The medical world has seen many developments, but healthcare PR has, too. Beth Herskovits looks at eight sectors leading the charge
The introduction of direct-to-consumer (DTC) marketing almost a decade ago changed the course of healthcare communications. And while DTC has garnered enormous attention, it is not the only area of healthcare PR that has evolved. Following are eight healthcare sectors that are tackling new issues and opportunities.
1. Clinical trials
Recruiting patients for clinical trials has become more difficult than ever.
"Clinical trials is a major area moving forward for the pharmaceutical and biotechnology industries," says Marie Fay, who specializes in this discipline at the Chandler Chicco Agency. "They are under a lot of pressure to get people enrolled."
John McAnulty, SVP and partner at Fleishman-Hillard, notes that about 85% of clinical trials are running behind schedule, and in one in four cases, the delay can be attributed to patient recruitment. Such impediments add to drug-development costs.
Recruitment has been made more challenging by the guidelines of the Health Insurance Portability and Accountability Act of 1996, which deal with medical privacy, and have made it more difficult for companies to obtain information about eligible patients.
In the late 1990s, companies first turned to advertising and media relations to speed recruitment. "Today it's more sophisticated in that we have a variety of strategies in place to influence the influencers," McAnulty says.
Fay adds that media relations efforts have become more localized than in the past.
"There's a lot of stigma about clinical trials," she says. "All of those efforts help reduce that stigma."
She also notes that clinical trials themselves have also become more targeted as researchers increase their understanding of how different drugs affect different segments of the population.
Ellen Miller, who heads Chandler Chicco specialty agency Biosector2, notes that difficulties arise when companies try to recruit for an obscure disease or emergency medicine - where it's either difficult to find patients, or patients don't have the opportunity to volunteer.
"Doing traditional outreach doesn't necessarily help," she says, adding that, in those cases, physicians need to train their colleagues on how to identify prospective patients. "It is more important to [promote clinical-trial recruitment as a way to] elevate the institution."
McAnulty notes that one Fleishman ROI study found a 47% difference in the number of patients who were enrolled in a trial when local outreach was employed. But he adds that there are still opportunities for agencies to become involved earlier in the recruitment process.
"The tendency for pharmaceutical companies is to come to us ... in a rescue mode," he says.
Fay agrees, noting that pharmaceutical companies often outsource clinical-trial responsibilities to a third-party research firm. "They're not media savvy," she says. "That's created a need for us to shepherd" those companies through the process.
2. Healthcare technology
Healthcare technology - everything from electronic patient records to bar codes on hospital bracelets - is still a young sector. But its marketing tactics are starting to resemble those entrenched in the drug industry.
A second generation of leaders has stepped up, many who got their feet wet in the bio-pharmaceutical world, notes Gil Bashe, EVP and health practice director at Makovsky & Company.
But growth is being fueled not only by new leadership, but also the greater number of stakeholders who need to hear the messages.
In the past, "as long as I could get my message to physicians, it wasn't clear that I needed to communicate with the hospitals," says Marijean Lauzier, president & CEO of the Racepoint Group. Now, though, "there are so many more constituencies involved in the purchasing decision. For these clients, there is a core need [for] brand building."
Health-policy issues are also significant, from the debate over limitations in stem-cell research to patient privacy. Clients need to communicate with not only policy-makers, but also advocacy groups that will add context to how patients benefit from a new technology.
"Part of our job is to be agents of positive change," Bashe points out. "It's tough to have breakthrough technological advances if you're not sharing expertise."
Makovsky client B. Braun, for instance, currently makes a product that uses bar-code technology to "match" patients with the right medication. The message that the company has communicated is that more people die from medical errors than car accidents.
"They need to educate the hospital administrators about why medication errors happen, what the ramifications are ... and how hospitals can prevent them," Bashe says.
AnnaMaria DeSalva, EVP of healthcare for GCI Group, also notes that companies need to develop a "constituency of support" for new products, convincing healthcare purchasers that the products will either reduce costs or improve patient outcomes.
"They're blazing a lot of trails in medical technology," she says. "As those technologies grow, it's obviously creating a greater [financial] burden on our healthcare system. How do we make sure we're growing the market for new healthcare products?"
On the consumer front, aging baby boomers are also increasingly interested in - and sophisticated about -sectors of the healthcare market that were considered too complex for the public to understand.
"Consumers' appetite for health information is growing every 24 hours," says Lauzier. "We're really looking very actively at the business, finance, and lifestyle media."
DeSalva notes, however, that medical technology is still very much targeted to medical specialists. "I think they're going to have to cultivate and develop greater relationships in primary care."
Healthcare tech companies are also getting attention from larger pharmaceutical corporations, which are increasingly investing in them, Bashe notes.
"That involves having a broader and deeper understanding ... of how the health system collaborates," he says. "The most gratifying thing is the [number] of clients seeking expertise in these areas."
3. Health insurance
As consumers become savvier about new medical treatments and options, they expect more choices from their health insurance companies.
But as employers attempt to hold down medical costs, health insurers are caught in a tug-of-war between members that want greater flexibility and companies that do not want to pay higher premiums.
"This is an era when the entire healthcare system is changing," says Laura DuDell, president of DuDell & Associates. "We need to deliver more and different healthcare options to different audiences."
The newest development has been a greater move toward consumer-directed health plans, where members have greater control, but pay more out-of-pocket costs.
"DTC [drug] advertising has created a consumer that's more knowledgeable and involved in their healthcare," DuDell says. "The challenge that we face is helping consumers and businesses understand how these health plans work."
Ben Singer, SVP and national practice leader for health services at FischerHealth, predicts that consumer-directed plans, which came into vogue within the past four years, are likely to become more popular, as the biggest players in the health insurance market invest in the smaller companies that currently offer them.
And as consumers absorb a greater percentage of healthcare costs, they're also becoming more educated about the healthcare system. "Consumers are now really being faced with the decision-making process," says Singer. "There will be a continued effort to engage consumers in new ways."
That shift has created opportunities for third parties, like pharmacy benefit managers (PBMs), to reach out to consumers and create their own identities. Singer notes that it is no longer enough for PBMs to remain silent middlemen; they're now proactively educating consumers about how they decide which drugs are included on a formulary.
Outreach now has turned to brand marketing and, more specifically, building trust and credibility.
"They're all looking for what we call 'emotional Velcro,'" Singer says. "We [as PR pros] become the interpreters. If we do our jobs correctly, we also become the trust builders."
Hospitals were one of the first segments of the healthcare industry to adopt DTC promotional tactics. But new issues facing this sector have meant a greater reliance on grassroots and branding efforts.
"Hospitals have been DTC for 30 years," says Waggener Edstrom SVP Kathy Lewton. "We're actually starting to see saturation at the advertising [level]."
Hospitals are now using more relationship-building tactics, particularly through promoting their physicians and new technologies.
"The number-one thing we should be measuring is the satisfaction of the people who are coming to us for care," Lewton says. "The advertising is having less impact because consumers either tune it out or they don't understand it."
Ame Wadler, chair of the healthcare practice at Burson-Marsteller, notes that hospitals are employing more brand marketing efforts. Not only do patients have a choice of which hospital to use, they also have strong preferences for a particular medical center.
"The pressures on hospitals are tremendous," she says. "It used to just be about how to communicate new research. [Now] there's a lot of, 'How do we keep our heads above water?'"
Many hospitals in smaller communities need to contend with limited budgets. Kathy Cosgrove, GolinHarris SVP, recalls two grassroots campaigns where hospitals needed to build community support to add beds and services.
In both cases, competitors had been holding up the process. "Once you take the issue to the community, they understand those needs," she says.
The uninsured have created a financial burden for hospitals, which have a legal and ethical responsibility to provide care regardless of the patient's ability to pay.
"That's what hospital CEOs lie awake worrying about," Lewton says. "It's still very much a sickness system. Most of the care that's given is to people who are sick - and that's more expensive."
Wadler agrees. "It's really [about] how do we make the experience more holistic for patients," she says, emphasizing such things as prevention and elective procedures. "I think that, increasingly, hospitals are trying to drive income from a wellness community."
Employee relations is also a significant part of outreach. The nationwide nursing shortage, for example, has prompted hospital administrators to build better relationships with staff.
"You've got to engender a sense of community in the people you work with," Wadler says.
Lewton adds that hospitals are also trying to ease tensions between physicians and administrators. "In most cases, the physicians don't have a financial stake in the hospital," she says. "[Outreach] has more impact on a peer-to-peer, influencer-to-influencer basis."
5. Managed care
In the 1990s, managed-care companies faced backlash as consumers protested the lack of freedom to choose their own doctors and medical facilities.
But Wag Ed's Lewton notes that these companies have made significant strides to meet patient demands, loosening some of the original restrictions.
"You don't hear the consumer complaints you used to hear," she says. "Managed care at one time was absolutely vilified. They realized that they couldn't exist with that kind of continuous criticism."
But she adds that these companies must now hold down costs while still maintaining flexibility.
This year's Harris Interactive poll has credited heavy news coverage of the Medicare Modernization Act for taking the heat off managed-care companies.
But managed care is a part of the massive educational effort surrounding the legislation, as these companies attempt to enroll seniors into one of their private health plans.
To hold down its own administrative costs, the Centers for Medicare and Medicaid has encouraged private health insurers to offer their own plans to beneficiaries. Seniors typically pay a premium for these programs in return for more services.
Eve Dryer, president of Vox Medica, calls the Medicare issue "our newest and most gripping."
"It's an unusual dynamic, where there's an opportunity for our commercial clients to work with government agencies," she says, adding that managed-care companies are also forging alliances state-by-state with local advocacy groups and medical associations.
Warren Levy, chief strategy officer at Vox Medica, emphasizes that the outreach is much more about developing strategy than simply getting out messages. He notes that the new Medicare act and the aging baby-boomer population are driving more discussions about cost of healthcare.
"The broader, deeper, and more troubling aspects [of this legislation] are going to be realized during the second phase," he says. "This is expensive, probably more expensive than we had planned for."
Cost issues are going to require "another level of communication leadership," Levy adds. "All of our clients are asking us, 'How do we make our voice part of this?'"
Dryer notes that she expects to see "less polarization and more collaboration" across the industry. As the healthcare delivery system changes, companies in other healthcare sectors have realized the need to collaborate with managed-care companies.
"It's no longer managed care, or managed marketplace," she says. "It is the marketplace."
6. Medical devices
Unlike some of the other sectors of the healthcare industry, medical-device companies have always placed a greater emphasis on PR over advertising to promote their message.
"They've spent very little on DTC advertising in the traditional sense," says Fleishman-Hillard SVP Robert Hanvik, who recently joined the agency from Medtronic.
Medical-device companies have been trying to overcome the perception that the field is too complex for consumers to understand, he notes. They are also addressing a lack of awareness about both the technologies themselves and the problems they are tackling.
"I think there are so many great stories to be told," he says. "There are great opportunities to simplify the message."
FischerHealth SVP Laura Nobles notes that companies are using advocacy groups, grassroots tactics, and web-based outreach to target consumers. And although more of these companies are interested in adopting traditional DTC tactics, it's not always the best strategy for them.
"One of the things that we stress is that while a big story has a lot of cachet, you really can't address some of the key influencers along the continuum," Nobles says. "The messages need to be deeper to explain new therapies."
At the same time, many of these companies are telling stories that the media haven't heard before, Hanvik notes. Many new medical devices, for instance, allow doctors to offer more targeted and less invasive treatment.
"When you look at medical devices, those technologies are able to treat local conditions locally," he says. "That really gets people pumped up."
Although the technology is sometimes hard to describe, communications are often made easier through the convergence of different disciplines. For instance, pharmaceutical companies might develop new compounds, but medical-device companies create more effective ways of delivering them.
"This convergence, or integration, has become part of the fabric of what we do," Hanvik says.
7. Medical education
Lifelong learning, or continuing medical education (CME), is one of the requirements of being a doctor. But over the past few years, this staple of healthcare communication has been the target of greater scrutiny.
Doctors and patient advocates alike are calling for more transparency in who is funding CME, as well as a stricter delineation between the company selling a product and the clinicians educating their peers about it.
Burson's Wadler notes that the challenge for companies that sponsor these courses is "not crossing the line between education and promotion."
A new conflict-of-interest policy from the accrediting body for CME courses went into effect last month - and companies must make sure that they are up to date on the guidelines.
"How companies get their arms around that is really important," says Wadler.
Still, she argues that traditional CME courses are being rendered obsolete by a faster moving, 24-7 media environment. With the news media increasing its coverage of medical research, busy doctors are having a difficult time keeping up with their patients.
For physicians to remain authoritative, "the publishing world [must] look at ways to use internet technologies to get information to physicians faster," Wadler says.
Nobles of FischerHealth notes that the agency is currently working with a client on a mobile CME product. "We are acknowledging that more and more physicians are starting to use PDAs," she says. "It's not just going to conferences anymore. It's about getting information out there."
8. Medical meetings
Long before marketers took their campaigns directly to consumers, medical meetings were a prime opportunity to introduce stakeholders to groundbreaking research on a new product.
Jeff Hoyak, president of MCS, notes that they are still the gold standard in medical communications.
"Medical meetings are the film festivals of pharmaceutical research. They are where the buzz starts," he says. "They're viewed by the media as respected forums for scientific research."
Biosector2's Miller adds that medical meetings are one of the few forums that allow physicians to share information with their peers about new therapies, like off-label uses for a drug.
"I firmly believe that medical meetings will always be a mainstay of PR. I can't see that ever going away," she says. "Medical meetings are one of the few opportunities that companies have to present their data as the FDA would like them to present it."
She adds, however, that regulators have placed these meetings under greater scrutiny.
"In some sense, there are more restrictions on our clients," Miller says. "The FDA is on-site at every single medical meeting ... and you have to make sure that you don't step out of bounds."
Both marketing representatives and clinical investigators alike must be educated about the line between education and promotion. "Sometimes [researchers] get caught up in the enthusiasm of their findings," Miller says.
Medical meetings themselves have also changed with the times, Hoyak notes. Conferences increasingly draw a global audience, presenting an opportunity to deliver a message internationally, as well as an increased number of analysts and investors keen to gain firsthand knowledge of a company's intellectual property.
But there are fewer long-lead and consumer reporters covering these meetings on-site, and Hoyak advises clients to set up ways for reporters to cover new research remotely, via press releases or pre-meeting interviews.
Hoyak notes that he counsels clients to showcase one or two studies that have the most relevance to consumers.
"It really should be translated to a patient benefit; play that up - that's the highlight, that's the headline," he says, pointing to the amount of attention given to a recent study that linked deer hunting to heart attacks.
"There's a lot of noise at these meetings; there's a lot going on. The challenge is really getting your voice heard," he says. "If you have several studies, pick the one that's going to generate the most interest. Pick your battles."