Don (PMN): Hi good morning everyone, welcome to the pharma marketing podcast. I’m your host Don Langsdorf and I am here today with Bob Baurys and Mark Stinson from 83Bar and also the authors of patient activation. Bob and Mark thanks for joining us today.

Bob (83Bar): Great to be here.

Mark (83Bar): Yea thank you

Don (PMN): Wonderful. I think it would help our listeners to know a little bit about you first before we jump into the meat of the interview here. Mark, Bob, if you want to give a little background on yourselves and give us a little introduction to who you are and what you do and why you’re involved in what you’re doing.

Bob (83Bar): Hi this is Bob Baurys. I come to the pharma space from being a medical operator of clinics for the last 15 to 20 years where we took care of patients with specific disease conditions that were often overlooked. Chronic fatigue fibromyalgia, ADD, ADHD, and service those patients through a series of national clinics.

Mark (83Bar): Yea and I was almost in service to clinics like Bob’s. My background for decades now is in the pharma marketing and branding space, working with all sorts of pharma products, devices, diagnostics. Both from an HCP marketing and communications and for patients, direct to consumer, and patient platforms. Working in both marketing and advertising campaigns but also market research, strategic planning, workshop facilitation. So when Bob and I got together, it was this “how can we service clinics” but also how can we help patients find the clinics that have the medical answers that they’re looking for.

Don (PMN): Right and so this is what you do at 83Bar right, you have some proprietary software and tools that you employ with your clients. So a lot of different software companies build software for healthcare, but at the end of the day they all start out as software companies. What’s the significance of this in relation to the approach you take and I mean obviously with your respected backgrounds coming from the provider side and also in the pharma marketing side, I’m sure that comes into play, you come to the table with a different perspective.

Bob (83Bar): Sure, we do, and it’s because after operating clinics and taking care of patients directly for the last 15 to 20 years, what you learn is that patients really don’t absorb the information as easily as we think as medical marketers that they do. Oftentimes they understand that they have a need and they would want to come and get some sort of treatment but there would be a lot of hesitation because their preferable knowledge of what’s involved and how much it was going to cost and what their requirements that they were going to have to be involved with. We’re very limited and so for as many patients who would begin treatment we had often hypothesized that there were often 5 to 10 patients who would have an interest level but wouldn’t take the next step because they didn’t have the knowledge, they didn’t have the assets available to them to be able to be able to sort of shape their decision making and give them the confidence to move forward.

Don (PMN): Sure, yea patients need to be aware of their conditions and also be motivated to see their doctors for treatment right.

Mark (83Bar): So that’s the challenge. As Bob and I were talking about our experiences, almost every strategic kickoff meeting I would go to, the client at the pharma company or whatever would say, you know there’s X amount of people who suffer with this condition but it’s underappreciated, under acknowledged, under diagnosed and under treated. It could be a magnitude of half or it could be a magnitude of 90% that a fraction of the people are actually getting the medical care. But I think you’ve touched on something; we didn’t build a software platform and go to a medical company and say you could use this. We understood the medical process and journeys of these patients and say couldn’t something software base some digital health mechanism in order for these people to find the care they wanted. So, it was definitely from that angle rather than we have a software program, can’t someone buy it for healthcare.

Don (PMN): Right and with my understanding, it is beyond just software as well. It’s more about the process of patient identification, aggregation and of course this term activation. You do it more on a concierge level, you’re really connecting one on one, patient with provider.

Bob (83Bar): Sure, that’s exactly it, we spend a good deal of energy identifying patients who have a possible need for a medical condition or product or service. Through the technology, we gather the information from that patient, providing them with some beginning point of education. Our software starts to hook into the human element, we have 35 to 40 nurses around the country who work for us, who are in contact with the patient directly and then act as that intermediate step. If you think about every time someone gets sick in a family, there’s always a go to person in the family who’s usually a nurse or someone in the medical field that everyone turns to and asks for help translating and sort of giving them the insight of what they think they should do before they actually interact with the medical system which often times can be confusing. Our nurses act as that person, our nurses act as that confidant to that family and begin to provide that education services to that person who’s seeking a solution.

Don (PMN): Sure, it’s beyond getting the person managing their conditions beyond getting them off the couch, it’s actually connecting them and motivating them to actually see their doctors and leading them to the right solution.

Mark (83Bar): Well that’s exactly right, and when you mention this word that we found ‘activation’ you can think of it as the medical side of activating synapses or activating receptor sites or what the drugs do. But we really found that this is what we have been doing for patients. Saying that we were patient education, that wasn’t enough. Saying that we were patient engagement, that wasn’t enough because that getting off the couch factor is exactly what we’re talking about. I mean how many campaigns was I involved with, be it commercials or ads, like “Ask your doctor what’s right for you.” As a patient, sometimes these people don’t even have a doctor who they could ask or know what it means to ask a doctor or feel empowered enough to ask a doctor. So we really felt that all of those folded into this term ‘activation’ that we needed to move from “I’m just aware of my condition or aware of the new drug or new treatment” but really I had to be educated, empowered, and navigated to find the right doctor to stand in front of so that we can have that dialogue.

Don (PMN): So based on what you just said, one of the first things that comes to mind for me is clinical trials and your platform seems like it would be a perfect fit for recruiting for clinical trials and helping marketers reach patients who might be interested in those clinical trials. Is that something that you do as well? Do you connect patients with the clinical trial folks?

Bob (83Bar): Yes, we do. I think the clinical trial model is a perfect model that is broken and needs to be enhanced. The current concept is if you take a patient and you find that patient and they want to become that part of the clinical trial, you can imagine that patient has a significant amount of questions before they go through something which would be an experimental procedure.

Don (PMN): Yes certainly.

Bob (83Bar): How we handle that right now is basically the marketplace gathers these people and sends them into a research site, and then hopefully the research site has enough time to explain what’s going on and they have to make a decision. We’re that stutter step in between where we identify the people and we give them a 15-minute conversation plus send them information and make them fully aware of what they’re signing up for and give them the background they need to be able to make a decision. So that when they do show up at the research site they’re prepared and ready to act. It works for both parties at that point.

Don (PMN): Great. I’m a little more interested in what you just said from the marketer’s standpoint. Obviously, I think a lot of our listeners would be interested in that as well. Pharma marketers and healthcare marketers are looking to reach these patients directly. How does your platform enable that?

Mark (83Bar): That’s a good point and the blur of does the marketing department at a company handle this? Does the clinical development department handle this? Is it the scientific researchers? The word marketing, if you’re talking about a department, that doesn’t really work here, but if you’re talking about patient outreach, and identifying people who could be good candidates for a clinical trial, you just have to think in a different kind of way. We start off working with a lot of clients who are just running a poster in the hospital hoping to catch somebody who is standing in that department and says, “Would you like to be a part of a clinical trial?” Instead, we’re turning it on its head and saying there’s people out there looking for answers who might be good candidates. As Bob was saying, you can’t just say “come to the downtown medical center and see if you want to be a part of a clinical study.” There’s a lot of steps in between that. It does require some bridging between what is traditionally the clinical and commercial side to the company and because those areas are blurring a lot more.

Don (PMN): So it’s a really nice segway in speaking about activation, and a nice segway into the book you co-authored called Patient Activation. We know in recent years the concept of Patient Activation has been gaining some credence and widely being accepted among clinicians and academics and think tanks world-wide. So, let’s talk a little bit about Patient Activation. What does that mean? Where does that phrase come from? What are some of the principles and philosophies that are the foundation to this approach?

Bob (83Bar): Well I think Patient Activation, as we talked about before, kind of springboards off of this idea of patient education, patient outreach or patient engagement. A lot of companies now have this concept of patient centricity and they actually have people in the C suite who are like are we keeping the patient at the center of everything we do. For us though I think it was the idea of ‘can a patient who is more aware, motivated, and move to a behavioral change.’ Whether that’s I have to actually call to make an appointment or if I actually have to stay compliant, or I do want to be part of a clinical trial. So, the ‘can I take action’ rather than can I just be more educated. So, the principle and philosophy of that is then what really wanted to capture in the book. The book was certainly a way for us to articulate these four steps. First you have to identify, then you have to educate, then we navigate, and then we show patients how to advocate for their own health. These four steps may seem common, and that’s what we thought, is that this was the natural patient journey, but could we facilitate that, could we speed that up and accelerate that on behalf of the patient. Then obviously there is a benefit for the provider because now they’re going to be able to see and help more patients and then if there is a benefit to the company, they’re able to make their product more accessible and more available across the board and get out of the clinical trial faster and or help more patients with the drug that’s on the market. Certainly with the marketing process, we were happy to articulate that in a book, what surprised us is that many people have responded by saying this also helps if a patient themselves read this book, it’s not a marketing process for them, it’s an ‘ah-hah’ that says ‘now I know more about how the system works, how to take advantage of the system for my own healthcare, how to navigate to the benefit of myself.’ We even had two reviewers on our amazon page who were medical professionals who said, “gosh I wish I knew more about this idea before because it helps me communicate with patients better.” So, all the way around, we’re glad to see that it took on more than just a business to business book, which may have been and how we started out.

Don (PMN): Right, and it seems to me from what you’re saying, I mean the patient activation portion, this four step process that you’ve presented in your book, it seems to be really a foundation for a more fully integrated system that will help patients and healthcare providers move from awareness to action.

Bob (83Bar): It is, and there’s three constituents in the party. You have the patient, the patient’s aware but they don’t know the next steps to take. So, what you’re doing is providing them the tools and the assets to be able to help them make that decision. I can tell you this from being a provider for many years, the provider sitting there and trying to run a proficient business model, but the patient is coming unprepared, uneducated and starting from ground zero, or worse yet their carrying 60 or 70 pages worth of doctor Google uncrated information from the web. Right, so it doesn’t work for them and the clash of the patient wants to know more and wants to try to be activated and wants to try to move forward, but the physician doesn’t have time to do it because they can’t distill the 60 or 80 pages in the amount of time. That’s a breakdown in the process. Ultimately the other party and the transaction is the manufacturer, the distributor who’s trying to keep their message to the consumer in a direct, correct, manner so that everybody understands the information that is proper, and curated, and not uncrated information from the web that may or may not be accurate. So, when profits of taking someone from the state of awareness to activation is fulfilled in a regimented way, all three of those parties, the patient understands, they know what they have to do, and they want to do it. The doctor is getting a patient who is prepared and ready to act and has key questions and the manufacturer is making sure their story is being told in a way that is proper and correct.

Don (PMN): Sure, and we circle back to what Mark had said earlier about this concept that we’re all very familiar with in recent decades I would say. This idea of patient centricity, it seems like there is no patient centricity without some sort of process like patient activation because the patient is not involved until they are aware, until they’re ready to take action and they’ve been guided to the right referral to a physician, provider, or a clinical trial. It’s not really centered around the patient until the patient is a part of that equation.

Mark (83Bar): Yea exactly, and I think in our discussion so far, we’ve been maybe very clinical and very business-like about how this model works but I think one thing that will strike a reader from the book is the tone or the style is very first person because these stories are also very personal to Bob and I as patients, as family members with people who need care. The total breakdown that we all experienced, I mean we are educated people in the medical field, even if it’s just from a communications standpoint, we’re not doctors, but I’m talking about how we have experience on how to talk to doctors. Yet I can tell you, I can go into a doctor’s office and freeze and won’t know what to say. Or I’ll be talking to my mom and it’s like if the doctor wanted me to know about this new drug, he’d tell me. It’s like, well that’s not the way it’s supposed to work. Bob will say “I suffer these conditions myself.” Several places in the book we’re also, let’s say…honest about the current healthcare system and how insurance works and how the providers get paid, and how your deductible may never cover what you really want or need as a patient. So, it is multifactorial and we’re not saying that all doctors are bad, or all manufacturers just want to sell drugs. That’s not the point of the book, but rather like you said, we’re trying to bring some patient centricity and their voice to the party. Saying we developed these four steps that if all of the three constituents Bob was referencing, if the patients, the providers, and the manufacturers could see their way to this is the natural journey and can we facilitate and accelerate that journey for everyone’s benefit we’d all be better off.

Don (PMN): Yea, I couldn’t agree more. I’ll tell you what, let’s pause right there, we’re going to come back to this in just a moment. I want to take a beat and hear a word from our sponsor.

Don (PMN): Ok, welcome back everybody. Before the break we we’re talking about true patient centricity. So, what you’re saying is less of a criticism and more of a reality check. We have to understand the rules of the game and what the playing field looks like before we can engage with it and your book helps outline that process, the services that you provide at 83bar help guide that process of building that awareness. It’s educative, and it continues on to connect the patient with the right provider.

Mark (83Bar): Yes, and I think we talk about this word ‘empathy’ and again ‘patient centricity’. Are you empathetic to the patient? Are you empathetic to the doctor? I don’t know how many meetings I’ve sat into and people say, “well if only the doctors, they weren’t aware, they weren’t educated.” Well, far be it to accuse today’s family practice physician for not being educated in the 493 diseases they see every day and in the 7 minutes they have to treat a patient. So, you can’t hold them to blame, you can’t hold a patient to blame because they didn’t read the manual before they go into the doctor’s office. So, you know, all of the above.

Bob (83Bar): From employing 25 physicians myself, I can tell you the number one thing that burns out physicians is the stress level of feeling like they try to condense a 10-8 minute visit and feeling like they might have missed something that will literally come back to haunt them. Such as if something happened to the patient. The process of having the patient ready and having the patient well thought through and ready to activate themselves so they have thought through all of their symptoms, organized their thought processes and are able to communicate them effectively, gives that physician more time to be able to practice the art of medicine rather than to practice the art of diffusion. Which is what is happening when they are trying to understand and interpret all of the data that is coming at them, and then try to feed it back into the patient in an understandable language. Right, so the cofinal revolves around the patient. If the patient isn’t ready for the appointment, the appointment is not going to be efficient. If the appointment is not going to be efficient, there is a risk of error. When there’s a risk of error, the stress levels go up and there’s nothing more frustrating for a physician to feel like at 8 o’clock at night when they go home and think “god I hope I don’t miss something.” That happens because there’s just not enough focus time because processes are just not prepared.

Mark (83Bar): Going back to your clinical trial, application of the system too. I mean it’s not just the physician burn out, but you think of the clinical site coordinators or the people. Every one of these trials have an inclusion criterion, and if they’re spending half their day talking to people that you already know are excluded. It’s like if we’d already known that the patient has diabetes or a previous surgery, or they have some other condition that excludes them from the trial, I wouldn’t have wasted my time. So, it seems simple, but by having the patients answer our health assessment quiz online, by having them talk to one of our nurse counselors on the phone. Not to help guide or steer them or provide medical advice but rather, to just make sure that it’s the right fit. Also, it’s important to make sure that they get the appointment in a timely fashion. This is some of the simple logistic stuff that these are the realities that we were talking about before. If you can’t get an appointment for six months or even six weeks, that’s not good for the whole system.

Don (PMN): Once you get that appointment, it’s even more so important knowing that you have limited time with your provider to make sure that you’re prepared, to make sure that you have a sufficient amount of knowledge to get the best outcome.

Bob (83Bar): Well, I think it’s also the psychology of winning place of affect here right. So when the patient isn’t prepared or the patient isn’t screened, the front desk person and the physician or whoever is running the research side or even in the physician office, you can only lose so many times in a given day before it starts to affect your psyche. So, if you’re running a clinical trial, and you’re at the front desk running screens, your screen fail rate is 70% at the front desk because they weren’t the right patients that came in. At some point there’s a psychological issue that starts to happen, where the system is set up where it becomes nonfunctional because you’re losing too many times. So, to create efficiencies, you really need to make sure your patient is either educated or screened before they get through the process. Ultimately, that creates efficiency, and when people start to feel like they are helping the person in front of them, the morale and the overall lift of the stress begins to happen.

Don (PMN): That’s a great point. How are your clients at 83bar or other leading healthcare organizations, how are they applying your model successfully, in any wide range of different initiatives?

Bob (83Bar): Well, we work on behalf of any number of diagnostic devices and pharma companies, just to give you a for instance, what we just talked about in terms of making the process more efficient. If you have a device that only really works as a third or fourth line where the patient has had a fail, one or two pharmaceuticals haven’t worked for them, physical therapy hasn’t worked for them, then that type of patient really only qualifies for that device once they pass those thresholds. By using a process like we do, in terms of our activation process, what we’re doing is we’re taking that massive amount of patients who may have been afflicted from this condition, in this case it was overactive bladder, so you have a massive amount of population that’s affected by overactive bladder. Instead of sending all of those people over to their physician’s office and trying to get them asking questions about something they learned about over the TV or something they learned about in an advertisement. What we’re doing is we’re intervening in the middle of that and we’re helping them understand if that’s appropriate for them. Also, if they are qualified for that, where is the local place that they can get it done, here are some of the questions you should really be thinking about before you go. What that does is it takes that massive patch of population and cultivates it down to the patients who it’s really appropriate for and the patients who are really prepared to have that serious conversation as to whether they want to move forward. That takes a lot of stress off the healthcare system, takes a lot of stress off the front desk, and it elongates the period for the patients who are prepared and give them more time with their provider. If done correctly, the system becomes much more efficient for everyone involved.

Mark (83Bar): I think the other way that the clients are using us, we’ll move down the journey a little bit to this third step called navigate. The outcome of so many of these ads online or on TV or otherwise are ‘is this ask your doctor’ and I can’t tell you how many times patients run into this where it’s like ‘I do want to talk to my dermatologist about this new drug’ or ‘I do want to ask my orthopedic about this surgery or new device but I can’t get an appointment, I don’t know which provider is covered by my insurance’. So, all of these very logistical things or ‘I tried to call the office I left a voicemail and they didn’t call me back.’ So, patients get very frustrated with this. SO, they go to a physician locator online and then click on the locator and the doctors have moved their office. So, when we’re talking about a reality check these are the realities. So, our clients are trying to say, ‘look we’re trying to address this in a more organic, a more universal fashion, so can you help us with that.’ They see our system as a way to cut through some of those problems and that where the word like concierge like-service comes in. You know, you can’t get a reservation at the fancy new popular restaurant downtown, that’s what a concierge is for. So, we want to help you get an appointment for the doctor that can help you the most, answer the questions and we have ways of doing that.

Don (PMN): So, the techniques that you have both been speaking about, for our own listeners primarily in the pharma marketing space. How can they apply these techniques in their own efforts from a marketing perspective?

Mark (83Bar): Well I would look at it across your marketing plan and say if you have a classic marketing plan that says ‘I need to address current patients’ that might be about compliance and adherence. You might have part of your marketing plan say that you need to reach new patients, undiagnosed patients, and educate them. You might have part of your plan that says ‘we need to help the HCP’s see more patients or give them better tools to communicate with their patients. As we said, let’s cross the hallway to the clinical development side and say that you might be in stage two or three of trial. How do we accelerate that? Since only 3% of the population knows and can participate in a clinical trial. Nobody has really thought about that, so how do we get that word out more? Everyone of course knows the benefit of accelerating the trial and that the drug gets evaluated quicker, gets submitted to the FDA quicker and gets approved quicker. There is a commercial benefit to that, but mainly it’s to get the right medicine to the right patients faster. So, it’s all the way across the board, I think if clients are talking to us about what their need is or if they’re trying to launch a new product, or they’re trying to get one out of trials, or they’re trying to stimulate the sales and the uptake of a product that’s been out there and is not reaching its full potential. I think any of all of those would benefit our clients.

Bob (83Bar): I would just like to add that, at a core level I think that marketers could do is to really start to think and continue to think about patients as a human being, that isn’t attached to the healthcare system, doesn’t understand the new ounces of the healthcare system, lives in a complete different ecosystem than we live in as people who work in the healthcare field. So, our knowledge base kind of gives us an unfair advantage when we’re dealing with healthcare, and it also taints our thinking a little bit. So you want to think about a human being who has no idea what any of the medical terms mean, has no idea what each type of doctor is for, really doesn’t understand the insurance all that much, and then if you take that baseline, really start to figure out, what are the steps that person needs to go from that baseline of knowledge to a point where they can actually make a decision. It’s less about ‘try my drug’ or ‘this is what these can do for you’ it’s really more about ‘here’s the condition, here’s the multiple options you have, here are some of the points you might want to consider, here are some of the questions you should be asking.’ Give them the ammo that they need to help self-service their own issues in a way that doesn’t have expectations being in the healthcare environment their whole life. If you’re building cars for a living, or your building computers, or doing a service business, you’re a photographer or something like that, you don’t have the bases by which all of us in healthcare are coming from. You just don’t have that personal knowledge to start. I think a lot of what we do is we have a biased mindset when we start this stuff and we just make a lot of assumptions that people do have that knowledge based and it’s higher than it actually is.

Don (PMN): Bob and Mark, thank you both so much. You have been wonderful guests; this has been a really insightful conversation. I certainly learned a lot and I know our listeners have as well. Where can our listeners go to learn more about patient activation and how they can apply it to their own efforts?

Mark (83Bar): Sure, first our website is, there is a contact button there. We also have a number of case studies, market reports, examples that we would be happy to share with folks. Also, the book, Patient Activation, is available on amazon, both as a paperback and a kindle.

Don (PMN): Fantastic, thanks again. This has been a real pleasure, and I look towards further conversations in the future.

Listen to this podcast, Ep. 006 – Mark Stinson & Bob Baurys here: