized skills. The risk, however, is that these groups are left to develop their own strategies for a brand, rather than the brand creating the unifying strategy and then guiding the execution of all of those business partners.

When a particular micro-moment or phase of the CareFlow is affected by dissonant communications from a brand owner, it at best diffuses the power of each of those messages; at worst, it creates confusion in the patient or HCP. In contrast, when multiple tactics combine in a well-coordinated, holistic patient- or HCP-centric strategy, the whole becomes worth more than the sum of its parts (see the example of Crossix analysis in the Introduction, where this was shown quantitatively for a brand).

One of the most striking aspects of the Digital Age is the sheer proliferation and complexity of the ways a brand can connect with an audience. Audience fragmentation is the new normal for digital marketers and their agencies. This new world is vastly different from the past, when pharmaceutical marketers only had to manage a fairly limited number of paid media and direct sales channels that constituted traditional models.

Fortunately, if one is disciplined and systematic, the correct actions can be isolated and executed against without becoming overwhelming. First, the most arduous aspect of the process is determining all the things that need to happen. Once the long list of desired actions is drafted, it’s worth stepping back and asking whether everything is really of the same priority. Maybe some micro-moments can be deprioritized, or maybe a whole persona can be placed on the back burner. Once this prioritization has happened, the marketing team will have a list of actions that tend to cluster. Although the list was built bottom-up from personas and micro-moments, some of the resulting implied actions will be similar to one another. Said another way, each persona will end up with a unique combination of priority actions, but those actions will not necessarily all be unique from one another. As a result, marketers will find that many actions will converge as a single rock poised to kill many birds.

Complexity can also be managed by building content modularly. Practically, this means taking a group of actions that will require a common message and then developing a single content module that is designed agnostic of the channels the content will be delivered through. The basic messaging, charts, diagrams, etc. should be able to work across multiple media and multiple planned types of actions. Creating a single content master and then versioning it saves a lot of time on creative development and an equal amount of time fixing elements of the execution that have strayed from the core message. It’s like creating a single roux that can serve as the base for many different types of meals. McKinsey has seen this type of approach reduce creative costs by 30% to 40% in some client situations.

Another key benefit of working from a common master is that the company’s legal and regulatory team can approve the “master version” before marketers adapt it for mobile, web, sales detailing, and other formats. Certainly legal review will ultimately be required after all the adaptations are made, but the legal review process will be dramatically shortened if the fundamental content is already agreed upon. In some cases, McKinsey has seen this approach reduce the legal review time by as much as 70%, depending upon the type of content and the extent of the versioning. This approach makes segment-level, multichannel content possible in a regulated world.

The corporate brand is an important and vibrant area where pharma companies typically have more flexibility. Corporate brands operate with fewer constraints than specific product brands, so they offer the potential to be more engaging and compelling in their messaging and tactics. If the product brand is linked to the corporate brand, the product can piggyback on the associations and allegiances the target has with the corporate brand. In the transparent digital world, the corporation is more exposed than ever anyway, so why not manage corporate brand and reputation more deliberately and proactively?

As previously stated, one way to streamline the legal review on individual activities is to start with a common core of legally approved content and then adapt that to specific channels. Another way to address this is through designing highly transparent, integrated, and streamlined processes. One pharmaco we worked with built an extremely strong relationship between its digital-marketing team and regulatory compliance, such that the regulatory team promised rapid turnaround of content and cut approval times from a month to days. This produced a valuable side benefit; as the regulatory team became more accustomed to reviewing copy changes, its members became more adept and ultimately created a very solid and rewarding partnership with the marketers. This facilitated truly responsive marketing, despite the inherent risk-averse constraints associated with pharma messaging and copy.

The engagement system covering all the touchpoints, tactics, and objectives needs to match the measurement system, while both the engagement and measurement systems need to be capable of supporting learning and adaptation. Too often, we see pharma companies measuring outcomes with the wrong rulers. Most old systems only allowed them to track commercial outcomes, like doctor discussions or the download of online patient guides. In an era of engagement, every tactic deployed needs to have a counterpart in the measurement system. For instance, a video that is designed to create an emotional connection with the audience can’t be measured on how many website visitors or doctor discussion guides it generates. It should be measured on things like degree of audience engagement after viewing, amount of forwards/shares/likes, and the sentiment of the social buzz created by the video. Similarly, a video designed to generate disease awareness should not be measured on immediate sales lift, but on video views as well as total impressions and view-time duration, as well as lifts in post-viewing search volumes associated with the disease. Awareness and purchase happen at different decision points on the CareFlow, so each should have metrics matched to those parts of the CareFlow.

One way to approach measurement is to look at it across three different dimensions, each with slightly different nuances. The first is the brand/business view, which looks at traditional share-of-voice, social-media chatter, and the change in prescription share between the brand and competitors, so the general state of the business can be gauged. The second dimension to measure is at the level of the patient and should include the number of patients in each state of the CareFlow and the number advancing to the next stage by segment over what span of time. The third dimension is the campaign and content view, where the marketing team learns how the programs and content are performing and whether they are moving patients past barriers identified as opportunities for engagement.

The essentials of digital measurement come down to reach, engagement, and impact. (Note the parallel to the typical measurement of traditional media, which focused mostly on the reach and frequency of exposures.) In addition, each of these metrics is measured differently depending on the channel deployed. For example, reach may be the number of opened emails or the number of sales visits by the field sales team. All three metrics are important in measuring the effectiveness of the tactics and the content itself in moving people through their CareFlows.

Examples of digital metrics in each category across broad portions of the CareFlow are identified below.

So here we are. Discover has yielded some amazing insights into areas on which the marketing team can have an impact. The team has designed a content strategy and assets that will best invite the target audience (represented by personas) to engage with the brand at the right point in their CareFlow. And it has determined the key metrics that should be tracked to determine progress and inform the ongoing cycle of optimization and improvements.

It is now time to deliver on that plan. The final dimension of the 3Ds, Deliver, is where pharma marketers realize the promise of digital engagement with patients and HCPs.

After a pharmaceutical company (or franchise) has set its strategy, decided which initiatives to pursue, and begun designing them, it must plan how to Deliver to and engage with the intended audience.

Most pharma companies have the skills and experience for effective marketing through traditional channels. As a result, they need to make two big changes in order to engage patients and HCPs in the Digital Age:

For most companies, building these new muscles is a significant undertaking. It’s significant in two dimensions. First is the scale of the change that is necessary: virtually all commercial functions will need to change to some degree. Second, the organization as a whole will need to learn to work together differently. A successful digital transformation is multidisciplinary in nature; it is not a one-person or single-team initiative. It requires bringing together multiple functions and levels of expertise in the organization (IT, strategy, sales, managed markets, etc.).

These changes must be executed swiftly; otherwise, they are unlikely to make inroads to the extent required. In addition, it is imperative that digital initiatives have the right level of corporate support so that they can weather tough budget seasons and corporate skeptics alike. Making these investments for brands or franchises can be considered equivalent to the investments made in clinical trials and product R&D. Although each investment might come at a very different time in the product’s life, both are critical to commercial success in today’s market.

To lead the digital transformation, companies typically lean on an individual or team to spearhead or champion the digital change. This person or group fosters coordination within the overall commercial team and ensures linkages exist outside of commercial (as necessary). Unless the company is already all-in with digital, such as having a Chief Digital Officer who works closely with the Chief Information Officer and Chief Marketing Officer, the digital “transformer in chief” will likely need to earn credibility through proof-of-concept pilots that should be positioned as the first phase of a scalable push into digital.

It is also valuable for that person (or group of champions) to bring to the role strong cross-functional connectivity within the organization, a history of successes in other domains within the company, previous experience with digital, tight relationships with senior leaders, and a compelling vision for the future state of the organization. It’s unlikely that too many individuals will have all these qualities, but if several qualities can be found in combination, the missing pieces can be addressed over time.

One model that we have seen work in several cases is to take a senior line or functional leader and make the digital transformation half or two-thirds of that person’s job (retaining a good chunk of the person’s prior role). Although we have also seen leaders succeed when they are 100% focused on driving the transformation, it’s harder for the digital champion to be marginalized or deprioritized if the person is simultaneously wearing another hat in the business.

All organizations can make this change to better match their commercial approach to the digital patient and HCP (although it will be far from easy for most). Success requires four specific changes:

Importantly, all four changes need to happen in concert with one another. When all four do occur, the organization is very likely to change. If even one is missing or halfheartedly executed, the chances of success can drop precipitously.

This chapter is about how to lead an organization to accomplish all four objectives. Doing so requires considerable commitment, determination, and guts, but those who succeed will create a real source of competitive advantage for their organizations. Not only will the company be able to better connect and engage with physicians and HCPs, but also it will be more agile and responsive to market changes overall.

These changes create significant value for companies and their shareholders. McKinsey conducted research into companies with stronger digital operating practices, measuring companies across four key areas and 18 management practices that combine into an overall “Digital Quotient” (DQ^TM) score.² Cross-industry analysis with dozens of companies suggests that organizations with well-developed digital competencies financially outperform those that have yet to undergo significant digital transformation. As summarized in the bar chart, companies categorized as “digital leaders” by the DQ^TM see much stronger financial performance, measured by five-year compound annual growth rate of revenue and by total return to shareholders, than “digital followers” or “digital laggards.”

Of course, there could be other reasons why leaders succeed beyond their embrace of digital. It could be that the best financial performers have the easiest time investing in digital capabilities. Or it could be something unique about the business models of high performers that causes them to be both most digitally advanced and strong financially. However, it is striking that for each year the analysis was performed, the most digitally advanced companies considerably outperformed the rest. This suggests that, at least in some cases, there are attractive rewards for digital fluency.

Probably the most important step in successfully delivering on plans to innovate the commercial approach of a company, franchise, or brand (hereafter we’ll use “franchise” to cover all of these) is to align and excite the organization with the belief that the change will deliver meaningful value. Changing what people believe and how they behave on a day-to-day basis is always challenging, but it’s also quite possible (even if you don’t have at your disposal someone whose personal charisma is enough, on its own, to excite people to change).

The first step is usually to establish the “burning platform,” meaning the reason why it is so important to change. This argument often begins with a realistic assessment of the franchise’s current state. This can involve a strengths-weaknesses-opportunities-threats (SWOT) analysis, patient or HCP research on perceptions of the franchise, share trend analysis vs. competitors, or any other types of analyses that show a gap in performance.

Another important aspect of the burning platform is explaining how the franchise got to where it is today. Typically, this is best if it doesn’t assign blame but does acknowledge why past decisions were made and highlight how those decisions (if not changed) will make the franchise increasingly less competitive in the future. Ideally, highlighting key drivers of the gap in performance, or key decisions of the past that need to change, will link to the major aspects of the proposed change program.

It also may be true that the franchise is performing quite well in the current state. The burning platform can, of course, still be as compelling. There may be dramatic opportunities to further accelerate performance or share gains. It may be that new script trends are strong, but if adherence were stronger, total sales would rise considerably. It could be that a product has very advantaged intrinsic benefits but has yet to launch. Whatever the context, the goal is to isolate the nature of the opportunity in its purest form and to add considerable urgency to capturing the opportunity.

An important aspect of the burning platform is a quantification of the value at stake in getting this new commercial approach right. This can be done at a high level to begin with. Later, the leader of the change will develop a detailed business case to support these numbers. A high-level quantification typically matches up to the gap analysis that was developed for the burning platform. For example, if a key brand in the franchise is losing share to a rival, one can calculate what each lost share point costs the franchise. If the losses are an ongoing trend, illustrating the value of two or three years of consistent share loss could be compelling. On a more positive note, one can also calculate the value of increasing a brand or franchise’s growth rate. Sometimes even 100–200 basis points of incremental growth is worth quite a lot.

The change story should feel quite real to people (i.e., neither academic nor idealistic or naive). Although it should be bold and focused on the long term, it should also be realistic about the challenges ahead and not project that the organization already knows how to overcome all of them. It should be phrased in a way that individuals can truly relate to it and understand the practical implications for their daily life. Think hard about how to appeal to people’s values, not just their achievement orientation.

The change story should also be easily embedded into communications that are compelling and powerful for the people expected to carry out the change, such that when the story is cascaded from the executive team down through each layer of the organization, each successive set of leaders can both relate to it and make it relatable to their team’s work. In fact, it should be adapted and improved, on an ongoing basis, to reflect the feedback of the staff.

Writing out the change story is valuable because when leaders write, deliver, and gather feedback on their story, they quickly surface weaknesses in a change program. It also forces leadership to keep the staff in mind, as these are the people who will carry out the change. Two-way communication is vital to a successful change program, and the change story begins that from day one. Finally, involving leaders at all levels to create and own their version of the story increases momentum behind the change.

One final idea about building momentum behind the change story: think through, from the start, how to best capture success stories (illustrations of people making the change and benefitting from it). This should include, but not be limited to, quick wins. You want to be able to celebrate heroes, particularly those who are far down in the organization who took a risk to behave differently and created a benefit for the company as a result.

Because the change story starts best from the top, in some organizations the key question is “How do we get the top team aligned with the change, especially if they’re the primary holdouts?” The first answer is that the burning platform and value at stake need to be strong enough to be compelling to a critical mass of senior leaders. If they aren’t, the story needs to be improved. Once a corpus of senior leaders is on board, the crafting of the change story can be done as a collaborative process with all the senior leaders, which will serve to build further alignment within the top team. It is rare that people’s opinions of a plan don’t improve once they’ve become part of the planning.

If the initial change story gets the organization excited and generally aligned with the future direction, a solid fact base is required to truly solidify the future vision. This means having a clear business case developed for the change, as well as alignment across the organization over what each part of the organization needs to do to achieve the end-state vision. Delivering each of these typically requires real-world evidence of the impact of the vision and change.

To generate this evidence, most companies choose to run a pilot or series of pilots to demonstrate impact. We recognize that organizations run many different types of pilots for many different reasons, including times when pilots are run simply to satisfy a group that’s passionate about it. This is obviously not what is being recommended, but even if that’s how a change leader gets endorsement for the pilot, that’s a step in the right direction. The key is, then, to set up the pilot for success.

A successful pilot is designed to do three things:

A successful pilot therefore should be structured specifically around illuminating each of these points. For example, from the very start, metrics need to be defined to track and quantify impact. These metrics should link directly to the business case to be developed with the finance team. This seems basic, but it’s surprising how often this step is skipped, and then people scramble to show the value of their pilot after the fact.

Similarly, the pilot should be planned with the expectation that it will lead to a broader rollout, and it should involve a big enough portion of the franchise’s marketing spend that people will readily believe that the results can be extrapolated to the franchise as a whole. In fact, it’s sometimes valuable to call this a “lead market [or brand or franchise] rollout,” rather than a “pilot,” to emphasize that the rest of the business will follow along shortly thereafter. Planning as if this is the first of many steps often leads companies to select different focal points for the pilot. It also makes the organizational experimentation more real and something people work harder at because they’re more likely to live with it long-term. The pilot should also be time-bound, with milestones agreed to up front. Pilots without a definitive end date have a tendency to fizzle.

Likewise, it will pay off to make special efforts in the pilot to ensure that it builds the organization’s capabilities in working across product lines, so that the new model can then be scaled effectively to maximize commercial impact. Getting people involved in the pilot’s core working team who not only can be evangelists for the change once they return to their “natural habitats” but also are knowledgeable enough that they can train others will multiply the chances of success.

A critical success factor for the pilot is demonstrating (and then building alignment around) the power of integrating digital and traditional commercial execution based on a strategy developed through the Design phase. It should be clear from the pilot how, by unifying execution into a single patient or HCP experience, each investment complements the others, and that their collective power strengthens the broader commercial strategy. This should be planned so that the organization learns what the (quantified) impact of unified experiences is, why the whole is greater than the sum of the parts, and how it will need to work differently to deliver that incremental value in the future.

To adequate demonstrate the power of integrating digital with traditional approaches, the team must do three things:

As a practical matter, leading a successful pilot requires the same factors that the overall change program will need for success: a clear and compelling vision, role-modeling (the overall champion of the effort should take an active leadership role in the pilot and accept personal responsibility for its success), involvement of the right talent and skill sets, and changes in the operating model (processes, systems, etc.). Implementing changes in the operating model, as detailed below, is the most time-consuming piece of the pilot, but each step of the pilot process is crucial to illustrating what needs to happen in the organization’s future state.

Before launching the pilot, all the critical stakeholders (business owners, legal and regulatory teams, marketers, sales, etc.) must align on the pilot approach and how their teams will support the effort. Stakeholders should also recognize that the pilot is an ever-evolving process and their teams should be ready to iterate and improve on the ingoing design. The pilot design must sync with existing marketing investment allocation (most typically along product lines or brands) and expand upon it to demonstrate potential for improvement.

Finally, because the team knows the desired outcome of the pilot (demonstrating value, showing the new way of operating, and working out the kinks), it should begin planning the “road show” of the pilot’s success when the pilot is no more than two-thirds complete. At that point, the team will have a good sense of how much progress has been made on each of the three objectives but will still have time to adjust the pilot in the event that the outcome must be improved on one or more of the objectives. The team can also test the road show pitch with some friendly supporters and get feedback on how to improve the pitch before anything is finalized.

Many people are familiar with the quote, “Be the change you wish to see in the world,” which is often attributed to Mahatma Gandhi (although it’s unclear if he really said this). When it comes to leading change to an organization’s commercial approach, truer words could not be spoken.

Role-modeling is the collection of actions taken by people in the organization that clearly signals that change is happening. For most people to make a change, they need to see their leaders, colleagues, and staff behaving differently—or at least beginning to.

Interestingly, although success depends on all four components of driving change (a clear and compelling vision, role-modeling, the involvement of the right talent and skill sets, and changes in formal mechanisms), McKinsey research shows that role-modeling is the single most important element.⁴  To drive change, powerful role-modeling must happen at all levels of the organization. This change is ideally started from the top and cascaded downward, but it doesn’t need to start at the absolute top with the CEO. Rather, it can occur at all levels up and down the organization.

Given the importance of role-modeling, you would think that this would be the top priority for any leader who wants to drive change. In reality, we usually observe an underinvestment in this component. The reason: most leaders believe they are already demonstrating the change in a clear and compelling manner. Unfortunately, feedback from their teams typically says otherwise.

Investing in the receptiveness of the target audience through role-modeling is cheap, efficient, and critical to building and sustaining momentum behind the new way of working. As a result, it should be the priority of any pharma company’s effort to introduce a new commercial model.

Effective role-modeling is a hands-on affair. The leader needs to go out to spend time with employees, including the junior ranks, to directly share his or her perspectives. To use a timeless example, when Arkadi Kuhlmann, CEO of ING Direct USA, was trying to role-model a change in customer intimacy, he moved his personal base of operations (along with his assistant) from his headquarters to the middle of the bank’s call center, where frontline employees field questions from and offer advice to customers.⁵

Leaders also need to show support for the effort in all of their actions. To reinforce the “don’t take yourself too seriously” culture he felt was critical to Southwest Airlines’ success, CEO Herb Kelleher would famously impersonate Elvis and constantly joke with his coworkers. He also built his office with no windows when designing Southwest’s headquarters so that his office wouldn’t be envied and people would know he was there just to get the job done, like everyone else.⁶

Perhaps the most important thing role models do is to stimulate a culture change within their organization. Companies that are effective in relating to patients and HCPs in the Digital Age have a different character than those that were built for a more traditional interaction model.

Before thinking about how to lead a culture change, leaders must start with a clear vision for the culture they want to inspire. A critical success factor in responding to patients and HCPs in the Digital Age is being agile and responsive to feedback from those they’re engaging with. To do this effectively, most pharma companies need to dramatically increase both their flexibility and sense of urgency in responding. They certainly need to streamline responsive processes (more on that below), but even if processes are “leaned out” on paper, the people carrying out those processes need to be ready to pivot, adapt, and try new ways of doing things to accelerate responsiveness.

Probably the most fundamental change pharma companies will need to make is shifting to an agile, test-and-learn approach to commercial programs (similar to agile software development). Test-and-learn is a culture, a mentality, a set of processes, and an analytic problem to be worked through. Today’s marketers must design everything they do with the expectation that they will test their approach, see how it performs in the marketplace, and then improve.

The implications are numerous for pharma, where the historical approach was to develop a program that would last for months and then run it until performance declined. This required tons of preparation, prelaunch testing, and forethought. Test-and-learn doesn’t eliminate that prework, but it does lower the bar for perfection somewhat. It lowers the bar because it recognizes that all the work that went into those annual programs didn’t deliver perfection either. Instead, test-and-learn means putting forth a best-efforts program and then improving on it numerous times until it performs better than any fire-and-forget program ever could.

Test-and-learn does not, however, mean lowering the bar for regulatory compliance. A brand team should never put out a marketing tactic that they don’t think is regulatorily appropriate. Test-and-learn means that, within the confines of regulatory acceptance, the effectiveness of marketing programs can almost always be improved from their first iteration.

Leaders of commercial teams must think hard about how to create this approach. It is equally important to the customer-centricity that is core to the Discover and Design stages of this process.

To inspire the culture just described, leaders need to start by thinking about how they lead their teams. Digital leaders typically create small working groups to tackle initiatives, allowing roles on these teams to be fluid and prioritizing collaboration and knowledge exchange. They also tend to reward people who have an external, customer-back orientation, who are effective at working cross-functionally, and who are doers rather than delegators. The customer obsession—the orientation that a relationship with customers is always on and the desire to make a step-change in user experience—is particularly important. In considering performance measurement, these leaders focus on business impact rather than effort. Adopting these practices at the top of the organization naturally cascades them down, throughout the organization, increasing agility and responsiveness.

Increasing the flexibility of people’s thinking and their fundamental hunger for results can only be done through leadership by example, reinforced by aspects of the operating model such as performance evaluations. People who see that their leaders care deeply about being responsive and who themselves act responsively with patients and HCPs also grow more responsive over time. People who see that their leaders are constantly driving for greater results and higher aspirations begin to set their own sights higher.

An important accelerant of this change is the degree of people’s empowerment to make decisions and take actions that are responsive. Empowerment authorizes employees to think, behave, and make decisions autonomously. Self-directed employees know what needs to be done, and they do it without being told. Leaders who have self-directed employees can spend less time overseeing the day-to-day operations and more time thinking strategically and/or looking for ways to improve processes. More importantly, however, the only way to have high agility in a large organization is for people to have a high degree of empowerment (at least when it comes to being responsive to customers and driving for strategically consistent results).

In Chapter 4, the Design chapter, we mention how marketers can borrow the Scrum software development method to develop stories that address the needs of specific personas. Although Scrum has been around since as early as the 1990s, it is one of many agile methods that emerged within the always-evolving tech industry. In 2001, a group of software developers convened to formalize an overarching philosophy of agile that could reconcile all of these lightweight development methods; this gave rise to publication of the “Manifesto for Agile Software Development.”⁹  Our book is not about software development, but the agile philosophy is one we frequently espouse to marketers, as in some ways, “Every company is now a technology company.” For pharmacos, the new, customer-centric experiences are enabled through digital channels where patients and HCPs expect rapid, “agile” responses to their needs.

The Agile Manifesto explains how its proponents have come to value the following:

The manifesto acknowledges that there is value in the items on the right in each list item (e.g., processes and tools), but it argues that the items on the left, which we have presented in boldface (e.g., individuals and interactions), are more valuable.

This manifesto is rooted in a dozen “agile principles,”¹⁰ which are worth a read. In considering these principles, it may be helpful to think about the “business people” as brand owners, “software” as digital campaigns, and “programmers” as marketers and technology specialists, who develop and execute the digital campaigns.

In applying the Agile Manifesto and its principles to the purposes of digital marketing, the highest priority is on customer satisfaction: Are campaigns truly adding value in conveying relevant and timely information to the brand’s priority personas? Fortunately, the digitization of marketing has allowed for continuous customer interaction and rapid responses to a dynamic market landscape with ever-shifting consumer opinions. Agile marketing should empower motivated employees with high transparency and collaboration across functions. These teams should be trusted and, as much as possible, enabled to make their own decisions, which allows them to execute very nimbly (this is why it is recommended that Scrum teams of three to nine people sit together). The test-and-learn approach will allow these teams to experiment with many concepts in-market and continuously optimize their campaigns.

It’s an old saying that borders on cliché, but “Don’t tell me you’re funny, tell me a joke” rings true when one considers leading a change as significant as changing the commercial approach of a pharma company. The point is that talk is cheap; people want to see that you mean what you say and that the change isn’t a passing fancy. Role-modeling is a critical element in driving change, and it is hard to get anything done without it. In a more positive light, role-modeling multiplies the effectiveness of the other three elements of change exponentially, the more effective one is at it. Leaders should prioritize this as they think about how they’ll deliver on the solution they’ve designed.

There is no single, standard set of roles and capabilities to deliver on the new commercial model. Leading a commercial transformation requires the organization to work backward from its envisioned future state to define the capabilities. With that view on capabilities, digital talent needs can be scoped by converting business needs into functional skill requirements. Grouping similar skill sets aligned with functional areas helps define the roles that provide the required capabilities and insights for success. As a practical matter, ensuring the organization has the right skills and capabilities (and, therefore, right talent) to effectively market in the Digital Age is probably the most time-consuming aspect of leading the commercial transformation. Fortunately, knowing what competencies the organization needs will make developing a recruitment pipeline to deliver the required talent a more straightforward process.

When it comes to digital capabilities, most pharma companies are far from where they need to be. Although most pharma companies have pockets of deep talent and expertise, the scale needed to truly engage with patients and physicians (as well as many very specific capabilities) is usually far away from the current state. To provide some solace, pharma is not alone in this. According to a recent MIT Sloan Management Review article,¹¹ “77% of executives we interviewed mentioned skills gaps as a hindrance to driving digital transformation. The skills needed go beyond pure IT to include specific technologies, such as social media or mobile, as well as the analytic skills to drive value from big data.”

In pharma, the capabilities that companies typically lack or need to strengthen when they shift to a more digitally oriented commercial model include the following:

Having the right capabilities typically means having the right talent, which executives responding to our surveys report is often their highest hurdle in trying to rapidly shift to a more digital-centric orientation. There are limits to the skill and will of every individual, and that sometimes means companies need to hire external talent if existing personnel are maxed out on either or both of these dimensions.

In a similar vein, McKinsey forecasts that demand for analytic talent in the United States could be 50% to 60% greater than its projected supply by 2018.¹³ Many pharma companies also report that even if they can recruit the right talent (often from other industries), they struggle to retain that talent. This section will therefore focus on three critical activities: role definition and assessment, talent attraction, and retention.

To build a stable of digital talent, companies should start with a vision of their end-state organization and the capabilities it requires. Then, they should synthesize those competencies into a first-cut set of roles. They should validate those roles with internal experts and external best practices from digital leaders, and adjust them as necessary. One McKinsey client in the banking space did this and defined 22 different roles, segmented into strategists (e.g., digital-architecture strategists and digital-agency managers), specialists (e.g., media buyers, content editors, campaign managers, social-community managers, search engine specialists, and customer insights analysts), and technologists (e.g., mobile developers and user-interface and customer experience designers). A pharma company may have more or fewer than this (22 isn’t necessarily high or low), but the critical point is to have identified them.

The roles defined will be unique to an organization, because they will reflect its specific commercial vision and strategic goals. For each role, however, the company should develop a role profile, including key responsibilities, required skills (technical, industry, commercial, and company-specific), desired behaviors and cultural fit, and reporting considerations.

The role profiles should then be used to implement a fast but fair talent assessment process that prioritizes customer-centricity, speed and agility, and the other cultural themes the company intends to support, but also stays true to corporate talent philosophy and approaches. Ideally, the result will be a healthy balance of existing company natives who know how to work within the system and are shrewd product marketers and digital natives to bring the “tech DNA” and skills to the table. The focus of the talent assessment will be largely on skills (and potential to learn new skills), as opposed to prior experience alone, since in many cases, the future state is significantly different from the current state. It is particularly critical to screen for soft skills (on top of the “hard” capability and knowledge dimensions), with a particular emphasis on mindset and influence capabilities, given the collaborative and cross-functional way of working that the company is developing. Ideally, the company will also be able to attract inspiring leaders who can cultivate, develop, and inspire the best digital talent and create consistency across the company in the new way of working.

To attract or redeploy talent, veteran and new employees alike will need a strong value proposition to take the risk in moving from traditional marketing teams or other organizations. Part of this value proposition is building assurances that the organization is willing to make a long-term commitment to investing in digital engagement and prospective talent to enable the company to outpace competitors in adapting to the Digital Age.

In some sense, attracting digital talent is very similar to attracting the other specialized talent that pharma companies have sought for years. It is different in two ways, however. First is the fact that in many cases pharma companies will need to reach outside the pharma industry to find the best talent (versus other roles, where the best talent is typically inside the industry—managed markets, for example). This creates a talent identification challenge (e.g., the possible need to use different recruiting sources), as well as an evaluation challenge (i.e., evaluators being less able to relate to the backgrounds of candidates). The second difference is the scarcity of talent, given the high demand for this expertise (particularly if the company’s facilities are not located near a source of talent like San Francisco, New York, or other major cities).

Overcoming these challenges takes commitment and a lot of hard work. Ideally, this recruiting process will have not only senior management’s endorsement, but also their direct involvement. If leaders prioritize this, the organization will put more effort behind it.

The first step is creating a clear value proposition that can attract top talent. This should not be terribly hard, given the change story already crafted, but it does need to account for talent coming from other industries, who may need to be educated about the nuances in pharma and excited about the unique aspects of the industry (not all talent will need to come from outside pharma, but likely a number of key roles will). The value proposition should be consistent with the overall program aspiration, but it should be tailored to resonate with target new hires.

Next, the process needs to focus on attraction. Prioritize “anchor” hires, that is, people who will sit in leadership roles, will directly shape the culture and direction of the commercial approach, and can help recruit kindred spirits. At all levels, employees are typically the best ambassadors and recruiters of digital talent, so the planning should keep this in mind and consider incentives (e.g., finder’s fees). When it comes to outreach, no event is too small at a company looking to recruit a lot of talent. The company may also need to explore creative recruiting tactics (e.g., using social media and digital recruitment tools) to accelerate progress. Attractive internship programs are also a terrific way to find and vet high talent.

Finally, the company needs to ensure that the right interview process is in place to hire talent with the needed skill sets. This calls for a cross-functional group of interviewers who have fully bought into the vision, can appreciate the value of the different backgrounds to be interviewed, and have a consistent methodology for evaluation across candidates (to ensure all evaluations are consistently calibrated). The evaluation approach must balance looking for traits that are consistent with success in the organization independent of role with capabilities that are unique to the roles being recruited for. For example, failure is not a bad trait in a candidate, as long as the person has learned from the experience. Consider creating a hands-on application or interview experience where the candidates must provide a peek at how they solve problems and what capabilities they really have.

Most pharma companies have well-established hiring processes. Some of these may be well suited to the expansion of a digitally savvy team. In most cases, the processes will need to be adjusted to operate at the pace at which competitors for this type of talent operate. The company should streamline the hiring process by paying a lot of attention to the coordination of the process; for example, it’s better to have all interviewers evaluate the candidate in a one- to three-day period, rather than subjecting the candidate to many visits and asking some interviewers to recall meetings they had weeks before. The process should apply best practices like batch interviewing to avoid losing identified high-value candidates to firms that move faster. Along with this, the company must ensure that its HR team has sufficient capabilities and accountability to truly “own” recruiting end-to-end.

Finally, as with everything in the company’s commercial process, it is essential to use data effectively. The company should track recruiting data analytics to make better decisions, such as identifying how to move faster and hire smarter. This means testing and learning, as in any other marketing program. The recruitment and hiring process should be an analytical exercise, not one that’s subject to uncontrolled uncertainty.

Retention is, at some level, a matter of success with the other elements of the change (a clear and compelling vision, role-modeling and inspirational leadership, and changes in operating model). But it goes beyond that. Retaining top talent—digital or otherwise—requires special attention.

First, the environment needs to be right. The organization needs to have made a big enough commitment to the new way of working that those who have been recruited to carry out the new commercial vision can do so without being overworked or underresourced. That means knowing what staffing and budget levels are needed so as not to “starve the vision” and getting organizational commitment to avoid dipping beneath that low-water mark. Overall, the aim is to create a culture that allows challenge, creativity, and autonomy, so the leadership needs to focus on that from the beginning, in who the company hires and how it coaches them.

Next, individuals need to be stretched with attractive personal-development opportunities and clear career path opportunities. These should be paired with adequate rewards (financial and social recognition) and assurances of job security. Many high-talent employees will have opportunities with less established companies that promise greater upside but much higher risk. Pharma companies should be clear about how their value proposition differs from that, and should focus on high-talent people whose priorities (e.g., job security) align with their value proposition.

Next, the company should ensure that new hires are set up for success from day 1 with the right level of training, support, and understanding of their role. There should be a structured onboarding process from training and reference materials. New employees should have a clear understanding of specific objectives they’re responsible for. The company should also assist them in navigating through the complexities of the organization. The aim is for their integration to be seamless and easy.

Finally, the organization should make an active effort to bring new hires out to the rest of the organization. Leaders need to think hard about how to use the new hires to “change the DNA” of the company. Ways to do this are to showcase their successes and highlight the impact they’re having. Many legacy employees, whose roles have not changed, will not understand the role the newcomers are playing. Leaders need to make the value they’re delivering very tangible and tie it directly to the change story to position them as accelerators of success.

An operating model is a blueprint that defines how the organization will work together in the end state to build, deploy, and drive adoption of commercial programs. The operating model should be designed with the following features:

In making the change, planners also should look for opportunities to take out cost and complexity by consolidating spend (e.g., global agency spend, outsourced technology builds). They should maintain flexibility to adjust to specific needs of the business unit, franchise, or brand within a broader working approach that fosters high degrees of coordination and collaboration across the organization. Finally, the organization should be designed to be a learning organization that builds core capabilities and competencies over time to improve overall performance.

Overall, the organization should retain many elements of its legacy corporate culture, but it’s beneficial to infuse a bit of a “start-up” feel that raises personal accountability and aspirations. The key is to find the right blend of these elements so that there isn’t rapid “organ rejection”x of the new approach.

When the aspiration is to have capability to discover and design integrated (digital and traditional) experiences for patients and HCPs embedded in every commercial team, most pharma companies are far from that. The question, then, becomes how to stage the evolution of the organization.

For many companies, the right solution has been to establish a center of excellence (CoE) focused on responsive marketing. This model is unique from CoEs focused on digital capability only, although we have also seen those deliver success (particularly for retailers where a whole digital business unit can be created). The argument for a CoE model is that it concentrates expertise, helps clarify responsibilities and accountability, and highlights progress on key initiatives. It also can create a bit of a “company within a company,” where culture and operating practices are unique and apart from the broader organization. The other advantage of a well-functioning CoE is that it can help break down the traditional silos in an organization (e.g., product vs. sales) and create greater integration of commercial activities. When CoEs work well, they accelerate and facilitate the adoption and integration of responsive marketing best practices (especially digital).

The advantages of the CoE model also bring with them disadvantages. In particular, the broader organization can ring-fence the different capabilities, ways of working, and colleagues in the CoE and thereby use it as a way to avoid facing change.

As a result, we often see CoEs established early on in a company’s digital journey only to be later disbanded to infuse these capabilities directly into the franchise and across global and product domains. Eventually, those who have decentralized these commercial capabilities often reestablish one or more centralized teams of specialists in advanced analytics and other “unique” commercial activities that require the deepest expertise and specialization, hardest-to-find talent, and the lowest continuous utilization by a particular brand. Centralizing specific functions that benefit from scale (e.g., media buying, partner management) can also increase both efficiency and effectiveness. In effect, the center of excellence evolves into a more precise model of which capabilities should sit where, with the central roles becoming clearer as “centers of expertise” (which concentrate scarce skills) and “centers of scale” (which exist to maximize economies of scale and create high-skilled single points of contact with outside partners).

A further evolution of the model where we have seen success is the creation of communities of practice (CoPs). In this case, people with similar functional skills are embedded in business units, franchises, or brands but organize functionally to share best practices, get training, gain guidance on career pathing, and so on. Companies structured in a matrix will sometimes choose to make the solid-line reporting relationships functional, even though people are co-located with their dotted-line business unit, franchise, or brand team. This and the CoE model are not mutually exclusive; a company can choose a hybrid of the two, where the CoE has some direct responsibilities while also working closely with experts who are embedded in the businesses the CoE supports. CoPs bring the decentralized capabilities together enough to coordinate their best practices, shared assets (such as databases), and so on. The CoP approach is complementary to centers of expertise and centers of scale because those centers are often the natural conveners of the communities and can propose common solutions such as technology stack vendor choices.

Many leading software companies have chosen to officially organize functionally to ensure professional development and best-practice sharing, but then deploy people into cross-functional teams where they are managed by the business owner. They find it’s important for personnel with similar functional expertise to be tightly linked with one another. If this is not the right solution for a particular pharma organization, the CoP model affords many of the same benefits.

While there are multiple viable organizational solutions, the CoE approach is still the one most companies choose to start with to introduce expertise into the organization that will facilitate better connections with digitally oriented patients and HCPs. As a result, we’ll provide an overview of how to set one up effectively.

The first step in designing a CoE is to determine what role the CoE will play relative to the businesses it supports. CoEs could employ any of four archetypes, ranging from more consultative roles to direct ownership of business results. In all cases, the CoE will have a central role in defining and maintaining standards for commercial execution (particularly digital execution). On the consultative end of the spectrum, the direct responsibility for all commercial activities sits in the business, with the CoE providing a coaching and assistive role. On the other end of the spectrum, some companies have developed entirely stand-alone business units to operate with a fundamentally different business model (see the Otsuka case study in the following chapter).

Many times, leadership teams will have strong hypotheses about which archetype will work best for their organization. To complement that perspective, a good first step is to identify and catalog all the commercial activities (also sometimes known as “task requirements”) that will be needed in the future commercial model. Planners can then do a rough assignment of those activities to the businesses or the CoE. The collection of activities in the CoE will likely align, more or less, with one of the archetypes. If this bottom-up approach matches the top-down approach to archetype selection, that is ideal. If not, it’s usually fairly straightforward to reconcile the views. It’s also important to remember that the responsibilities and even the existence of the CoE are likely to change over time, so decisions are not forever. Hopefully, the new structure will be highly effective for a long time, but a better assumption is that the organization will test and learn, or iterate over time.

With an archetype selected, the next step is to go back through the activities and assign them to organizational teams at a much more detailed level. The CoE and the BUs will get the majority of the activities, but other teams, such as IT and regulatory, will have important responsibilities. External parties will also likely carry some of the load. The planners must consider who should manage those third parties, because the answer may differ based on the activity.

It’s valuable to make these decisions before organizational lines are drawn, so that the organizational design is custom-tailored to the work to be done. Additionally, discussing this in the absence of boxes and lines largely guards against territorialism or self-interest.

Next, based on how the activities are sorted, the planning team should develop a preliminary organizational structure (i.e., boxes and lines without names to denote functional areas or teams to be built out). The boxes’ labels should be at the level of “social media,” “front-end management” (e.g., website design, SEO optimization), “digital development,” “patient and HCP analytics,” “content creation and management,” “partner management,” and “patient services,” as well as others. The organization’s leaders should then consider the resources required for each function. This headcount-by-function estimate should be done at different time horizons, assuming that demand will scale over time. Sometimes it is also necessary to decide whether the CoE should sit within a region or at the above-region level. Again, there are no hard and fast rules, but we typically see greater accountability and partnership with the brand teams when the CoE operates on the regional level rather than at corporate headquarters.

With a sense for the future organization and how activities will array, it’s valuable to pressure-test the design by conceptually working through a series of critical-use cases. From the activity list, or based on a hypothesis of the actions that will be most important to commercial success, the planning team chooses four or five things the future organization will need to do frequently and seamlessly. Then it runs through each to figure out how it will work in the future organizational construct. Some teams will come up with flowcharts for the activities and develop RASCI (Responsible, Accountable, Supports, Consulted, Informed) charts for each step in the flow. That isn’t absolutely necessary, but “shadowboxing” each of the use cases will be very helpful for identifying weak points in the design. This is valuable, since responsive marketing is an inherently cross-functional activity, and the more parts of the organization that are involved, the higher the likelihood of confusion or dropped balls. The teams should revise the design based on the insights generated by this process.

Depending on how the organization operates, it may be useful to come back to this and formalize the mapping of processes and assignment of responsibilities. Many organizations allow this to happen more organically, particularly when working with digital talent, who often operate more effectively in a flexible model. Ideally, it will be possible to create an organizational construct that accommodates relatively dynamic resource allocation. The ability to rapidly assemble teams, based on functional needs and expertise, in order to jump onto the resolution of a new issue or opportunity, is critical to agility in the market.

This process should also help with planning how the CoE interacts with the rest of the organization (e.g., cadence of standing meetings, key artifacts such as weekly dashboards, monthly or quarterly content calendars, person who convenes on particular topics) and what key performance indicators are used to track CoE performance. Operating practices are powerful complements to the boxes and lines of an organizational design. These include the committees formed, the nature and cadence of regular meetings, the creation of interest groups and functional communities (formal or informal), and the usage of technologies like internal social networking. Planners should think also about how to reinforce the new approach by using elements like co-location, job rotation and career tracking, training programs, and internal knowledge management systems. The overall goal is to create a community of people who believe in and can directly support the new way of working. Actively fostering this community increases its effectiveness and builds overall momentum for organizational change.

Next comes budgeting, which should match up with the scaling plan and should focus primarily on headcount spend. Spending not related to headcount, brand, or project typically is budgeted as part of the natural business-planning process. It is, therefore, more variable, whereas the focus of the organizational budgeting is to plan the more fixed portion of costs. Organizational-design plans typically need to be adjusted to accommodate budgeting realities.

The final step is to evaluate existing talent relative to the headcount needs, then fill the newly created positions. This likely involves a combination of lifting-and-shifting employees, or interviewing to slot people into roles, while hiring externally to fill gaps (see the earlier section on talent and capabilities).

Given the degree of change in roles and organization compelled by the shift to a more responsive approach to patient and HCP marketing, virtually all commercial processes will need to be reviewed and modified somewhat. This review and adjustment process should start with the activities focused on when determining the organizational design, as these will likely be the most important to get right. This aspect of planning should be methodical and comprehensive, however, as the whole business system is changing.

Like the other elements of the culture change, the processes should be developed with a focus on delivering the overall aspirations of the ambitious change story. They should support rapid decision-making, flexibility, and responsiveness. They should also be developed to work cross-functionally but not hierarchically. What this means is that the processes should bring together people from different functions and skill sets, but they should have their own, streamlined decision process; each functional representative cannot have to go back to his or her functional supervisor to get approval to execute. The planning team should also look for opportunities to automate processes where possible.

The processes that typically need the most change tie fairly closely to the big changes in commercial orientation described in the chapters on Discover and Design, as well as on their logical antecedents (i.e., if an organization has designed an experience that heavily involves a new type of HCP services, it needs a process for managing those services). These process changes typically cluster in a few types: opportunity identification and prioritization processes, planning processes, and flawless-execution processes. We’re specifically not using the words discover, design, and deliver here because, although there is a good deal of overlap between the three marketing stages and the three process groupings, many of the processes cut across and link together the marketing stages.

The next group of processes help the organization identify opportunities based on insights from patient and HCPs. How does the team currently segment, target, and solve? Does it create personas? Assuming not, it needs a consistent way of doing so. Importantly, these opportunity identification processes should not be buried in marketing. These decisions affect the overall brand or franchise strategy and (like many others) require cross-functional and top-leadership attention. The processes must be established at the right level of the organization and with the right degree of input.

Finally, the team should evaluate how the overall commercial strategy is developed. Is it a process of identifying how patient and HCP opportunities can align with the business objectives for the brand, or is it a process of knowing the business objectives and then figuring out how patient and HCP activities can be arrayed to accomplish those business goals? It should be the former, although there is no question that business objectives need to be reliably met. Therefore, creativity is required to develop commercial efforts that generate value for patients and HCPs while also allowing the company to capture a sufficient amount of that value.

With a solid commercial strategy developed, the next set of processes translate that strategy into a true commercial plan. This set of changes is typically a rather radical departure from current state for organizations, because it means shifting away from a strictly annual planning process and creating an approach that is much more dynamic and responsive to shifts in the marketplace and what is and isn’t working with patients and HCPs.

Things that almost certainly will change include how the organization (and its agency partners) think about planning initiatives by channel, including traditional-media marketing (e.g., TV, print), search engine marketing, display and video marketing, mobile marketing, app strategy and design, social-media marketing, content marketing, sales support and collateral development, sales training, sales performance management, and more. It’s unlikely that the planning team will need to go back to the drawing board on many (if any) of these, but it is quite likely that the approach will need to change to reflect the new orientation the business is taking to patients and HCPs.

As a result of these changes in how initiatives are planned, the overall calendaring of activities run for patients and HCPs will likely need to change. Digital content appears at breakneck speeds, with instantaneous Twitter and Facebook updates. Marketers need to plan a steady stream of content while also rapidly respond to current events. Many have a quarterly or monthly campaign calendar, with planned content and interactions with patients and physicians. The nuance is that patient and physician segments are significantly smaller, and campaigns are much more responsive to feedback. The idea of a fixed calendar therefore doesn’t work for all that the marketing organization will do, but certainly it will be worthwhile to sequence out the introduction of offerings and special events. In parallel, the planning team should reevaluate the organization’s processes for planning and provisioning for ongoing support activities (e.g., patient services, HCP live-chat resources) and critically evaluate how the organization is working with third parties (e.g., advertising agencies, media-buying groups), to ensure a seamless partnership.

Another area that may need significant reevaluation is that of pricing, rebates, patient support programs (e.g., copay cards, access programs), and other elements of contracting. Even processes like health economics and outcomes research (HEOR) and policy or advocacy support may need reevaluation as a result of the organization’s new understanding of patients and their experiences. In many cases, these topics are the sole domain of the Managed Markets team. Not anymore. The planning needs to be cross-functional to create a seamless, end-to-end patient (and to a lesser extent HCP) experience. Most likely, the Managed Markets or Market Access team will still implement much of this strategy, but the planning process will likely need to shift considerably.

The final planning processes that typically change a lot are the budgeting and resource allocation processes. Strong financial controls, transparency of spend, and rigorous spend optimization are, of course, critical. At the same time, flexibility needs to be built into the process, so that the organization can flexibly pivot based on unexpected events or based on what teams learn along the way. Budget authority also must rest with the people best positioned to make decisions on immediate commercial priorities. Resource balancing and optimization is also an ongoing process.

Executing the commercial plan consistently and superbly is typically a function of industrializing a set of ongoing processes, which means making them systematic and repeatable and continually improving on those processes based on regularly captured feedback or data. Any process that creates part of the experience of patients or HCPs (whether executed by the organization, a partner, or another third party) should be scrutinized for improvement and/or redesign. Consider a few examples processes.

User-centric experience design. Another ongoing process that likely needs industrialization (and maybe even formation) is design of a user-centric experience. This includes solution prototyping and implementation, as well as ongoing improvement based on test-and-learn. The more important aspect, however, may be how the organization coordinates across functions (and third parties) to deliver on these designs. Cross-functional collaboration is critical but can be a challenge for some pharma companies.

Content development and management. An ongoing process that many pharma companies may need to almost build from scratch is content development and management. The integrated marketing and publishing calendar can never go dark, so the organization needs a team that is always ready to build on the latest developments or pivot focus. One way to think about good content creation is that it equals [(data + storytelling + shareability) * distribution].

The biggest difference for pharma commercial teams, however, may be the shift to a mindset that content marketing is not advertising and shouldn’t be overly focused on sales support. Consumers don’t want to be convinced to purchase items. Instead, they want to be informed and entertained, which ideally can lead to a later sale. Good content marketing is more publishing, reporting, and curating relevant, personal, and unique content (which can be a picture taken on the way to work) than traditional marketing. It needs to stimulate a reaction in that moment (e.g., the photo resonates because I am also on my way to work, and I appreciate that the brand understands I also needed help getting off the bus). The organization’s processes need to reflect a clear point of view on who the brand is publishing for and why the audience should want to follow or like what the brand stands for and what it inspires.

Finally, the organization’s processes need to be able to execute rapidly to react in (seemingly) real time to consumers’ data or specific events, while also producing distinctive always-on content (e.g., product explainers). So the processes must work at two speeds. Overall, marketers will be dealing with much more content but in smaller chunks and often executed in or around events that capture lots of attention (like sporting events) to reach a large audience with relevant context for that moment. The processes must be purpose-built to deliver on that objective.

At the 2014 Oscars, host Ellen DeGeneres tweeted a selfie she took with about 10 other stars, using her Samsung Galaxy phone. Within days, it had been retweeted over 3 million times and reportedly seen by 37 million additional people directly on Twitter (in addition to the more than 43 million Oscars viewers who saw it live). Millions more soon saw or heard about it through the considerable media coverage that followed.

It seemed like a spontaneous moment of good fortune for Samsung, which quickly acted to fuel the viral success of the selfie, but it actually had been orchestrated and planned in great detail by Samsung.

As reported by multiple sources,¹⁴ Samsung invested about $20 million with ABC, the network airing the Oscars, to sponsor the broadcast. This included ads run during the show and product placements. The Galaxy smartphone was specifically to be integrated into the show, including on-air usage by DeGeneres and a series of selfies to be taken by participants backstage.

Apparently, prior to the show, DeGeneres independently decided to take selfies during the show. ABC suggested using the Galaxy (given the sponsorship agreement), and Samsung executives trained her in how to use the smartphone during rehearsals. Before the broadcast began, Samsung “planned a Samsung-shot selfie of host Ellen DeGeneres and actress Meryl Streep,” according to the Wall Street Journal.¹⁵

The actual moment of the most famous selfie, when millions of television viewers watched DeGeneres walk down the theater aisle taking selfies with the Galaxy, invite Meryl Streep to challenge the record for the most retweeted photo ever, invite other stars to join, and ultimately hand Bradley Cooper “her” Galaxy to take the selfie, was spontaneous.

In fact, Samsung and Ellen did break the record previously set by President Obama. While the tweet didn’t mention Samsung, the fact it had been taken by a Samsung phone was clear to all viewers, and Samsung immediately retweeted it. It clearly buoyed Samsung’s notoriety during the event. Adweek reported that social-media tracking company Kontera found Samsung had achieved 40,000 brand mentions during the show as a result of the selfie, with a peak of about 900 mentions a minute. They found the selfie had also drawn attention to the commercials Samsung ran during the broadcast.

Samsung then fueled further buzz by donating $1.5 million each to DeGeneres’s two favorite nonprofits, St. Jude Children’s Research Hospital and the Humane Society ($3 million for 3 million retweets). DeGeneres then specifically thanked Samsung as she retweeted a thank-you St. Jude’s sent, which included an imitation of the selfie, featuring actress Marlo Thomas and a cast of St. Jude’s kids. Samsung also retweeted a parody of the tweet drawn by Simpson’s creator Matt Groening (and tweeted from “Homer’s” account).

Later, in a speech to MIPTV, Maurice Levy, CEO of Publicis, whose agencies arranged the product placement, valued the selfie at $800 million to $1 billion in total value to Samsung—not a bad return on a $20 million investment.

As the Samsung example illustrates, effective content distribution processes are as important as content creation processes. Most marketers are already thinking about how to optimize across their owned, earned, and paid media (including with search engine optimization or SEO). This process must be done continuously, since good content execution builds and maintains positive momentum, without necessarily predicting the direction of that momentum.

Partner management. Another ongoing process, partner management, includes managing the organization’s relationships with agencies, media-purchasing groups, and any other third parties involved in the commercial mix (e.g., copay card companies, co-promotion partners). There is real value in getting this process right: some recent McKinsey work found an average 19% reduction in agency fees from improving briefing processes. The key is to align all parties around clear business and marketing objectives and share essential information about the campaign up front (usually facilitated by a single briefing document that consolidates insights and priorities). The rest is ensuring that subsequent interactions are aligned with the agreed-to campaign framework, follow a consistent format, and have clear signoff and involvement from senior leaders.

Patient and HCP services. Processes for patient and HCP services and any other types of hands-on delivery of experience also are likely processes that need revision. Most pharma companies have patient services as well as call center operations already established, but fewer have similar resources for HCPs. Virtually none design the interactions through these channels to be seamlessly integrated with all other elements of the commercial mix. Social care, including live chat, are other capabilities that may be integrated into these processes, depending on the experience that is intended. The retention and relationship management process is rooted in understanding patients’ and physicians’ needs while actively respecting privacy and adhering to regulatory guidelines. To do so, the organization must build an integrated view of these individuals across channels and then provide value-adds, such as adherence support to encourage patients and physicians to engage. This engagement creates data that can then help the team tailor content and services better in the future.

Sales support and meeting and convention management. Regardless of where in the organization it sits, an integrated commercial plan will also involve a considerable amount of sales support and, to a lesser extent, meeting and convention management. It is unclear how much the fundamentals of these processes will need to change, but certainly the nature of the what is being planned and delivered through these processes will need to change. Each of these processes or functions also provides considerable potential for feedback and insight into HCP reactions to programs. Those data should be used to improve future execution.

Training. Again, with training, the fundamentals of delivering the product and skills training across all commercial functions may not change. The content, however, will change considerably, and even the process for content development may change to incorporate more real-world insights and feedback.

Regulatory processes. Finally, regulatory processes will need to be streamlined and matched to the agility and responsiveness intended overall. As stated previously, this is not a matter of lowering standards. It is typically a matter of improving communication and collaboration between commercial teams and regulatory experts. One of the keys to this is establishing routines, service-level agreements, clear expectations, and consistent ways of working between brand and regulatory teams. The more systematic the collaboration, the better—and the easier to refine and improve over time.

A strong organization and efficient processes are core requirements for delivering new experiences to patients and HCPs. However, without a robust technology architecture, marketers will have a hard time capturing opportunities at scale. Leading companies are developing two-speed architectures to help move at the pace of digital supported by foundational capabilities and marketing-specific technology.

Marketers play an important role in selecting and building the supporting technology architecture along with the information technology group. A strong partnership between the chief information officer and chief marketing officer, and between their respective organizations, will ensure successful implementation and better return on IT investment.

Unlike enterprises that are “born digital,” such as Amazon, most pharma companies do not have the luxury of starting with a clean slate. Given the pace of change, however, they cannot afford to wait three to five years to implement a new architecture. This shift therefore requires a continuous process of delivering new functionality while taking steps to modernize the architecture.

One retailer learned the hard way why a new IT architecture is required in the digital world. The company tried to launch an e-commerce business as a new unit separated from the traditional brick-and-mortar operation. While the time to market for this offering was short, it was limited to the online channel and could not offer the user experience that many customers expected.

It quickly became clear that the retailer could compete in the digital marketplace only if it could provide a sophisticated, multichannel experience that gave customers functionality such as reserving goods online and picking them up in the store. To implement this broader offering, IT leaders had to overcome challenges in both the new fast-speed IT architecture and the legacy transactional systems.

While the retailer continued to develop the fast-speed architecture of the original online offering, it needed new development frameworks and processes in order to speed up the deployment of new software and integrate it with third parties, such as software-as-a-service providers. What’s more, the entire IT organization had to adopt agile application development methods, and the business organization had to get much more involved in the transformation, particularly regarding the budgeting process and the approval of new projects.

Adapting or replacing some of the transactional legacy systems so that they could support a multichannel offering involved its own challenges. Some of the IT systems were outdated and developed in programming languages that are no longer common among young software developers. In addition, the legacy systems could only offer inventory information via a batch interface, while customers of the online offering require the information in real time. Some of the legacy systems proved costly to maintain as well.

Balancing the transformation of the transactional architecture with the development of the new fast-speed architecture is one of the main challenges the retailer is facing. Also, both the IT and business sides understand that, unlike most traditional IT projects, building a two-speed architecture is a continuous-improvement program that has to deliver new functionality at early stages of the transformation and will continue to run on an ongoing basis.¹⁶

Foundational capabilities. Several foundational capabilities are needed to support digital activities. These capabilities, which can be shared across the company, are relevant beyond marketing and can be applied to areas such as R&D and supply chain. They are typically managed by the information technology group as part of the enterprise technology architecture to take advantage of scale. Enterprise architects will select a handful of preferred technologies and work across the organization to implement.

Most companies need to invest in the following capabilities to support today’s commercial strategies:

In practice, data analysis is difficult, due to information coming from multiple sources, each with its own schemas and definitions. Marketers may enlist the help of data scientists and developers to make data sets usable by tracking down missing elements and eliminating duplication, gaps, and misclassifications. These colleagues may use a data lake combined with data discovery and mapping tools to ensure that marketers can get the insights they need.

Marketing-specific applications. Over the past decade, the marketing technology landscape has been characterized by significant M&A activity. Major technology vendors have each developed their “stacks,” in hopes of wooing digital marketers to consolidate business with a single vendor. And for good reason, IBM and Gartner Research both famously predicted chief marketing officers would become the biggest buyers of IT products and services.¹⁷  Digital marketing teams are becoming the key decision-maker when it comes to their parent organizations’ technology-purchasing decisions.

These marketing-specific applications allow for automation of processes and the ability to generate unique insights on patient and HCP behaviors. The marketing-specific technology enables functions such as the following:

Every digital marketing organization has its own suite of marketing automation tools, business intelligence systems, social-listening posts, content management systems, and advertising technologies. Some prefer to adopt a broad single-vendor marketing cloud; others assemble their own suite of specific point solutions and attempt to integrate the data and content between all of them. The most common categories in the modern digital marketing stack include the following offerings.

DATA AND STORAGE

Customer data platform. The traditional backbone of B2B interactions, the customer data platform is used to track physician information and interactions with sales reps. As physicians begin to engage on digital channels, pharma companies have started to track these physicians’ digital interactions.

Campaign data and patient response. A rich set of digital campaign data is key to tracking campaign success and adapting these campaigns through a test-and-learn approach.

Data management platform (DMP). This platform leverages data (including purchased external sets) to create patient and physician segments and personalized treatment strategies.

Content management system (CMS). A CMS—increasingly referred to as the “Digital Experience Delivery Platform”—manages the library of educational web content, promotional content and videos, and the personalized delivery of digital experience across multiple devices. Examples of content management systems:

Personalization algorithms. The algorithms provide the logic or “brain” to deliver personalized pharmaceutical experiences.

CAMPAIGN MANAGEMENT EXECUTION

Email platform. Marketers use the email platform to execute and track email campaigns. Examples are ExactTarget, Experian CheetahMail, and YesWare.

Bid management platform. This platform lets marketers optimize keyword bidding for paid search. Examples are Marin and Kenshoo.

Ad server, Demand-side platform (DSP). These are used for programmatic buying and targeting of display ads. Examples are DoubleClick, Atlas, Sizmek, Turn, MediaMath, bluekai, and Adobe.

ANALYTICS AND PERFORMANCE

Business intelligence and predictive-modeling tools. These tools let marketers analyze engagement data to evaluate opportunities and set strategy.

A/B testing platform. With this platform, marketers can run tests at scale. Examples are Google Analytics, Optimizely, Maxymiser, monetate, Adobe Test & Target, and Acquia Lift.

Web analytics platform. This type of platform enables the tracking of computer users’ traffic and customer behavior on the company’s website. Examples are Google Analytics and Adobe SiteCatalyst.

Attribution modeling tools. These tools test and iterate web experience, so marketers can drive engagement.

The software developers, the senior IT architect, and the most technically advanced marketers in the company are crucial to selecting, implementing, and operating a strong digital platform. If the organization chooses the wrong stack, the company could find itself struggling to attract and retain developers. If it overcommits to a single vendor’s product roadmap, it may become frustrated with its inability to react quickly to emerging innovations. Building the right stack is a multiyear journey and an evolution over time.

Very recently, a U.S. logistics provider wanted to drive bottom-line growth within a small customer segment (home businesses, occasional shoppers). At the time, this segment represented low volumes but with high profit potential.

Marketing began the effort by focusing on the early stages of the small customer decision journey—how these customers became aware of logistics offerings in the first place, how they decided to use one provider over another, and what their digital engagement with the business was like as they went through both initial and recurring purchase decisions.

Over the course of 10 weeks, the team identified pain points along the small customer journey that were stifling growth, such as issues with account sign-up or order placement. Working with IT and procurement, the cross-functional team then identified the required technology capabilities to address these issues.

Marketing tech stack components and high-level requirements were provided for core digital-marketing functions (these included data storage and management, campaign execution, analytics, and performance management) and linked to customer engagement and ultimately business impact. A roadmap for needed technology archetypes was developed, along with a path for selecting technology partners. To jump-start this process, the joint team hosted several “industry days” and set up a formal request for proposal (RFP) process to identify partners that could provide the needed technology and also fit with company culture.

In addition to improving the technology stack, this effort resulted in a more agile marketing organization overall. That improved organization was equipped to rapidly deliver effective digital campaigns to the small customer segment.

IT cannot operate alone in developing an underlying architecture. This needs to be done in collaboration with marketing, sales, and other functions such as regulatory affairs. In successful companies, this collaboration takes the form of a true partnership. In this one-team partnership, marketing does not just hand over requirements to IT. Marketers must work closely with IT counterparts to explain needs, collaborate on technology selection decisions, and ultimately work side-by-side in the trenches during implementation.

To help guide technology investments, marketers can illustrate their needs through use cases. These should drive revenue or increase share while also proving the value of IT investments. Use cases are rooted in experiences that commercial leaders want to deliver for patients and HCPs. For example, in preparation for a product launch, a brand manager will want to reach HCPs to help them learn more about the product. She needs a consolidated view of all interactions with HCPs, along with an authoritative source of contact information (email addresses, office addresses, and phone numbers) and the ability to track level of engagement. The IT team can identify potential solutions, such as data storage, master data management, campaign execution, and measurement, and then begin to evaluate investment needed and the relative advantages of buy versus build.

Buy versus build. Organizations have typically taken a capability-driven approach to buy-versus-build decisions for core technology. Generally speaking, if there is a core need for a specific capability, then organizations try to develop it internally. If they don’t have the expertise, then they look externally to co-develop or source that capability after accounting for delivery urgency and operating-risk concerns. The graphic illustrates typical considerations in balancing buy-versus-build trade-offs.

The suite of marketing technology tools has matured significantly in recent years, and vendors provide many capabilities out of the box. Internal IT can configure vendor solutions and integrate them to work with one another, as well as ensure that they are plugged into the company’s data architecture. IT often helps to build company-specific views into the data (e.g., sales versus competitors in a particular territory) and offer digital experiences to HCPs and patients (e.g., apps).

Internal IT also can play a role in evaluating vendors. Not only can they provide expertise to understand vendor products and cost of ownership, they also can help set up proofs of concepts customized to the company to see capabilities in action.

Agile implementation. Companies no longer have the appetite to fund IT projects that take years to complete before delivering results. As noted in the Agile Manifesto, through lightweight development practices, projects can be broken down into smaller chunks, each taking a matter of weeks. A team will include developers, testers, designers, and marketers who will work side by side to build out the technology to support a use case. Teams will start by building a minimum viable product to address a basic set of needs and then add functionality over time. Going back to our example, the marketer and IT team may start by focusing on email campaigns, collecting data from disparate sources around the company to build a mailing list for HCPs using the new technology architecture. In subsequent development cycles, they can then add other characteristics such as social-media handles and office addresses, along with the capability to track interactions.

Funding. When funding technology investments, companies need to consider individual projects to deliver against immediate needs and underlying foundational capabilities. To build a single view of HCPs requires master data management, a foundational technology capability that enables data integration. Tying the investment and deployment of master data management to supporting product launches will satisfy the needs of IT and marketers. IT has an architecture that it can maintain and enhance in the future, while marketers will see value today from their investment. IT may share the cost of funding these foundational capabilities across the company, because the capabilities may benefit other parts of the company, such as R&D and manufacturing.

The IT and marketing teams need to work together to define a target state and roadmap. Depending on the starting point, it can take 18 to 36 months to achieve the target state. It is important to break efforts down into releases that last no more than 6 months, with quarterly funding and benefits.

While technology architecture may seem like a daunting topic for marketers, IT colleagues can help provide guidance to navigate software, systems, and vendors. Companies that succeed are able to build a new high-speed environment on top of their legacy systems to enable digital patient and HCP experiences and use agile to configure and integrate the suite of marketing solutions.

Deliver is the last of the 3Ds in our new commercial approach. It is not a specific discipline per se, but rather a collection of disciplines (and the change processes required to retool or create those disciplines) that are united by a philosophy of valuing deep understanding of and true engagement with patients and physicians.

What we are describing is a Digital Age commercial function that differs significantly from how most pharma companies are used to thinking about marketing and commercial capability. The responsive marketing described for Deliver is operating in an overall faster and more data-driven way. There is more:

Not surprisingly, everything must move faster and be more agile, flexible, and responsive to external forces.

Three roles are particularly important to staff right: insights/analytics leader, head of engagement and brand strategy, and head of marketing operations and planning. They’re so important, in fact, that it’s worth adjusting the “ideal” organization design to attract and accommodate outstanding candidates for those three roles.

Stepping back, having worked with many companies that have undergone transformations to respond to the digital era, we have ten final reflections and recommendations for you to keep in mind as you begin your own journey:

The journey you’re about to undertake is a significant one. Success in digital carries with it a responsibility to promote its benefits, openly disclose its risks and shortcomings, and imbue the entire organization with a CareFlow-first approach to the patients and physicians it serves. Their expectations have been cemented by more than two decades of ubiquitous, always-on access to the world’s knowledge (knowledge literally sitting in the palm of their hands). Concerned patients can now leave their physician’s office, sit alone in their car, and wirelessly ask the digital world to help them get well again. We believe the imperative is clear and a noble one for pharma. The soul of the industry has always been about healing and improving lives. It’s pharma’s destiny and responsibility to engage more fully and more generously with its patients and professionals.

Our experience is that internal factors such as culture, structure, fragmented data and customer processes, and talent gaps represent the largest barriers to pharma companies’ expanding digital innovation. Fortunately, all of these are within the control of pharma companies to address. Next up, we offer illustrations of how a number of leading companies jump-started their transformations to more patient- and HCP-centric commercial models.

Written in collaboration with Dr. Adrienne Boissy, Chief Experience Officer of the Cleveland Clinic

In the mid-2000s, the Cleveland Clinic was routinely ranked in the top five U.S. hospitals in terms of health outcomes, but when compared with peers of similar sizes, it performed at or near the bottom in terms of patient satisfaction. Under the traditional paradigm, these “softer” satisfaction metrics would have been relatively unimportant; the assumption was that outcomes were all that mattered. But that began to change in 2006, under the leadership of the clinic’s CEO, Toby Cosgrove. Cosgrove was giving a talk at Harvard Business School when a student raised her hand and said, “Dr. Cosgrove, my father needed mitral valve surgery. We knew about Cleveland Clinic and the excellent results you have. But we decided not to go because we heard that you had no empathy there. We went to another hospital instead, even though it wasn’t as highly ranked as yours.”¹⁸ Cosgrove was struck by this comment and, as time went on, started seeing care for the patient beyond the actual diagnosis and treatment administration to be a large capability gap for the clinic.

This spurred Cosgrove to begin a top-down transformation to turn the clinic into an organization that rapidly discovers patient pain points and designs and delivers responsive actions. To ensure that this new focus, which had previously been largely unappreciated, was given the appropriate priority and resources, he created the office of chief experience officer. It was the second CXO, James Merlino, who helped Cosgrove truly revolutionize the patient experience at the clinic. Merlino was an experienced surgeon at the clinic and had additional, personal motivations: five years earlier, while Merlino was doing a fellowship at the clinic, his father had been diagnosed with bladder cancer and checked into the clinic for treatment. During that week-long stay, which ultimately ended in his death, Merlino’s father faced a terrible patient experience with little interaction with his physician and other caregivers, and little communication with his family. Merlino actually left the hospital for a time because he was so frustrated with his father’s experience, even though the treatment itself was top-notch. In Merlino’s own words, the hospital appeared to be “the worst place in the world for patients.”¹⁹

The clinic’s approach to change generally mirrored our 3D framework. Merlino started by attempting to identify the major pain points in the patient’s care experience. Internal conversations with caregivers in the emergency department led to the articulation that patient dissatisfaction was driven by several traditional “hard” metrics—most of all, extensive wait times. But Merlino was unsatisfied and brought in an external analytics firm to do more rigorous analysis with real patients. The team found that, in fact, wait times were the least important factor identified by patients in determining satisfaction. The most important factors were actual soft metrics: caregiver respect for the patient, communication between caregivers, and the happiness of the caregiver. Further analytics also found that the scope of the problem was much broader than expected. Although it was true that patients valued the relationship between themselves and their doctor, patient satisfaction data showed that patients often interacted as much or more with nurses and support staff (for example, cleaning and other support staff) as with their physician. While primary care physician interactions were clearly important aspects of the CareFlow, real impact would require buy-in from all employees.

As a result of this discovery, the clinic spearheaded the design of several initiatives to reduce the pain points in the patient’s CareFlow. One common complaint identified during the Discover process was the difficulty of finding and making appointments, particularly with shorter time frames. To make the appointments fit seamlessly into day-to-day life, the clinic streamlined the process, building a centralized booking system that would accommodate the newly announced same-day appointments and thus ease the work required of the patient in the CareFlow even before the actual treatment was conducted. This reaction to an articulated consumer pain point was extremely effective: patient visits increased by 20% in the first year of the program.

Another common complaint, as seen in Merlino’s father’s tragic case, was the infrequency of communication with caregivers, particularly nurses. In response, the clinic changed how the nurses conducted rounds and asked them to interact with patients using a preset, purposeful list of questions every hour. This minute, relatively costless change led to outsize impacts in consumer satisfaction in all domains, since it changed the patient’s experience of care.

Finally, and perhaps most importantly, the team built up a strong organization to ensure effective delivery of service. As noted before, patients interacted with staff at all levels, not just physicians, during the CareFlow. However, many of the support staff thought of themselves as simply support, rather than as caregivers with direct impacts on patient experience. To help change this mindset and transform general organization culture, Cosgrove instituted a program that required every employee, from physicians to janitors, to go through a half-day workshop where they would brainstorm, learn, and implement ideas on how to be effective caregivers, regardless of their official titles, learn service recovery in Communicate with H.E.A.R.T.^TM, and discuss the new mantra of Patients First. While some questioned the impact of removing caregivers from patients for a half day, Cosgrove pushed ahead, and the Cleveland Clinic Experience program represented a massive commitment to its caregivers and to Patients First as an organizational priority.

In addition, the clinic built an organization designed to continuously and rapidly discover, design, and deliver as new issues are unearthed. Almost 200,000 patients, or 30%, fill out Cleveland Clinic surveys every year. These surveys are now heavily analyzed for new insights, and the clinic is starting to move beyond descriptive statistics to building predictive models (for example, modeling the length of time estimated post-surgery, to better understand capacity needs and allocate staff accordingly). To react to new pain points, the clinic has created a unique test-and-learn environment coordinated by the Office of Patient Experience. Within the hospital, each department is run with a fair bit of individual autonomy. To determine best practices, the OPE finds departments that do better in patient satisfaction, determine the factors of success, and attempt to disseminate them across the hospital. This scaling is done via a test-and-learn environment: the OPE builds pilot programs, tests to see their efficacy, and incorporates the consumer and caregiver feedback into the next iteration of testing.

The clinic also has structural incentives for crowdsourcing ideas, primarily through the Cleveland Clinic Innovations. CCI allows employees to take full days to brainstorm innovative solutions and then provides the resources and manpower to actually build the solutions. Since its launch in 2000, the CCI has resulted in 75 companies receiving almost a billion dollars in investment. While many of these are medical devices, several exciting products have focused on innovating broader patient services, including FlexLife, a recently acquired start-up that does remote patient monitoring, and XDI, a Series A start-up that builds lean processes to enable frontline staff innovation. This decentralization has helped the clinic rapidly respond to pain point solutions identified by those closest to the patients—the day-to-day staff. Finally, the clinic has also partnered with external thought leaders. Since 2011, the clinic has hosted an annual conference on patient experience, the Empathy and Innovation Summit, which regularly brings together leaders in all relevant areas of healthcare. Hosting this conference, the largest of its kind, allows the clinic to understand and incorporate best practices developed by industry leaders.

As a result of this structured approach, the Cleveland Clinic’s patient satisfaction ranking, as measured by the Centers for Medicare and Medicaid Services, has dramatically increased, from the 55th percentile among all clinics in 2008 (and a much lower percentile score when compared with peers of similar size) to the 92nd percentile in 2012.²⁰ Cosgrove and Merlino have each written well-regarded books on implementing Cleveland’s best practices at other hospitals and are frequently interviewed in trade publications about their work.

The lessons for positive patient experiences are clear. First, organizations need to discover pain points along the patient’s CareFlow, and they need to look beyond narrow patient journeys. Looking at how patients viewed their interactions with their physicians during treatment was insufficient, because such interactions were only a small fraction of the total interactions that patients had with the hospital. Designing effective solutions to these pain points require careful consideration of how to seamlessly integrate such interventions into patient’s overall CareFlow. Finally, organizations need to ensure they have the capabilities to deliver, which requires buy-in from all relevant stakeholders (in the case of the Cleveland Clinic, not just the physicians and nurses, but also the janitors and waiters). This process is not a linear journey from start to finish; rather, it is a circular flow that should be continuously iterated and refined.

Transforming to more patient- and HCP-centric commercial models is not easy, but a variety of pharma franchises and brands have made great strides in successfully innovating their commercial models through digital tools and channels. In so doing, they have found new ways to partner with patients, HCPs, caregivers, payers, and regulators and genuinely engage with them to improve outcomes. Teams at Pfizer, Otsuka Digital Health, and Shire realized that to win in today’s digital world, they would have to rethink the classic commercial model. The bold approaches each of these organizations has taken provide models that other companies can learn from and build upon in their own strategies.

In this last chapter, we will show you how these companies, while targeting three very different therapeutic areas and different geographies (therefore facing very different patient and HCP CareFlows), used 3D thinking to guide their digital transformations. They all took a customer-centric approach to Discover how to effectively engage with patients and providers at specific micro-moments in the CareFlow. They used these insights to Design customer experiences that aligned content, messages, and channels to build a mutually beneficial relationship in the micro-moments that matter. And they transformed their operating models to Deliver those experiences effectively to their customers. As a result, each achieved exceptional stakeholder engagement and was able to grow in its respective markets and segments.

Co-authored by Pfizer

Pfizer’s branded medication, Lyrica, which is approved to treat several chronic pain conditions, lost exclusivity in Latin America in 2013. The brand was facing severe competition from branded and unbranded generics and struggled with declining sales in Latin America. The brand team recognized that in order to distinguish themselves from the competition they would need to better understand the patients’ needs and develop a patient solution and value proposition that would be unique to Lyrica and Pfizer.

The Lyrica team set out to understand the patient CareFlow and pain points. They interviewed physicians and mined insights around what happens when the patient visits the doctor.

What became evident from their research was that a key component of successfully treating patients with chronic pain conditions is the need to understand the detailed pain history of the patient. To that end, when patients arrive to their doctor’s office, physicians typically give them a questionnaire to rate their pain levels over the previous weeks, as well as how the pain interfered with their sleep and other comorbidities. The CareFlow breaks down because patients have difficulty remembering and describing their pain levels accurately, particularly over long periods of time. Some physicians provide their patients with a diary to record the pain at home during the time between visits, however, patients often neglect to complete this as it is cumbersome to retrieve and bring along. Understanding their pain is critical for patients with chronic pain conditions to be able to better manage their daily lives.

Both patients and physicians were frustrated by the lack of accurate recording of the pain history. The Lyrica team identified that they could solve a key need that would help patients and physicians if they could have an easier and more accurate way to record their pain levels in real time.

Maria Lanzarone, the Regional Brand Lead for Lyrica in Latin America, sat on a bus, discussing with a colleague and fiddling with her wearable. She had the epiphany that if she could somehow re-program the wearable to enable Lyrica patients to input information about their pain intensity, it would be an easy way for them to record their level of pain in the exact moment when it was happening to get an accurate overview of their pain experience and provide the physicians with a report at their next visit that would have the real-time information.

One of Pfizer’s strategic priorities was to strengthen the company’s engagement with patients and physicians through digital. To engage colleagues around the world with that goal, Pfizer’s Global Innovative Pharma (GIP) business unit launched a digital innovation fund. Anyone in the GIP business unit with an idea for patient or physician engagement via digital could submit an application to the digital fund.

Maria knew that she would need support from many other functions within the company to design the solution, including Medical, Business Technology, legal, regulatory, compliance etc. She decided to submit her idea to the digital fund in hopes of achieving traction and support from headquarters.

The digital fund received 170 ideas from around the world and of the 9 ideas selected for funding; Maria’s idea of a wearable electronic diary for Lyrica patients was selected.

Developing a prototype

Once the idea was selected, Pfizer’s Digital and Mobile center of excellence in the Business Technology organization teamed up with Maria to flesh out the idea and put together a prototype quickly. They recognized that in today’s digital world, solutions needed to be brought to market quickly and iterated with customer feedback in order to have a chance at succeeding. To that end, the digital fund provided the team with funding as well as resources and senior level support to enable them to push the idea more quickly through the usual channels.

Once they had narrowed down to several technologies that existed in the market and had the capabilities they needed, the team had to think through the business model. What was the perfect price point for ROI? They decided that, in order to comply with local regulations and streamline the fulfillment process, the pilot in Brazil and Mexico would leverage the existing, locally approved patient support programs. The long-term goal would be to turn Lyrica, when paired with the wearable, into a solution that may be more effective in terms of Lyrica patient monitoring than the generic competition that is not paired with a pain diary solution.

This enabled them to narrow down the potential options and they settled on a pilot technology partner called Striiv.

Again focused on speed to market, the team, partnered with Medical, Striiv, and with Pfizer’s Business Technology team to develop an app that would work with the wearable diary, and Striiv’s team adapted the firmware of the wearable to suit the needs of Lyrica patients.

Putting all the pieces together to deliver the solution

In parallel, the team worked with the supply chain organization to ensure that they would be able to import the wearables and deliver them to the patients as quickly as possible to support the pilot launch.

The team also worked creatively with their advertising agency, Sudler & Hennessey in Mexico, to develop the materials necessary to explain to the physicians as well as to the patients how this new and very different program and wearable would work. Given the different nature of the wearable to the usual work that Pfizer does, the agency leveraged the expertise of other groups who worked with consumer wearables.

Simultaneously, the group met with Pfizer’s Global Software Medical Device Steering Committee as well as Legal, Regulatory and Compliance to understand what they would need to do to ensure that the pilot would be compliant and be able to get to market quickly. The prototype they designed would enable Lyrica patients to input three types of information manually: Intensity of pain (0-10), intensity of anxiety (0-10), then the quality of their sleep (1-5). The wearable would automatically track activity in terms of steps and distance as well as length and quality of sleep as measured by arm movement.

The pain-related endpoints were selected based on Lyrica’s ability to improve them as reflected in its indications and published clinical data, but are not sufficient to appropriately assess chronic pain in general or its impact on patients’ function. In addition, the scale presentations were simplified for the pilot and are thus significantly different from the validated versions.

The team also worked with Legal and Compliance and sought guidance from local regulatory authorities and industry associations to ensure the pilot and the way the electronic wearable diary was distributed to Lyrica patients was permissible and eligible for import into the pilot markets.

Market testing and iteration

The team’s efforts to move quickly on all fronts paid off, and within two months they had a first wearable and app prototype ready for market testing together with materials for Lyrica patients and HCPs. The team decided to conduct a Lyrica patient “user acceptance test” as well as an HCP Advisory Board to test the wearable, App, and associated materials as well as the branding and logo. They arrived at the testing with two prototypes and brainstormed live with the participants to narrow down the solution and make on the spot changes where possible. The Business Technology team, the advertising agency and the Marketing and Medical team all joined the sessions to enable quick decision-making and agile changes to the prototype.

Based on the feedback from these consumers, the team reworked the prototype, the App and materials to re-test five weeks later in Mexico. After two iterations and 3.5 months, the team had a consumer-validated prototype, App and support materials including a promotional campaign, logo and branding.

Given the stiff regulatory environment that pharma faces and in order to assess the business impact of the offering, the electronic wearable diary for Lyrica patients, named BeLive, would need to be tested in a controlled environment before being fully launched on the market. The priority for the pilot was to approach it with an open mind, achieve early learnings and modify and adapt the wearable before and during launch rather than continue to optimize.

Launching the pilot

The team had worked intensely in the weeks prior to design what the pilot would look like with a priority to maximize the data output from the experiment. Given that in Latin America, pharma companies are not allowed to communicate directly with patients, they decided to leverage their existing patient support programs and call centers to administer the pilot. As permitted by local authorities, physicians gave patients a brochure on the program when they gave them a Lyrica prescription, and the patient could call in to receive the BeLive wearable and be enrolled in the program once they had filled their Lyrica prescription. The data in the program are tracked anonymously and randomized to ensure compliance with privacy regulation while at the same time evaluating the success of the pilot.

The BeLive team designed a robust KPI and metrics framework set up to test the most critical and uncertain assumptions that would need to hold true in order for the pilot to be successful. The team is closely tracking the data to assess which components of the program are successful and which learnings will enable them to tailor the solution in the future.

To date the team has launched one pilot in Brazil and one in Mexico. Their short-term goal, once the pilot is complete, is to adapt BeLive, as permissible by local regulatory and legal guidelines, for Lyrica patients around the world as well as evaluate the feasibility to expand the project into other disease areas.

In the long term, BeLive’s vision is to increase the capability of the wearable to support adherence and, if possible, provide basic behavioral modification guidance for Lyrica patients. Eventually, if permitted by local authorities, the data collected via the wearable electronic diaries could enable the team to use real-world data to change the shape of the Lyrica patient CareFlow.

Co-authored by Otsuka Digital Health

Behavioral health is complicated by the heterogeneity of diagnoses, meaning that patients with the same diagnoses may require different pathways of care, the data systems supporting this care are siloed and not standardized, behavioral and physical health programs are disconnected, and social and environmental determinants of care may exert substantial impact on outcomes. Additionally, states follow very different policies for both treatment and funding, so the success of a treatment system requires significant insight into the regulatory and legal landscape. ODH leveraged its deep expertise in working with psychiatric patients, payers, and governmental entities to analyze challenges in behavioral health systems to identify opportunities to improve patient outcomes and rationalize healthcare costs.

Through this analysis, ODH identified a broad set of challenges in the care of people with behavioral health disorders. In particular, many severely mentally ill patients fall through the gaps of the system, relying on only episodic care in a variety of different care settings that include emergency rooms, mental health clinics, shelters, and even prisons. This episodic care makes it difficult for providers to treat patients effectively. Providers often do not have access to complete patient data, limiting their ability to make proper decisions at the point of care or proactively follow up to provide timely interventions to prevent further deterioration or exacerbation of the patient’s condition.

In addition, the Otsuka analysis revealed that payers have limited or no ability to risk-stratify the member population by need for behavioral health services. As a result, they cannot focus resources on those patients most in need of care or proactively provide services that would help improve outcomes. Otsuka also learned that payers struggle to effectively manage the diverse network of healthcare providers.

Based on these insights, ODH’s vision was to create a platform that would help payers understand the behavioral health risks and needs of meaningful segments of their member population, including those with comorbid physical and behavioral health diagnoses. The platform would also provide the analytic insights and technology to improve the clinical care of these members, and the performance of the provider network and system delivering that care. Said another way, ODH set out to design a platform that would provide a solution to rationalize the cost of care while simultaneously improving patient outcomes. As Michael Jarjour, CEO of ODH puts it, “It was through our deep knowledge of the behavioral health environment, coupled with our experience in the payer and provider space, that we were able to design a solution that addresses many of the shortfalls in the system. We paired this insight with profound analytics and reporting capabilities to which no one in this industry space has had previous access.”

The solution that emerged, Mentrics, is a digital platform that collects and tracks behavioral and physical health data on all patients covered by a payer. These data support three services for payers:

The ODH team realized during the process of product development that housing Mentrics within a pharmaceutical company would create regulatory and business obligations that would not be present in a stand-alone entity. In response, ODH was established as an independent company. ODH now exists as an independent entity in the Otsuka Holdings portfolio and as a peer to Otsuka Pharmaceuticals. This independence has also facilitated the rapid iteration, innovation, and market flexibility that are critical for success in digital health.

Fully delivering on the Mentrics vision, however, has required more than just an independent company. It also required the following strengths:

ODH is commercializing its Mentrics platform and continuing to build and evolve its features to transform the management of behavioral health. As the solution scales, it continually mines insights from ODH’s growing data sets. The solution is poised to help bring to the behavioral health market a new technology and analytic capability that can truly transform the outcomes and economics of behavioral health.

Co-authored by Shire

The Shire Neuroscience Business Unit engages patients at the different stages of their CareFlow, with customized digital marketing efforts that target communication around the need of patients at different stages of their treatment. This digital marketing strategy delivers differentiated messages starting with disease awareness and acceptance, moving to understanding treatment options and eventually to patient adherence and advocacy.

Shire has made digital marketing a priority for the company; several brand marketing teams include digital specialists with experience in the tech world to incorporate the latest in patient digital outreach. Shire has a centralized IT department that provides tools and support to the different marketing teams to ensure successful launch and implementation of digital strategies. In addition, Shire’s chief information officer is thinking strategically about how to incorporate the latest advancements in digital health, seeking out new vendors that have latest platforms to enable Shire to be at the forefront of personalized care with digital marketing for pharmaceutical products.

Shire Neuroscience Business Unit’s digital marketing strategy incorporates the 3Ds: Discover, Design, Deliver. In Discover, the Neuroscience team is building analytics capabilities to better understand the patient CareFlow; in Design, the team embraced a “mobile first” strategy understanding that most patients view the site on mobile, and in Deliver, they invested in a new operating model that will enable them to execute on the strategy in a nimble way.

To launch a best-in-class digital marketing strategy for Vyvanse, Shire invested in robust analytics capabilities to be able to base decision-making on prescription data and return on investment. The Neuroscience team contracted with several different vendors to map the patient CareFlow as well as to quantify the success of their different marketing strategies. They developed metrics to understand sales their marketing activities were driving and to adopt a test-and-learn approach to refine their communication strategy at different patient touch points.

To lay out the patient CareFlow, Shire is mapping the full patient journey from awareness to acceptance, treatment, adherence and eventually advocacy. The journey helps pinpoint the most critical touch-points and what type of information patients want at each of these inflection points. The goal is to create different communication strategies to build awareness of the disease, get patients to accept that they have the disease, encourage them to seek help for treatment, help them collaborate with their doctors to make choices about treatment options, and lastly ensure they adhere to treatment protocols before becoming advocates for the brand (or treatment option they have selected).

Shire partnered with Crossix, a vendor that has developed a tool called DIFA (Digital Impact for Agencies^TM), a cloud-based analytics solution that enables ongoing optimization of campaigns using actual treatment behavior. Since Crossix is able to join prescription and claims data together with media deployment information, it is able to correlate individual media campaigns to prescriptions and sales, capturing audience reach and conversion impact as well. For example, Crossix was able to help Shire identify how many prescriptions came as a direct result of a Facebook advertising campaign for ADHD awareness, measuring cost per conversion and ROI. These powerful insights enable Shire to refine its media planning through a test-and-learn approach that optimizes its media spend and ensures Shire has the most effective communication possible at each patient touch-point within the CareFlow.

Shire has also adopted Google Analytics Premium to provide greater visibility into what is driving traffic into Shire’s websites. This program can determine which advertising campaigns have the highest click-through rates as well as the ”view-through” rate, which captures site visitors who were exposed to an ad but did not click. In addition, Shire is working with APT (Applied Predictive Technologies) to drive sophisticated big data analysis utilizing synthetic control groups for past activities to improve decision-making across their marketing spend.

To accelerate its understanding and adoption of digital platforms such as online video and mobile, Shire created a deeper partnership with Google by bringing Google staff members on-site for education and consultation about these platforms. The company recognized that in order to stay current and remain agile, it needed dedicated resources. Through regular communication and embedded resources, Google will be consulting on user experience and provide frameworks for content creation. Google will also provide customized analysis of Shire’s Google campaigns to establish measurement goals to optimize Shire’s Google investments. Throughout the year, there will be on-going optimizations and consultation to establish and drive meaningful patient engagement and business results.

Shire has adopted a test-and-learn approach to its digital-marketing strategy, leaving behind the old pharma paradigm for marketing, a very slow moving, phased approach that does not incorporate immediate feedback. The test-and-learn approach leverages powerful analytic tools to quickly get insights, rapidly design and generate content, and deliver it to the market in a continuous iterative manner.

By having a quick turn-around that embraces feedback and data analytics, the Neuroscience Team can quickly respond to patient needs. For example, Shire found that about ~85% of traffic to its websites is accessed from mobile. As a result, the Neuroscience Team has embraced a “mobile-first” strategy, requiring its agencies to redesign advertising assets in a format that optimizes mobile formats and use patterns to maximize the impact.

To deliver on this innovative approach, the Neuroscience Team has invested in changes to its operating model, not just internally, but also in its interactions with agencies. Marketing teams have become more interdisciplinary with digital experts joining the brand team, and processes are being revised to be more nimble to enable Shire to react quickly to real-time data by adapting its communication strategy accordingly.

In addition, the Neuroscience Team has driven collaboration across multiple advertising and media agencies to drive best-in-class ideas, practices and analytics across its business units.

Acknowledging the magnitude of change, Shire has decided to apply it organically by developing these capabilities internally first within the Neuroscience Business Unit, given its high investment in consumer marketing. The plan is to subsequently share the capabilities, once developed, with Shire’s other BUs.

Unlike the companies described in the prior case studies in this chapter, Shire is in earlier stages of the effort to recast its marketing approach in 3D. The full impact of its digital strategy is yet to be seen, but early indications are strong. The test-and-learn approach for its digital marketing effort has already led to more refined, high-impact communications that speak directly to patient needs. Aspirations are high; Shire aims to continue further developing its digital capabilities, looking for the latest advancements in this space to ensure they will provide their patients with personalized messaging. This effort is expected to be rolled out to other products, ensuring that best practices are leveraged.

BeLive, Mentrics, and Vyvanse show the power of leveraging data to identify the true needs of each stakeholder (patient, provider, regulator, payer, and caregiver) at specific micro-moments across the CareFlow. The insights generated from these data enabled them to design solutions that truly engage their stakeholders and answer their needs. The three brands were able to successfully deliver because they also changed the way in which they traditionally operated, collaborating across the organization and partnering with carefully selected third parties.

The brands’ success in getting to market was driven by the 3Ds:

Leverage real data from the patient CareFlow to generate insights. Mentrics from ODH showed the power of combining traditional primary market research data with advanced analytics on patient episode data to achieve deeper insights. Through their years of working with behavioral health payers and patients, ODH used many traditional sources of primary market research to identify the pain points for behavioral health patients. Complementing these insights with patient episode data allowed them to design an algorithm-based, digital solution that drastically changed their understanding of the CareFlow for patients, providers, and payers. Similarly, BeLive interviewed patients with chronic pain around the world to understand the pain CareFlow and in so doing revealed a considerable opportunity to improve patient care by giving doctors more accurate and timely information on episodes of pain (an excellent example of applying NOBLE marketing, as discussed in Chapter 4). Finally, Shire’s Vyvanse leveraged digital media and analytics to get deeper insights into campaign performance and based on deeply understanding how behaviors differ at the various stages of the CareFlow. As a result, they were able to optimize their marketing and personalize the experience for the patient.

The solution is about the stakeholder (patient or physician). The inspiration for Pfizer’s BeLive solution was the insight that the company could take a platform that the patient already wanted to use (a wearable) and add value to that platform by working within it. A hallmark of a well-designed solution is that it fits right into the way the user currently lives his or her life and then improves that life in a way that is straightforward to operate and not taxing. The BeLive solution did just this.

Similarly, Mentrics developed a solution that enriches the patient experience across the CareFlow, independent of a specific brand. The insights engine and algorithm generator are able to benefit the brand by supplying unique knowledge on patient CareFlows and needs to the marketing team; however, the solution itself is not tied to a particular brand and its success. Vyvanse uses digital technology to separate and personalize messaging differently for patients who have been exposed to a brand versus a disease awareness campaign.

Establish an enabling structure and build critical capabilities quickly. Once the company has agreed on a design, it is critical to quickly build the capabilities needed to maintain momentum and not lose the unique opportunity identified. Otsuka and Pfizer did this in two different ways. Otsuka Pharmaceuticals created a separate sister company, Otsuka Digital Health, which did not have the same constraints as Otsuka Pharmaceuticals (e.g., regulatory requirements), in order to enable Mentrics to have the freedom to design the best solution. In addition, ODH hired over 25 data scientists to help with the Discover and Design tasks, rapidly building a core capability that was critical for the success of Mentrics. Pfizer established a Digital Innovation Fund and a digital and mobile center of excellence in the business technology organization, which enabled the team to mobilize senior-level support, funding, and rapid decision-making to enable the electronic wearable diary for Lyrica patients.

Partner to gain access to capabilities that are lacking internally and may not be easy or beneficial to build internally. In addition to building capabilities, it is critical to recognize where a gap exists that can be best filled by partnering with another organization that already has those capabilities and skills. Shire partnered with Google, PHM, and Good Apple to envision and execute on their digital-marketing strategy, often getting the partners in one room together to brainstorm and solve problems. Otsuka Digital Health recognized that technology was not going to be their key strength, so they partnered with IBM to build the technology platform for Mentrics. Pfizer found the Striiv wearable and then worked closely with the manufacturer to ensure the firmware was updated to handle the BeLive software.

Cross-functional collaboration. Pfizer and Shire both recognized that it was critical to leverage the capabilities and input from across the organization to design and deliver a good solution. The BeLive team included the regional Lyrica brand team, business technology’s digital and mobile center of excellence, and the creative agency, as well as input from the regulatory, compliance, medical, and legal teams. Vyvanse’s brand team partnered with Shire’s digital center of excellence and chief information officer to envision a new patient experience and co-develop new marketing solutions to deliver on that experience.

Agile and iterative process (test-and-learn). The BeLive team focused on rapid iteration and getting a product to market quickly, rather than creating the perfect version the first time around. This enabled them to get a prototype to market testing within four months and have the pilot ready, with feedback from first users, four weeks after that. They made trade-offs in terms of capabilities in order to prioritize speed. Similarly, ODH has positioned Mentrics as an agile, evolving solution, with new features being deployed continuously to stay ahead of the competition.

Stepping back, this book opened with the observation that digital engagement is now a fundamental part of how patients, caregivers, physicians, pharmacists, and others live their lives. We also observed that while many pharma leaders recognize this shift and acknowledge that their companies could benefit from adapting to the new reality, most don’t have a clear view of how to effectively plan and lead the required transformation.

Also, don’t be a stranger. This e-book is an ongoing project. We expect that several times a year, we will update the content on a rolling basis and add new case studies (you can stay informed here). Maybe yours?