The Nordic Model: “Co-Creating” your Way to Better Health Outcomes
Petteri Jarkka, Customer Engagement Manager at Janssen Nordic, talks to eyeforpharma about how the company is responding to recent calls for a ‘beyond the pill’ approach, and how they’re working with stakeholders to ‘co-create’ services improve health outcomes.
As a Customer Engagement Manager covering the Nordic region, Petteri Jarkka deals with multiple customers including the patient, payer and physician, in a role which combines marketing and patient engagement elements. As he explains, “this is a fairly new role which reflects a new direction for Janssen. Partly this has something to do with the technology; just as the whole area of digital healthcare services is fairly new, so are the roles around them. Yet it also has something to do with the situation in the Nordic market, a very mature market with limited access to the physician. We’re averaging less calls than we used to, everyone is, even with Medical Scientific Liaisons (MSLs), so clearly there is a greater need for customer-facing access and the use of multiple channels. I think we will see the same things happening more and more in other European countries as those markets mature.”
“There are a lot of easier, more engaging, more impactful things to be found in physician and customer engagement than social media”
In terms of engagement, especially physician engagement, Petteri says that the Nordics are trying to avoid the social media hype. “We don’t think it’s a fad, we could be doing it but that also means we won’t be doing something else, so it’s a trade-off, like any strategy position. That’s not to say that we aren’t doing anything with social media or mobile, it’s just that it isn’t the highest priority for us, partly due to the complicated regulatory environment surrounding social media. We often use the comparison that wanting to do social media is like wanting to climb a mountain, starting with Mount Everest instead of the hill in your own backyard. Basically what we mean is that there are a lot of easier, more engaging, more impactful things to be found in physician and customer engagement than social media.”
One of these other aspects of physician and patient engagement is the ‘co-collaboration’ on value added services. Petteri says that “co-creation is similar to ‘engagement marketing.’ It means you’re doing something not to the customer but with the customer; this means engaging and co-creating a product as you go along. A typical example where co-creation is a vital part of our method is for adherence in patient support programmes. Doctors and nurses usually know more than us about the factors that affect successful and holistic patient health outcomes, so it would be very naïve for us to build something in our brainstorming sessions and then just deliver it to our customer saying, “Here you go, use it and like it.” It’s more about, “What is your need? What do the patients need, what do they talk about? What would you say would help us the most?” Understanding the patient journey and having a genuine objective to improve healthcare are prerequisites.
“It’s insights like these that end up making or breaking support programmes and we need those insights, which is why co-collaboration is so important to us”
“For instance, when building one particular patient adherence programme we thought about including a box with extra material, to be handed out by the nurse to patients. When we had our first co-creation session with our customers, they told us “That’s great, sounds very good as long as you don’t come out with the box.” When we asked why not, they said that “two of your competitors already hand out boxes so we don’t want the patients leaving with a stack of boxes, that’s just not practical.” It’s insights like these that end up making or breaking support programmes and we need those insights, which is why co-collaboration is so important to us. Another example would be our work with prostate cancer sufferers, where we have tried to go beyond the pill and create services that help patients cope more generally with the disease. A diagnosis of advanced prostate cancer usually means limited life expectancy, and after talking with patient associations and with nurses and GPs we realised that we could be doing more to help the patient’s family cope with the news. I would say that the traditional marketing aspect of my job has become less important as co-collaborating in healthcare services has become our main focus.”
In a recent interview with eyeforpharma, the head of Merck Serono’s Global Fertility Franchise David Stern talked about the need to harmonise a ‘beyond the pill’ approach with an understanding of regional and even sub-regional differences. Petteri believes that the co-creation method represents the best way of doing this. “An illness can have a totally different stigma and a totally different psychological burden depending on the country, making it very difficult to come up with a regional solution or a global solution. We’ve noticed that with Janssen’s range of products, patient support and adherence systems may end up looking very different in each of the different countries, even though the therapeutic area and the target group might be exactly the same, because of the local customer and market needs and patient needs. This is why patient associations and co-creation are vital; even though we might operate in a European model or a regional model, it’s still the local insights that will make or break a service.”
“A fair challenge for any customer engagement, digital or patient adherence team, is to show that they have done their homework. If it is such a strong direction to be heading, then making the case for it to management shouldn’t be such a big challenge”
While regional and local differences might drive the development of individual services, one thing Petteri is clear on is the global nature of the challenge pharma is facing, and the change that this calls for. “I think what we see here is pharma under a lot of pressure from a lot of angles. I think that pharma knows it needs to change and it’s a very safe bet to say that we need to focus on the customer – I don’t think there’s an industry who cannot afford to say that. Who this customer is will differ depending on which country you are in, but in a lot of cases the role of the payer is becoming more important. In the very mature Nordic market, for instance, the lack of access to physicians and governmental austerity measures mean that the payer’s role is increasing.”
One of the things often seen as getting in the way of innovation for pharma is the traditional reliance on ROI measures. Petteri acknowledges that fighting for a bigger budget allowance for novel initiatives is “a tough challenge,” saying that “it doesn’t make it any easier that you are proposing something new, something potentially untested, something that where the ROI is difficult to show or calculate without running a Phase 4 study, which itself is very, very costly and sometimes out of reach.” However, he also thinks that proving ROI is “a fair challenge for any customer engagement, digital or patient adherence team to show that they have done their homework. If it is such a strong direction to be heading, then making the case for it to management shouldn’t be such a big challenge.”
Instead, Petteri sees the biggest challenge for pharmacos thinking of adopting the value-added services model as a legal and regulatory one. He says that often, “the law doesn’t expressly forbid us from doing something. Instead, laws and regulations are a bit ambiguous and it comes down to interpretation. There might be different interpretations depending on who you ask and how you ask the question. If it was crystal clear what the laws and regulations were saying, I don’t think we would be having such a debate. Of course, it always helps to include legal and regulatory people on your team from the start when developing a new initiative.”
Finally, Petteri highlights the importance for pharma companies of being able to embed any new service programme within pricing and reimbursement discussions taking place with the payer. This may mean being realistic about what can and can’t be measured: “health outcomes are about measuring and analysing data. If we’re not able to measure the added value of our patient support and adherence systems, then it’s hard to demand or hard to expect different outcomes regarding the discussions around compensation and reimbursement.”