In the pharmaceutical industry, patient journeys are often used to better understand patients and diseases. However, throughout 3Rock’s more than 15 years of experience with a variety of brands, we have seen many cases in which the tool is badly utilized – for instance, when the patient image is too abstract to be helpful, or the patient perspective is simply unrealistic. In this article, we will consider the perspectives required to create a patient journey that can truly inform your strategy.
Patient Centricity’s Direct Relationship to US Business
The concept of Patient Centricity in the pharmaceutical industry began to gain momentum over 10 years ago, as the product-out strategy prevalent in the blockbuster era gradually gave way to an effort to better understand and take into account the end-user patient’s perspective.
The impetus for this change can be attributed to the strong influence of Direct to Consumer (DTC) advertising in the United States. In America, pharma companies are not prohibited from including branded drug names in their commercials, so just as with general consumer goods, strong messages like “Talk to your doctor about Brand X!” can be deployed through TV and magazines to drive disease awareness. Early on, most DTC spending was aimed at primary care lifestyle diseases and pre-symptomatic patients, but now its use has expanded to include cancer patients already undergoing treatment as well as those with undiagnosed rare diseases. Huge amounts of money are spent every year, with extremely large business effects.
It is against this backdrop that global companies began to introduce the use of the patient journey to the Japanese pharma industry as a framework for understanding patients and encouraging behavior change. In this context, we define a patient journey as “an analytical tool for visualizing and analyzing the overall flow of specific behaviors around patient care, in order to identify opportunities for potential intervention (leverage points)”. Similar to the well-known “patient flow”, which quantifies a macro perspective, it is a more qualitative evaluation of the process that patients follow at each treatment juncture such as screening, consultation, treatment initiation, and dropout.
Challenges & Needs Vary by Patient and Provider
In the US, in addition to using ads to drive presentation rates, pharma companies often create Patient Support Programs (PSP) designed to prevent patients from discontinuation of treatment, which often occurs due to differences in medical insurance coverage by region, facility, employer, etc. The patient journey plays a significant role in the design of PSP, wherein pharmaceutical companies have direct contact with patients with various perspectives.
However, under the Japanese healthcare system, pharma companies have few opportunities to communicate directly with patients. So while many brands have created patient journeys, most could be considered fairly proforma, and are not being fully utilized to support strategic thinking. In order to create something more practical and useful, two issues must be addressed.
First, it is important to think carefully about the reason the patient journey is being created in the first place. Developing a patient journey that covers a long period of time, for instance from birth to death, will certainly help us understand the patient better. However, especially in the case of progressive chronic diseases or specialty disease areas that require complex, ongoing treatment, creating a holistic journey can be a huge undertaking, and a team can be easily overwhelmed with an excess of information, resulting in a lack of clarity on the truly important points.
To avoid this, we recommend using data to define the important intervention points before delving into a detailed analysis. The key here is to use the patient flow. Leveraging quantitative and objective indicators, map out the flow, identifying where groups receiving “sub-optimal treatment” appear. Then prioritize those in order of quantitative potential business impact in order to explore the stages that deserve more attention.
After that, the question remains “we can see the quantitative potential, but can each of these really be considered a leverage point?” To answer this, many factors must be evaluated. These include who would be involved as stakeholders, what impact their behavioral change would have on patient outcomes, whether such changes would be relevant to the brand’s strategy, and also feasibility considerations including whether the certainty of success is too remote or whether it will take too long to implement. By evaluating these issues before starting work on a patient journey, the end product can be used much more effectively and efficiently as a marketing resource.
So rather than creating an entire framework from scratch, be aware of important events in the patient experience, and think of these as chapters in a novel. As in the example in the diagram below, these could include “pre-treatment”, “treatment” and “progression”. Think of these separately and focus on what is important in each, for example in the flow of treatment choices after a confirmed diagnosis is made, what critical factors contribute to optimal treatment? First select the “chapters” to focus on and then deep-dive into them. The goal is to extract useful insights and create deep understanding, not to paint a pretty but shallow overall picture.
Another problem is that pharma companies often create patient journeys based on a “transactional” mindset. This means they tend to force the expression of patient needs to match their own products, or present only the most convenient and/or ideal diagnosis and treatment choices that match guideline algorithms. Many lack the emotional component of the patient’s complex experience, including frustration with incomplete or incorrect information, and the ever-changing trust relationships their doctors. Although treatment should of course be rational and evidence-based, when this analysis remains abstract and is not brought down to a level concrete enough to express the needs of real patient groups, strategies based on this general logic will not match the actual situation. Issues will get “averaged out” so much that they cannot lead to real solutions, because while the information might be true, it is not specific or edgy enough. Just putting together a list of general comments that are correct but not useful is a waste of everyone’s time and energy.
One solution to this problem is to create a persona (or patient profile) that allows you to better consider personalized aspects of the patient journey. We recommend creating at least one representative patient profile for a given disease, but sometimes it is helpful to create several patient profiles, as there is no such thing as an “average patient.
Where a single persona is not sufficient, and it is best to create multiple patient profiles, first imagine which different people might need different kinds of support in order to receive optimal treatment. But keep in mind that while every patient’s treatment experience is unique – in Japanese we say 千差万別 “sensabanbetsu” – having too many types can also lead to confusion, so we recommend a maximum of up to three personas be created to represent specific patient segments that can help to inform a brand strategy.
Another point worth mentioning is the importance of understanding which healthcare professionals and other stakeholders play a role in interactions along the patient journey. To do so, teams should also create a “customer journey” for each of the other players (mainly physicians, but also other stakeholders) that engage with and affect the end-user patient’s journey. At key stages in the treatment of a certain disease, the addressable challenges and needs will vary depending on the touchpoints of different patients with these health care providers. If teams can deeply understand and design appropriate intervention at these points, they can drive positive changes in the patient’s treatment process. 3Rock calls this concept the “Intersection of Healthcare Needs.”
Please look for more in a follow-up article in which we will expand this concept to include government and other area stakeholders that can provide support and services to patients in their daily lives, with the goal of achieving “community alignment” in healthcare.
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