Measure for Measure

Kevin dismantles one of the biggest barriers to real investment in patient services – the ongoing argument for reliable ROI.

Last month we discussed the importance of measuring customer satisfaction when dealing with patient support programs, and we mentioned the Net Promoter Score (NPS) as an excellent way of tracking this.  Remember, anything that even smells like a service must entail the tracking of satisfaction if you want it to be successful.

However, as important, nay crucial as this is, what we're really trying to affect is adherence to treatment. This should be measured as well.

This raises an interesting point - one that frustrates me. I've heard a number of pharma executives complain that one of the problems with patient programs is that it's so difficult to measure their impact. How do you know what you're getting for them? It's all very fuzzy.

Right. And of course you know exactly what the impact is of your last one or two reps (after all, a decent adherence program only entails about the same all-in cost of a rep or two). You know exactly the return on investment on that 173rd rep, right? You know exactly how to calculate the ROI on those 1000 calls, or on your new iPad-based detail aid, or on the sponsorship of the international halitosis convention.

In fact, when you look at it closely, what many execs mistake for return on investment is in fact SOVOI - share of voice on investment (I just made that up.... not the same satisfaction I got with supercalifragiphobia, but you can't hit a home run every column).

So many pharma execs have lived so long considering that share of voice is some kind of end in itself, that they worry themselves sick about movements in SOV, even if there's no discernible link between SOV and market share.... and even less of a link between SOV and sales.

I've been plying the consulting waters for over two decades now and while there used to be all these nice, clear, evident curves that showed the link between frequency and results, those curves are becoming harder to see, and in many cases are absolutely non-existent. Nevertheless, SOV is still an endpoint, an objective for many. One thousand calls will certainly help your share of voice, but it may do diddly squat for your actual sales. As such, you're currently spending a pile of money on a promotional channel that might well have no discernible return, at least at the margin.

Adherence programs, on the other hand, can generate ROI that is relatively easy to measure. From the ROI perspective, what is interesting is the Medical Possession Ratio. This common adherence measure is calculated by simply dividing the actual doses acquired by a patient over a given period with those prescribed.

For example, if someone is supposed to take an oral medication once a day, then over the course of a year they should have acquired 365 doses. If they actually acquired 182 then their MPR is 50%. Whether this is because they religiously took the medication for six months then stopped (non-persistence) or they continued to take the medication, but not with the right frequency (non-compliance) we don't know, but their overall persistence was 50%. The equivalent measure for hospital-administered drugs is PDC, Percent Days Covered.

MPR can be measured by declaration via patient surveys, or by tracking sales to the patient via insurance records or pharmacists. Of course, the longitudinal data is not always available, but for sample populations it is not difficult to set up a small study to track the impact of your investment. Keep in mind that while it would undoubtedly be useful to get granular data to see if the implementation of the program is going better or worse in different regions, you can already start with a relatively limited sample of patients.

This can give you a direct measure of the impact of your program: if MPR moves from 50% to 60%, you've just increased your sales by 20% for those patients in the program (if you just did a double take with those numbers, you made need to break out the old college math book again). 20% increase in sales, multiplied by your price (or margin, more exactly) is the return - compare that to your investment and you have return on investment.  It's really that simple.

I'd point out that the consulting world and the data analytical world are starting to realize that you're going to need these types of analyses and they are currently looking for ways to provide ongoing adherence figures for patient populations. This will make it all a bit easier to calculate, but the real point here is that uncertainty about results, or about return, is no excuse to remain stuck in the past.

Now, of course, if you're only measuring return in terms of what it does for patient acquisition then it may well be more difficult. Patient support programs do indeed have a beneficial effect on prescribers, and as such they may help your market share and therefore your sales. In fact, I'm sure they do, but I would suggest that you simply consider this icing on the cake: if your adherence program can't pay for itself via greater adherence then you should try something different.

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