mHealth Monthly Mashup: Release 19.0 – four healthcare industry trends that influence every mhealth decision

Michael Spitz


In this month’s mhealth Monthly Mashup Michael Spitz talks us through four healthcare industry trends that influence mobile health.

Knowing when to hold ‘em or fold ‘em is the name of the game, nowhere more apparent than in digital. And once we raise, all our focus is on implementation—still the biggest challenge throughout every vertical, healthcare likely the most difficult arena to get things digitally done. For mobile health enthusiasts, entrepreneurs, and e-marketers the minutiae are what count, making all the difference between a successful launch and a hand that falls flat. But in order to accurately gauge the relevance and justify the potential effectiveness of an app build, responsive design experience, or cloud-based initiative, we should first take a few steps back and discover how broad industry trends and pressure points drive these individual projects and initiatives.


So in this month’s column, let’s dive deductively on down, and describe four seismic shifts in the healthcare industry—from revenue and regulatory to treatment and tech—and their impact on mobile health decisions for pharma and medical device companies large and small. By having these four “aces in the hole,” we’ll be able to provide relevance and context to each mhealth project, help strategize and justify the risk, and play to win.


“The patent cliff is real and imminent, with US pharma alone hemorrhaging more than $120B in sales over the next few years…”


Trend 1) Pharma Phuture: “From Splurge to Purge”

The age of the blockbuster has seemingly come to an end, inducing crisis and paradigm shift at the core of how the pharmaceutical industry does business. The patent cliff is real and imminent, with US pharma alone hemorrhaging more than $120B in sales over the next few years, while pipelines are similarly shrinking, a majority of promising new Rx candidates falling into increasingly targeted, orphan drug categories treating progressively smaller and more nuanced patient populations. On the medical device side recalls and reputation problems continue, often one innovative step forward to several quality control steps back. The bottom line is negative impact to the bottom line, resulting in shifting strategies and knee-jerk reactions in response to diminishing margins and markets, including often surprising consolidations, divestments, mergers and acquisitions, reduction in budget for research and development, renewed strategic focus on global opportunities and international market share, and expansion of core competencies to encompass diagnostics, big data, consultancy, and even investment in line extensions outside of traditional healthcare.

Such a shift from “splurge to purge” has cascaded down to induce equally disruptive changes within marketing and communications departments, now forced to grapple with expanding responsibilities amid imploding budgets. Cost cutting pressure has compelled brand teams to pull back on creative exploration and market research on the up front, and reshuffle their media mix down wind, greatly reducing or completely eliminating expensive broadcast media DTC plays such as television spots and magazine advertising, and re-evaluating healthcare professional-focused standards including speaker bureaus, expert panels, conference sponsorships, and the like. The good news for e-marketers is an overall increase in digital spend, historically just a small sliver of the overall media pie but now responding to audience expectations for more expansive multichannel engagement, and the sheer need to pick up the remaining slack left by the far more expensive and obsolescent broadcast void.

The upshot for mobile health is two-fold: The new strategic landscape is compelling pharma to become bullish about digital spend, but ROI pressures and the inherent riskiness of newer and lesser-known channels create their own barriers of entry. Although all indicators point to the powerful potential of mhealth, pharma and device manufacturers on both sides of the pond remain hesitant, slow adopters. How to bridge that gap? Companies under stress need assurance, guidance, and a tangible, proven vision of success, since fiscal pressure and risk-aversion remain the double-whammy of healthcare tech, opportunities abound for savvy experts and entrepreneurs to supplement in-house capabilities with scalable partnerships focused on effective, compliant solutions. So as tighter budgets in turn shrink marketing departments, and digital inexorably becomes the dominant communications channel, the role of mobile health providers should go beyond mere tactical implementation, and encompass exciting opportunities as a full-fledged strategic partner.


“The culture of pharmaceutical and device sales, particularly in the United States, has undergone a 180-degree turnaround from only a few years ago.”


Trend 2) Regulatory Roughhousing: “From Cruises to Bruises”

The culture of pharmaceutical and device sales, particularly in the United States, has undergone a 180-degree turnaround from only a few years ago. Goodbye are the gratuitous physician gifts, the Caribbean cruises, the opaque payments to influencers and unabashed data mining—and hello are individual states, the federal government, and the industry itself orchestrating a series of sweeping guidance, legislation, and best practices to curtail conflict of interest and reinstate a more ethical, balanced, and fair marketplace. These governmental and self-regulated mandates have impacted virtually ever aspect of the pharma/physician/sales rep experience, including placing tight limits and outright bans on gratis incentives, forced transparency and full disclosure concerning compensation for consulting, speaking engagements, and other influencer services, licensing and enforced management of sales reps, express limits on the sale of physician information for marketing purposes, and many others.

A subtle and long-overdue improvement in the questionable reputation of the pharmaceutical and device industries notwithstanding, this transformation from “cruises to bruises” has forced marketers to rethink their sales strategies from the ground up. Given a more level playing field and an obvious reduction in physician incentives to engage, sales reps experience infrequent and greatly compressed windows for contact. With less tolerance and less time, the point of care “elevator pitch” and sharing of sales collateral must be optimized and made more friendly and efficient than ever before. Regulatory constraints have also directly impacted the form and content of branded messaging, with strict boundaries and limitations now set within approved indications, precluding aggressive selling and tangential dialogue, thereby creating a more forced, linear trajectory during each call. In parallel, healthcare professionals increasingly access clinical content online, empowering themselves like never before to the point pharma and device sales reps no longer monopolize their role of sole information resource and trusted partner, and are beginning to be seen as redundant and intrusive.

The implications for mobile health are profound and already well recognized by physicians and all the major healthcare players, the future taking the form of the so-called “virtual sales rep.” Seen as augmenting and in some cases ultimately replacing the physical sales force, the idea is an extension of the “interactive visual aid” (IVA), long the cornerstone of digital engagement at the physician/rep level. Sweeping regulatory changes have only heightened the significance and application of point of care mobile sales tools that drive a controlled narrative, while the prohibitive costs of maintaining an actual sales force make a digital substitute increasingly appealing. Medical device companies are less constrained by compliance issues, so content management apps that contain gigabytes of sales collateral in diverse multimedia formats are low hanging fruit for mhealth developers, with seamless integration into and other enterprise-level sales management software par for the digital course. The key takeaway here is that the largest and most urgent opportunities for pharma and device mobile health development lie not in the one-off branded apps, but in “virtual sales rep” and similar CMS platforms that work for broader franchise and portfolio-wide plays across the industry.


“…tightening budgets and regulatory constraints demand fresh strategies for extracting the most value from limited resources.”


Trend 3) Treatment Evolution: “From Stealth to Health”

As we’ve seen, tightening budgets and regulatory constraints demand fresh strategies for extracting the most value from limited resources. By driving economies of scale, integration, and innovation, pharma and device have stepped up to these seismic industry tremors with varied degrees of success, arguably making the most progress in terms of shifting focus from molecules and gizmos to treating the whole patient, right down to the individual. The interesting healthcare convergence between how companies market and professionals treat is worthy of note: Just as physicians have discovered that addressing a single ailment is insufficient given comorbidities and holistic lifestyle considerations including diet, exercise, emotional well-being, and other factors, so too have marketers understood that engaging doctors through broader portfolios and practice management tools are more expeditious and economical than marketing individual brands. The trend has even shifted beyond brand-to-franchise expansion, and now encompasses a flurry of disease education and preventative measures, all designed to transform the industry from reactive healer of the sick and “drug peddler” to proactive health and wellness partner, freshly focused on social good.

Changing the personality of big pharma and medical device manufacturers from “stealth to health” is smart business and ultimately brings the best benefit for the ultimate end-user, the patient. From a marketing and communications point of view, full transparency and an overt commitment to health and wellness is novel and noble, but require more complex strategies that embrace social media, and exacerbate the already delicate and often contentious relationship between brands and franchises. Nonetheless, the repositioning introduces opportunities to repurpose and multipurpose digital assets in ways that get the most out of finite spend and team bandwidth. The more recent evolution of to portfolio platforms and portal structures have been adept at consolidating the overall value proposition and simplifying pharma-to-physician relationship management, but implementation has been uneven and new challenges have often out-weighed innovative approaches leading to frustration from both users and builders. Additional challenges include trying to figure out tolerance levels for social engagement, and determining where one brand benefit stops and another starts, clearly a fully integrated, holistic approach is the end-game, but getting there requires going beyond creating a Twitter profile and repositioning franchises, instead figuring out how companies reinvent their infrastructure from the ground up, and learn how to engage with multiple audience segments having divergent needs and expectations.

Mobile health is ideally suited for an empowered physician who acts more like a health advocate than a mere medical problem solver, and caters wonderfully to the e-patient who proactively and independently takes care of their own health and wellness. The missing link has so far been pharma and device companies embracing mhealth with commensurate enthusiasm and prowess, an unfortunate situation being mitigated and slowly corrected by this “slickening up” of the whole healthcare industry. Interestingly enough, the evolution from brand-specific to wellness-focused engagement de facto removes many of the regulatory restraints plaguing mobile health commitment and implementation. This trend, combined with reformulating digital health strategies provide ample opportunities for the industry and its digital partners to tackle two viable, vibrant, and complementary approaches: 1) Unbranded preventative and educational mobile tools, and 2) Branded enterprise-level content management and sales support mobile resources.


“The evolution from brand-specific to wellness-focused engagement de facto removes many of the regulatory restraints plaguing mobile health.”


Trend 4) Tech Transformation: “From Digital to Pivotal”

The evolution of pharma digital marketing is fascinating. At the turn of the millennia a pharmaceutical with a downloadable pdf of the Prescribing Information was a big deal. For the next few years product websites grew from empty shells to robust clinical and educational resources, an “outhouse-to-gazebo” online crescendo that peaked when professi0nal sites started to migrate into franchise portals, and unbranded disease content became increasingly problematic on patient sites. Since then the social media revolution has fueled chaotic media fragmentation, in turn segmenting and sub-segmenting smaller and smaller, more purpose-driven audience types who get their healthcare information from multiple sources, while most recently the ascendency of mobile has redefined and transformed the digital users experience into an increasingly visual, intuitive, and modular approach characteristic of aggregator mashups such as Storify, and last year’s explosively popular and influential Pinterest interface. Gone are the days, thankfully, when pitching pharma and device clients required flipping through gargantuan market research decks substantiating that endocrinologists and diabetes patients used Google, but contrary to nearly every other vertical, pharma digital spend remains oddly disproportionate, and doesn’t demonstrate the geometric growth you’d expect from a trillion dollar global industry.

Although admittedly sluggish compared to consumer goods, entertainment, and other sectors, healthcare marketing is catching up, in large part to the personal and professional popularity of the iPad. Love him or loath him, Steve Jobs not only helped launch the personal computing revolution, but was central to untapping that power with tapping, and placing it right into our pockets. That amazing combination—touch screen tech and mobility—has utterly transformed how users engage with digital, destroying boundaries and inviting everyone from toddlers to seniors to actively and enthusiastically participate. Included in that nearly ubiquitous digital demographic are the once digitally phobic pharma and medical device marketers, regulatory attorneys, and clinicians. Since fear is based on ignorance and the antidote to fear is experience, the simple fact that all these folks at long last actively use the software and technology automatically creates a more conciliatory, inviting, and eager audience for getting things done in digital health.

All that translates to measured optimism and excitement for mobile far as pharma and device companies are concerned, at least in the medium- to long-term. As “digital becomes pivotal” throughout the media mix, mobile health as an integral slice of the pie becomes a more natural, organic, and inevitable commitment. In terms of getting things done, relationships are more important than sheer technical prowess, and patience is the foremost virtue. With careers on the line, reputation management remains paramount, the best advice to follow is the time-honored truism in healthcare marketing that “Everybody wants to be second!” In other words, the most expeditious path forward is based on assuring clients that expert recommendations are substantiated by proven precedent and concrete examples of successful builds that were audience-sensitive, risk-averse, and ROI-driven. By sharing and deconstructing case studies, extracting best practices and making sound suggestions, strategic partners help create a solid framework and tangible roadmap for pharma and device companies to succeed in the otherwise risky, intimidating mobile health space.


“…relationships are more important than sheer technical prowess, and patience is the foremost virtue.”


Summary and Key Takeaways: “Four Aces”

The best digital builds follow a proven methodology and resonate with sensitivity to objective, audience, experience, and detail. Relevance is contingent on context, so understanding, appreciating, and addressing healthcare industry trends justify mobile engagement and help overcome barriers and objections. As we’ve seen, pharma and medical device company challenges on the highest levels cascade down to their marketing and communications departments, presenting issues that digital and mobile health are optimally suited to solve. So despite lingering resistance and hesitancy to embrace the inevitable, having these aces in the hole can help frame up and justify mobile health plays, giving e-marketers the confidence they need to take a risk and win:

• Ace of Spades: Tighter budgets actually increasing digital spend.

• Ace of Clubs: More restrictive regulatory actually increasing digital need.

• Ace of Hearts: Shift to health and wellness increasing digital engagement.

• Ace of Diamonds: Digital dominance increasing mobile health demand.

Are you ready to go all-in?

About the author:

Michael Spitz is SVP, Managing Director of the Healthcare and LifeSciences division of ZEMOGA. Spitz combines his passion for technology with more than 15 years of clinical content expertise to help engineer digital healthcare solutions. Follow @SpitzStrategy on Twitter for his daily – often hourly – updates on all things digital for the ultimate benefit of patients worldwide.

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