Healthcare Dynamics Model: "Go with the (patient) flow"

Historically, the focus on understanding healthcare choices through research with physicians and other healthcare professionals was a strong approach to healthcare marketing research. In the evolution of healthcare systems, for many patients, their physicians are no longer the sole influencers of brand choices.

Pharmaceutical marketing has broadened in its scope so that efforts are made to achieve effective marketing across all relevant stakeholders. By way of example, in the current environment, the decisional role of physicians is often combined with: patients' perspectives, caregiver concerns, pharmacists' influence, health plan decisions, and governmental policies. In any therapeutic category, for marketing research to be an effective partner in the marketing process, research tools need to provide an understanding of the relevant stakeholders and how their perspectives interact to result in the choices of brands. Physicians may wield considerable influence, but in the current environment, they are rarely making unilateral decisions.

A high level research approach that is well suited to achieve the goal of integrating the attitudes, beliefs and choices of healthcare stakeholders is to construct an understanding of the buying process that is in place for a therapeutic category. To conduct research on the "buying process" broadly refers to building an understanding of the steps which occur, over time, to result in the selection of a brand. Within healthcare, phrases such as "patient dynamics," "treatment algorithms" and "market flow modeling" have been used to describe a similar concept. The idea of following the progress of a process over the course of time is, in and of itself, not novel. From a healthcare perspective, a "case study analysis" is typically reported in terms of the sequence of events that have occurred for a single patient. Similarly "chart audits" while often focusing on a singe point in time, can be implemented in order to identify how a cohort of patients progresses through the healthcare system. The Ipsos Healthcare Dynamics Model is a systematic enhancement of these fundamental approaches to healthcare marketing research.

The Ipsos Healthcare Dynamics Model (HDM) is, at its core, a primary research methodology that seeks to build an understanding of each of the important stakeholders in a therapeutic area. Through the use of several questionnaires based on an integrated design, we achieve a multi-stakeholder, comprehensive analysis that is reflective of the sequence of steps through which healthcare is actually delivered. Since our design architecture is in place prior to the initiation of a program of research, we can achieve a flexible approach for clients. From an investigative standpoint, it may be appropriate to start with research delving into the patient's perspective and the physician's perspective on the buying process. Research with a patient and a physician cohort will have points of integration in terms of data collection, analysis and recommendations. It is common for marketers to believe, at the outset, that several stakeholder groups are impacting the treatment and brand decision process. Occasionally, it only becomes apparent after initiating the research with a few stakeholder groups that other stakeholders are important as well. The HDM approach allows for multiple stakeholders to be included in the research design and for follow-up studies to be implemented so that additional stakeholders can be merged seamlessly into the original research with additional findings and recommendations developed in a consistent context.

Core elements in the HDM approach are the: 1) Patient's experience as the organizing principle, 2) High level process steps that are frequently found in research across a range of therapeutic categories and situations, 3) Detailed analysis of process steps specific to the therapeutic category being studied and 4) Assessment of the relative impact of each of the various stakeholders. The experiences of a person who perceives that they have a health problem and then enters the healthcare system should be focused on as the fundamental building blocks of a buying process analysis. The twists and turns that patients pass through as they negotiate their way to solving their health problem are critical points to be understood and evaluated as potential leverage points for marketing. HDM research often identifies patient experiences that can be categorized as is illustrated in Figure 1. The patient perceives they have a health issue. They subsequently "originate" or enter the healthcare system and proceed to be evaluated, diagnosed and treated. Subsequent steps include the delivery of a healthcare solution, compliance with treatment recommendations and follow-up activities. Keeping these steps in mind while evaluating patients' experiences provides strong guidance, but does not produce a questionnaire or discussion guide, in and of itself. Careful inquiry, beginning with a focus on what occurs prior to officially entering the healthcare system (sensing a problem, checking the internet, etc. prior to seeing a healthcare professional), and sequentially tracing through the experiences of patients throughout their experience to a solution (which may be the control of symptoms, a cure of a condition, or leaving the healthcare system with less than what was originally sought). Using the HDM approach, the perspectives of other stakeholder groups are gathered with questionnaires that focus on the elements of the patient's experience that are known to those stakeholders (e.g. physicians can provide strong detail on office visits, but not on the reasons for origination nor the extent of compliance).

We have represented the potential for different stakeholders to have input to selected steps in the buying process in Figure 1 with the icons for each of the commonly recognized shareholders.

With the HDM data collection strategy optimally including patients reporting on their personal experiences, physicians reporting on specific patients who meet select criteria, and pharmacists, managed care decision makers, family members /caregivers, non-physician practitioners providing their perspectives on the same types of patients the full 360 degree view of the buying process is revealed. With a research design that begins with the recognition of the need for integration, findings and recommendations are focused on the key leverage points in the buying process and the stakeholders who are most important for each of them.

The analysis is exemplified in Figure 2 and Figure 3. In Figure 2, we show a fundamental analysis resulting from an HDM approach to the buying process. The horizontal bar chart shows the drop-out of patients as they pass through the healthcare system. Theoretically all appropriate sufferers are included at the starting point at the top of the diagram. A general observation in HDM studies is that as sufferers go through the sequential steps in obtaining a healthcare solution, more and more of them are lost to the system. This adaptation of an actual study shows that for a particular pharmaceutical company offering a pharmaceutical solution to a condition, only 10% of the theoretical target population is still in the healthcare system at the point where a prescription would be written.

The extent of drop-out is identified quantitatively. Figure 3 illustrates the approach for integrating the findings from multiple stakeholders. It is important to consider multiple relevant stakeholder perspectives at each step along the way in the process to identify both significant opportunities and pragmatic solutions that will optimize product/brand choice. At different points in the process, the mix of influences in decision making can change. Physicians may be dominant in determining a diagnosis and play a leading, but not exclusive role in the selection of a brand, but patients are critical to the compliance process - even though other stakeholders (physicians, caretakers, etc.) play a part. By building the linkages in the data collection phase, the analytics of the HDM provide a systematic approach to identifying the key stakeholders and the impact that each has.

Ipsos Healthcare Dynamics Model research programs usually begin with a qualitative phase that is designed to uncover both the specific steps in the sequence and the language that is used by the key stake-holders. The qualitative phase also provides insight into the range of reasons given for the various decisions made as the patient passes through the system. This qualitative learning is then used to inform the quantitative data collection phase. The steps of the process are quantified, in terms of the numbers of patients flowing through the system, the roles of the stake-holders and the importance of the attitudes and beliefs of these stake-holders. The HDM approach to the buying process is to apply a flexible design architecture that can accommodate all the steps in the healthcare system, for a wide range of therapeutic categories and stake-holders.

The signature outputs from the Ipsos Healthcare Dynamics Model include graphic representations of: the number of patients in the system at various points in the process, and the importance of the perspectives of various stake-holders. And (for some therapeutic categories), an additional option is an EXCEL based simulator which forecasts the impact of marketing initiatives on the buying process and allows for the testing of many hypothetical scenarios. These outputs provide commercial insight on the critical elements of focus for healthcare marketers. The outputs illustrate: the size of various actionable opportunities, who are the appropriate targets for marketing initiatives and how do they mutually influence the outcome of the process and finally, what tactics and messages are most likely to be effective.

For more information, contact: Paul Snyderman at [email protected]