Healthcare Roundtable: Detailed prognosis

Industry leaders joined Gideon Fidelzeid at this Chandler Chicco Companies-hosted roundtable in New York City to discuss how the next administration and a more informed consumer impact outreach efforts.

Industry leaders joined Gideon Fidelzeid at this Chandler Chicco Companies-hosted roundtable in New York City to discuss how the next administration and a more informed consumer impact outreach efforts.

Lisa Davis, VP, corporate affairs, MedImmune
Stephanie Fagan, worldwide VP, comms and public affairs, Johnson & Johnson, Global Medical Solutions Group
Kate Hahn, Executive director, corporate comms, WebMD
Aaron Kwittken, CEO, Kwittken + Company
Terry Lynam, VP of PR, North Shore-LIJ Health System
Rosemary McGillan, EVP, Porter Novelli
Sherry Pudloski, VP, policy, external affairs, and communications, Pfizer
Thomas Rubino, Director of public affairs, Horizon Blue Cross Blue Shield of New Jersey
Lisa Stockman, MD, Chandler Chicco Companies

The impact of reform
Gideon Fidelzeid (PRWeek):
Discuss how the landmark Affordable Care Act has and will continue having a major impact on communications strategies.

Lisa Stockman (Chandler Chicco Companies): Under the Affordable Care Act, the government will now be the largest insurer. For the first time, we'll be looking at the government as an entity with which we need to communicate effectively because it will be making decisions for most Americans in terms of access to health. That's a big change because the government values different things in a physician, a patient, or other stakeholders than we're used to communicating about in terms of the medicines our clients provide. This will inherently change how we communicate that value story.

Thomas Rubino (Horizon Blue Cross Blue Shield): From the health insurance perspective, we need to really educate the consumer, our members, on what it means to them. It's a tricky discussion because of how political this has become. Even if you're telling people basic facts, they will take that as you're either against it or for it. You have to break through that just to educate people on what the act will mean to them. It has also really sped us up in trying to understand our consumers. There will be more individuals purchasing insurance for themselves as opposed to getting it through their employers.

Terry Lynam (North Shore-LIJ): Hospitals have been preparing for health reform for many years. A lot of it has been spurred by what the Centers for Medicare & Medicaid Services have been doing – demanding more quality, performance-based contracting. We're starting to partner more with insurance companies in putting together our own versions of ACOs [accountable care organizations] with the intention of eventually becoming the Kaiser Permanente of the East, serving as both a provider and an insurer.

Lisa Davis (MedImmune): From a communications standpoint, this will drive what we're going to say and how we're going to talk about it. That will change according to a broadening number of stakeholders. And employees will be important. Not only do we face external customers as a business, but we're all healthcare providers for employees. We're healthcare users as employees, as well.

Stephanie Fagan (Johnson & Johnson): Communications has always had an opportunity to engage a diverse set of stakeholders, but those stakeholders are very different now. They're broadening and the relationships are different because they are now looking for solutions. We're partnering with a lot of hospitals and payers to actually offer up communications solutions to help them meet this need of communicating beyond the clinical value. The new act offers communications pros a huge opportunity to bring a different level of value to our business by providing solutions.

Rosemary McGillan (Porter Novelli): A lot of what is required within Affordable Care Act-related work is translating very complex health topics to the consumer audience. Providers also need a level of education and outreach that we haven't thought about before. The consumer will look to them to help figure out what a health exchange is. What are electronic health records? Providers will need our assistance. There is a huge opportunity there to look at them as a new communications channel, but also a new business opportunity.

Kate Hahn (WebMD): Consumers look to us for that trusted, credible, physician-reviewed health information. It's more important than ever that WebMD provide this so people can have better conversations with their physicians.

We're also finding that the definition of health is expanding to include healthy living. That's going to be a shift over the next year – focusing on educating consumers beyond chronic illness or whatever medications they're taking and providing that information across multiple platforms.

Rubino (Horizon): We do a lot of research to find out what our members look to and what sources they trust for this information. If you or your child have a symptom, where do you go? First, is still the doctor. But after that, it's Google or WebMD. Then it's family and friends. So we still have to communicate broadly, but you must be one of those trusted channels for that information. That's the difficult part of this opportunity.

Sherry Pudloski (Pfizer): Given today's environment, Pfizer realized it needed a dialogue not just with the influencers making the policies and not just with the physicians choosing the medicines, but also with the influential consumers who will be advocating for certain policies.

We've started our own social media dialogue about getting old. We realized we had to go to a place that was meaningful. How do we help you get old? What is relevant to that conversation? We need to think of new ways to have those connections and dialogues that are meaningful to our customers as opposed to being just about Pfizer.

Aaron Kwittken (Kwittken + Company): For those in the medical technology and medical device industries, the healthcare delivery system is going to change. For them, the biggest issue is the excise tax on technology and medical-device companies. What that has done is force this conversation of AdvaMed, which is the governing body for medical technology, as to the real value and whether or not this will stifle innovation.

What it's done for our clients, in particular, is change them from being an ingredient brand to trying to become a hero brand. At the same time, however, they're dealing with value-based purchasing, increased price transparency, trying to communicate that through doctors, through patients in a more meaningful way, where once this industry was very much a transactional industry. It was a commodity. How can you make it a longer-lasting dialogue with the patient? That's the type of communications we've been pursuing for them.

Davis (MedImmune): Communications will need to help define what these regulations are going to be. And not just at the federal level, but at the state level because you've got state Medicaid. You also have global issues you must understand because a lot of decisions are being made by people starting to look at other countries. We also have consumers in other nations.

The final piece goes straight back to economics. A lot of decision-making is based on the balance of economics and health value.

McGillan (Porter): We're seeing a delocalization of healthcare in a lot of ways. People have relied on a more localized level of communication when it comes to who their trusted sources are or how they get the messaging, but across the board, we're going to see less localization and a lot more nationalization and, basically, globalization.

Rubino (Horizon): Healthcare is so complex. People don't understand health benefits at all. They've been getting them from their employer for many years, so they really didn't have to. However, as healthcare has gotten so expensive and more employees are purchasing it individually, they need to understand it better. That's a big opportunity for us to educate folks on what the costs are and how an excise tax on medical devices, for example, affects their health insurance premiums.

Davis (MedImmune): In the US, you have a cultural mentality where people think healthcare is a right. People's health and the health of their family, friends, and colleagues is also a very passionate issue. It's not an issue that can be defined by rules, regulations, straight science, or facts. Where we go wrong in communications is thinking that we're having a factual conversation. In healthcare, we're having a dialogue about something that brings out people's emotion and passion in a way that is different from how we might choose a stock or a meatloaf special.

Stockman (Chandler Chicco): Healthcare is innately human. It really brings you to that physician-patient relationship and that human exchange to help another person with an illness. All of that will definitely change as we get into the next decade. It has to because putting this many people into the system will weigh it down. You'll have more patients trying to see fewer doctors. You will have to come up with other ways to service those individuals.

Empowering supporters
Fidelzeid (PRWeek):
What is changing about advocacy outreach and how are companies responding to these developments?

Fagan (J&J): It used to be if you were working on a particular disease, you automatically navigated toward an advocacy group for that disease. Now, manufacturers, providers, payers are all facing the same challenge together. You're seeing this real appetite to partner more, to learn from each other, to share best practices.

There will be real value in widening our lens in terms of putting together multidimensional partnerships that really speak to different aspects of whatever healthcare topic you're trying to tackle.

Stockman (Chandler Chicco): We have worked with clients pulling together some coalitions, such as the Stop Obesity Alliance. It has more than 50 groups trying to get at what is standing in the way of this country facing its obesity issue from a structural standpoint. It's really amazing when you get these people to put their agendas aside. They're much more willing to partner these days because they're realizing funding isn't what it used to be. They're also here to solve an issue. This group's really been successful in doing that and you'll see more groups coming together to solve a problem they wouldn't be able to on their own.

Davis (MedImmune): Advocates have been useful and beneficial partners for years. As we get into trickier territory around healthcare, they will continue to play an important role. What has changed dramatically and positively is the role of the citizen advocate. Coming out of healthcare reform, we're going to see a lot of that. It's not just about an institution or group. People are going to feel this personally.

We've got all the great tools now. How many times have we seen movements happen because somebody had the right thing on YouTube? That's where we're going to have to engage differently and expand our definition of advocates from the big groups to the people who might not be part of some organization that ends with “association.”

Kwittken (Kwittken): We've been trying to talk to our clients about the concept of crowdsourcing as advocacy. It's like this singular collective.

Quite frankly, the way journalists are now sourcing stories isn't because they're coming up with these genius ideas or we're coming up with the editorial. They're also looking at what's trending based on search. That's how they're forming their stories. Put that together with the new advocacy of crowdsourcing and that is part of the design of communications programs now.

Lynam (North Shore-LIJ): In terms of advocacy, we started partnering with a patient safety group made up of people who have been victimized by medical errors. Years ago, most hospitals would keep those people at length. We bring them in under the tent, talk to them, and have them advise us on what we can do to improve. They had suggestions on what gnaws at patients about the hospital experience. It's been valuable for us.

McGillan (Porter): What's a bit tricky on the advocacy side is this need for ROI on anything PR-related. Advocacy efforts tend to be unbranded. How do you balance the need to show ROI from our PR and investing a lot of dollars on building unbranded coalitions? 

Pudloski (Pfizer): We recently had our first blogger summit. There are ways through social media and digital that we can run some of these very disciplined experimentations around relationships for which we'll start to see payoff in the future on issues that have a common objective. For instance, how do we make our cities healthier? Every company and firm could get around that issue. We all might have a different take on it, but there's value in uniting around that kind of an objective.

Fagan (J&J): With all the changes being spurred by social media, I'd put bloggers at the top of my list as advocates.

Rubino (Horizon): We also work with a lot of groups through our charitable giving in different communities. We have a big childhood obesity initiative we fund with the state YMCA. It's the largest after-school childhood obesity program in the country. Once you have these groups, you can work with them to get the message out among a wider group of advocates.

Hahn (WebMD): We have advocacy with our online communities that are focused on a variety of health and wellness topics. We have our own experts in there, but we also partner with nonprofits and hospitals that provide their experts to the community. The end goal is empowering the patients so they can have better conversations with their physicians.

Direct to consumer
Fidelzeid (PRWeek):
No matter the type of healthcare company, there seems to be more of a retail focus than ever before. How are you all adjusting to this?

Rubino (Horizon): We recently opened a retail center, first one in New Jersey. We want people to have a different kind of relationship with us because they will be engaged with their insurers more directly in this increasingly retail environment.

Hahn (WebMD): WebMD has that relationship already with tens of millions of consumers coming to our site. However, as other constituents in healthcare have an increased retail focus, we're facilitating that relationship and helping connect those brands with consumers.

Fagan (J&J): We have a very large medical device and diagnostics sector within J&J. The retail focus is there, but we're also focusing on what will help our customers communicate to their patients. Take infection prevention instruments. Hospitals are looking to us to communicate to their communities about why patients should go to that facility. It's because they're using the latest and greatest infection prevention solutions. Products in our portfolio that were very much b-to-b and trade-focused are becoming much more consumerized.

Kwittken (Kwittken): I was part of the first DTC program for a medical device company, Stryker. We took them out with [golf legend] Jack Nicklaus back in 2003. Then you saw a whole host of med-tech companies go out in the orthopedic space. We found you have to spend a lot of money to do this and the med tech industry isn't accustomed to that and hasn't seen the returns on that from a volume standpoint. Physicians are still a little resentful that the patient coming in is a do-it-yourself patient when it comes to devices, surgical techniques, innovations, and procedures.

What happened was you had this DTC pushing medical technology and medical devices. Then the Department of Justice came in and started to question the relationships between these surgeon consultants and the med-tech companies. Then everybody went quiet. Now you're seeing a bit of a resurgence, but it's still experimental. I have yet to see whether or not something could be accretive to the business or if it's a dead end and whether or not earned and sponsored media is going to be more effective than paid media, especially when it comes to the DTC, at least for med tech.

Pudloski (Pfizer): This all re-emphasizes the need for integration. We introduced a lung cancer product. It was effective in only 5% of patients, but it cured them. So you had to be very responsible in how you offered the education about that to the consumer because you didn't want to create false hope.

The key was you had to test to see if you were one of those patients. So from a payer perspective, you didn't want anybody getting on the drug who wasn't eligible because you were running up costs. From a physician perspective, there needed to be an education around what the product could and couldn't do. From a patient perspective, we ran a campaign called Cancer: It's Personal. It's about your health. It's about you. It's about your life. It's about your family's life.

The integration of all these different stakeholders is critically important. As communicators, we are often the few people sitting at that table who have that full perspective. Our executives in our companies, our colleagues, really appreciate and value that.

Davis (MedImmune): Healthcare is a very heavily regulated industry. When it comes to communications, we can't just put out whatever we want. What makes it uniquely creative and actually fun, however, is that the advancement in technology means there's a broader education of the public that goes beyond the brand.

For example, MedImmune produced the first FDA-approved four-strain flu vaccine, Quadrivalent. There's a lot of education about what a four-strain flu vaccine is. What does that mean for my health? People care, they want the details. So the conversation with the consumer is very much about education on innovations, whether it's in a medical device, healthcare, or insurance. And there's the direct to consumer relationship or conversations that you will have about a specific product or brand. We've got to think about the many facets of communication as this whole field continues to grow and shift systematically.

Kwittken (Kwittken): It's a tricky balance because you want to tell a patient this material science is used in the space shuttle, but all they really want to know is will it last 20 years before they have to get another operation. From a regulatory standpoint, though, you can't guarantee it's going to last 20 years. That's the trick.

McGillan (Porter): The key there is figuring out what the patient wants to hear so we can make sure we're addressing that within the confines of the regulatory limitations.

Stockman (Chandler Chicco): We work with some large hospital systems. They're so much more retail focused than our pharma and biopharma clients. They have more latitude to the point where they can engage with an individual and see how they can make things better, whether the physician's bedside manner wasn't what they thought it should be or it took them months to get an appointment. They're very much realizing that these customers are making decisions about the hospital at which they're going to get care.

Are we going to get to the point where we'll be able to engage directly with individuals? Pharma and biopahrama companies have a lot of information that would be really helpful to a patient, but with all the regulation, liability, and everything else that goes with it, they're not allowed to say it. In the hospital space, however, it seems that direct conversation is starting to happen in terms of the experience patients have at the hospital.

Lynam (North Shore-LIJ): Patient satisfaction is a huge component now because the federal government requires the distribution of patient satisfaction surveys. Any consumer can go to the Health and Human Services website and find out how their own hospitals rank against others. It's put a lot of pressure on us.

Rubino (Horizon): Social media is instantaneous. You have to monitor it and then be wise in how you respond, if you can respond at all. You have to know the ins and outs, as well, from a HIPAA (Health Insurance Portability and Accountability Act) compliance standpoint. We've had good success in getting answers to people who have complaints. They'll go back on the social media site and thank you. That's a win for you in terms of advocacy and, potentially, retail.

The doctor is in

Dr. Scott Gottlieb, resident Fellow at the American Enterprise Institute and former deputy commissioner for medical and scientific affairs at the FDA, addressed a breakfast audience on a variety of health issues:

The FDA's communications challenges:
“Over time, there has been an increasing distrust of pri­mary physicians. At one point, the label was the primary tool for risk management. Now the FDA feels it needs to go beyond the label and engage in active risk manage­ment. They don't trust doctors to read labels and make the right decision. A trend is emerging where the agency is trying to more actively manage aspects of the practice of medicine – a role it is uncomfortable with and one where it doesn't have clear legal authority.”

Social vs. traditional media:
“I've found blogs and social media to be a quick way to defend myself. However, the best way to get a new idea out proactively is still through an editorial in The Wall Street Journal or another major publication.”

Sources of information for physicians:
“You would be surprised at the sources from which doctors are getting their information. Many physicians are receiving updates on a variety of healthcare-related topics from non-medical sources. They will often read news about new drugs in outlets such as the Financial Times. I even came across some statistics about a high rate of physicians using Wikipedia.”

Challenges President Obama faces with the healthcare plan in his second term:
“The president is going to have a difficult time getting health insurance exchanges in place by 2014. However, there is a good likelihood that people will move into them as they are a better deal because of the subsidies you can get.”

The informed patient
Fidelzeid (PRWeek):
What communications opportunities and challenges have arisen from the fact that consumers have more health information available to them than ever before?

Lynam (North Shore-LIJ): Consumers rely on online video content very heavily for health education. Over the years, we've found that the videos with the largest hits are those that provide short, three- or four-minute features on what a cardiac bypass surgery or angioplasty is like.  

McGillan (Porter): Social media is efficient. You have very broad reach when it comes to disseminating through various channels. What we've found, however, is that it has to be part of an integrated campaign. Social media alone isn't driving health behaviors. It's driving consumption in terms of the information people are getting, but you still need to make that human connection with the information. The impact comes when you make that part of your larger campaign.

Hahn (WebMD): Social media and word of mouth are really just a point of reference in the healthcare conversation. Consumers are really still going to trusted sources of health information. The challenge is continuing to innovate. Whether it's social media, mobile, or a multi-screen platform, you must give consumers the information where and when they want it.

Pudloski (Pfizer): The interaction with the healthcare professional is a seminal experience in how you're going to choose to behave, but it's not the only experience. You need to bring it out to the retail setting of the pharmacy and to what the person is experiencing in day-to-day life.

Average people with a chronic disease don't think of themselves as that. They see themselves like any other person who goes to their job every day and has high cholesterol and is a mom and a wife. How do you help support healthy behaviors on an ongoing basis? We still have a far way to go to get all the right information to the community that serves a person's health with that person owning it first and foremost. You have to take ownership to make it happen.

Kwittken (Kwittken): We're always telling our clients we live in this multimodal world. I just read a stat that there are 40,000 or so healthcare-related apps. Most of them are fitness and 12,000 of them live on iTunes alone. Our clients are growing more interested in co-developing or being part of these apps and, more importantly, changing the culture with the healthcare practitioners so they're more comfortable in discussing and taking part in this dialogue, so when the patient does come into the office, they understand what this world is all about.

Stockman (Chandler Chicco): You're not only trying to reach that patient through a very cluttered environment, but also trying to make sure patients have good exchanges with their physicians in the few minutes they have with them. Doctors have come to a point where they realize the patient, for the most part, is going to come in much more informed than they have in years past.

Hopefully, they're getting to see, as well as a lot of the clients in the doctor/patient relationship, that a more informed patient is a good thing. If we can just help the physician deal with this enlightened patient and then help the patient find reliable sources, that's the next big thing – a search engine that actually filters by credibility of information.

I read a statistic that 90 million Americans are getting health information from social media. So even though there are the credible sites, there's still a social aspect to health. They're still going to go online. We mentioned the community before. That's where they're getting a lot of information, especially if they have a chronic disease. They're trying to find patients like them. They're trying to learn from others that have the disease. We can't discount the fact that's happening, it's going to happen. How do we as communicators deal with that patient who has that information and then help that doctor do the same thing to get a different result?

Fagan (J&J): The social aspect is only going to help us improve healthcare. People who are engaging in these apps to change their behavior become more informed. The engaging in social media part has so many elements to it, not just the sharing of information. Take a site such as Somebody goes to that site because they want to better understand how to manage their healthcare issue. It's that actionable information. A lot of that will come from social media.

Hahn (WebMD): We actually launched a chronic pain app. In helping facilitate that patient-physician conversation, we're going to find that mobile apps are really going to help doctors in terms of accuracy, adherence to medication, all of those things.

Davis (MedImmune): Everybody agrees that a more educated consumer is a better consumer. Social media is opening up all kinds of channels, but as communicators, we have to be clear. That is the difference between purpose and outcome. Everybody around this table has some source of information that will make a consumer a better consumer. Where we get the greatest value is when we become that trusted source.

If I went to Google and I typed in “breast cancer,” I would get a million different sources where I could go. We've got to think about where is the unique advantage and how do we move into the trusted source space versus just being a source.

Then we need to think about what is the purpose? That goes into the conversation between physicians and patients. Doctors are very protective. Sometimes it has created pushback in some of the things we want to provide, understandably so. It's one thing for a patient to come in and say, “I saw this, let's talk about it.” Where I've heard physicians object is when they prescribe for themselves and say, “I want X or Y.” You can see how there's a tension between a company and a patient about what our goals might be versus what the outcome and the need is with the doctor.

Another concern physicians have as they engage more and take on more responsibility electronically is liability. We've got to think about purpose and outcome as best we can when we're starting to embark, engage, and utilize all these grand new tools.

Rubino (Horizon): Today, we have more information at our fingertips than ever before, yet we're unhealthier in terms of chronic disease. It's not an information problem. We all want to be healthy, but we end up not doing things that would make us healthy because it's tougher than not doing it. The bigger challenge is actually transforming behavior before they get to that point.

Kwittken (Kwittken): Our organizations need to be more involved early on in education and use technology as a vehicle. I know my kids are constantly looking at that. It's just a really interesting point because it's behavior and culture.

Fagan (J&J): I heard Thomas Goetz, author of The Decision Tree, speak about a year ago. His son wanted to get out of the booster seat in the car. He used an app to show his son where his weight was, his height, and how he had to grow over time to get out of the booster seat. The parent was involved. His young child was involved. It was still all about safety.

Hahn (WebMD): WebMD is really focused on preventing childhood obesity. About two years ago, we had a partnership with Sanford Health, the largest nonprofit rural healthcare system, to launch FIT Kids. Recently we launched, with Discovery Health, an in-school online health curriculum aimed at preventing childhood obesity. It's really about reaching these kids at an age before they're making health decisions on their own and teaching them about mood, exercise, everything that's related to being healthy.

Staying connected
Fidelzeid (PRWeek):
Connected health is a rising model in this space. How do you determine which markets or demographics to focus on initially and which messages are most effective to establish that initial impact?

Pudloski (Pfizer): The markets that make the most sense are the ones that have the most restrictive formularies. So, for a pharma company, the dilemma is an interesting one. The markets that seem to be most advanced are ones such as Minnesota, the Pacific Northwest, places where there's been a consolidated provider, where there was early adoption of electronic medical records and shared risk in the provider area. Are people healthier in those markets than those living in the more disparate markets of New Jersey and New York? Do those people access and engage in health differently?

With organizations such as that, you can go in and do holistic health education in a more effective way. We need to realign our objectives and sit around the table with all the stakeholders contributing to the health of the community and see where they fit and make progress happen.

Lynam (North Shore-LIJ): One of the biggest problem areas in terms of chronic disease is diabetes. We find the greatest success when we get together with church groups and have people on-site providing screenings after they're walking out of Sunday mass. That tends to really have an impact on the community.

Fagan (J&J): When you talk to a lot of payers, physicians, and hospitals, diabetes is often a major topic because of the prevalence of the disease and the associated comorbidities.

An interesting twist to connected health is related to diabetes, as 80% of diabetes in the future will come from emerging markets. We have more and more governments calling us to ask how we can help them control this epidemic? They're coming at it from the perspective of controlling the healthcare costs. What we find interesting is they're asking us to show them a connected health solution. They don't want the product anymore. They want the whole comprehensive solution. That global perspective on connected health is fascinating.

Rubino (Horizon): We had a pilot program with connected health. Case managers were given to diabetes patients. Their vitals were being collected daily or weekly with their case manager and nurses at Horizon. When issues arose, that case manager would call that patient and help them in a manner that would keep them from having to go to the emergency room, which would be a lot more expensive than just keeping that patient adhering to their program. 

Stockman (Chandler Chicco): NPR recently did a story about e-health and the evolution that will be taking place. One company was highlighted – and there are several who do this – that's trying to reduce healthcare costs for employers based on phone-a-physician. The doctor is available to employees virtually only to diagnose and prescribe. They were talking about how that's actually saving costs. They also cited a statistic that 70% of ER visits are not necessary. With this, you're able to quickly do something about that problem before getting to a more expensive solution. This is interesting in terms of the connections that will be made through technology.

A second matter is accountable care organizations. They will provide an economic incentive to connect health because they're all going to be responsible for patients' health and well-being. They're going to be incentivized based on how well they take care of that patient. Thinking back to how we change behavior, economic incentives are very powerful. If that accountable care organization model gets traction, we're going to see a lot more forced connections of health, which hopefully leads to better patient outcomes.

Talking to the doctor
Fidelzeid (PRWeek):
What are the opportunities and challenges in communicating with physicians?

Stockman (Chandler Chicco): A lot of reps aren't getting in to see physicians anymore, so a lot of our clients are looking at eDetailing and anything to connect with a physician virtually. Reports indicate that doctors actually prefer this because they can access that information when they need it.

At the end of the day, though, physicians are consumers, so it's not just about reaching them from a medical standpoint through The Journal of the American Medical Association. You must reach them via other channels, such as The Wall Street Journal, which is something we've always done.

As for social media, it's an interesting dynamic for physicians because of the intimate relationship they have with patients. Do they really want that relationship online? However, they're definitely consuming what they see online. With the advent of new channels and people on devices 24/7, there's just a lot more ways to reach doctors.

We've even seen this play out with medical meetings, as the number of physicians going to those is decreasing dramatically. They are able to get that information either via a webinar or in real-time as people blog from the session. Even the way they educate themselves and stay abreast of healthcare topics has changed with technology.

Hahn (WebMD): The largest online site for physicians, Medscape, is part of our professional business. We have apps for physicians. We're finding that doctors have very little downtime in between patients, so they're accessing information via mobile or, at the point of care, they will look up drug reference information on a mobile device.

Kwittken (Kwittken): We work on education programs that have nothing to do with clinical education, but more business management. Just as consumers are incentivized by economics, so are physicians. Most doctors are now transitioning to larger physician practice groups. Smaller practices are definitely going by the wayside. We can help them with that transition and manage their practice, not just clinical outcomes for patients.

Stockman (Chandler Chicco): With our medical communications group, there are a lot of peer-to-peer physician communities. They're coming together virtually to learn from other doctors.

Davis (MedImmune): It's also not just about the physician anymore, but the total office. Nurse practitioners are hugely important. You must look at how medicine is being delivered and all the people who now touch the patient in a whole new way.

Lynam (North Shore-LIJ): One successful thing we've done is the creation of a physician-lifestyle publication that has all these quirky stories and features about their colleagues. For example, one piece looked at the songs doctors have downloaded on their iPods. A lot of people got a kick out of that because they never thought the person they're going into surgery with listens to a certain kind of music. We made it available as a downloadable app on iTunes.

McGillan (Porter): We've been looking at this audience much less from the trade outreach side and much more from the consumer outreach view. We've also sought different ways to get feedback from them, whether it's online bulletin boards or one-on-one interviews.

Rubino (Horizon): As a health insurance company, we obviously have a lot of communication with doctors. What's changed is their openness to looking at different ways to deliver care. For my industry, that has been helpful in just starting those dialogues based on healthcare reform. There are more conversations going on about issues other than reimbursement rates. It's more about making changes to benefit the patient.

Pudloski (Pfizer): We have great insights into physicians, but insurance companies have a venue to get to doctors because there is a business necessity for it. The two coming together could actually impact overall care delivery, which has been an opportunity our company has been looking to leverage.

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