Gregg Fisher

Global brand and commercial organizations (including pharmaceutical companies and their supplier partners) are making investments in building next-generation patient support programs (PSPs). These programs integrate modern digital, data, and behavior science techniques to differentiate brands in a competitive environment, while improving adherence and supporting patient outcomes. But, too often, these programs struggle to realize their promise because of underwhelming patient and health provider enrollment. Our pharma clients involved with innovation of patient support programs, routinely cite patient enrollment as a top unresolved challenge.

This enrollment challenge is especially difficult for patient support programs that aim to provide value beyond the medicine to support disease management or adherence, versus patient support programs that patients must participate in to access or use the product, such as co-pay assistance programs.

Potential solutions to the enrollment challenge are influenced by many factors, including therapeutic area, lifecycle stage, competitive outlook, country-specific market constraints, and corporate culture. While no silver bullet exists, experience has helped in defining the following six critical success factors for driving enrollment in PSPs.

1. PSPs must deliver compelling value and address a real unmet need

Healthcare providers (HCPs) only recommend PSPs if they see clear potential for it to make positive, tangible differences to the way they care for patients, and the way patients care for themselves. The same goes for patients. Unless PSPs help them improve the way they live with their condition, they are unlikely to enroll or stay engaged. Too often, assumptions are made about unmet need, and little regard is given to options currently available to address the issue.

Pharmaceutical PSP teams should consider two questions: “Is this a burning need that, if not addressed, the patient will have limited success with therapy?”, and “Is there any existing support that our PSP would be competing against?” Recognize that the competition to a pharma PSP program includes not only other drug companies, but also support provided by a growing number of third-party content and service providers. Examples of such third-party support outlets are niche digital health solutions and online disease social networks.

In-depth research will help one understand the scope and shape of the problem faced by prospective PSP users, be they the patient, caregiver, nurse provider, or consulting physician.

: Run co-planning sessions with patients and providers to prioritize pain points. Perform competitive analysis to understand the solutions landscape and identify potential partners.

2. Integrate PSP messaging into brand strategy, value messaging, and communications

Pharma teams put significant effort and spend into brand strategy, value message development, marketing, and communications focused on the product launch, but similar attention is not paid to PSP messaging. If PSPs aren’t prominently factored in as part of strategic launch planning, companies could be missing a golden opportunity. PSPs should be an integral part of the messaging architecture and align with value messages.

PSPs should be prominent in the creative assets and communications materials at launch—or shortly thereafter—to help HCPs and patients appreciate the benefits of a new therapy and the accompanying support being offered.

: Create a comprehensive PSP enrollment strategy prior to launch.

3. Target the right audiences with a combination of face-to-face and non-personal

Understand who, besides the physician, has responsibility for supporting patients. Promotion of any PSP should factor in communication with the wider clinical team, including nurses, nurse educators, and pharmacists.

Sales reps often don’t have the time to integrate PSP messaging into a sales call. Therefore, consider having small teams of virtual reps whose sole focus is reaching out to the wider clinic to talk about patient support. Focusing on the staff that directly engage with patients is important and can be done affordably. Depending on the number of clinics and the therapy area, as little as one person per market can be sufficient and will make a big difference to patient enrollment.

While face-to-face engagement is the anchor of successful enrollment, do not assume that conversations alone will draw patients into your PSP. Ensureinfluential members of care teams have the right materials and opportunities to actively engage the patient with your program.To raise and maintain awareness of PSPs, consider a mix of peer-to-peer educational events, key opinion leader (KOL) speakers, testimonials, webinars, and rep-generated emails. Finally, do not assume a digital-only approach is a silver bullet, as digital channels may struggle to drive enrollment unless they form a part of a more integrated channel mix.

: Create an enrollment targeting strategy. Create a multi-channel enrollment plan for your PSP.

4. Simple enrollment at the point of care (POC) creates sticky engagement

Enrolling patients at the POC makes practical sense. This is a time when clinical teams can give influential endorsement and spend time answering any questions. Make sure all areas of the PSP are well covered, but not too onerously described, since there is a chance that patients can forget part of what is discussed in a clinic. Providing scripted guidance, information leaflets,brochures, and support materials that allow care teams to readily share the benefits of the PSPs helps secure initial patient enrollment and longer-term engagement.Reinforcing the “what’s in it for me?” in follow-up materials and ongoing care team discussions keeps patients engaged.

To make the process of onboarding more seamless and effective, encourage the nurse to initiate the sign up at the clinic. Then, create a link from the clinic to enable at home sign-ups. For example, QR codes on support materials or sample products allow people to connect directly to information on their phone and quickly fill in any required forms. Also, trigger email reminders to extend engagement beyond the clinic. Reminders should provide reassurance and simplify the sign-up process. Making the process as simple as booking a table at a restaurant or buying goods online can be the difference between patients signing up or not.

: Map enrollment flows and patient experience.

5.Co-create and partner with patient influencers and advocacy groups

Many patients look to national and international patient advocacy groups for information and guidance on managing their disease/condition. These groups have access to very specific, and sometimes niche populations. They understand the lived experiences of these populations. Genuine and compelling value can be revealed through direct engagement withpatient organizations, either as part of the development of a PSP or through the co-creation of one. Shared ownership of PSPs can solve enrollment issues, as the endorsements of patient advocacy groups create awareness and credibility with patient groups. If you are looking to run a PSP in a particularly rare or difficult-to-reach population, consider running webinars and/or providingsimple brochures or tools to the relevant patient organizations. Similarly, patient online influencers can play an important role in creating patient awareness of PSPs.

: Explore patient advocacy and influencer partnerships.

6. Monitoring helps drive the evolution of PSPs

To demonstrate that your PSP is delivering value, whether to support resource investment or to showcase your PSP to external customers, you will need to build in processes that allow you to assess and measure the success of the program rigorously and continuously. Such monitoring helps to support decisions concerning the PSP by providing insight into how many people were made aware of the program, how many were trained on it, how many received materials, and what proportion of patients were offered the program and consequently signed up. It also lets you see the percentage of patients that may have fallen out, and then explore ways to recapture the attention of these audiences.

In some instances, especially if you have little experience running PSPs, it might help to run a pilot program to identify unforeseen blockers, determine enrollment drivers, understand how scaling works, and clarify operational efficiencies.

: Develop a measurement plan for each PSP.

Finally, a bonus step for PSP change agents and innovators at pharmaceutical companies: Don’t forget the importance of ongoing education in developing more innovative and impactful PSPs. Frequently, brand teams view PSPs as a “tactic” or a “marketing expense” rather than as a “product” or an “investment” requiring careful planning, promotion, and maintenance. When the organization adopts this limited view of PSPs, it often shows up in the limited enrollment and usage the program generates.

The factors articulated in this article can help you avoid this fate and deliver a program that brings real, differentiated value to patients and providers, which can be measured in healthy enrollment.

Gregg Fisher is managing partner of The Stem, a global networked consultancy specializing in customer engagement and digital transformation in the life sciences sector.

Articles

Although there is no ‘one size fits all’ solution, the process is influenced by factors such as lifestyle stage, competitive outlook, and market constraints.

Six Steps to Driving Patient Support Program Enrollment 

 digital media environment, with social media and other forms of online communication exerting influence equal to (or greater than) traditional media, digital communicators are rising in importance. From this, it follows that the “digital opinion leader” (DOL) should be taking his or her place alongside the traditional “key opinion leader” (KOL) in thinking about market outreach. This article will introduce the DOL concept, the opportunity for life sciences managers to leverage this important group, and a process to identify and engage with DOLs.

The DOL is an influential member of an online community to whom others turn for advice, opinions and information. Their influence flows from their reach within a community (how many followers they have), their resonance (how much their content is shared) and their relevance (how relevant their content is to a particular objective). In the medical world, DOLs include clinicians exchanging opinions on therapies, discussing presentations from medical conferences, and sharing practical advice on disease and patient management. In recent years, DOLs with professional backgrounds have converged around Twitter as a medium for publicity and public discourse, particularly around major medical conferences, while simultaneously turning to closed healthcare provider (HCP) platforms for peer-to-peer discussions.

In the patient world, DOLs include patients, caregivers and patient groups. Health bloggers and so-called e-patients taking an active role in their healthcare have amassed large online followings. Patient DOLs utilize a variety of online channels and, notably, are not beholden to a single medium, but continue to experiment with new channels, such as Instagram or Periscope.

“Key Opinion Leader (KOL) management” has been a staple of life sciences business strategy for decades. Commercial and medical teams routinely identify and engage KOLs for tasks such as research, publishing or speaking. Currently, DOLs and KOLs exist in largely different universes with little overlap. Typically, less than 20% of KOLs will also have a social media presence and just a handful will rank alongside DOLs in terms of online reach.

By properly involving DOLs in the creation of programs and by regularly sharing with them, life sciences communicators have a built-in megaphone that can expand the authenticity and reach of their messages, as DOLs willingly amplify messages across their social networks.

A process to identify and engage with DOLs

The first step to successful DOL engagement is to know who they are. Identifying DOLs requires approaches that depart from traditional influence mappings that scan through PubMed records and tally peer recommendations. It may be tempting to match existing internal KOL lists with digital profiles, in hopes of finding KOLs with a blog or Twitter account, but this exercise will only reveal a portion of the DOL universe and will miss HCPs who don’t have a publication record, but have built strong reputations among online audiences, as well as numerous new, non-medical influencers, including e-patients.

We highlight three steps to identifying DOLs in the healthcare space:

Social media analytics tools offer unprecedented opportunities to map influence across disease areas. Silicon Valley tech executives like to speak about the “social graph” in referring to the network of connections and relationships between users. Mark Zuckerberg, CEO of Facebook, has frequently touted the social graph as “changing the way the world works.” Facebook and other networks keep most of this information for themselves, accessible only to their internal advertising and content teams, but portions of the data are also made public and allow detailed maps of entire online health communities to be generated.

In a given disease area, the online community of interest will consist of several hundred active members, who have each contributed in some form to the discussion around the disease. Silent followers or lurkers will number 10–20 times the size of the active community. In certain high-interest disease areas, such as breast cancer or multiple sclerosis, the community will be even larger, with many thousands of active members and hundreds of thousands of followers.

Many health influencer projects have failed by neglecting to understand the communities they are seeking to influence. A list of influencers based on followers or some variation of a Klout Score is a shortcut that results in lists of names with no clear context of the greater online community of interest and, most likely, will gather dust in someone’s desk drawer.

Knowing your customer is vital in the healthcare industry, both from a regulatory and planning perspective. A DOL who is also a physician must be treated differently from a DOL who is a patient or an accredited journalist, even though the subject matter and online audiences may be very similar. Influencer tools designed primarily for non-health industries rarely consider this requirement and measure influence without particular concern for the background and profession of the DOL. A good consulting partner will bring databases and segmentation models that are customized for life sciences needs.

A DOL with a massive following does not necessarily represent the best opportunity—a subject matter expert DOL may attract a small, but important audience of specialist followers. It's vital to seek out DOLs with interests that align closely to business objectives. For example, in the case of a pharmaceutical company launching an innovative drug, DOLs with a track record of contributing content around new therapies in the relevant disease area would be potential targets.

All the work that has been done to understand the online community of interest is now used to identify and prioritize DOLs that are both relevant and likely to engage with brand or company objectives. Second- and third-tier influencers that would have been passed over by simple “top influencer” lists may now reveal themselves to be the ideal partners. Detailed profiles of individual DOLs should be generated at this stage, providing insights around favored topics and preferred channels, but also uncovering specific areas of opportunity for engagement.

Many life sciences companies have some experience engaging with DOLs. Unfortunately, most of these projects have failed to drive impact. Common reasons include identifying influencers but not taking steps to engage, lack of clear internal guidelines for engaging with DOLs, focus on one-off activities versus sustained relationship building, failing to find mutually beneficial projects, and unclear roles and responsibilities. In many cases, life sciences firms don’t have the expertise in-house to carry out a DOL program from end to end.

We offer three tips for pharma leaders who wish to maximize the opportunity:

 to both DOLs and the life sciences firm. Stay away from single-brand promotional projects. Focus on franchise building, disease education, patient support, clinical trial, services provision, and other projects that are patient or provider-centric.

 DOLs are most attracted to a mutually beneficial relationship that grows over time. Most are not interested in one-off meetings or summits. The more a life sciences firm invests in the relationship, the greater the payback in terms of influence. The smartest companies think about how to integrate DOLs into their strategy and tactics over time.

DOL engagement represents a new capability for life sciences firms and with that come a host of organizational considerations including role definition (who owns different DOL relationships), process (how can we engage DOLs offline and directly through social media), regulatory (what are rules of the road for DOL engagement), and data management (how will we integrate DOL profiles into our CRM databases). The most mature organizations create standard processes for DOL engagement so the activity can scale.

The above steps require an intricate knowledge of digital data sources, along with a solid understanding of the disease area in question and pharma regulations. For pharma companies without in-house expertise, a partner with both the analytics and consulting capabilities would be ideal to ensure DOL research is fully linked to business strategy.

Gregg Fisher is Founder and Managing Partner at The Stem (

). Gregg is a thought leader with more than 20 years’ experience at the intersection of strategy, marketing and technology. He is passionate about reinventing healthcare customer engagement through technology; this has been his primary focus as a consultant, executive and speaker over the last 12 years. He can be reached at gfisher@thestem.com.

Kevin Michels-Kim is a lead social media analyst at The Stem. He is also a partner in Merakoi, a social analytics firm based in Basel, Switzerland.

Like traditional thinking about key opinion leaders (KOLs) in healthcare, consider the DOL as part of a marketing campaign

Digital opinion leaders (DOLs) and their role in pharma markets

 their digital marketing sophistication, one channel that frequently remains an afterthought is: the Digital Opinion Leader (DOL).

DOLs are influential members of an online community to whom others turn for advice, opinions and information. Their influence flows from their reach within a community (how many followers they have), their resonance (how much their content is shared) and their relevance (how relevant their content is to a particular objective). The DOL is a new player in healthcare, born out of social media and technologies that didn’t exist until a few years ago. Their distinguishing characteristic is their use of social media to either create or amplify messages.

Few DOLs begin with the intention of becoming an “influencer;” most turn to the online world out of necessity: to seek advice, accomplish a task, share information or connect with others. Consequently, health DOLs are a varied bunch, ranging from healthcare providers and researchers, to patients and caregivers, to journalists and investors.

In the medical world, DOLs include clinicians exchanging opinions on therapies, discussing presentations from medical conferences, and sharing practical advice on disease and patient management. A further group of researchers and academics are exchanging knowledge around models of disease understanding and the implications of the latest studies.

In recent years, DOLs with professional backgrounds have converged around Twitter as a medium for publicity and public discourse, particularly around major medical conferences, while simultaneously turning to closed healthcare provider (HCP) platforms for peer-to-peer discussions. In the patient world, DOLs include patients, caregivers and patient groups. Health bloggers and so-called e-patients taking an active role in their healthcare have amassed large online followings. Some have leveraged their influence to form nonprofits, online media companies or patient associations. Traditional patient groups have also joined the fray, seeking new ways to reach audiences with their missions and messages.

Patient DOLs utilize a variety of online channels and, notably, are not beholden to a single medium, but continue to experiment with new channels such as Instagram or Periscope.

“Key Opinion Leader (KOL) management” has been a staple of life sciences business strategy for decades. Commercial and medical teams routinely identify and engage KOLs for tasks such as research, publishing or speaking. Patient advocacy teams regularly partner with patient associations or support groups on mutually beneficial projects. Few industry executives question the value of these activities.

Yet, few firms have adequately responded to the rise of the Digital Opinion Leader. DOL identification efforts tend to be fragmented and often fail to yield a repeatable process that can generate rich and actionable profiles. DOL engagement is often constrained to one-off projects, such as blogger summits, versus a sustained, continuous process of relationship building. The lack of clear organizational roles and guidelines within life sciences companies also limits potential impact. This is unfortunate because the emergence of the DOL is a force multiplier for life sciences peer-influence programs. A traditional KOL may have influence in terms of the articles written or the conferences at which they speak, but only a DOL has the outsize reach made possible through social media. Currently, DOLs and KOLs exist in largely different universes with little overlap. Typically, fewer than 20% of KOLs will also have a social media presence and just a handful will rank alongside DOLs in terms of online reach.

By properly involving DOLs in the creation of programs and by regularly sharing with them, life sciences communicators have a built-in megaphone that can expand the authenticity and reach of their messages, as DOLs willingly amplify messages across their social networks. Engaging with DOLs involves mapping online communities of interest, identifying and profiling DOLs within those communities, and then engaging with them.

The applications of DOLs to life sciences firms—specifically in achieving communication objectives—are extensive, from early research to commercialization on both the medical and patient sides. Examples include using DOLs for clinical trial recruitment, for disease perspectives, on advisory boards to shape education and support programs, for feedback on marketing messaging or tactics, as peer-mentors for patient support programs, judges for contests, as amplifiers of disease awareness, patient motivation messages, and patient support content and tools.

Gregg Fisher is founder and managing partner at The Stem (

). Gregg is a thought leader with more than 20 years of experience at the intersection of strategy, marketing and technology. He is passionate about reinventing healthcare customer engagement through technology, and this has been his primary focus as a consultant, executive and speaker over the last 12 years. He can be reached at gfisher@thestem.com.