In this week’s #ChalkChat, Krystina Smith, research analyst at Palio, shares 4 key insights to conducting social listening research for pharmaceutical and healthcare products.

#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 Krystina at Krystina.Smith@palio.com.

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

By Steve Toman, Account Director, Palio Managed Markets

Medicare is a federal healthcare plan run by the Centers for Medicare and Medicaid (CMS), and it is available to Americans aged 65 and older and to those with particular disabilities. It is divided into Parts A through D, each of which helps cover specific services:

• Part A: Hospital insurance
• Part B: Medical insurance
• Part C: Medicare Advantage (a plan offered by a private company that contracts with Medicare to provide the benefits covered under Parts A and B; most Part C plans include Part D drug coverage)
• Part D: Prescription drug coverage

Medicare Part D was enacted as part of the Medicare Modernization Act of 2003 and went into effect on January 1, 2006. Most Part D drug plans have their own formularies that define their drug benefits. Part D plans are required to include at least 2 drugs in each category and class covered by the plan, and CMS may require plans to cover more than 2 drugs for certain categories and classes.

There are 4 stages of Medicare Part D coverage for 2012. Depending on which stage a Medicare patient is in, the amount he or she pays varies substantially. It’s important for patients to understand and to be aware of the cumulative out-of-pocket (OOP) costs that they accrue as they move through the stages, particularly those patients who are on expensive therapies.

To illustrate the ins and outs of Part D, let’s consider Maude, a fictitious Medicare patient who works her way through the system by requiring brand-name drug therapies that total $20,000 in 2012. Her Medicare Part D plan provides a “typical” set of benefits.

• Stage 1: Deductible. Deductibles vary between Medicare Part D drug plans, with some having no deductible. In 2012, no Medicare drug plan can have a deductible greater than $320. Maude’s plan has a $320 deductible, so she is responsible for the first $320 of drug cost. Simple enough
• Stage 2: Co-insurance. Although co-insurance levels may vary from plan to plan, Maude’s plan covers 75% of drug costs, which means she is responsible for the remaining 25%. Stage 2 ends when the cumulative drug costs reach $2930
• Stage 3: Donut Hole. Medicare Part D does not cover prescription coverage during Stage 3. Maude is in the “donut hole” and hopefully has been able to save for this rainy day. The good news is that manufacturers do offer a 50% discount on brand-name drugs for patients in this stage, and both manufacturer and patient contributions are applied to the annual cumulative drug costs, up to $10,385
• Stage 4: Catastrophic Coverage. Once cumulative drug costs reach $10,385, Maude enters the fourth and final stage of catastrophic coverage. In this stage, her plan pays 95% of the drug cost, and she is responsible for 5% for the remainder of the calendar year. It is important to note that once the calendar year ends, coverage starts over again at Stage 1

So if Maude had no prescription coverage, she would have had to pay the full $20,000 for her medications. What is her responsibility under Medicare Part D? About $5560. And that includes her Part D plan premium of $30/month. No wonder Maude is a big fan of Medicare Part D!

Fortunately, most common medications, especially generics, are relatively inexpensive. But what if Maude doesn’t have $5560 a year for the medications she needs? Medicare does offer low-income subsidies for patients who qualify. In addition, some Medicare patients are eligible for charitable programs offered by foundations such as the National Patient Advocate Foundation and the National Organization for Rare Disorders. Additional information is available at http://www.medicare.gov/, and at the websites of individual charitable foundations.

But for Americans who can afford the standard benefits of Medicare Part D, there are changes on the horizon. The discounts that are applied to drug costs in the “donut hole” are scheduled to rise, courtesy of the Affordable Care Act. In 2013, the discount will rise from 50% to 52.5%, and by 2020, the “donut hole” is scheduled to close completely. By then, the memorable words of Ty Webb from the movie, “Caddyshack,” are projected to come true: “A donut with no hole, is a Danish.”

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 Steve Toman at stoman@palio.com.

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

In this #ChalkChat, Jim Mittler, PhD, Medical Director at Palio, discusses how the HITECH Act and the evolution of EHR technology will bring about an important shift in evaluating behavior in patients and prescribers to provide a more analytical and objective approach to gaining insight.

#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 Jim at jmittler@palio.com or @jim_mittler.

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

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 jmittler@palio.com

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

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 jlichtenberger@palio.com.

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

By Micahlyn Whitt-Flicker, Copywriter, Managed Markets at Palio, m.whittflicker@palio.com

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.

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 tryan@palio.com.

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

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.

By Micahlyn Whitt-Flicker, Copywriter, Managed Markets at Palio, m.whittflicker@palio.com

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.

This episode of #ChalkChat features “Acronym Soup” with Paul Harrington, Palio’s SVP Creative Director, who shares 5 key guidelines to keep in mind when creating your next advertising campaign.

#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 Paul pharrington@palio.com.

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