The Marketer's Role in Early Diagnosis and Treatment

Okay. Good morning, everybody. How's everybody doing? Good. I wanna make this a little bit different than maybe some of the other presentations this morning and make it a little bit more interactive. I I I am a person that doesn't enjoy being spoken to. I I love talking to people, but being talked at is usually pretty annoying. So I'm gonna do my best to engage with you guys this morning, and we can have a kind of a meaningful conversation. I was asked by Simon and and the crew to speak on early intervention specific to this conference. And you might ask yourself, what the heck does early intervention have to do with marketing? So, hopefully, I can bridge that gap with you guys in the next fifteen, twenty minutes, and then we can answer some questions together. But by a show of hands, how many people in this room know someone or have a family member that's been impacted by cancer? Okay. Did you guys see how many raise your hands again. Okay. Take a look around the room. Okay. So the next question I have for you, because I'm kind of on the other side of the old geezer spectrum here, is why are you here? Right? Why do you do what you do? And what gets you up in the morning? And it can't just be a paycheck. I was talking to a few people this morning, including this young man right here who's a student, and a couple of other students are here, and they're exploring our industry. And one of the questions was why do you do what you do? You know? It's easy for a physician to say, I do what I do because I like to heal people. And as a marketer, what would you what would you say? You're working in the industry. Right? So the question is why do you do what you do? And I would sub submit to you this morning that we all sort of started on this journey because we actually care about the patient. Many of us went to medical school. Some of us are PharmDs. I know many of my colleagues are PharmDs. My friend my colleague Mike, who's here in the audience this morning. And and others have been various types of clinicians and have migrated over to the commercial side of the business, so to speak, as we call it, over time. But we all started with this vision of trying to do something to impact patients' lives. Right? That's why we do what we do. And when we lose sight of that, that's when bad decisions get made and people get hurt. So we've gotta stay focused on making sure that we are doing the right thing all the time for the patient. K? Today's gonna be a little bit of a personal conversation for me, but and I'll I'll share some personal family stories with you guys and just be very open kimono with some of the stuff that we've encountered as a family. And hopefully, you can take that and learn from it and talk to your teams about it and and hopefully it helps some other people. But speed to therapy for me is, I think, one of the most important things I've seen in health care, particular to marketers, because we know that speed to therapy is really what drives outcomes. Today, I'm gonna talk about cancer. It's why I had you raise your hands. But it's the same in every disease. Right? Alzheimer's, speed to therapy, you can delay the, you know, the dementia set in, all of those pieces. And we could go through the patient journeys and we could talk about the different comorbidities associated with all of these things. But today, we're gonna focus on breast cancer. Specifically, we're gonna focus on triple negative breast cancer. So what does early intervention do? Okay? Early intervention, it can it can basically slow or eliminate the patient's progress on the disease, at least for a period of time. And the example that I've got today, as I said, is going to be triple negative breast cancer related. Okay? What are some of the early what are some of the barriers to early intervention that we all know about? It's it's all of these things that you guys deal with on a daily basis. I saw Derek Fetzer here a couple minutes ago. Don't know if he's in the room now. But Derek and I did work together at at market access for J and J. I saw Tom Lennox's kid here and Ryan, and he's following in his dad's footsteps. We were at BMS together, back working on market access stuff when market access was an afterthought. There's a couple of you who are probably old enough to remember this, but back in the early days of drug commercialization, we didn't even talk about market access when we were commercializing drugs. Right? It was all about building the market, you know, launching the drug, understanding the sales, finding the physicians, all of that stuff was done. And then at the last minute, someone would raise their hand, did anybody call the market access guy or gal? And everybody be like, oh my gosh. We gotta get the guy in the room. And so they would come in the room and and then all of a sudden would say, guys, your your launch plan is great except we can't get it reimbursed. And then we would spend the next two quarters trying to figure out how to get it reimbursed. Right? So that's the way that things were. Now when a launch plan is happening, guess who's sitting at the table? The market access team. Right? There's an omnichannel team, there's a digital team, there's a data team, and it looks totally different than it did twenty six years ago when I started doing this. It's just a completely different industry. Right? And and it's largely because of these things that we know that are problematic for us in the industry, fragmented care, shorter doctor visits because insurance companies want to see how many people they can churn through the hamster wheel and and without, you know, impacting the quality of care. And I would argue they don't actually care about the quality of care. Sorry payers if you're in here, but that's just the reality of it. Right? Diagnostic costs are really going through the roof. We have rural access gaps. How many of you have heard of the of the term health care deserts in our country? Anybody heard of that? Okay. It's the majority of our country. Right? We've got MSAs that are pretty populated around New York and, you know, Chicago and some places in California and maybe out in Colorado, but the vast majority of our country are health care deserts. Right? Which means people are difficult to reach and it's difficult for us to be able to help them. It's difficult for them to be able to get diagnosis. So where does technology come in? I wanna share with you guys a real personal story. This is actually this is about myself. So in two thousand eleven, I was in New York having dinner with some Pfizer colleagues and we went to a steakhouse. I can't even remember which steakhouse it was. But I was sitting there having steak and the head of commercial operations, a guy from Germany, wanted me to try this specific German steak that he was just crazy about. And and so, anyway, I got it, and we're sitting there chatting. And as I'm eating the steak, I bit my tongue, and it hurt like crazy. You know, you bite your tongue probably twenty times a year, thirty times a year. Right? By accident, it always goes away. It heals. No issues. And you kinda move on. Right? So a week goes by, two weeks go by, and I still have this like imprint on my tongue. And I'm thinking, what is going on here? So I decided to go in to see my dentist. My dentist said, I'm not sure. You should go over to the oral surgeon and just have it biopsied and see what's going on. And it it just looked like a, you know, like a bite mark on my tongue that just wasn't healing. That was in August of twenty eleven, so thirty days later. K? August of twenty eleven, two weeks later, I found myself at Mass Eye and Ear, which is a division of Massachusetts General Hospital and I had a cancer diagnosis. I had a tumor that was on the base of my tongue and it was stage one so it wasn't metastatic disease although at that point we didn't really know. And very quickly I was taken by the head of oncology who thankfully was a personal friend, Derek Lynn, and brought immediately into surgery and the tumor was resected, removed twenty five percent of the back of my tongue, which your tongue tongue regenerates. I don't know if you knew that, might be TMI, but anyway it does. Don't cut it off though just in case. If you were thinking about it, don't do it. And and then I had my lymph nodes removed on the left side of my neck because metastatic disease lingually is bidirectional so you always stay on one half of your body and then it progresses to lung cancer and so forth. So anyway, you get on this journey, right? So now that's just the start of it. When resection happens and you have surgery, you have a tumor removed, now you're on the pipeline journey, you're on the conveyor belt, and you keep going back and back. So I had the distinct privilege of getting that immediate radiation going out, and then every, you know, week I would go back in for more radiation, more testing, more CT scanning, and then I graduated from weeks to months, months to quarters, quarters to half a year, and so on and so forth. And now we're in twenty twenty six, and I'm so grateful and so blessed to be here that that I wanted to be able to share that story that, you know, it's been since twenty twelve that I've been cancer free, which has been a huge blessing in my life. Okay? Thanks. I I had and we have no family history of cancer. Okay? I'm not a smoker. I don't drink alcohol. No HPV. I jog three times a week, eat pretty healthy. Although I'm an old geezer so I could stand and lose a few LBs, but back then I was pretty lean and mean. And, you know, when I went in, would have probably been the last person you would have expected to have any type of lingual cancer at all. And there I was. Okay? And so part of what we do as marketers and as people that are working in this industry, it goes way beyond putting ads in front of people. Okay? If all you want to do is put ads in front of people programmatically, I can give you five other places where you're gonna make a lot more money and have a better quality of life because you're gonna work less hours. But if you're interested in actually helping people, you're in the right spot. Okay? And so what are what are some things that we can do? Well, here are some things that we can do. Okay? We can get over some of these structural barriers. Alright? And this is this is why I wanted to mention triple negative breast cancer because I think it's just the absolute cleanest way for you guys to be able to see technology and people and everything interacting in this ecosystem in a really mapped out way. And you'll have access to these slides. And if you've got questions, you can reach out to me and you can reach out to my colleagues that are gonna be here anyway. But here's the situation. Okay? Triple negative breast cancer, for those of you who aren't aware, is the worst form of breast cancer. Okay? It requires three different diagnostic tests, all three of which are performed in different locations by different people. They all take time and time is the big enemy. Sorry. Time is the big enemy and that's what we're gonna talk about today a little bit as far as far as using technology in diagnosing these patients. Okay? HCPs also have a very limited ability to understand what's going on with the patient beyond the normal testing that you guys are aware of, HER two positive, negative, stuff that we've been dealing with for years. Okay? This is more novel. And right now there are only two drugs that are approved for it, and there is no diagnostic code, singular, for this specific disease. Everybody in here know what an ICD ten code is? Raise your hand if you do. Okay. How many of you rely on ICD ten codes for your marketing efforts? Many of you. Right? There's no code for this disease. Okay? And so you're in this weird vacuum of trying to help oncologists and PCPs because they're working together in this instance and OBGYNs work together and these are people that are not used to working together. Okay? And so, you know, here's here's a couple ways in which it fell short. So overly broad NPI lists. Right? We would take these in pharma, large NPI lists, find the high deciphered physicians. And again, we're still doing this, which drives me crazy, but it's like we decile out these physicians, we find the high prescribers, and then the false assumption is if I just continue to market as heavily as possible to the high prescribers, they're gonna prescribe more. What's the what's the false narrative there, guys? In order for a physician to prescribe more, they have to have more what? What if they don't have any patients? So now you're throwing all your money at these physicians that actually can't write anymore. Where do you think those patients might be? They might be in some of those health care deserts we talked about. Okay? And because there are only roughly four thousand total triple negative breast cancer patients in the United States, that's kind of like a needle in a haystack scenario, isn't it? Right? So very, very tough. Only ten to fifteen percent of those patients. No trigger, like I said, difficult to locate. So here's what we did, okay, with the first with the first brand that launched. And I'm I'm gonna leave this up and we'll circulate it again so you guys can see it. Because I I think it was powerful what we did. And we did this in collaboration with another manufacturer which was really a blessing. So first thing we did was we said we can't start with the doctors. The doctors actually don't know where these patients are, and we're running out of time. So we've got to start with the patients. Alright? That was the first thing. Don't start with the doctors. Start with the patients. Find every single patient that is a triple negative breast cancer patient. Well, that's difficult because we don't have ICD ten codes. Okay. What's the next thing we're gonna look for? We're gonna start looking for those diagnostic test orders, and we'll find the orders, and then we'll use the real world data like Gunjan was talking about. We'll feed it into our our machine learning platform and our AI will predict whatever is missing. So we could see maybe two of the three or one of the three and maybe other comorbidities and the AI would fill in the gap. And the minute we filled in that gap, we looked at geolocation of where that individual token was because these are hyper compliant situations. Right? We're not breaking HIPAA envelope issues here. And we're going to see who the treating physicians are for that specific patient. And once we see the treating physicians for that patient, we're going to immediately activate information to those physicians and say, you likely have a patient in your current treatment pool that is a triple negative breast cancer patient, and we would furnish that information to that oncologist. And that would that would drive a conversation to happen between the oncologist, the OBGYN, and the PCP. It would facilitate dialogue proactively. Okay? And that's the engage component to it. And then obviously, from that level of precision, we had really good conversion. And, you know, one of the things that we talk about inside of OptimizeRx continually is we only want to have digital conversations that convert. We don't wanna blast everybody with, you know, untargeted messages, annoy the crap out of everybody. Physicians just get exhausted of it, guys. They do. Prescribers don't want more marketing. They want information that they can take an action on, and they want it to be able to make an impact on their patient's life. And so by making sure that we're good stewards over that data and we're only delivering data with integrity, they begin to trust it and they know, hey, when I get this message from OPRX, Mike Paladino, I know I can trust it. If I get the five hundredth email of the week from, you know, fill in the platform x y z and it's not relevant to the patient pool, it might not even be relevant for my specialty, that's just gonna annoy me to death and I'm gonna opt out if I can as fast as I can. K? So that's the way that we built the technology. So what was the outcome? K. We saw a twenty eight percent increase in patient starts. Alright? That is a huge increase. And this is in year one, by the way. So this wasn't that we had to launch this program and wait thirty six months, no. Year one it was a twenty eight percent increase in patient starts. Eight to nine month improvement in time to start to therapy. Okay. The average life expectancy for a stage four metastatic triple negative breast cancer patient is fifteen months post diagnosis. So giving these people another, you know, eight to nine month improvement is a pretty big deal. Okay? And I'm not here to take credit for that. I think the manufacturer deserves all of the credit for commercializing incredible therapy. But boy, if you're here because you are purpose driven in what you do for work, it feels pretty good to look at numbers like that and say, we helped people. We made a difference. K? Really powerful. It's not just about HCPs, by the way. I'm just giving you an example of how we inform the HCPs using our technology to mobilize doctors and and and enable that digital conversation to happen, but it also works with patients. And how many of you are working on the direct to consumer side in here? I know we have the PulsePoint guys outside. So many of you. Right? There's definitely now a convergence of these two modalities, isn't there? It's the HCP team and the DTC team now need to work together. Right? Because you're all trying to find the same audiences of patients and physicians to talk to. And the more you can synergize between those two disciplines, the better the outcomes will be for your doctors and your patients. So it's super important that you talk together. Here's what we, you know, we deal with on the on the DTC side. Right? Significantly underdiagnosed patients, everybody knows that. You're dealing with it every single day. HCPs are miss misattributing symptoms. Right? They're missing stuff. They're running a million miles an hour to try to see as many patients as they can so they don't have Aetna calling them and screaming that they're not seeing, know, enough hamsters on the wheel. And then patients are overlooking disease indicators. Right? We all do that, And we do it under the guise of, I'm I'm fine. I don't need to go see the doctor. I know that I'm bleeding someplace or my eyeball's falling out or whatever, but, you know, my dad was a Vietnam vet. He was a green breeder in Vietnam, and he so we grew up in a a very specific way. And so it was never appropriate to complain or go to the doctor or do anything but get up, make your bed at five AM and get out the door and do a couple laps around the property before you got on the school bus. So that was just how we were raised. Early recognition treatment slowed progression. Right? And then other dem demographic TV channel choices and stuff. We're starting to see the changes in that, aren't we? And we know I'm I'm not here to talk to you about the legislation, but all of you are, I'm sure, laser focused on what's going on with legislative changes, linear television, CTV, ATV, First Amendment rights, all of those things. Okay? So it's hyper local. Right? That's the way we think about our technology and that's the way we encourage our partners to operate also. It's hyper local. Two times faster at scheduling visits when we apply this to DTC, eleven percent increase in cardiologist visits overall. Cardiology is probably our largest therapeutic area on the DTC side right now, I would say. And then, you know, seven percent increase in PCP visits. And while these are, you know, low double digit numbers, they're pretty meaningful. If you're a DTC marketer, you know those are those are good numbers. K? So marketers cannot control everything. Okay? We can't solve the world's problems. We're not here as neurosurgeons looking to resect tumors from, you know, people's frontal cortexes. It's not what we're doing. But we do have a really important role in the ecosystem of health care. And we and more importantly, we have an important opportunity to use our time and our company's time to help these patients that are really in desperate need of getting help. And we can do that with urgency, precision, relevance, and we can leverage all of the wonderful technology assets and data assets that have been democratized for our use. And that is something that twenty six years ago, and many of you I think are at my age and here, we didn't have that. Right? And so it's a real privilege to have a real world data asset like Gunjan was talking about with longitudinal patient level claims data integrated with lab data and EHR data and all kinds of stuff because you can start to interrogate it and find patterns, find patients, and do different things. That's not the only data. There are plenty of other datasets, but I thought her example was was really actually wonderful. So my invitation to you guys is just to think about why are you here and, you know, to to request, let's work together as an industry to try to do the best that we can to benefit patients. There are plenty of people. I was blessed and very fortunate to be able to find my situation out early, and have access to incredible care in Boston where I live. Many people are not that fortunate. And and my view is we have a responsibility because we're blessed to be able to work in this industry. We have a responsibility to make sure that we do our best to bless other people's lives. Thanks, guys. Steve, excuse me. We've got time for a couple of questions before our next session if anybody wants to hop in and chime in with anything. Happy to answer race car questions too if you have race car questions. I just realized the size of this room. Nothing about the Yankees though, please. Hi. Thank you for the presentation. I think you said something really important on focusing on things that convert because of that speed to therapy. I find that a lot of folks in marketing focus on that awareness phase of the funnel because it's easy, it's cheap, to your point. Let's just throw out banners. Let's send emails. What are your thoughts on awareness and if if awareness is actually a thing? It's a great question and I thank you for the question. How many people in this room are old enough to have worked? And I'm sorry I keep going back to the age, but we've got new students and we've got some of us who have been here for twenty five, thirty How many people have built an ATU in this room? Okay. What does ATU stand for? Awareness trial usage. Awareness trial usage. Okay. All three of those things are really important. Right? If we don't understand the awareness component, trial and usage never happens. But to your point, too many people spend a lot of time and money on the awareness component, and they forget about the trial and usage. And ultimately, what we're trying to do is drive trial and drive usage. That's the job of awareness. Right? So the more precise that you can get your awareness, the the higher the probability that you will drive trial and you will drive usage. How many people in here look at persistence and compliance charts all the time? Alright. Couple couple hands raised. Couple data guys in here. Those are incredibly difficult to look at. Right? Because you might get a first fill, although seventy percent of prescriptions the first time are not filled in the United States. I think you probably know that stat. Takes a second second attempt to get it done. But even the average compliance in the US, anybody know what that is when it's not an infusion mandated? Anybody know? Stats? No stats? It's roughly forty percent. Forty percent of patients stay on therapy a second and third time. K? So that sixty percent is what we call therapy abandonment. And that's why the gentleman over here works on persistence and compliance like he does because we spend so much money creating awareness to get that initial trial as manufacturers. All of that is get me that first script. Get me the first script. Okay. You're on. We've got you the first NBRx. They're in there. Okay. Now three weeks later, they're off. You wasted every dime of that. Okay. So great question. Yeah? Other questions? Anymore for Steve before we hop into the next panel? Yes. So I think what you said about intervention is really interesting for a rare disease because like you said so many patients aren't aware. So if you are reaching out to doctors at that time, collecting all the data, how are you striking that balance of helpfulness versus creepiness? Yeah. It's a really fine line is the answer to that. It's it's it's a really fine line. And what we've seen is that, at least I'll I can speak for OptimizeRx, the more precision we can provide, the happier the physician is. And we're not tracking the physician and we talked about a little bit in Gunjan's presentation and a couple of other presentations about social footprint of physicians and patients and tracking and all those things. We try really hard not to use some of those components when we're dealing with this level of specificity because it does feel like Amazon is invading your health care environment. Right? All of a sudden, you're, you know, talking with your spouse about, you know, inserts in your shoes and the next thing you know, they're all over the place because your iPhone heard about it. Right? So we we try to evitate that in our approach, but but it's it's avoiding that, but making sure you're bringing precision information to the front of the line. And and it's as important for the patient to hear about it as it is for the consumer or excuse me, for the physician. And if if the patient is feeling any types of symptoms, you've got to help the patient understand what those symptoms are and try to at least drive them to have the conversation with the doctor. At no point are we trying to get the patient to have their own know, to to go in and say, I wanna be on, you know, therapy x y z. That's not what we're trying to do. But we're trying there to get the patient to go in and have the conversation with their health care provider so that they can address the issues that they're undergoing. Great question. I think we all wrestle with that so it's a really good one. Others? Got one more, Simon. Anymore? Over here. Oh, over here. Sorry. I just wanna say I really love the purpose driven sort of messaging of your talk right here, and I think the triple negative breast cancer examples really emblematic of that. I was curious how you would approach or your strategy approach or how your strategy changes for less rare disease, something where it's a much more crowded space, there's a much higher patient population, and even the stakes are a little bit lower, changing your strategy but still maintain that purpose driven messaging? Yeah. I mean, we can use the GLP ones as probably an example because it's the largest population in our in our country. Right? Seventy percent of Americans. So it's it's the same methodology, right? It's understanding where patients are, what they need, reading the data that's in their chart, reading the data that comes in the claims and their profile generally and then making sure that you're engaging with the physician. And there's enough differentiation labels that you know which therapy would be better for which specific indication and comorbid profile. But that's the way that we do it. Still always data driven. And I would if there's one thing you walk away from today, be a data driven marketer. Do not be a spray and pray marketer because your job will be very short lived. Okay. Alright. Thanks guys. Appreciate it. Thank you Steve. Thank you. All right. Okay. So we're going to that was a thank you very much for you all for the questions and engagement there. So, we're going to hop right into our first panel of the day now. I'm going to keep things very brief. In fact, I'd like to invite Eric Duran, who's a team lead in the client and partnership side of things with PulsePoint.