Customer complexity in pharma marketing

In the new and 'still forming' NHS, one thing is clear: the pharma industry's customers are increasingly complex with a blurring of lines between clinician and payer, and growing patient power. These complexities make brand management – particularly strategic and tactical planning, and segmentation – a minefield.

The 'changing', 'ever evolving', 'new' NHS... how many times in our working week do we hear this? What does it mean, and what should we do about it? Most importantly, how can we ensure we are keeping up with the changes, and developing and implementing marketing strategies that will future-proof our brands?

The NHS environment raises many questions in the minds of domestic and global marketers, as many other markets regard the UK as a reference market - and not necessarily a positive one. The key question in all this is whether the changing NHS is really that complex, and how we can be successful with our brands in this environment.

More people to talk to

Over the last 10 years there has been a marked increase in the number of stakeholders, decision-makers and influencers in the NHS, and thus an increasing diversity of roles and responsibilities. The decision-making process has undergone significant change, moving from being largely clinically-led to substantially payer-led.

However, even prior to the move away from PCTs, the NHS operated on a multi-organisational and multi-stakeholder basis, with responsibility resting in many layers – it has merely become ever more complex, with more people to talk to:

• GPs:

o Frontline patient care/first point of patient contact

o Referral of decision-making to specialists

• CCGs

o Commissioning services from Primary and Specialist Care

o Managing CCG wide budgets

o Seeking support from Commissioning Support Units (CSUs)

o May be privatised in the future

o Currently are resourced by a large number of ex-PCT employees

• (Local) Area Teams:

o Ensuring national priorities are integrated into local commissioning

o Disseminating Specialised Commissioning policy

This multi-organisational and multi-stakeholder approach to decision-making reflects a matrix which pharmaceutical companies need to navigate to influence the use of brands.

"There is mixed success in engaging with the non-clinical or 'payer' audiences – not least because they are often see as 'one', when in fact they are many"

Whilst many companies have longstanding, well-established relationships with clinicians, and some influence with wider audiences of nurses and pharmacists, there is mixed success in engaging with the non-clinical or 'payer' audiences - not least because they have often been seen as 'one', when in fact they are many.

The roles of these 'new' customer groups are diverse, and the appropriate approach to engaging with them will vary.

Who are the Payers?

The 'payer' audiences include a number of different individuals with varying objectives:

• Pharmaceutical Advisors – clinical background, annual financial targets

• Medicines Managers – clinical background, monthly financial targets

• Pharmaceutical Commissioners - clinical background, financial and clinical targets

• Finance Managers – often no clinical background, financial targets

• Commissioning Managers – varying levels of clinical background, financial and clinical targets

This list is not exhaustive, and it is clear that the needs of these customers are likely to vary enormously based on their job role. But that is not enough to define what motivates them; they are individuals who have personal drivers alongside their role responsibilities. In addition, the local health economic situation will impact on how they make decisions: cost-effectiveness is one thing, affordability is another.

One further complication is that there appears to be a continuum from clinical to financial focus, even within specific job roles. From pure clinician to pure payer, there are a number of different customer segments with varying needs, and blends of clinical and financial value drivers.

Job titles only represent a vague guide of the specific nature of the role. Even within one organisation, there may be one commissioner with a pharmacy or clinical background, and another whose background and orientation draws their decision-making more towards the financial.

What is still changing?

Clearly the biggest change (arguably since the inception of the NHS) is that GPs are responsible for more local commissioning, setting out patient pathways, managing the total budget for healthcare provision to their patient list, and having the right to veto service changes.

But CCGs have already chosen not to take on all therapy areas, and are seeking support from CSUs to varying degrees (another nuance to consider).

Top-down control has allegedly been replaced by a more bottom-up approach to health service planning. Decisions 'should' be made more locally about appropriate care, with a broader value-based approach to efficacy.

The priority for all NHS stakeholders, whether clinically or managerially focused, is to save money in real terms, increase efficiency and reduce wastage, in a country with an ageing population and increased medicalisation of conditions.

In order to achieve the financial savings required, a spectrum of initiatives has emerged; from sickness prevention by encouraging healthier lifestyle to direct money-saving through reducing drug spend.

To ensure their communications are credible and compelling, many pharma marketers are turning to NHS stakeholders to help 'co-create' their Value Messages.

A Threat and an Opportunity

What does all this mean for the Industry? The changes represent both a threat and an opportunity. Initiatives to reduce spend may threaten brand use through 'switch' to cheaper options, but the ability to demonstrate cost savings elsewhere in the system would make for compelling reading to those whose financial responsibilities are more holistic.

To successfully engage existing and new customers, pharma must collaborate to fully understand and address needs. This will include recognising the different audiences that exist, and collaborating with them to develop materials and messages that truly resonate with them and clearly position and cost the use of brands within the patient pathway.

In reality, this means more than agreeing that there is a payer-type customer and a clinical type customer, and perhaps someone who fits in-between the two. To engage successfully with the new audiences without having to develop a different set of materials for each slightly different customer type, a new approach to segmentation is required.

To ensure these communication approaches are credible and compelling, many pharma marketers are turning to NHS stakeholders to work in partnership with them to 'co-create' their Value Messages.

Developing communication tools that convey a consistent story through understanding and meeting specific customer needs, and doing it with the NHS for the NHS is surely the most likely successful way to drive brand uptake such a complex field. The additional benefit of working closely with our customers is that we can keep abreast of the continual changes that could plague our ability to plan for the future.