Always Question the World Around You

By Riagan McMahon, Guest Blogger

Riagan McMahon was nominated to participate as a National Youth Correspondent, representing Saratoga Springs High School and New York State, in the Washington Journalism and Media Conference held July 8 through 13. As a National Youth Correspondent, she was recognized as one of the most promising young leaders in journalism and media and joined scholars from across the country to share in this experience.

As part of this elite group, she participated in hands-on learning projects that challenged her to solve problems, as well as dive deep into the creative, practical, and ethical tensions inherent in journalism and media. If she was interested in communications and public relations before the conference, she is downright committed to the field now.

Riagan reached out to Palio for corporate sponsorship and we made a deal: We would gladly sponsor her if she agreed to write about her experiences. In the next series of posts, Riagan shares the insights and moments that most impacted her during the conference. In this post, she discusses meeting Kevin McCarthy.

Hello, I am Riagan McMahon blogging about the experiences I was fortunate to have at The Washington Journalism and Media Conference. I am a senior at Saratoga Springs High School and an aspiring communications and public relations major

Kevin McCarthy is a film critic in the Washington, DC, metro area, and his reviews are published on He is a graduate of George Mason University with a degree in communications, concentrating on media production and criticism. Kevin inspired me in an unexpected way. His rise to fame and his perspective on his career were incredibly relevant to me.

McCarthy discussed his time at George Mason in a personal way, emphasizing the possible career choices for today’s students. This notable film critic has interviewed celebrities such as Russell Crowe, Angelina Jolie, and Steve Carell.

McCarthy’s list of interview subjects may be impressive, but how he attained his success was what I found most noteworthy. McCarthy made certain points in his discussion with us that I hope to take with me during my career. He emphasized the importance of internships to us as a wonderful way to find your “platform.” Through internships, you can make a name for yourself in the field you hope to work in. What McCarthy stressed as most important during an internship is to constantly communicate with the colleagues you interact with.

McCarthy explained that the most crucial aspect to obtaining your dreams is to continually ask questions – show your passion in all that you do by always questioning the world around you. Each and every word Kevin spoke showed the eagerness he has to make something of his passion for movies and his talent for critique. In order to be good at what you do, like Kevin McCarthy, you must be relentless in proving yourself.

Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.

Managed Markets Monday: The Value Challenge in Pharma

In this Managed Markets Monday, Jim Mittler, PhD, Medical Director at Palio, addresses the value challenge in the evolving pharma marketplace.

Managed Markets Monday is a weekly series that provides insight into what we think it takes to meaningfully and effectively communicate in the managed markets space. Follow up with Jim Mittler at

Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.

Palio’s #ChalkChat: 6 Rules for Finding Creative Inspiration

This episode of #ChalkChat, Philip Reynolds, VP, Associate Creative Director, shares 6 rules for finding creative inspiration that work for him.

#ChalkChat is a weekly video series that brings you insights on branding, marketing and multichannel integration within the pharmaceutical industry. Follow us at #ChalkChat. Follow up with Philip at

Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.


Managed Markets Monday: How the Oakland A’s Can Help Healthcare

By Krystina Smith, Research Analyst, Palio

The commonalities between Major League Baseball and healthcare economic modeling may not seem obvious, but let me explain! For anyone who hasn’t read Moneyball by Michael Lewis (or seen the 2011 Academy Award nominated movie starring Brad Pitt and Jonah Hill, both receiving Oscar nominations for best actor and best supporting actor, respectively), it is the story of how the 2002 Oakland Athletics baseball team reevaluated how they were scouting players. Because of the team’s limited budget for salaries, they had to find value in players who were undervalued by the market. Moneyball describes how the Oakland A’s used sabermetrics reporting, which is an analysis of baseball through statistics, to evaluate players purely on data. Other teams were using traditional data points to evaluate players – batting average, RBIs, and stolen bases. The Oakland A’s found that on-base percentage was more reflective of a players’ value and were able to advance to the postseason with a payroll of $41 million (the Yankees payroll that same year was $125 million!).

So what does this have to do with healthcare economic modeling? Well, similar to baseball, the healthcare industry has a lot of access to data, and yet it’s often not being analyzed in a way that identifies true value. The healthcare system is evolving every day in the United States, yet the analysis of the data isn’t evolving at the same pace. The consequence is that it becomes almost impossible for a payer to tease through all of the data available and come to an accurate assessment of the value of a product.  Sabermetrics reporting is an economic model that the Oakland A’s used to evaluate players’ value, and healthcare economic models can be used to help a payer evaluate a product’s value. A good healthcare economic model can take a very complex medical treatment, create a simplified representation, and help answer the question of “What is this product’s value?”

Although complex to develop and create, a healthcare economic model should actually be clear and straightforward to the end user. Ideally, a model should be looking to answer a very specific question. It could be that the model requires the user to consider 55 different variables – but all of the variables should be driving to answering the one question. Just like the Oakland A’s were able to do, use the data that are relevant to finding value, and don’t get too caught up in evaluating erroneous data. If the data aren’t relevant to answering the question, don’t complicate the matter by evaluating the data!

But as valuable as healthcare economic models are, they are not the answer to all of the healthcare industry’s problems of how to evaluate value. However, they can be a valuable tool in supporting a product’s value proposition because they can simply answer the question to a complex problem. And part of a model’s power is the ability to see it for yourself, using your own data. It is one thing to talk about national averages or general trends, but to actually allow a payer to see how the data are modeled out within their own plan can be really convincing!

And just for the record, I’m a lifelong Red Sox fan. They adopted the sabermetrics model in 2002 and won the World Series 2 years later.

Managed Markets Monday is a weekly series that provides insight into what we think it takes to meaningfully and effectively communicate in the managed markets space. Follow up with Krystina Smith at

Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.

Because We Can: We Ride

Jackson jumping

By Christina Schiavo, Corporate Relations Intern, Palio

Being that we’re here in Saratoga Springs, of course we’d have an avid horseback rider among the Palio team. Research Analyst Krystina Smith has been riding since the age of 12. She’s done everything from hunters and equitation to dressage and eventing. In fact, Smith was even a member of the equestrian team at Skidmore College during her undergraduate career. 

Smith was initially inspired by her grandmother, who used to ride horses. On a family vacation, they took riding lessons together for a week and she was immediately hooked! Shortly after the vacation, Smith started taking lessons at a local barn. On account of her other hobby (soccer), she was only able to ride once a week and couldn’t show in competitions. “I did soccer league year-round,” said Smith. “It wasn’t until I had my ACL reconstructed that I played less soccer and began riding more, leasing horses, and showing.”

Smith began learning how to ride on the flat, which is just the ring without any jumps. Getting experience with hunters and equitation eventually opened doors for her with riding. Smith then began dressage, which means “training.” This form of competitive equestrian is often referred to as “horse ballet” with the horse and rider memorizing and performing a series of predetermined movements.

During Smith’s high school career, she progressively moved onto eventing. Eventing is a combination of dressage, jumping, and cross-country in one horseshow. At that age, this was something Smith not only worked hard for but greatly enjoyed doing. “I loved eventing,” said Smith. “It was fun, but after a few falls and injuries, I wanted to try something different. When it came time for college, Smith knew she wanted to attend a relatively small liberal arts school. Skidmore sparked her interest, but even more so when she found out they had an equestrian team. At Skidmore, Smith was able to compete in intercollegiate horse-showing. This is when the rider is judged entirely on presentation, as in posture and how you look when riding the horse. Each show you attend, a horse is selected for you at random and you aren’t given time to practice. This is a way of leveling the playing field in competitions. “This is an equalizer,” said Smith. “It becomes a test of the rider rather than the horse because you need to get on and make any necessary adjustments immediately.”

Intercollegiate riding is much different in that during typical horse shows, you have the same horse that you work with. As Smith explained, “You train with the same horse, learn about each other, and essentially become one.” With intercollegiate, you’re really being tested on your skill level as a rider and ability to adapt to any horse that is given to you.

Throughout her time at Skidmore, Smith leased a horse from the college named Jackson. There was even a summer he went home to Massachusetts with her. For Smith, Jackson has been more than just some horse to ride, he’s been a pet. “Jackson’s not only a partner in athletic adventures, but he’s also a pet,” said Smith. “He can sense when it’s me coming down the barn and when I call his name, his head perks up. That’s the beauty of riding, you form such a bond with such a magnificent animal.”

The perception is that riding isn’t a “real” sport. The fact of the matter is it’s just as much of a sport as tennis or even football is; it just takes a different skill set. “The real sport in riding is to look like you’re not doing anything,” said Smith. “When, in reality, you’re controlling a 1200-pound animal.”

What most can’t imagine is the physical strength this sport actually requires. When riding, you’re using so many different muscles and, as Smith said, “muscles I didn’t even know I had!” She then discussed how everyone is under the impression that riding is all about leg strength, which is not the case. “Your core and back muscles are just as, if not more, important than leg muscles,” said Smith. “Your core and back need to be strong to keep the horse steady. If you’re not steady, the horse will feel it, which isn’t good.”

Smith illustrated a great example of the muscle control you need in order to control and guide the horse when riding. “If your horse is using faster steps, naturally people think pulling back would slow the horse, but this only makes the horse go faster, resisting your pull.” Smith then indicated that the best way to handle this would be to slow your posting. “Posting is when you move up and down with each stride, rising for one beat and lowering for the second. With this, you can tell your horse to slow down.”

For Smith, riding is so much more than competitive ventures and physical activity: It’s a way to just relax and clear her head. “It’s what I love most about riding,” said Smith. “Yes, it’s a sport and it’s physical, but it’s also so calming and relaxing.” Smith enjoys riding just to ride. “Training can be stressful and physically taxing, but when I set out for a simple ride or trail ride, I find it’s a great outlet for stress relief,” said Smith.

Smith’s passion for horses and riding is clear. When talking to her about it, you can see the excitement and joy that’s written all over her face. Fortunately for Smith, we’re located in beautiful Saratoga Springs, where horses are the underlying theme. There’s the thoroughbred horse track, polo field, and Skidmore barn and equestrian team right at her fingertips. Smith’s surrounded by what she is most passionate about. What could be better than that?

Interested in riding lessons, sharpening up your riding skills, or joining an equestrian team? The Capital District has a handful of places that can help! Schauber Stables, LLC, located in Ballston Lake, offers a variety of horseback riding services such as lessons, trail rides, summer camp, family outings, and birthday parties. Another available barn is Olde Saratoga Farms, which promotes the passion of equestrian sports. Here you can also take lessons and classes, attend camp, host birthday parties, or go on family day-trips.

Saratoga Lake Equestrian is located only 15 minutes from Saratoga in Clifton Park and has over 55 acres of marked trails for riding. Offered here are lessons for all types of riding from Western to English and jumping to dressage. You can even take polo lessons at this barn! In Ballston Spa there is a barn called the Lazy Horse Equine Center, with available svices including boarding, training, clinics, private and group lessons, leasing, trail rides, and birthday parties. There are lessons for beginners and more advanced riders. Enjoy lessons in jumping, horsemanship, barrel racing, and gaming.

Here at Palio, health and wellness runs through everything we do – in the office and out. And our employees are involved from every angle! From running to yoga, and tennis to ironman – you name it, we’ve got folks who do it. Because health is such a big part of our lives and work, our Because We Can health initiatives series is designed to highlight the passions, commitments, accomplishments and goals of a few of the members of our team.

Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.

Palio’s #ChalkChat: S.C.O.R.E.S – Effective Tool for Positioning

In this episode of #ChalkChat, Jeremy Lichtenberger, VP Brand Strategy Director shares a simple and effective tool you can use to help determine if positioning ideas for your clients brands will be impactful.

#ChalkChat is a weekly video series that brings you insights on branding, marketing and multichannel integration within the pharmaceutical industry. Follow us at #ChalkChat. Follow up with Jeremy at

Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.


Managed Markets Monday: CER 103

By Micahlyn Whitt-Flicker, Copywriter, Managed Markets at Palio,

In this Managed Markets Monday, the final blog entry in our 3-part series, we provide a snapshot of comparative effectiveness research (CER) in action for managed care.

Do well-designed, industry-supported CER studies have a role in managed care decision-making?

By 2019, it is estimated that up to 32 million previously uninsured people will be enrolled for medical coverage, including a significant increase in the Medicaid population. In addition, economists estimate that over $700 billion is spent annually on unnecessary and ineffective treatments and procedures. It’s also estimated that more than half of treatments delivered today are not based on clear scientific evidence of effectiveness in real-world settings. This, in turn, contributes to substantial variability in how diseases are managed and significant variations in healthcare costs and outcomes nationwide. With this, payers are keen to engage tailored CER that can help inform and shape their decision-making and formulary processes to provide more meaningful coverage options for their member populations.

While the Patient Protection and Affordable Care Act discourages the use of CER findings as the sole determinant for coverage or reimbursement decisions, private payers and pharmacy benefit managers are permitted to use CER to inform formulary decisions and benefit design. Managed care organizations and insurers are working to determine the value of existing interventions by examining high-quality clinical data alongside real-world comparative effectiveness data. Payers are also spearheading CER initiatives tailored specifically for managed-care interests.

Case Study: WellPoint

In 2010, WellPoint was the first health benefits company to publicly release CER guidelines for use in evaluating pharmaceuticals. These guidelines were then used to develop CER criteria that informed the value of clinically proven osteoporosis agents. The research focused on use and outcome results from pharmacy and medical payment claims data for 25,000 WellPoint members who were prescribed 1 of 3 leading osteoporosis medications (each with comparable high-quality clinical-trial data). The results of the study showed that for 1 of the medications, patients experienced lower levels of compliance, higher bone-fracture rates, and increased total costs of care. These real-world data helped WellPoint reassess their formulary decisions, and the medication that was shown to have lower compliance rates and increased costs of care was relegated to tier 3 formulary status. Every quarter, WellPoint completes 2 or 3 comparative effectiveness studies, examining how treatments in a particular disease category stack up on effectiveness and cost.

Cast Study: Intermountain Healthcare

Intermountain Healthcare has employed CER data to develop disease-management programs that provide tools and information to help practitioners within the Intermountain system deliver care in a consistent and integrated way. Each disease management system includes an evidence-based care model, patient education materials, clinical support materials to make care delivery easier, and a data measurement and reporting process to analyze practice patterns. The goal of this CER initiative is to help reduce variations of treatment within specific disease states and to produce more consistent outcomes.

Payer-Centered vs Patient-Centered CER

The case studies above are examples of how private payer organizations are tailoring CER to inform specific managed-care interests. Critics, however, worry that these types of initiatives may not benefit patients in the manner intended by the American Recovery and Reinvestment Act of 2009 and the Patient-Centered Outcomes Research Institute. Will cost-effectiveness models contradict or undermine patient-centered models of CER? Will patients have access to the right treatments and interventions at the right time, or will cost issues hinder this process?

Payer utilization of CER may identify some established, low-cost treatments that yield better outcomes than high-cost alternatives, but it’s also important to acknowledge that the reverse is also possible: CER analyses can persuade cost-conscious payers, purchasers, and patients that a more expensive new medical innovation is more effective and offers better long-term value.

I hope you enjoyed this snapshot of CER in action in the payer space. It’s clear that the advent of CER has and will continue to have a significant impact on the policies and practices of professionals across the spectrum of healthcare, as well as patients in need of more innovative and effective treatments and innovations.

Managed Markets Monday is a weekly series that provides insight into what we think it takes to meaningfully and effectively communicate with the payer customer.

Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.

#ChalkChat: 5 Insights to Effective Tactical Planning

In this episode of #ChalkChat, Tiffany Ryan, VP of Account Services at Palio, shares 5 key insights to developing an effective tactical plan.

#ChalkChat is a weekly video series that brings you insights on branding, marketing and multichannel integration within the pharmaceutical industry. Follow us at #ChalkChat. Follow up with Tiffany

Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.

With Timeline Changes, Facebook Alters How We See Brands

By Kevin Coffey, Account Director, Palio, @kevinwcoffey

With more than 163 million users in the U.S. – the majority of them in marketers’ favored 18-35 demographic – Facebook is the gorilla in the mass marketing room. And, when they make changes – as they did earlier in the year – everyone notices.

Facebook’s launch of Timeline for brands didn’t just change the world of marketers – it changed the fundamental way that consumers experience brands on the social media behemoth. In a webcam eye-tracking study for Mashable by EyeTrackShop, researchers found that participants spent less time eyeballing Wall posts and ads — and more time looking at the cover photo on brands’ timelines.

Researchers recorded eye movements of participants as they were shown brand profiles before and after being converted to timeline. Results suggest our perception of brands on Facebook has changed:

Ads get a boost. Ads on Facebook Timeline are less visible than ads on Facebook Brand Pages. While 30 percent to 40 percent of study participants looked at ads on brand Timeline pages, 80 percent looked at them on Brand Pages. In both cases, ads placed higher up on the page fared better than those below them.

Cover photos rule. Cover photos are the new Facebook Wall, as far as attention goes. On average, viewers looked at them first and for the longest amount of time. On the brand Timelines, viewers nearly always looked at the cover photo first and spent more time viewing it than Timeline content.

The Timeline takes a back seat. Viewers see Timeline content last. In every case, viewers looked at either the left or right column of Timeline content last — after ads, navigation buttons and brand logos.

Previously minor or invisible information is now front and center. Facebook moved the Like count, events and apps to prime territory. It now gets more attention than when it was listed in very small type on the right-hand side of the page.

Show your face. Cover photos with faces attract the most attention. Study participants spent more time on Good Morning America and “The Muppets” pages, which have cover photos with faces, whereas the Dallas Cowboys and Pepsi do not.

Taken as a whole, the changes mean brands on Facebook have an improved visual platform for communicating with fans and customers – if they know how to leverage it.  Whether it’s sharing brand history through video or adding more photos, visual communication can deliver powerful messages to fans and followers.

What are you doing to attract eyeballs to your brand?

Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.

Managed Markets Monday: CER 102

By Micahlyn Whitt-Flicker, Copywriter, Managed Markets at Palio,

CER and the real world

Most of us are familiar with the basic principles of study design for randomized control trials (RCTs). While RCTs continue to be seen as the gold standard for providing unbiased clinical evidence for pharmacological and other interventions, by design, these studies omit specific variables that exist in real-world settings. For advocates of CER, these real-world variables provide the foundation needed to glean important insights into the utilization and effectiveness of interventions. Ultimately, it’s believed that these insights and outcomes can lead to the development and support of more effective, patient-centered interventions.

In a recent article in the American Journal of Managed Care, the head of Medco’s personalized medicine research department commented on the potential for CER. He said, “If we do it right, we can learn a lot about how drugs work and for who, in what I believe is a much more realistic real-world environment.”

Of course, doing it right begins with the implementation of sound study design.

To CER or not to CER

There are many methods for conducting comparative effectiveness research (CER) and even more opinions and debates about which of these methods are most effective in producing unbiased outcomes with meaningful applications versus the gold standard RCTs. Retrospective observational studies and prospective observational studies are often cited as an important foundation for robust and comprehensive CER outcomes. These methods also provide an interesting contrast of advantages and disadvantages to RCTs.

RCTs continue to be viewed as the most accurate form of study for determining whether a new drug should be approved for marketing. These studies are believed to most effectively control for diagnostic and prognostic factors that affect treatment decisions. In contrast, CER that seeks to demonstrate the effectiveness of the real-world treatment and other intervention practices of patients and physicians are particularly appropriate for observational studies. For example, large observational studies are often essential when treatment effects differ across types of patients, and when analyses of subgroups are needed to understand which patients are most likely to benefit. Let’s take a closer look at these distinctions.

CER by design

Retrospective observational studies typically employ existing secondary data sources in which both exposure to an intervention and the outcomes of that exposure have already occurred. Researchers conduct comprehensive reviews of current literature, large established databases, (in­cluding electronic health records), and results from RCTs.  Systematic retrospective observational studies are often utilized in CER initiatives as a means for summarizing a body of evidence, identifying information gaps, and generating ideas for new research in areas of unmet clinical need.

A prospective observational study is another form of observational study in which outcomes occur after the creation of the study protocol and analysis plan and study commencement. Patient exposure to interventions being studied may have been recorded prior to the study initiation. Prospective observational studies such as those conducted over a 20-year period by the United Kingdom Prospective Diabetes Study Group (UKPDS) have resulted in providing influential long-term data that have informed treatment guidelines as well as research and development of new interventions.

Observational studies have also been employed to examine multiple treatment paradigms simultaneously. For example, the wide range of approaches for treating hearing loss including cochlear implants, assisted listening and electric acoustic devices, and habilitation and rehabilitation methods. A prospective observational study of patients being treated for hearing loss would permit researchers to examine treatment preferences as well as the risks and benefits of the different treatments. In general, observational studies are considered to be best used to evaluate the real-world applicability of evidence derived largely through randomized trials; to study patients and conditions not typically included or studied in randomized trials; to better understand current treatment practices and how patients are assessed in order to design an appropriate clinical trial.

Did CER help to shape perceptions about heart disease in the United States?

Retrospective observational studies have been particularly useful in identifying and reporting on the inequity of important disease-state research results; notably, previously underrepresented patient experiences. During the 1980s, for example, several retrospective reviews of major disease-state research identified a stark absence in the number of females as subjects in research, resulting in the recognition of an alarming void of information across the spectrum of healthcare for the female population.  Subsequent retrospective studies demonstrated significant lack of research data for other underrepresented populations, such as nonwhite and female populations in cardiovascular diseases. With this in mind, it’s interesting to consider that in 1948 the American Heart Association’s (AHA) campaign to raise awareness of heart disease in the United Stated was called “Walking Man.” Today, the “Go Red For Woman” campaign is a hallmark of the AHA’s awareness initiatives.

Room for debate

Researchers cite several advantages of observational studies versus RCTs. For example, larger numbers of subjects can be observed at more affordable costs. And this, in turn, allows researchers to examine a broader range of patient experiences such as those for meaningful subgroups and comparison populations. Another noted benefit of CER is longer follow-up periods, which make it possible to examine long-term risks and benefits.

As we can see, observational research methods can provide many viable options for identifying key outcomes data for many types of interventions. However, one of the primary criticisms of CER, specifically observational research, is that there is too much room for bias and inaccurate reporting. Some believe that because patient characteristics influence real-world clinical decisions, there will always be un­certainty about whether the subject (the patient), or the intervention itself, causes the observed outcomes.

While the impact and application of CER methodology and study design continue to be hotly debated, at the end of the day, or at least the end of this blog, most seem to agree that it will continue to play an important role in the future of healthcare, informing everything from practice to policy. The general opinion held is that in order to arrive at the best possible decisions about patient care, we need research that has met the highest possible standards in its conduct and reporting. This includes outcomes from RTCs as well as a comprehensive range of high-quality comparative effectiveness research.  

Next on Managed Markets Mondays: Do well-designed, industry-supported CER studies have a role in managed care decision-making?

Stay tuned.

Managed Markets Monday is a weekly series that provides insight into what we think it takes to meaningfully and effectively communicate with the payer customer.

Palio is an advertising agency revolutionizing pharmaceutical and healthcare marketing to create experiences that will Never Be Forgotten.

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