Digital Health solutions are part of the fabric of modern healthcare and the ecosystem around pharma brands. Yet, deciding what digital solutions to offer and how best to create and operate them remains complex. One decision that sets the foundation for the whole lifecycle over many years is between ‘off-the-shelf’ and a more customized approach. The former can be quickly configured within a limited range of flexibility. The latter offers greater customization and ranges from platform-based to fully custom solutions. Solutions that can be customized allow for tailoring to the market and strategy, while requiring some additional effort.
The competitive context into which digital solutions are targeted has intensified. Pharma R&D is increasingly exhibiting herding in new drug classes, meaning greater competition to be first or best. The value of being first to launch is increasing, supporting maximizing the competitive advantage and moat through complementary solutions. Likewise, when a drug is not first to market, the importance of shaping the product or market for advantage is also increasing.
Today's developer and provider ecosystem offers many options, from full custom development and operation to platform-based solutions that can be customized, pre-defined configurable solutions, and white-labeled solutions. Each approach has advantages and disadvantages depending on the context.
So, what is the best approach when delivering a solution? To answer this, we must first ask what outcomes matter for pharma when deciding how to deliver a solution.
Three key pillars to consider when delivering a solution:
- It’s impactful, requiring that it gets to and maintains good product-market fit to the needs and context, so that is useful, engaged with over time, and effective.
- It improves the competitive position for pharma
- That the probability of success for delivery of an effective, timely solution is high.
First, the solution needs to be impactful. It must match the unique market and pharma context to achieve product-market fit and product-to-brand strategy fit. Over the past twenty years, we have seen that making an impactful and compelling solution requires you to shape the solution to the specifics of your challenge and context in the external market and internal to the company. This starts with the ability to customize for product-market fit.
Considerations when customizing for product-market fit
- Needs of patients and other potential users or stakeholders, including caregivers (family and friends), health care professionals and teams, patient support services.
- Needs and context custom to each indication and specifics of the therapy(ies) for that indication.
- Local affiliates need a global solution that allows a global core to be shaped to local market needs, context, and opportunities.
The importance of customization for strategic fit
While a brand or franchise may pursue different strategic drivers, there is a common emphasis on shaping the solution fit to patients, HCPs, and payer needs and contexts, market and care pathways, and brand attributes and strategy. For example:
For a market growth or market shaping goal, the digital solution has to align tightly with the other aspects of your overall strategy, including medical education, treat-to-target, call-to-action approaches, disease, symptom, and progress awareness, studies and registries, value dossiers, and advocacy campaigns.
For a competitive differentiation goal, the solution must resonate with patients and healthcare professionals to influence Rx preference decisions. Global solutions have to be configurable and adaptable. They have to fit the local care pathways and condition context, as well as the brand attributes and strategic messaging.
Where the goal is improved persistence and adherence, the solution has to fit tightly to the product and patient journey, to the moments that matter, to have real effect.
How tailoring solutions can lead to changes for even the same drug
Customizability can become critical, even for the same drug. Often, we see that different approved indications lead to important changes in well-tailored solutions for the same drug. For example, in immunology, several drugs for psoriasis are also approved for inflammatory bowel disease (IBD) indications:
- Dosing regimens, educational content, and symptom tracking can differ significantly.
- The 'less well met' needs in IBD (versus treatment efficacy in psoriasis, which is reaching new heights) may drive significant changes in a solution for these higher acuity conditions. These require different types of condition management, behavioral interventions, and other supportive tools, which the solution needs the capability to support.
- Even content that is ostensibly the same across indications, such as cross-indication tools for stress management, should be adapted from case to case, as factors such as tone of voice, imagery, and framing from an appropriate 'messenger' vary by user group, age, indication context, and country.
Even small adaptations can improve treatment
Even minor tweaks to customize to the therapy can make a big difference to the patient's experience. An example would be a solution for a multiple sclerosis drug that is to be taken at bedtime every other day. The solution offered automatic scheduling updates based on dose data from a connected device. The solution treated doses taken up to 2 hours after midnight as belonging to the previous calendar day, a recognition of the many night owls amongst us and avoiding the arbitrary' calendar day cut off' a non-tailored solution might apply.
In a recent whitepaper, Paul Upham said:
"As you deploy those solutions molecule by molecule, you can copy and paste a fair amount, but then the devil is in the details. In the past, I've noticed that some partners claim to have a platform approach by designing a mobile app for patient self-management of chronic diseases. They often have underlying technology modules and reusable architecture, but they tend to overlook the user interface and user experience design, which are crucial for the success of such platforms. This approach creates a barrier to adoption because it assumes that a single solution can cater to all chronic self-managed conditions and user needs, leading to repeated failures in user experience design. Thankfully, it's clear that we've advanced beyond this approach."
Paul Upham, Global Head of Smart Devices, Roche
At a broader level, a tailored user experience increasingly matters in delivering user engagement, activation, and experience. People today have used multiple consumer digital products, and they expect the same quality of experience and personalization from digital health solutions to fulfill their needs in an easy, engaging, and safe manner.
How customization improves the competitive position
In a competitive market, a key part of value derives from differentiation versus the competitive set. When you start with an off-the-shelf or lightly configured solution, it is less likely to be tailored to a good fit with your context and less likely to be sustainably differentiating when the competition has access to the same provider and the same solution forms.
A critical attribute in a competitive market is a moat that makes it difficult for competitors to match your move. A well-tailored solution may take a little time to develop and evolve to product market fit. However, it is harder to replicate or copy, particularly if the solution continues to evolve to maintain fit and extend functionality as can be seen in successful cases. For example, Merck's GrowzenTM Buddy app release history in the UK App Store shows 24 version updates in the last 3.5 years. Similarly, the AbbVie Complete app in the US App Store has been updated 25 times in 2.5 years.
An emerging space is PDURS regulation. This offers new scope for leveraging value from a digital solution by including claims or evidence into the drug label. This requires clinical evidence and consequently a higher commitment and investment level. To go down this path with a one-size, configurable or white-label type solution would be to take all the initial risk of investing in proof, leaving a well-beaten track for competitors (including generics or similars) to follow with essentially the same solution.
Product differentiation in less competitive and fragmented markets
In a less-competitive market (e.g., sole treatment for a rare disease) or in a market with a dominant position, it can be relevant for pharma to invest in growing the whole market, as the net competitive position is improved even if some spillover value goes to competitors. However, the more fragmented a market is, the less value can be derived from growing the whole, and you may be enabling an ecosystem designed to make you replaceable.
A relevant case study is in the respiratory market, where connected health solutions from Adherium and Propeller Health initially generated interest and support from pharma. However, these companies' connected systems are open to all-comers, and they offer connected add-ons for inhalers or drugs from multiple manufacturers, including generics. In this end game, any differentiating value for individual pharma derives only from the inherent strengths of the drug or device, not from investment into the connected systems side. Such systems may improve adherence and outcomes, and it's potentially important for pharma to be 'in' these systems, depending on their eventual traction. However, there is little 'differentiation' rationale for investing to drive the uptake of such a universal system unless it can be done in a way that accrues return on investment to your specific brand.
Timely delivery
Successful, timely delivery is the third key pillar. Pharma needs solutions to come to market in a timely manner to take advantage of stakeholder alignment and interest that all too easily turns elsewhere. The delivered solution then needs to be impactful and aid the competitive position, which means not only delivering perhaps an initial pilot of small functional scope in a restricted geography but also being able to scale the solution within and across countries and to evolve and extend the functionality to the product market fit that drives uptake and scaling.
There is an order of magnitude of additional use cases and requirements beyond the initial patient use cases that often come to a pilot. This is where short-term decisions to go with off-the-shelf or lightly configured solutions are exposed by a limited ability to rapidly evolve across the differing contexts in multiple markets and often indications. Platform-based solutions that can be customized enable pharma to address specific patient, disease, or product challenges to maximize brand performance, and to adapt and evolve across markets and over time.
In summary
In summary, the competitive context for pharma brands and the importance of impactful, differentiated digital solutions supporting those brands is ever-increasing. Over time, successful solutions will find and maintain product-market fit and product-brand-strategy fit. This requires the ability to continue tailoring and evolving solutions for local contexts and, by indication, exposing the limitations of off-the-shelf and lightly configured solutions. Competitors will not easily replicate these solutions, and success will favor solutions that evolve to the specific brands and strategy and cannot be bought off-the-shelf by competitors.
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