Ensuring Profitable Patient Adherence Programs (mini)

Ensuring Profitable Patient Adherence Programs: Using Analytics to Release the Hidden Value in Brands
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Overview
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Companies miss a valuable opportunity to increase sales and market share by not adding more focus on keeping their existing customers

Pharmaceutical companies spend nearly 97 percent of their marketing budgets to capture initial market share.
Since the majority of spend goes towards attracting new consumers, efforts at retaining existing customers are given short shrift, with a paltry three percent of budgets. By focusing exclusively on new customers, companies are missing a valuable opportunity to increase sales and market share.
Pharmaceutical companies can no longer ignore the hidden value available by increasing patient adherence. Today, an estimated 70 percent of patients who begin a Pharmaceutical therapy discontinue it within 1 year, even those with chronic conditions that require ongoing treatment or those taking chemotherapy to prevent cancer recurrence. This costs the global Pharmaceutical Industry an estimated $30 Billion a year.
Put another way, increased adherence for a product with approximately $1 Billion in sales would translate to an additional $30 to $40 Million in annual revenue. In addition, since it costs six times more to attract new patients than to retain current patients, increasing the focus on, and yields from, adherence means additional money saved and earned.
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Companies who implement strategies to increase adherence and persistence with their products can better face the numerous challenges in today’s market, and increase their share of profits.
But how does a company even begin? In this report we look at the formidable barriers Pharma companies face in improving adherence, elements of successful adherence programs and methods for ensuring the best ROI.
Overview
In this report we look at the formidable barriers Pharma companies face in improving adherence, elements of successful adherence programs and methods for ensuring the best ROI.
For the full report, please visit: www.eularis.com or email us at contact@eularis.com

Barriers To Improving Adherence
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Adherence programs are doomed to fail unless organizations also evaluate and overcome existing barriers to their success

While developing patient adherence programs is admirable and necessary, these programs are doomed to fail unless organizations also evaluate and overcome existing barriers to their success. The biggest barrier? A perception that a focus on patient adherence is inefficient and not worthwhile.
Some companies point to the rather small gains made with these programs. One evaluation of 61 studies on a variety of efforts to improve medication adherence noted an overall increase in adherence of just 4 percent to 11 percent.
It also noted that no single strategy appeared best. That leaves way too much uncertainty for what many see as not enough return.
It also leaves an inability to explain to stakeholders outside the Industry how patient compliance is important and valuable.
Significant barriers to employing a successful patient adherence program are also found in the organization of Pharmaceutical companies and the greater Industry.
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This includes the short life cycle of brand managers, the short-term focus of marketing teams, the siloed organizational structures of Pharma companies, government regulations on patient privacy, and stock market pressures on Pharma. Other barriers to instituting patient adherence programs come from the very nature of adherence as it exists today:
A lack of understanding of the drivers behind non-adherence and the barriers to adherence. The complex nature of non-adherence is baffling to many researchers, and overwhelming to companies.
Lack of measurement standards. Since there are so many different methods of measuring patient adherence, all with limitations and issues, there is no gold standard. More reliable, exhaustive and standardized data could help support the push for improving patient adherence. However, in the meantime, the lack of easy measurement is discouraging to companies. These intrinsic problems when it comes to measurement lead to what may be the most pressing concern when it comes to patient adherence programs: proving overall return on investment.

Companies perceive ROI for these programs to be impossible to demonstrate or, at the least, lower than patient acquisition programs. How do we bypass these barriers and convince management of the need for adherence programs? One of the best methods to gain support is by demonstrating the costs of starting a program and the costs of waiting. A patient adherence program is a win-win for all involved. For patients, Physicians and payers, it improves outcomes at lower cost. For the company, it improves market share and revenue at lower cost. Alternately, the cost of waiting to implement the program sometime in the future means wasted opportunities and sinking revenues. The juxtaposition of these concepts can win over brand managers and company members.
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Elements of Successful Adherence Programs
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Remember that patient adherence programs are not ‘one size fits all’ approaches

The first step to any successful adherence program: Pharmaceutical companies must realize and remember that patient adherence programs are not ‘one size fits all’ approaches. They must be implemented after a complete understanding of the underlying reasons for patient non-adherence and with a firm grasp of their potential impact on the brand’s financial results and market share.
The over-arching focus for a successful adherence program should be on increasing brand value, both for the patient and for the corporation.
APPROACHES THAT DON’T WORK
Finding success with patient adherence programs is possible. For many companies, however, improving patient adherence has been a matter of trial and error, and has involved learning from mistakes.
Things that most companies and managers agree are not working in adherence programs include:
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One size fits all’ approaches. Adherence differs from patient to patient, so programs designed to improve adherence must be flexible and customized for a specific brand’s patients.
Expecting others to do the work. Buy-in by all members of a team is absolutely crucial, as is accepting responsibility for each member’s tasks.
Nagging direct mail reminders. Too much of a good thing hinders rather than helps. As we will discuss later in this chapter, direct mail can serve as a useful method to encourage adherence, but not when it comes too frequently. Also, impersonal direct mail is a big no-no.
One-way communication. A two-way dialogue is critical to improve patient adherence, where patients can express their needs and desires along with Pharma companies.
Big ideas without execution. A lack of follow- through and smart implementation for patient adherence programs doom them from the start.
Complex technology. Programs that use technology too complex for team members to understand will only discourage participation and continuation. Alternatively, if the technology used for patients is too complex, the company will not only lose the chance of improving adherence, but probably lose the customer as well.

APPROACHES THAT WORK What are the approaches that can improve adherence? Common methods that have been found to increase adherence, alone or in combination with other approaches, can be categorized into four areas: changes to the drug, technology, a focus on patient perspective and a focus on the physician. 1. Changes to Drug
Cost-related approaches
Packaging
Delivery options and dosing regimens 2. Technology
Electronic medical records (EMR)
SMS
Call Center Support
Brand Websites
Providing reminder systems 3. Focus on Patient Perspective
Patient education
Direct-to-consumer advertising
Patient assistance programs
Drug discount loyalty card programs
Changing patient beliefs
Involving family members
Patient experience programs 4. Working with Physicians and Medical Staff
Reminder Systems
Pharmacy interventions
Training physicians
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Conference participants at the 2004 EyeforPharma Conference on adherence programs described components that companies should incorporate to ensure the success of such programs :
Design programs from the end-user perspective
Understand the research
Clearly identify patient groups to target – not individual patients
Design program algorithms and conduct surveys upfront
Include two-way communication with patients
Include ongoing assessments as part of program evaluation
Communicate brand successes across the organization
Involve cross-industry expertise who can provide the continuity required for quality
Execute in partnership and/or in concert with other Healthcare providers
Utilize PA’s/NP’s/Nurses to manage programs In addition, companies should also work to make ROI evaluation simple, comprehensive and easily demonstrable. Developing a standard framework for ROI evaluation, as well as for ROI measurement across brands, are key steps.
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Return On Investment
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One of the inherent problems with patient adherence programs is difficulty in obtaining and demonstrating ROI

Mentioned earlier, one of the inherent problems with patient adherence programs is difficulty in obtaining and demonstrating ROI. This makes many companies leery of making the effort to focus on adherence.
What’s critical to remember, and to continually remind all team members and stakeholders, is the additional prescriptions that could be realized through an adherence program.
For instance, consider the use of a cell phone reminder system. Even if only 6.5 percent of a patient population participates, increasing their adherence rate from the typical 40 percent to 85 percent for a drug that generates 2 million prescriptions a year at a cost of $80 a month could lead to increased revenues of $45 Million.
If the intervention costs $5 per patient per month, then companies could realize an ROI of 300% to 600%.
Since ROI standards vary widely, proponents of patient adherence programs often have trouble finding evidence to support their initiatives. Most published reports of ROI with medication adherence programs focus on overall medical costs.
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One program assessed the cost-effectiveness of a collaborative care program for patients with depression, finding a significant clinical improvement for a moderate additional cost.
The collaborative care included patient education, an initial visit with a consulting psychiatrist, shared care between the psychiatrist and primary care physician, and monitoring of follow-up visits and adherence to medication regimen. Patients receiving the collaborative care experienced an average of 16.7 more depression-free days over 6 months, resulting in an incremental cost- effectiveness of $21.44 per depression-free day.
Another successful approach involved changing a drug delivery system. A study comparing adherence in patients using an insulin pen found the pen not only improved overall medication adherence, but significantly reduced total annualized health care costs ($14,857.42 vs. $31,764.78; P < 0.05) thanks to reductions in hospitalizations and outpatient costs.

However, an adherence program comparing the use of the MEMS system with usual care in 253 hypertensive patients with poor adherence found no significant difference in cost or clinical outcomes, likely because memory issues were not the underlying reason for non-adherence.
Ensuring your patient adherence program gets good ROI is about planning. It’s about understanding where the problem is and how much financial impact it has. It’s about establishing the means and methods of testing ROI continually, providing support for those guiding the project over the long haul, and it’s about the right support through powerful tools.
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Concrete Tools
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Examine the use of powerful analytic
tools for a patient adherence program

Disentangling, identifying and quantifying elements of adherence can be difficult to say the least. So can calculating the optimal approach. However, it is easier and more successful with sophisticated analytic tools. The Eularis Analytics System simplifies the process, encourages buy-in across company and eliminates anxiety. The winning approach involves a two-stage process. The stages work to concretely and accurately examine adherence ROI, use the data to predict the impact non-adherence has on the brand, and identify the root cause of non- adherence as well as potential interventions. The approach allows companies to:
Understand how adherence issues influence Physician prescribing patterns
Quantify the impact of the adherence on the brand
Identify rational and emotional aspects that assist or hinder patient adherence
Identify adherence programs that will provide the greatest effect on a brand’s market share
Quantify the potential prescribing impact of such adherence programs alone or in combination
Clarify the optimal mix (and budget) of adherence activities to maximize growth
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The first phase focuses on Physicians, the second on patients. Each involves four steps:
1.Evaluate existing promotional elements and the market environment. Research is conducted with target Physicians/patients common to several similar brands around areas such as messages, activities, environment, emotions, etc. For instance, with Physicians this includes product messages, sales representative detailing, detail aids/ visual materials, communications and promotional activities, sentiment, key influences and formulary issues.
2.Validate influences on Physician prescribing & patient adherence. The current cause/effect relationship is measured within multiple media using multiple regression analysis.
3.Incorporate predictive algorithm analytics and dynamic modeling. Key financial metrics (sales/market share and promotions spend) are used to quantify the cause/effect relationship within multiple media in combination and alone. Then, a planning tool is developed that uses “what if” scenarios to allocate promotional investments.
4.Analyze. In this step, all models are analyzed and all implications verified. Thereafter, conclusions are developed and brand-specific recommendations made.
Concrete Tools

Concrete Tools
With Physicians, those factors with the greatest influence on prescribing behavior are identified, the influence of adherence on prescriber behavior is assessed and the impact of adherence for the individual brand is quantified. With patients, the impact of the various components of adherence (rational and emotional, non-intentional, etc.) are quantified; the impact of existing adherence programs is evaluated; the more effective adherence program is determined; future performance based on these assumptions is forecast. This stage examines several intersecting areas that impact patient adherence and identify the relative importance of each:
Product attributes
(e.g. efficacy, side effects, dosing, etc.)
Moderating factors
(e.g. affordability, Physician communicating its use, ability to fill the prescription)
Non-intentional non-adherence
(e.g. forgetting to take the prescription, going away and forgetting to bring medication)
Available adherence programs and their effectiveness
Emotional factors
(e.g. patient feels better, wants to try non-drug alternatives, is asymptomatic so don’t feel they need the medication)
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Case Study
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Highly successful brand in chronic illness therapy
area where patient adherence was a major issue

The best way to explain the benefits of this approach is with an actual case study. Brand X was a highly successful brand in a chronic illness therapy area. However, patient adherence was a major issue for the brand, as it is for many chronic illness therapy areas. To assist with this, the company implemented a patient adherence program including SMS reminder programs, Web sites and patient experience programs. However, the patient adherence rate was relatively unchanged. In January 2006, the Client approached Eularis for assistance.
Figure below depicts the brand’s market position for Physicians at the time of the first analytics in January 2006. This graph shows that the brand was in overall good shape with the Physicians, apart from the perception of the patient compliance and the dosing regimen.
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Case Study

Case Study
Figure below shows the results of the stage 2, or patient, analysis.
This shows that the brand team was aware the patients were non-adherent and had put significant energy into short message services (SMS) reminder programs to increase adherence (shown in red). However, these programs were not having the desired impact, making it clear that they were not the appropriate approach for this brand. It also shows that emotional factors were the primary reason patients were non-adherent with this brand – not unintentional adherence, for which reminder programs like SMS might have been more appropriate. It is clear from the graph that the only intervention that was impacting adherence was the patient experience program (in green). In fact, such programs had helped increase adherence by almost two percent.
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Case Study
After this analysis, the company:
Refocused on key messages, including those around adherence, to increase scripts from Physicians who felt patients would not adhere to the prescription
Refocused sales representative training and promotional programs in the areas recommended by the analytics
Implemented patient-directed adherence programs that had the greatest potential increasing adherence rates
Reallocated its efforts to focus on those adherence factors identified in the analytics Following implementation of these changes, the results were measured again in July 2006. The results can be seen graphically below. The decreased spend on SMS reminder programs can be clearly seen, in addition to the increased spend in patient experience programs. The emotional factors underlying non-adherence were also vastly improved along with the actual adherence. However, an unexpected and pleasant surprise also awaited.
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Case Study
The figure below depicts the market share for this same brand six months after Eularis’ intervention. Market share had increased 2.2 percent and Physician perceptions about adherence as well as patient adherence itself improved.
By utilizing the sophisticated power of Eularis’ Analytics System, the company was able to find the patient adherence program appropriate for their brand and their customers. The results were increased adherence and market share, a significant ROI.
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Conclusion
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The opportunities to improve adherence
are many

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Conclusion
Adherence to prescribed medication, particularly for long-term therapies, poses a tremendous challenge to the world’s Pharmaceutical companies. While the reasons behind non-adherence are complex, the opportunities to improve adherence are many. Pharmaceutical companies have the power to increase market share and brand revenue by developing and implementing patient adherence programs. Creating the optimal program that increases company financial success (and improves clinical health outcomes) can be complicated. However, with an understanding of adherence issues, careful planning and the use of powerful analytic tools, brand managers and team members can eliminate anxiety and uncertainty, and find success through high ROI.

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