The concept of digitally-enabled healthcare convergence is not new; it was the subject of an Infosys white paper by Mujamdar and Bansal in 2010. What the term means, however, has changed significantly over the intervening years.
The Infosys white paper was mostly concerned with the integration and inter-operability of IT systems. Econsultancy’s view is that that digitally-enabled healthcare convergence is a combination of:
1. Increasing availability of health information online, which has changed how patients and healthcare professionals think, make decisions and take action.
2. Innovation in how patient health can be digitally managed and treated.
3. The responses within pharma and healthcare companies to these and other pressures.
The key components of this digital transformation are explored further in the following sections and summarised in Figure 2.
Figure 2: Digitally-enabled healthcare convergence as a driver of digital transformation in healthcare
When facing a health question or a health condition they wish to explore, 53% of patients will research the topic online; only 32% will consult their doctor first. According to Google’s own figures, one in every 20 online searches are health-related. When health-related information is found online, 78% of people will be extremely likely or very likely to trust it if it is from a physician’s or hospital website. If it is the website of a medical device company or pharmaceutical company, trust falls to 34%.50
Two of PatientsLikeMe’s recent accomplishments indicate the power such networks could hold in the future of healthcare. First, an article published in the journal Neurology reported that epilepsy patients given access to information on PatientsLikeMe increased their epilepsy self-management and self-efficacy scores compared to a control group. Second, an article published in Nature Biotechnology used PatientsLikeMe data to refute a previous clinical trial suggesting beneficial effects of the supplement lithium carbonate on the progression of amyotrophic lateral sclerosis (ALS) – a motor neurone disease.
Healthcare’s ‘Gutenberg Moment’
Dr Eric Topol suggests healthcare is currently having its Gutenberg Moment. Just as the printing press wrested control of the written word from the aristocracy and clergy of mid-15th century Europe, the current internet and mobile revolution is wresting control of medical knowledge from healthcare professionals.
In his book ‘The Patient Will See You Now’, Topol talks about a shift from doctor-prescribed healthcare to user-driven healthcare, turning the doctor-patient relationship on its head. A pivot point in this process, according to Topol, will come when patient-generated data (e.g. from wearable devices) plays a key role in healthcare. If patients can submit their own data to online expert systems of their choice, the role of the healthcare professional may be reduced to validating the diagnosis provided by the patient and prescribing the treatment.
The ‘Patient Pull’ factor in healthcare decision-making
The more informed the patient, the more they will seek to participate in the decision-making about their healthcare. This changes the dynamic between healthcare professional and patient – the healthcare professional is no longer the sole source of medical expertise and needs to become a better listener, not just an advisor. This opens up three opportunities for marketers in pharma and healthcare:
1. Providing healthcare professionals with insights into patient concerns and priorities, along with guidance on how best to ensure they understand their medical condition and why a particular treatment is the best choice in their circumstances.
2. Working with healthcare influencers and information providers to try to ensure that the knowledge patients find for themselves is as accurate and meaningful as possible.
3. Direct-to-consumer marketing for the countries that permit it (USA and New Zealand)
- Patients (and prospective patients) are eager consumers of online healthcare information and appear to be getting increasingly discerning in their trust of online health information sources.
- We appear to be in a transition from doctor-prescribed healthcare to patient-driven healthcare, a transition that could accelerate rapidly as patients generate an increasing proportion of the data needed for their healthcare management.
- Patients becoming better informed leads to new marketing opportunities for pharma and healthcare companies, including patient-centric content for healthcare professionals, outreach to healthcare influencers and direct-to-consumer marketing (in the territories where this is permitted).
The first year in which the majority of healthcare professionals were digital natives was 2014. As of 2018, over 88% of physicians are using the internet and social media to research pharmaceutical, biotech, and medical devices and 76% of physicians are using mobile devices in their practice. According to one study into the use of smartphones in clinical practice, mobile devices are being used for staff communication (by 69% of respondents), patient communications (51%), electronic health records or clinical assessment (50%) and clinical education (47%). Only 15% of respondents were able to accept patient data from a wearable device such as Apple Watch or Fitbit, mostly (61%) because it does not integrate with electronic health records. Physicians also believe that 75% of all doctor, urgent care and ER visits are either unnecessary or could be handled safely and effectively over the phone or video. A further 40% of physicians believe mobile health technologies can help reduce the number of visits to doctors’ offices.
The digital resources available to healthcare professionals are proliferating. For example, social networks for healthcare professionals include:
- Sermo, which claims 800,000 physicians in 150 different countries as members.
- Doximity, which claims to have 70% of US doctors as verified users.
Other social networks have a more specific focus:
- Figure 1 is a site for doctors to share and discuss medical cases and medical imagery.
- All Nurses and Nurse Zone are networking sites for nurses.
- Incision is a networking and professional education site for surgeons.
The ‘reach’ of healthcare professionals on social media is also substantial. On Twitter, for example:
- Dr Sanjay Gupta, staff neurosurgeon at Emory Clinic and CNN Chief Medical Correspondent, has 2.4 million followers.
- NHS Million which is “creating a super team of a million people who are grateful for the NHS” has 355,000 followers.. It is not officially run by the UK National Health Service (NHS), but by NHS staff.
- Dr Atul Gawande, surgeon at Brigham & Women’s Hospital in Boston and author, has 259,000 followers.
- Dr Phil Hammond, NHS doctor, Private Eye’s MD, author, health campaigner and comic, has 56,300 followers.
- Dr David Walker, pharmacist and social commentator of patient safety and developments in pharmacology, has 16,700 followers.
- Andrew Lopez, registered nurse and social commentator of nursing issues, has 14,800 followers.
- Healthcare professionals are overwhelmingly digitally literate with digital tools and processes embedded into their practice.
- An abundance of digital resources exist to educate, inform and update healthcare professionals, to help them share and discuss cases and for them to seek advice and guidance on their decisions.
Digital technologies are being used to collect data on patients, inform them, advise them and signal reminders or prompts to enable them to treat themselves more effectively.
At its simplest, this can involve SMS messaging, and has been shown to have positive outcomes for patients. In a 2018 study, researchers used SMS messaging to remind Medicare patients when they were scheduled for medication refills. The patients could also request their repeat prescription by replying to the SMS. The group that received the SMS messages were more likely to order their medication than those who did not receive the messages.
Smart devices are also used for digital treatment management, such as smart pill dispensers (e.g. Pillsy or Adhere Tech) that track when medications are taken and provide warnings or reminders when medications are overdue. The Abilify MyCite system is a digital pill that can track whether the medication has been ingested by the taker.
Between 2015 and 2017, a total of 153,000 new smartphone apps were launched on Apple’s App Store and Google Play in the ‘Digital Health’ category. Of these, just 41 apps had over 10 million downloads each. Over 55% of these most downloaded apps use sensor data, either from fitness trackers such as Apple Watch, Fitbit or Jawbone, or from dedicated sensors measuring body temperature, body weight, blood oxygen, blood glucose, blood pressure, ECG or EEG. Of the health apps, 40% are categorised as health condition monitoring. Of these, more than 11,000 are disease specific apps, with mental health/behavioural, diabetes and heart/circulatory conditions accounting for over half of them.
In a 2017 study, health condition monitoring apps in five treatment areas were found to have clinically validated value; diabetes prevention, diabetes management, asthma, pulmonary rehab (COPD) and cardiac rehab (MI). The cost saving to the UK’s NHS from use of apps in these five areas was estimated to be £171m.
Although such cost savings are significant, there is a much bigger financial agenda driving interest in digital treatment management: medication adherence. In the US, medication non-adherence results in 10% of hospitalisations in older adults, adds up to $100bn to $300bn of avoidable healthcare costs and results in as many as 100,000 preventable deaths.
- The Internet of Things, smartphone apps and messaging are offering a multitude of ways to help patients better manage their treatment.
- The value of improved patient treatment (in both healthcare savings and improved medication adherence) suggests that self-management through digital tools will remain a huge growth area for some time.
In September 2017, the US Food and Drug Administration (FDA) gave its first ever approval for a prescription digital therapeutic with claims to improve clinical outcomes in a disease. It was granted to Pear Therapeutics for reSET, a mobile app to treat opioid addiction. This represented a move in the healthcare market from digital tools to assist with conventional treatment types (e.g. insulin treatment of diabetes) to digital tools as prescribed therapies in their own right.
Another example of a prescribed digital tool is Deprexis, a computerised cognitive behavioural therapy that has been found to be effective for the treatment of depression. It has been approved and funded by Germany’s biggest public health insurer since 2017 and is being trialled by the NHS in the UK for approval by the National Institute for Clinical Excellence.
Neurotechnology startup Mindmaze has secured FDA approval for its Mindmotion Pro and Mindmotion Go platforms, virtual environments for early motor rehabilitation of upper limbs, following neurological injury such as stroke.
Digital medicine company Akili Interactive Labs has announced its intention to file for FDA approval for its AKL-T01 video game for treating Attention Deficit Hyperactivity Disorder. If approved, this would be the first video game approved as digital medicine. On its website, the company explains that its treatments are “designed to directly activate neurological networks and functions to lead to symptom improvements.”
Developer Big Health has created an app called Sleepio that draws from cognitive behavioural therapy approaches to treat insomnia. Sleepio has been clinically proven effective in six randomised controlled trials and is being trialled by the NHS in Berkshire, Buckinghamshire, and Oxfordshire.
“Digital therapeutics holds great promise to enhance patient care, create treatment efficiencies, and improve clinical outcomes.”
William Smart, Chief Information Officer, NHS
According to Grand View Research, the market size for digital therapeutics globally was $1.7bn in 2016 with a 21% compound annual growth rate, giving it a value of $9.4bn by 2025.
- Digital therapeutics is a fast-growing market attracting a lot of innovative thinking.
- Digital therapeutics also provides the ultimate example of the possibilities of digital healthcare – product promotion, product adoption, treatment management and the treatment itself can be entirely based on digital content.
Two key changes are transforming the way pharma and healthcare companies manage their product portfolio. The first is the decline in profitability of blockbuster medicines (medicines that have peak sales of $1bn or more), as patents expire and fewer new drugs are being developed to take their place. According to John LaMattina, former president of global R&D at Pfizer, “30 is the new 50” in the drug industry, with the number of new drugs being approved declining each year. Meanwhile, R&D costs are rising.
As a result, pharma and healthcare companies are having to manage a more diverse product portfolio by competing in markets where they are not the market leader and also tackling rarer diseases. According to CB Insights, rare disease (conditions affecting fewer than 200,000 people) is becoming an increasing area of focus in pharma, with a market size that could reach $169bn by 2022.
Figure 3: CB Insight’s Periodic Table of Companies Treating Rare Diseases
Source: CB Insights
The second big change is the move away from rep-based selling. “There is no role for the pharmaceutical representative in the office or hospital,” wrote US-based doctor Kevin Campbell in a 2016 blog. “These individuals have absolutely no bearing on my choice to prescribe a particular drug and do not contribute to my continuing medical education.”
This sentiment appears to be felt on a wider scale; in the US, a recent survey found 48% of physicians now limit sales rep visits. In Australia, 44% of physicians say they see sales reps once a year or not at all. In the seven years between 2005 and 2012 the number of pharma sales reps in the US fell from 101,000 to 66,000.
The move away from rep-based selling has two big consequences for pharma and healthcare:
1. New ways need to be found to reach healthcare professionals and, in light of their digital literacy, these need to embrace digital channels, including digital destinations and social networks, where healthcare professionals are already seeking and sharing information.
2. New ways need to be found of working internally to replace the role of the rep. In many pharma and healthcare organisations, the rep played the role of in-house client. The content that marketers produced needed to meet the needs of the rep. If feedback revealed that marketing materials needed to be revised or updated, that feedback usually came from the rep.
- The decline of blockbuster medicines and the move away from rep-based selling have led to big differences in the way pharma and healthcare organisations manage their products, often referred to as ‘beyond the pill’ initiatives.
- With these, companies are moving from a provider of a pharmaceutical compound to a more patient-centric healthcare service. This includes preventative medicine and the range of treatment management solutions reviewed above.
- They also lead to a more audience-centric approach to communications. This is discussed in more detail in the following sections on communications and content.
Following insights around the nature of transformation in the pharma and healthcare sector, this report will now explore how marketers can bring about change in their own organisations. The concept of strategic pillars is used. This refers to the strategic battlefields a business needs to win to be successful. Communications, content, data and culture are recommended for the pharma and healthcare sector. 
Our interviews for this report revealed three drivers of change in the way pharma and healthcare organisations communicate with their audience:
1. Cost savings – The need for cost savings is due, to a significant extent, to the decline of blockbuster medicines, as already described in the previous section (Section 3.5). This has driven a decline in rep-based selling; a trend accelerated by the increasing difficulties in reps gaining access to healthcare professionals in certain markets.
2. Payers – The increasing separation between the people who prescribe and those who pay (the payers) means that the needs of payers have to be factored into the communication mix.
3. Audience expectations – All parts of the pharma and healthcare audience have come to expect instant-response communications. Clearly these are all drivers towards digital communications, but they are also drivers towards specific aspects of communications, namely audience fragmentation and marketing automation.