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August 2009
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  I Think I’ve Finally Figured It Out!In my recent articles and presentations, I have written and commented on the fundamental changes in what we used to call “pharmaceutical marketing research.’’ As we saw the dollars spent on this type of research dwindle, we blamed it on the loss of patent exclusivity by many of the world’s major drugs, and the apparent inability of pharmaceutical company research and development departments to replace those drugs with new blockbusters. But there is a cause more fundamental than that. Quite simply, we are moving from an era of pharmaceutical marketing research focused on advertising and promotion to an era of health care marketing research focused on issues involved in health care reform. As I write in July 2009, the topic of health care reform at the federal level is getting as much attention as Iran, Iraq and Afghanistan. But what does the term “health care reform” mean? Many believe that health care reform at its simplest level means layering additional taxes on the wealthy and using the money to provide health insurance for the millions of Americans who do not currently have such coverage. Several flaws are inherent in this simpleminded approach. First, as the president himself has noted, it does nothing to improve the effectiveness of U.S. health care, where what we get vs. what we pay for is one of the worst deals in health care worldwide. In brief, the medical care provided in the United States is not nearly at the stellar world-leader level many of us believe it is, and nothing in the Robin Hood approach of taking from the rich and giving to the poor does anything to fix that. That’s a major oversight which calls for an organized plan to improve the quality of care, not just manipulate economics. As we have noted in prior articles, the key to improving the quality of care is not to build better doctors, but rather to develop standardized methods of care based on evidenced-based medicine. Another flaw in the Robin Hood approach is that in large part it is based on the belief that those who do not have health insurance coverage are simply too poor to purchase it. Wrong! Millions of Americans have more than sufficient money to acquire health insurance in the open market, but simply choose not to do so. Often they are young, healthy and would rather spend the money that they would have to spend on insurance premiums on other items. So Robin Hood won’t buy us full health care reform in this sense either. Up against the obstacles necessary to overcome in the implementation of genuine health care, I find it fascinating that there is so much emphasis in getting health care reform passed in a matter of weeks. Clearly, this concept has been a political football for years, and if President Obama cannot get something meaningful done on a timely basis, his popularity, which is already beginning to fall in some camps, will take an even deeper hit. I honestly saw a bumper sticker recently that said “I Was Anti-Obama Before It Was Cool.” So what does this mean to the researcher charged with helping health care companies and others chart a course toward genuine health care reform? One outcome toward which we seem to be moving is a situation where consumers will have the choice between buying health insurance from one of the commercial insurers or from the federal government. Without a doubt, millions of dollars in marketing research funds will be spent on researching the most attractive plans to the average consumer, on segmenting the marketplace and in determining the best ways to communicate the benefits of individual plans to potential purchasers. A situation in which the federal government is one of the players in a field made up primarily of commercial insurance companies will, no doubt, make for a highly competitive arena, with much marketing research being conducted to determine the knowledge, attitudes and practices of those who have purchased health care insurance, those who are contemplating purchasing health care insurance, and those who currently have no interest in purchasing health care. Their receptivity to various attributes and benefits of policies will be carefully studied, with a major wild card developing here in terms of how well the perceived safety of doing business with the federal government will compete with the images, already being promulgated, of bureaucrats making decisions that should rightfully be made by the physician and his patient. As an industrial psychologist by training, I am fascinated by the research that will need to be conducted, and the interventions that will have to be made, in order to get physicians, who are used to going about their day-to-day work on a largely self-directed basis, to transition over to a more orderly, effective, efficient system, complete with standard operating procedures, electronic patient records, etc. Clearly, polite requests for them to move in that direction will not suffice, and some combination of a carrot-and-stick approach will be needed to accomplish this outcome. On a different but related topic, virtually everything that is done in the practice of medicine and all the behavior of manufacturers that service the medical profession will need to be changed to reflect the new paradigm. In taking part recently in a workshop on product positioning conducted by a major pharmaceutical company, I reminded the participants that in years gone by we used to think in terms of positioning our products with the idea of getting greater market share. With medicine moving from being intuitively based to being precision based, and with standard operating procedures being developed to treat various conditions, we are now finding ourselves positioning our product for inclusion in these SOPs, with failure to do so leaving us out in the cold entirely. Other mainstays of pharmaceutical marketing and marketing research practices will also either be modified or done away with as genuine health care reform kicks in. There is little purpose, for example, of conducting an expensive, large-scale physician segmentation study if our ability to communicate with physicians is limited and they are all following the standard operating procedures for treatment interventions in any event. Needless to say, the stakeholders we study will no longer be restricted to the physician. Already, nurse practitioners (such as those who staff MinuteClinics) are being studied by some of our clients as to how they make decisions in this new kind of medical environment. Patients, who have long been viewed as the target of DTC in order to get the first prescription, are now being viewed more holistically, with emphasis being placed on drivers to seek treatment, stay with the therapy once initiated, etc. Ethnography and other anthropological techniques are being actively employed to gain information on these important issues, since if we can’t win market share in a standard therapy environment, at least we can make sure that the patients we actually do get remain on their medications for as long as appropriate. Perhaps the most fundamental kind of health care reform requiring our research services will be a determination of how to get patients to take better care of themselves, since wellness is clearly less expensive and more generally desirable than sickness. How we educate and motivate patients to live more healthfully will, without a doubt, require a great deal of in-depth research. Any discussion of health care reform would be incomplete without consideration of who is going to allocate health care once it is reformed. Surgical procedures, radiation therapy, chemotherapy, etc., all require large expenditures, and whether they are “worth it” under particular circumstances is highly dependent upon whether it is my life that might be preserved, or at least lengthened by the use of the therapy, and upon the public’s perspective of how health care dollars should be apportioned. In the end, make no mistake about it. Health care reform is not only a hot political issue but is also going to represent, no matter what form it takes, one of the greatest tipping points in recent years. And as health care marketers and marketing researchers, we will play a significant role in determining its course. 
Richard B. Vanderveer, Ph.D. CEO, GfK Healthcare 
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