Well is the word

By Christiane Truelove chris.truelove@ubm.com
The role of traditional DTC – highly branded messages in television and print – continues to shrink as marketing is evolving into a multichannel spectrum. A new trend is unbranded messages to consumers and patients about health and wellness in a variety of digital mediums, and for pharma, the challenge is being able to claim that space in a way that eventually connects back to the brand in a meaningful fashion.
Industry thought leaders have been noticing this health and wellness trend among their clients. Alexandra von Plato, president and chief creative officer of Publicis Healthcare Group, says a number of factors are shaping this trend.

“We’re seeing really an alignment of incentives take shape where payers and providers and patients all recognize that getting the patient to take care of themselves and helping the patient make better healthy choices is good for business,” she says. “We’re seeing people connect with sources of content and information that help them make better decisions and we’re seeing brands trying to build brand awareness and loyalty and preference around being the source of information and inspiration, not just of the solution itself, in terms of the drug.”

Bill Drummy, president of Heartbeat Ideas, says a number of macro factors are driving this trend. “One of them is the fact that with the Affordable Care Act now being implemented, and all the incentives in the Affordable Care Act to move from a pay-for-performance model to more of an outcomes-based model, everyone really is incented now to look at the overall wellness of a patient, and not simply look at particular therapeutic regiment to accomplish only this specific goal with no harm being done and there’s some efficacy. It’s actually about, ‘Am I making the patient better and at a lower cost than an alternative.’”

Paul O’Neill, president of Ogilvy CommonHealth Wellness Marketing, is also seeing the wellness trend play out, but sees the main driver being the way consumers are becoming more independent about how they seek healthcare.

“We as healthcare consumers, all of us, are captains of our own destiny at this point much more than we’ve ever been, and I think marketers have smartly said that if I try driving you into making a branded request around the HCP, that’s not enough; more and more it’s about educating healthcare consumers as their own self-advocates in driving their own care, to understand the context of health and wellness and also potentially their disease and to engage them within that context,” he says. “The brand is completely part of that, part of the solution. But to really have a broader view of the disease and their role in managing the disease or maintaining health and wellness is recognizing that they’re more in charge than they’ve ever been, so we should be talking to them a little differently or engaging with them in a different way.”

According to von Plato, this evolution is a positive trend as healthcare reform and adherence become more important. “We see that the wellness component of a brand story, the behavior medication, the lifestyle management, the helping people through the long tail of chronic illnesses not just acquiring the patient and getting them on drugs, but keeping them on drugs, and keeping them healthy on drugs and proving that the combination of the drug therapy and lifestyle modifications, actually are successful and beneficial to the patient. All of that is causing brands to examine their strategy and invest a little bit more in wellness messages and wellness content.”

Drummy says the trend in wellness messaging is being driven by the efforts to make everything more patient centric. “I have a problem with the whole phrase DTC as direct to consumer. First of all, referring to someone as a consumer of healthcare is an odd way to be putting it, to be honest with you. I don’t think people consume healthcare services in the same way you consume Cheetos. You probably should not, and there is probably a negative correlation between the two. So, calling someone a consumer of healthcare is wrong probably, at the get-go. So talking about it as patients is a much better idea. They’re people looking to improve wellness, make their lives better, and there’s lots of ways to do that, not just narrowly looking at the therapy itself, but everything around the therapy.”

Another driver of non-branded wellness messages to consumers and patients is the move by pharma and healthcare to move “beyond the pill.”
The phrase itself is overused, Drummy says, “But it is really about delivering services beyond the therapy itself in a meaningful way for all the people involved in the patient’s wellness – the doctor, the patient him or herself, the caregiver, all those folks have a role in that. And increasingly, there’s also a role for the people who are, quote on quote, more the financial decision makers.

“And increasingly, we’re seeing how important it is to make the pharmacoeconomic argument as well as the safety-efficacy argument, so that people understand that if you take this particular therapy you will actually be reducing overall costs to the healthcare system, if this particular therapy can be proven through its clinical trials, do what we do to reduce bad outcomes, reduce rehospitalization, for example, reduce the number of days somebody spends in the hospital, that sort of thing, if you can show a correlation there, you can actually then make a case that not only is it a safe and efficacious therapy, but it is one that is less costly to the overall healthcare system. And increasingly, that’s where we have to be going.”

The medium for the message
It has become quite clear that the expansion of the medium for DTC – beyond just general television spots and print ads into digital and mobile – has allowed pharma to craft unbranded messages that go beyond the messages of benefit and risk.

“Everything we’re doing now [at Digitas Health] is multichannel; almost every ad campaign has some kind of a back story or some kind of content offer that has to do with the condition,” von Plato says. “Our clients are looking to provide things that are of shareable value, that have some kind of a service component to them that’s across the board. We have very few clients that only want an advertising campaign. They might want something that would include and add strategy, but the larger strategy is a multichannel brand strategy that has content and media partnerships and apps and a social strategy, all designed to engage a customer in a conversation that a patient would want to have. So you have to figure out what patients are interested in almost back the brand positioning into that.

“It is a little bit of a different way of working than the traditional approach, which is you figure out what your label can say and then develop messages to make that relevant to consumers,” according to von Plato. “We are actually looking at what consumers or patients are looking for or need, and how do we use that to inform the brand platform and the ultimate technical plan, which includes many different kinds of channels and approaches.”

O’Neill maintains that traditional direct-to-consumer messages will not go away, but they are going to continue to be far less dominant.

“It still has its role in the mix in terms of broad and rapid awareness as a primary driver of its value, but as we get into wellness messaging and ask for a mindset shift among the healthcare consumer, there’s a depth of information that must be conveyed and a higher level of engagement, beyond just driving a branded request into the HCP,” he says. “So I think that will drive even further this movement towards more media channels that provide a greater and deeper engagement.”

Von Plato points out that traditional DTC can be effective for specific brands. “If you have a big indication like cholesterol was, there’s a reason to use mass media,” she says. “You have a pretty educated audience, and you can simplify your message and use mass media strategically.”

With pipelines yielding products with more niche indications, however, traditional DTC will not be cost effective for these brands.

“But that being said, all brands need to engage with the customer on their terms and the customer, and the patient, and the consumer is using multiple channels and multiple points of reference to form an opinion and make a decision, and gain confidence and decide to act,” von Plato says. “Nobody relies solely on television anymore because they recognize that even though it might give them the reach it has to work with other channels, primarily other digital channels and other sources of content.”

Cegedim Strategic Data shows that DTC spending dropped 22 percent in 2012, to $3.10 billion.

According to Nielsen data, the industry spent $3.47 billion on direct-to-consumer advertising during 2012, 12 percent less than in 2011. Breaking down the spend, Nielsen reported that $2.17 billion was spent on television in 2012, a drop of 11 percent compared with the previous year. Magazine spending dipped 16 percent to $1.01 billion. Newspaper advertising spending dropped 21 percent to $192.3 million. Radio advertising spending had the biggest decline, 34 percent to $23.1 million. Spending on outdoor advertising rose 61 percent to $3 million.

Also per Nielsen, the industry in 2012 spent $68.4 million on Internet and digital advertising (excluding Myspace.com, Realtor.com, Yahoo! Mail and YouTube), with the 2011 figure not reported.

Citing Nielsen statistics, Richard Meyer, blogger at World of DTC Marketing, reported in April that DTC Internet media spending went down 33 percent in 2012. He had heard from agency contacts that pharma was actually increasing its spend, but from pharma people that all budgets, including that for Web, were being cut.

“Given that pharma cannot fully leverage search marketing because of the requirement for fair balance, I could see pharma reducing their spending, especially on drugs that have high awareness,” he says. “That leaves actual site development, mobile marketing, and CRM programs. With the consolidation of interactive agencies and pharma’s insistence that they use only approved vendors, I could see how the costs of actually building a product Website could increase. ... So we are left with overall declining DTC budgets and less money being spent on internet media. This could mean that more money is being shifted into digital marketing at the expense of TV, but again, even though the Nielsen numbers show that the web media is taking a bigger hit than TV, that does not include a lot of online marketing initiatives.”

Spending on traditional direct-to-consumer marketing will continue to decline in 2013, Meyer says. According to Meyer, spending will be down in most categories as drug makers are forced to cut back because of changes in the Affordable Care Act and the continued loss of some big-name drugs coming off patent. He predicts that spending on digital marketing will increase but not in terms of media, as more dollars will be spent to develop and test digital marketing to healthcare professionals and consumers, but that will not translate into more online media spending.

“The biggest decline in Internet spending, I believe, will be in paid search and marketers will rely more on organic search,” he says. “TV is great for building awareness but with more and more consumers multi-tasking and time shifting TV watching, DTC marketers are going to look for other ways to build awareness. In addition, research has shown that more and more consumers are ‘tuning out’ when it comes to DTC TV ads.”
Additionally, newspapers and magazine will continue to decline and dollars will be shifted more to targeted health magazines, he says.

With the precipitous drop of traditional DTC marketing and the switch to digital, it is no surprise that the style of the messages is changing, Drummy says.

“In digital, it’s really been an interesting and effective approach to talk about condition state and not necessarily always lead with brand, because in digital, you want to create an engagement of value, a long-term relationship with folks who have a particular condition, and you move into the branded conversation when it’s appropriate,” he says. “But very often it’s not the very first thing you do, because in many cases there’s no awareness of what the issue is, so you need to target the right people and give them a message about the particular condition, and then move from condition to brand and it’s a multistep process, which is really easy to accomplish, really effectively in that realm. It’s a little more difficult to accomplish that in the television realm or in the print realm, but it’s a very effective approach in digital.”

Unbranded initiatives are increasingly taking center stage, von Plato says.

“I do see more unbranded initiatives I think in the last year than I have seen in previous years,” she says. “Some clients are looking now, whereas a couple of years ago they would have said, ‘We would never do unbranded,’ they’re finding a way to use unbranded to connect with their audiences, maybe different segments of their audiences, and start a conversation with a different group of people.”

Companies are using digital media to be able to more effectively segment their audience and talk to different cohorts, especially undiagnosed people. “We’re seeing this sound more like a wellness conversation because obviously you’re not talking with people who are overly symptomatic, or they haven’t been diagnosed, you have to find a way to start the conversation or try to get them interested, and it usually starts with something that has to do with wellness or lifestyle,” von Plato says.

Part of that digital expansion is the use of mobile, according to Drummy. “With mobility being a bigger and bigger part of how healthcare information is being consumed, and how we are able to add value to the relationship between the physician and the patient, we see that as a huge area of growth for pharmaceutical companies and other healthcare providers,” he says. “And also it shows a different way of approaching the question of how do we help and are we really only about advertising, or are about something broader.”

Traditional forms of advertising are limiting, Drummy says, and he believes communications with consumers and patients should be about creating value, in terms of providing information or utility that will help a patient and a physician come to the right medical conclusion. “We’re not practicing medicine of course, but we are trying to enable better outcomes through a conversation between a healthcare provider and a patient,” he says.

As a result of this philosophy, a lot of the work Heartbeat Digital has been doing in the app space has been about facilitating the dialog, making it easier for the right patient to walk into the doctor’s office with the right questions and to prepare the doctor for the right conversation with the right patient. “These things are really heavily enabled by the digital revolution and those apps and mobile solutions that are most effective are ones that actually make that possible in a more valuable way,” Drummy says.

Shifting the viewpoint
Although some clients have enthusiastically adopted the nonbranded, health and wellness approach in their messaging, it is still far from universal in the industry.
“In pharma, there is a tendency among marketers to do what they’ve always done because they’ve always done it,” Drummy says.

Because television has been traditionally the most prominent way to get messages to a consumer audience, many marketers are reluctant to lessen their reliance on it.

“In many cases it makes sense, but in many other cases, it really doesn’t make sense or let’s say, to put it this way, it’s not the only thing that makes sense,” Drummy says. “I think we’ve gotten a little too comfortable with doing things that way, and it sometimes works really well, but in many cases, it’s not the most effective or efficient way of reaching the target audience.”

Digital programs can target down to the ZIP code level or the behavioral level, making them more inherently efficient. And when marketers say digital does not have the reach of broadcast TV, Drummy has challenged that. “I’ve said I don’t think that’s true any longer, with the networks that are out there now, we can get tremendous reach comparable to TV reach,” he says. “There’s lot of ways you do things with much better targeting in the digital realm, and then much more effective TV-like creative to get attention.

“So by combining things such as the superior targeting with the high-impact, television-like creative, you can really get some tremendous results. We have a campaign in market right now for one of our clients that is doing extremely well, because we combine multidimensional targeting – geotargeting, behavioral targeting, along with high-impact creative.”

Heartbeat has had a lot of success with wellness and health messages in direct-to-patient digital for another of its clients, Corcept Therapeutics. For Corcept, Heartbeat designed Cushingsconnection.com, a digital campaign for patients with Cushing’s disease. Corcept markets Korlym, a glucocorticoid receptor antagonist that is indicated to control hyperglycemia associated with Cushing’s syndrome.

Heartbeat helped develop a solution for patients to know whether their Cushing’s disease was returning after surgery. An app helps these patients track their symptoms, and they can use the information gathered by the app to have a conversation with their doctor. Besides the app, the Website also contains links to a Facebook page and a way for patients to share their stories.

“It’s been very successful in identifying and being an aid to patients who really are trying to understand what is the exact state of their disease and what other types of therapeutic options they may want to consider,” Drummy says. “So it’s all unbranded, which is what we were saying in the earlier part of the conversation. But it’s really focusing on how can we add value to the conversation between the patient and the doctor.”
According to von Plato, if pharma marketers don’t start shifting the message to health and wellness issues, other markets will claim that message.

“I’m seeing non-pharma brands all over wellness,” she says. “I’m seeing McDonald’s all over wellness, I’m seeing insurance companies all over wellness, I’m seeing K-Mart and Walmart and everybody is getting into this.”
The Affordable Care Act with its incentive-aligned issues is driving many industries and companies to become part of the solution, even if they were part of the problem, von Plato says.

“The danger in that for pharma is that the skillful storytelling and marketeering that goes on in other categories, they’ll claim health and wellness right out from under the pharmaceutical industry, which has every right and reason to be a beacon for promoting health and wellness,” she says.

O’Neill indicates the success Nike has had with its fitness devices and apps. “If you think about the Nike Fuel or Nike One or some of these other programs, they’ve created a role for the brand itself both in the context of fitness, in what the word fitness means to people,” he says. “This device becomes part of a much bigger or ongoing relationship than just a brand purchase or anything like that. It’s how integrated into their care system, the opportunity within healthcare, and some of the consumer products that have succeeded.”

Von Plato points to a “beautiful” campaign done for Special K cereal. “It’s about numbers and women, how we’re taught to measure everything like our weight, our body fat, our calories, our bra size, and it’s another take on real beauty. But it’s such a beautiful, emotional women’s health ad and at the end of it, it’s from Special K. And Special K, I bet the lifetime value of a customer to Special K is $50. I mean, how many boxes of Special K can a person eat?

“And the lifetime value of a customer for someone who’s being treated for diabetes, hypertension, depression, is tens and tens of thousands of dollars,” according to von Plato. “But this territory of wellness and well-being and taking care of ourselves and the virtue of health over wealth, the value system that says being healthy is important, it’s important as being wealthy, it’s important as being employed, it’s important as being successful ... but I think as other things in our world change, we’re going to have to evaluate our own ability to take care of ourselves and these other marketers are going to get in and take it right out from under us.”

Posted: December 2013


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