A new foundation for designing winning brand strategies The Patient Journey re-envisioned

WHITE PAPER
PATIENT JOURNEY
A new foundation for designing
winning brand strategies
The Patient Journey re-envisioned
Authors: MAneesh GuptA, siMone seiter, heAther von AllMen And howArd JAffe
TM

2A NEW FOUNDATION FOR DESIGNING WINNING BRAND STRATEGIES
iMs ConsultinG Group
Medicine has been described as a“science of uncertainty and an
art of probability.” The same can be said of marketing –
particularly when it comes to developing the foundation of the
brand strategy – the Patient Journey. The Journey is a powerful
framework for understanding the market and designing winning
strategies. However, several practical issues in building and using
the Patient Journey have limited marketing teams in harnessing
the potential of this concept.
With the availability of the latest, comprehensive methods for
understanding the Patient Journey, companies can proceed with
new-found confidence in the foundation for their brand plans.
Using a combination of innovative techniques including
Real-World Evidence analysis, social media listening platforms,
and projective techniques to understand the underlying
emotions that drive behavior, brand teams can uncover unmet
needs, spot growth opportunities, and position their product in a
way that resonates favorably with providers, payers, and patients.
In the following pages we will share our observations on issues
we have seen the industry face as they build and use Patient
Journeys. We will offer our recommendations on how to get the
most out of these efforts by taking advantage of the latest
methodologies and tools. We’ll also provide tips on how best to
ensure that the resulting insights are used downstream for
commercial success.
For further information, please contact Maneesh Gupta at mgupta@imscg.com
or Simone Seiter at sseiter@imscg.com

THE PATIENT JOURNEY RE-ENvISIONEd 3
white pAper | the pAtient Journey
“Good enough”no longer is
The years immediately preceding a pharmaceutical product launch are arguably one of the riskiest
periods in business.“Getting it right”has never been more essential – nor more challenging – given
increasing development costs, shrinking pipelines and growing patent losses. And even once a product is
launched, the amount of change in the marketplace dictates that brand teams must constantly refresh
their understanding of current conditions and alter their strategy accordingly.
Brand teams rely heavily on the results of research into the current state of the market to set and revise
their brand strategy and to develop corresponding tactics. While the traditional methods for assessing
the market through an understanding of the Patient Journey may have sufficed in another era, they no
longer serve companies well in the existing, dynamic market environment. Times have changed, and so
must companies’research standards and practices.“Good enough”no longer is.
Conducting qualitative studies with a few dozen physicians followed by quantitative research among a
hundred or so more is simply inadequate for building a successful product strategy; too much is left
unexplored – including integrating the patient and payer perspectives into a single view. It is impossible
to gain insight from physicians about the beginnings of the Patient Journey – before the patient presents
in a consultation – or the aftermath of the physician visit, for example.
The foundation for the brand’s go-to-market strategy may therefore either be skewed, sending a product
off in the wrong direction, or incomplete, preventing the product from realizing its full potential.
Regardless of the quality of a company’s research
into the Patient Journey, many companies face
another stumbling block in converting the brand
strategy to deployable tactics. Often, opportunities
are overlooked when objectives are set, and
frequently, the behavioral objectives that are set are
not even tracked, even as the brand team focuses its
resources on somewhat disconnected ATU
(Awareness, Trial and Usage) studies.
Several brand teams in the industry recognize the
challenge with the current approach. Polling from a
recent IMS Patient Journey webinar (Figure 1)
indicates that incorporating the‘physician, payer,
and patient into a single view’and‘quantifying the
Journey’remain to be the biggest challenges in the
industry.
The art and science of building and using Patient
Journeys is a journey by itself. We have seen clients
along the continuum with some clients using the
latest techniques, where as others are still focusing
on primary across research with physicians. IMS
research suggests that nine out of ten brand teams
do not use the latest practices for building and using
Patient Journeys, leaving gaps in market
understanding or strategy execution and ultimately
yielding sub-optimal brand performance.
fiGure 1: severAl brAnd teAMs in the
industry reCoGnizetheChAllenGewiththe
CurrentApproACh
Polling from a recent IMS Patient Journey
webinar indicates that incorporating the
‘physician, payer and patient into a single
view and quantifying the Journey’ remains to
be a big challenges in the industry.
Where do you see your biggest area of challenge
in building and using the Patient Journey?
Based on 70 votes.
Incorporating the patient payer and physician into a single view
2 24.2%
Quantifying the Journey
2 28.5%
Understanding the potential evolution in future
11.4%
Identifying all potential opportunities and challenges
15.7%
Ensuring connection between objectives and execution
12.8%
Tracking against objectives
7.1%

A NEW FOUNDATION FOR DESIGNING WINNING BRAND STRATEGIES
4
the importance of the patient Journey
The“Patient Journey”is a description of how patients experience a disease or condition from their first
awareness of symptoms through all stages of presentation, diagnosis, referral and treatment, fulfillment,
monitoring, adherence, and follow ups. At each juncture along the way, it reflects the decisions made
and hurdles faced by patients and providers, the rationale behind those decisions, and the emotions felt.
A comprehensive depiction of the Patient Journey will provide both quantitative data surrounding each
milestone on the Journey as well as qualitative data on what patients, caregivers, and providers are
thinking and feeling along the way.
These insights provide answers to a long list of
questions that must be answered before a
company can devise an effective product
strategy (See Sidebar 1). Most companies,
therefore, must first seek an understanding of
the Patient Journey when a compound is still in
Phase II of clinical development and therefore
several years from entering the market.
Because the market is dynamic, one’s
understanding of it cannot be static; the Patient
Journey should then be revisited when launch is
imminent and routinely thereafter once the
product is on the market. We recommend that
the Patient Journey be refreshed at least every
two years, or more often if market events (such
as a competitive launch, for example) occur to
change physicians’or patients’perceptions and
practices.
The Patient Journey lays the foundation for the
brand strategy and informs downstream
decisions including segmentation and targeting;
product positioning and messaging; and
physician, patient, and payer engagement
models as seen in Figure 2.
Sidebar 1: Questions to answer with the
Patient Journey
Companies should undertake building the
Patient Journey with six objectives in mind
1. Understand “what is happening” i.e., the
full patient experience (from awareness
through adherence) along the Journey; role
of physicians, payers, nurses, pharmacists,
and caregivers; their unmet needs and;
decisions made along the continuum
2. Gain insight into the “why” behind the
decisions made throughout the Journey
3. Understand “how often” by
understanding number of patients and
physicians at each step and sub-step in
the Journey
4. Estimate “how” the typical Patient Journey
will evolve over the next several years,
especially in pre-launch situations and
make the patient, health care provider, or
payer experience better, while driving
brand uptake
5. Align on “where to add value” within the
Patient Journey and design strategies and
tactics to win in the marketplace
6. Ensure that the team answers“how do we
know we are winning” by measuring
progress against the prioritized objectives
within the Journey

IMS Health research suggests that nine out of ten brand teams do not use the latest practices for
building and using Patient Journeys, leaving gaps in market understanding or strategy execution
and ultimately yielding sub-optimal brand performance.
fiGure 2: the pAtient Journey lAys the foundAtion for A stronG brAnd strAteGy
UNDERSTANDING
Strategy
Patient
Journey
Tactics
PLANNING
Aligning the brand’s value with unmet needs of the market
Based on the outcome of each step, earlier steps need to be constantly re-assessed
EXECUTION
Segmentation Target
Segments
Positioning Messaging Promotion
Mix
Performance
Tracking

A NEW FOUNDATION FOR DESIGNING WINNING BRAND STRATEGIES 6
early Journeys
For many years, companies have built their Patient Journeys on data collected via primary research with
physicians. These studies, typically consisting of interviews with a few dozen physicians followed by a
quantitative survey of a few hundred physicians, were at one time the soundest approach available.
However, even as the market environment has evolved considerably, and patients, caregivers, and payers
have become important decision makers, the approach to building and using Patient Journeys has
remained broadly the same. This introduces inherent shortcomings that limit their usefulness in forming
anything as business-critical as a brand plan – particularly as other, more comprehensive methodologies
have become available.
Relying on decades-old approaches in building Patient Journeys in today’s market is no longer
recommended, since they often:
• Produce biased results. Conclusions are drawn from a small sample of physicians who respond to
questions based on their memory and their perceptions.
• Omit direct input from patients and payers. Ironically, the Patient Journey is often built from
information gathered from physicians and does not incorporate feedback directly from patients or
payers, both extremely important stakeholders today.
• Cover only a portion of the Journey. Because physicians are often the primary source of information,
little can be learned about what happens outside of the physician’s office, both pre- and post-
diagnosis. So, questions pertaining to the impact of managed care, fulfillment of prescriptions at the
pharmacy, adherence, the cost burden of treatment, and so forth cannot be answered. Physicians do
not always even have complete information about patients’co-morbidities, time between steps, or
referrals between specialties.
• Provide limited insight into the“why’s”of behavior. How successful interviews are at uncovering the
emotional drivers behind decisions is heavily dependent upon the skills of the researcher and the
techniques used. Often, people’s motivations are subconscious, and straight questioning fails to
surface them.
• Focus on the present. While understanding the status quo is certainly a primary goal of the research,
many things can change between the time of an initial study and a launch. Research needs to include a
forward-looking view to ensure that a brand can succeed in the future environment.
• Cost excess time and money. Primary research and chart audits take several months to complete and
the recruiting, honoraria, and interviews add to the tab significantly.
Beyond gaps in building the Patient Journeys, there are significant gaps in how they are used by brand
teams. Following are some of the issues that we have commonly observed
• Opportunities and challenges are not comprehensively identified. Objectives related to timing,
influencing referral patterns, and improving fulfillment rates and medication compliance are rarely
identified since these dynamics are often not captured in the first place. At the same time, these can
represent significant opportunities. In one case, a brand team did not realize that patients with a

condition were not presenting for up to five years after the appearance of symptoms because they
associated their symptoms with aging. In another case, a team understood two years after launch that
40 percent of their patients were not fulfilling their scripts at the pharmacy since the overall cost
burden to patients was significant. In both cases, these opportunities were missed in the Patient
Journeys and equated to losses of several million dollars.
• Disconnect between objectives and execution. Sometimes, behavioral objectives do not connect well
with actual execution in the promotional mix, messaging, and field force tactics. In one example, a
brand team identified improving referral patterns between primary care physicians and oncologists as
an objective. However, this objective did not translate into detailed mapping of the current referral
patterns at the physician level or into tactics by the field force to improve referrals.
• Objectives not tracked. Brand teams often do not track performance on objectives rigorously. In one
case, even though a brand team had identified patient adherence as an objective, the company was
tracking brand performance using conventional ATU studies. These ATUs, while useful, did not shed
light on progress against the adherence objective.
In summary, the Patient Journey is a powerful framework for understanding the market and designing
winning strategies. However, several practical issues in building and using the Patient Journey have
limited marketing teams in harnessing the potential of this concept (Figure 3). The end result is often a
sub-par brand strategy that is based on an expensive, time consuming, and ineffective process.
fiGure 3: CoMMon issues often underMine the end result
BUILDING THE JOURNEY USING THE JOURNEY
Patient perspective is largely ignored or
based on physicians perceptions
Issues such as funding flow and influence
mapping are often not integrated into a
single view
Important dynamics such as time, referrals,
patient affordability, and adherence are
often missing or misleading
Opportunities and challenges are not
comprehensively identified
disconnect between objectives
and execution
Objectives not tracked
End result:
Subpar brand strategies based on an
expensive, time consuming, and
ineffective process
Whys behind the decisions and potential
future evolution are not well understood
COMMON ISSUES

A new Journey of discovery
Ideally, a description of the Patient Journey will extend from disease awareness through final treatment,
covering not only the current situation, but how the treatment paradigm is likely to evolve in the next few
years. And, it will not only reveal what happens and how often it happens, but why it happens—both
from the physician’s and the patient’s perspective. Furthermore, once the Patient Journey is built, the
brand team needs to know where to add value and how to tell if the brand is winning.
Getting such a comprehensive view requires combining multiple research sources and methods as are
discussed below.
Real-World Evidence
For the past decade or so, it has been possible to use a wealth of Real-World Evidence sources to analyze
patients’touch points with providers, creating a map of how patients flow through the system from diagnosis
through adherence.The input for these maps comes from diverse and rich databases including EMR data from
physician offices and hospitals; diagnostic data from labs; longitudinal, patient-level databases; claims data
covering diagnosis, treatment, and adherence; and managed care data covering prescription fulfillment (Figure 4).
fiGure 4: rwe CAn Add siGnifiCAnt vAlue to pAtient Journeys
JOURNEY PHASE
Origination
• Consumer database
• Social media analytics
• Lab values data
• Longitudinal patient data
from pharmacies
• Claims data from health plans
• EMR/physician office data
• Hospital data
• OTC data
• Scripts written by physicians
• Institutional purchases
• Managed care benefit design
• Formulary details
• Rejection/reversal data
• Incidence and prevalence
• Patient demographics (age, income, education, geo)
• Co-morbidities/underlying conditions
It is advisable to start building the Patient Journey with secondary data and use primary
research to plug in the gaps.
• Patient’s perspective – symptoms, awareness,
information search, presentation decision
• diagnosis rates
• Lab values
• Newly diagnosed/previously diagnosed
• Severity & staging
• Referral and patterns
• Continuing
• dynamic - new/add on/switch
• Share by line of therapy
• dose titration
• Substitution and abandonment
• Method of payment/tiering
• Co-pays and patient cost burden
• Time on therapy
• Compliance and persistence
Awareness /
Presentation
Diagnosis /
Referral
Treatment
Fulfillment
Adherence
INFORMATION AVAILABLE DATA SOURCES (US EXAMPLE)

drawing from an array of such robust databases that incorporate information on millions of de-identified
patients and thousands of physicians and payers, one can quantify the treated patient population and
various market dynamics. In addition to providing a standardized framework that is easier to refresh than
primary research, it provides the most accurate view of actual patient behaviors.
This research will answer questions such as:
• How many patients reach each step of the Journey? How much time elapses between points along
the Journey?
• Are there patients who never get drug treatment?
• What is the opportunity for a non-first line therapy choice?
• How many patients move through multiple treatments, and what are the most
common treatment pathways?
• What percent of the population seems to have success with the first treatment selected
for them?
• What co-morbidities do patients suffer? How could these impact their treatment choices? Might these
create an opportunity for a Fixed-dose Combination that treats both conditions?
• do patients fill their scripts and adhere to their treatment regimen?
• Regardless of physician intent, what are the actual prescription fulfillment behaviors exhibited by the
patient? does fulfillment differ from intent?
• How does the cost burden influence patient behavior? does it differ by patient characteristics, such as
income levels, geography, or education?
• What are the patterns in how and when physicians refer patients to one another? Once a physician
initiates treatment, is the referred to physician likely to change the therapy?
It is now possible to use a wealth of Real-World Evidence to create a rigorous, granular and
comprehensive patient flow maps from diagnosis through adherence. Beyond relying on
perceptions of a few physicians, Journeys can be now be built based on millions of actual decisions.

fiGure 5: reAl-world evidenCe sourCes CAn help understAnd the pAtient Journey And the
true opportunity for A produCt
In this summarized view of the diagnosis and treatment phases of a Patient Journey, one is able to easily see the
power of Real-World Evidence. Note that the size of the diagnosed hypercholesterolemia population available
through longitudinal data, including those who were newly diagnosed during the 12-month observation period, is
64 million patients. Among those diagnosed, visibility is also provided to the treated population, and the
opportunities for first-line treatment (newly treated, n=6.7million). Among all patients, the total opportunity for
non-first line patients (add/switch) is also captured, showing that 8.1million patients changed therapy, and that
multiple types of changes may have occurred during the observation period. However, when discounting for
changes that involved a titration in therapy or patients discontinuing all therapy, the opportunity is reduced, with
6.2 million switches or adds occurring. For a product that is being introduced to this market as a non-first line
therapy, having this information provides valuable input into the opportunity, as the details of patient treatment
are revealed. The real opportunity for a new product is 6.2 million therapy change encounters (i.e., switch and
add-on) and not the 29.5 million patients (all Rx treated patients) that an assessment without doing this type of
analysis may suggest. This could be further reduced if the product is only considered when a specific type of switch
or add is occurring.
Origination
Fulfillment
Stain Mono 5.0m
Switched Med 4.1m
Add on Med 2.1m
Titrate Dose 3.3m
Discontinuation
ofTherapy 3.0m
X Mono 0.07m
X Mono 0.3m
Adherence
Treatment
Diagnosis
Flow
Newly Diagnosed
10.4m
Untreated
36.0m
Existing Tx
22.8m
Change in Tx
8.1m
All Rx Tc Pts
29.5m
No Change in Tx
21.4m
Newly Initiated
on Rx Tx
6.7m
Total Diagnosed
64.1m
Previously Diagnosed
53.7m
Sample includes
millions of patients
Perceived
opportunity for
new drug
Granular breakdown
of Tx flow
Actual opportunity
for new drug
Reason for
Change
Rx
Treatment
Flow -
Hyperlipidemia
Market
Awareness/
Presentation
Diagnosis/
Referral

Social Media Listening Platforms
The Pew Internet & American Life Project has been measuring“peer-to-peer healthcare,”the tendency of
patients to“lend a hand, lend an ear, lend advice,”using the speed and scale of the Internet. According to
Pew, patients turn to fellow patients, friends, and family far more (59 percent of the time) than to medical
professionals (30 percent of the time) when seeking emotional support for a health issue.1 The rise of
social networking has given patients an electronic avenue for that outreach. In fact, patients can become
members of online communities through such sites as PatientsLikeMe.com, MedHelp.org, and
CureTogether.com, which instantly connect them to fellow sufferers. They can participate in forums and
exchange private messages with others who have stories and advice to share.
At a minimum, companies can“listen in”to public conversations conducted via online forums to get a
sense of what is on patients’minds. Ensuring, of course, that all laws and FdA guidelines are followed,
companies can gain more systematic insight into conversations conducted in social media through data
aggregators. These companies scan social media key words which are then coded and analyzed for trends.
Through this data mining, we can learn the answers to such questions as
• What are the topics that patients, caregivers and physicians talk about most often as they go
through the Journey?
• What experiences and feelings do patients share with one another about the disease,
diagnosis, treatment options, drug efficacy, side effects, and co-pays?
• What do patients and physicians really think about the product? About the competition?
• What are the questions and frustrations that patients have?
• What are the unmet needs that surface online?
• What is the patient profile by age, gender, and ethnicity?
• What are the attitudes of different profiles?
• What is the mindset surrounding pharmaceutical and non-pharmaceutical options?
• Why do or don’t patients switch brands?
• What are the issues that different patients face on a day-to-day basis? How do they manage
these issues?
• How do patients adjust to their condition/resulting limitations? What behavioral and
emotional changes do they experience?
• Are there ideas in dealing with the condition from which other patients may benefit?
• What are physicians communicating to patients? How satisfied are patients with the communication?
• What are the online sources of information that patients use?
• Who are the social advocates that patients listen to most often?
• What are they saying? What are their interests and views?
• What are the interests and views of key social opinion leaders?
• What are ideas for product innovation and patient services beyond the pill?
REFERENCE:
1
Fox, Susannah,“Mind the Gap: Peer-to-Peer Healthcare,”Pew Internet & American Life Project, February 28, 2011.

Patients and caregivers are becoming increasingly vocal about their experiences along the Journey, even in
debilitating diseases such as cancer. As seen in the example below, a patient describes her experience on social
media. She talks about her melanoma mis-diagnosis, diagnosis, experience on different drugs including IL-2,
temodar, ipilimumab (Yervoy®) and vemurafenib (Zelboraf®). The patient discusses efficacy, outcomes, side-effects,
and even persistence on treatment over a period of eight years.
Social media can add a another dimension of patient perspectives to the Patient Journey.
Outcome
Efficacy
Mis
diagnosed
Re
diagnosed Stage Iv
Reappearance of
Melanoma
4 rounds of chemo
Started
Temodar
and
docitaxel
IL - 2
Tumor in left
leg, some
lymph nodes,
bowel, and
groin
Ipilimumab
2003 2004 2005 2006 2007 2008 2010 2011
Positive Partial Partial
Persistence
Treatment
diagnosis
Timeline
Switch to
other
treatment
Remission for
one and half
years
Resistant tumor in leg;
waited for lpilimumab
approval
Starting
vemurafenib
2009
Stuck to drug
in spite of
having side
effects like
diarrhea,
stomach pain,
tiredness,
exhaustion
Positive
Stopped after
three cycles
due to
congestive
heart failure
Not effective
fiGure 6: pAtient eXperienCe As GleAned froM soCiAl MediA
The internet and social media have become key influencers. Health information has become the
third most popular online pursuit (Pew Survey) while 30-40% US adults are likely to be influenced
by social media in their choice of providers, therapies, and insurance plans.

Importance of Emotional Drivers for Patients’ and Physicians’Behaviors
Experiences, opinions, and decision-making exist in two domains, the rational and emotional. Often,
individuals are unaware of the important emotional drivers of their behaviors, as many act on a
subconscious level and influence the more easily observed rational processes. However, it is essential to
get to the underlying emotional themes that drive patient and physician decisions, but it is generally
necessary to use less direct research techniques to do so. Under direct questioning, respondents do not
always speak the truth; they can be embarrassed, they can anticipate the answer the interviewer is
seeking, or they can be unaware of their inner emotions and only present rationale explanations for
their behavior.
One recommended solution is to use projective techniques as a research tool with patients and
physicians. Projective techniques are frequently used in psychological diagnosis and treatment,
specifically because they access underlying emotional influences on behaviors. Projective research
techniques to understand emotions and feelings complement the standard interview or survey
techniques that emphasize rational and behavioral aspects and are best implemented as a parallel series
of interviews, usually with a smaller number of subjects (perhaps half the number who are interviewed).
These techniques are“projective” because those interviewed are prompted to project their beliefs and
feelings onto an ambiguous stimulus – such as an incomplete picture or story. Projective research, when
conducted by trained therapists, is quite successful in eliciting the subject’s emotions – emotions that
may never otherwise have been expressed.
There is a large body of science behind these techniques, and a battery of different types of tests has
been standardized, and their interpretation validated. If, for example, people are asked to add details to a
silhouette drawing that symbolizes their own body, therapists can read meaning into their choice of
media, their choice of colors, and what they draw…as well as what they omit.
Projective techniques can be used to discover how patients and physicians experience a disease, the
treatment process, and their relationship to one another from an emotional (and often subconscious)
perspective.
different approaches can be taken to answer questions such as
• How adequate are the current therapeutic options?
• What treatment criteria are most important to patients?
• How do physicians and patients perceive specific products?
• How do physicians and patients relate to one another?
• How do patients view their physician’s role? How do physicians view their own role?
• How do patients cope with the burden of illness?
• How does the disease or condition affect the patient’s sense of self? How does this change as
a disease progresses?
• What would a successful treatment mean to a patient?

Perhaps the best way to understand the power of projective research techniques in adding dimension to
an understanding of the Patient Journey is through a few examples:
• When asked to draw a map of their route to work, patients with Over-Active Bladder (OAB) voluntarily
drew in every public bathroom on the route—a very tangible expression of how their lives are
circumscribed by their condition.
• When asked to depict their treatment of patients suffering from Irritable Bowel Syndrome (IBS) using
the prop of an aquarium in the illustration, physicians showed patients as little fish in the aquarium
with an aggressive, big fish. They drew themselves as feeding the little fish from a distance. This
illustrated that physicians felt impotent in treating these patients and related to them at arm’s length.
• When asked to draw themselves with cancer patients, oncologists drew dramatically different pictures
at different stages in the disease progression. Initially, they showed themselves as holding the patient’s
hand. Once the cancer had recurred, they added space between their figure and the patient’s. Once
the tumor had metastasized, physicians stopped drawing the patient’s facial features and portrayed
the tumor as the patient’s dominant feature. This reflected physicians’need to disengage emotionally
as they lost control of the fight against the cancer. Ultimately, the cancer came to define the patient in
physicians’eyes (Figure 7).
fiGure 7: proJeCtive teChniques help Get to deeper drivers of behAvior
Therapy choice: patient and
physician are close, patient can feel
safe knowing she will be cared for
Progression: patient and physician
are further apart, patient feels alone
and feels that she has no future

Trained clinicians (typically doctoral-level psychologists with a master’s degree in art therapy, or board-
certified art therapists) have the necessary insight to design tasks that will generate emotional responses
from the subject and to provide expert interpretation. drawings are categorized according to the
presence and omission of indicators such as positioning, color, affect, size, and quality of shape and line.
Placement of forms, erasures, and manipulation of materials also reveal nonverbal attitudes and levels of
emotions. Additional information gleaned from the personal observation of the drawing process is also
significant and might go unrecognized if the tasks were not observed by a trained clinican.
Such insights are a goldmine for brand teams looking for unmet needs or hoping to strike a chord with
their audience in their messages.
While having a comprehensive Patient Journey in hand is essential to creating an effective brand strategy,
that alone is no guarantee of success. Companies must be able to translate the insights from the brand
plan into a strategy and then into tactics that are actually implemented and measured.
Two elements of Patient Journeys support important opportunities for many biopharmaceutical
companies.
Connecting objectives, strategies, and tactics
Most pharmacos do a satisfactory job of identifying and prioritizing behavioral objectives in the
Patient Journey. However, when it comes to laying out action plans behind these behavioral objectives,
we have seen several brand teams falter. Many times the Patient Journey effort is stopped prematurely
after the behavioral objectives are identified. In reality, aligning on the behavioral objectives is just the
foundation to winning in the marketplace. As seen in Figure 8, it is important to lay out current and
desired behaviors clearly and to support strategies that will achieve the desired state with a detailed list
of tactical action items.

Tracking performance against objectives?
Even though brand teams typically conduct ATU studies throughout the year, there is often not enough
attention paid to tracking performance on behavioral objectives.
Brand teams can follow the five step process outlined below and illustrated in Figure 9 to ensure that the
brand is winning in the marketplace.
1. Identify and define leverage points (e.g., patient adherence)
2. design and implement tactics to influence (e.g., co-programs with hospitals and health systems,
patient apps, and text message reminders)
3. develop methodology and definitions for performance tracking including defining the targets
(e.g., ensuring that 80 percent of patients stay on therapy after three months, as seen in longitudinal,
patient-level data)
4. develop dashboard for performance communication (e.g., looking at persistence curves monthly)
5. design and implement a performance mitigation plan (e.g., email blasts if persistence is below 70 percent
after three months, or initiate kick-off market research to understand why patients are not adherent)
fiGure 8: An eXAMple ConneCtinG obJeCtives, strAteGies And tACtiCs for enCourAGinG
pAtients to be Adherent on therApy
Desired
behavior
Current
behavior
Drivers
Patients remain on therapy to manage their diabetes
• 75% of adults fail to adhere to, or comply with physician prescribed treatment regimens
• Patients drop off therapy overtime
Patients are motivated to
beat diatetes
Engagement of patient advocacy groups around topic
Encouraging patients to share experiences online and offline
SMS reminders to patient/caregiver cell phones
Apps to track symptoms, vitals, medication intake, progress,
exercise, and nutrition intake
Patient and caregiver education materials, provided through
physician offices
Co-programs with hospitals, payers and health systems stressing
the importance of adherence
Show patients results by providing encouragement to them through tools, educational
programs and support services that help them better understand how therapy keeps
them healthy over time and reduces complications
Nurse hotlines
Patients cannot see short term results
and do not receive positive feedback
John Feb
Jill Feb
Raj Apr
Chris Mar
Laurie Jun
Yu Aug
Howard Aug
Barriers
Strategies
Tactics

recommended Approach to building and using the patient Journey
The following methodical approach will allow you to take full advantage of the Patient Journey in
meeting your business objectives (Figure 10):
1. Understand“what,”“why,”“how often,”and“how will it evolve”
As discussed above, first ensure that the Patient Journey presents a realistic and comprehensive view
of how the patient“flows”through the healthcare system and includes the“why’s”that drive behavior
as well as a view of how the future is likely to unfold.
Use a rich combination of social media listening platforms, epidemiological, diagnostic, script,
longitudinal patient level, managed care, claims data, and targeted primary and projective research to
answer these questions. Then, analyze the Journey for what it reveals about the unmet needs, drivers, and
barriers to a patient’s progress through all the stages of their experience – today and tomorrow.
fiGure 9: trACk obJeCtives to ensure thAt the brAnd is winninG in the MArketplACe
6 month patient
adherence for target
patient cohort
Identify and define
leverage point
Launch research to
understand‘why’if
adherence benchmarks
not met at 6 months
design and implement
performance
mitigation plan
Monthly custom
persistence curves
(email blasts on
update)
develop dashboard
for performance
communication
Tracking persistence/
compliance in
patient-level data
develop
methodology for
performance tracking
design and
implement tactics to
influence behavior
Patient adherence
programs
OBSERVATIONS
ARE FED BACK
INTO THE
BRAND PLAN
Example
Process
1
2
3
4
5

2. Align on“where to add value”
Identify points in the Patient Journey that can be leveraged to ensure that the brand will win in the
marketplace of tomorrow. develop realistic, but challenging objectives for the brand by being
innovative and holistic at the same time. These goals might be, for instance, to increase awareness
rates, decrease time to presentation, improve referrals, increase prescribing, increase/decrease
switching, enhance fulfillment, and improve compliance or persistence. Thereafter, it is important to
prioritize the objectives based on their impact on the brand and the effort needed to achieve the goal.
Then, devise supporting strategies and tactics for achieving the prioritized objectives. At this stage, it is,
of course, critical to ensure that those creating the tactics have the necessary expertise in pricing and
market access, HEOR, marketing, sales, and medical affairs to develop realistic tactics. Knowledge of
what has worked in other launches with analog products is very useful.
3. Make sure the“brand is winning”
After developing the detailed tactics, it is important to align the methodology and definitions for
performance tracking against the objectives. develop dashboards that will allow the organization to
monitor its progress at a glance and then proceed to do so with secondary and primary data inputs.
Finally, feed the observations that come out of performance tracking back into the brand strategy and
tactics so that potential issues can be resolved quickly and effectively.
fiGure 10: usinG best prACtiCe to Answer key questions
‘What’,‘why’,‘how often’
and‘how it evolves’
ObjectivesFrameworksOutcomes
Understand the current
and future journey
comprehensively
Rigorous and realistic view
of the Patient Journey
• Comprehensive understanding
of events, decisions,
stakeholders and, their needs
• View of the future evolution
Prioritized objectives along
the Patient Journey
• Drivers and barriers
• Supporting strategies and
tactics
• Implementation plan
Ensuring execution on strategy
• Metric definitions
• Benchmarks and dashboards
• Process to handle issues
Identify objectives,
supporting strategy
and, tactics
Track performance
against objectives
Where and how to
add value?
Are we winning?
PHASE 3PHASE 2PHASE 1
E
Secondary data case study
Approach Phase 1 Phase 2 Phase 3
Sample
includes
millions of
patients
Granular
breakdown
of Tx flow
Actual
opportunity for
new drug
Perceived
opportunity for
new drug
Large sample size and granularity provided rigor and realism
dancoeS catadayrda dystuseca
chaopprA 1seaPh 2seaPh 3seaPh
dancoeS
mpsaergaL
catadayrda
ragdnazesielmp
dystuseca
edviropytrialunra larednarogride smi
Track objectives to ensure that the brand is winning
in the marketplace
Observations are
fed back into the
brand plan
Develop
methodology for
performance
tracking
Develop
dashboard for
performance
communication
Design and
implement
performance
mitigation plan
Launch research to
understand ‘why’
if adherence
benchmarks not
met at t+X
Monthly custom
persistence curves
(email blasts on
update)
Identify and define
leverage point
6 month patient
adherence for
target patient
cohort
Example
Patient
adherence
programs
Tracking
persistence/
compliance in
patient-level data
Design and
implement tactics
to influence
Process
1
2
4 3
5
IMS’ Patient Journey
Hypertension
Patient Persistence can be assessed and different types of
therapy can be compared, in this example anti-hypertensives
Average remaining PersistentAverage remaining Persistent
In the UK
ARBs and
Diuretics
associated
with best
persistence
on therapy
Period assessed:1st May
2001 – 30th April 2004
N= 144,240
Drop-off defined as
discontinuation of
therapy for at least 60
days
One patient may be
represented more than
once in the analysis
(if prescribed multiple
therapies)
Source: IMS® Disease Analyzer UK
Identify opportunity to add value
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B,9)&#+)6-
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1,$*)*+,-+
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,D1,&+#+)6-*
,D&,,9,9Opportunities sometimes missed in traditional journeys
A comprehensive understanding of the opportunities
BrandImpact
Ability to Influence
Improve
presentation
rates
2
Incorporate X
risk
assessment
4
Encourage
collaborative
decisions
5
Switch from
current
treatment
7
Prioritize leverage points
HighLow
Low High
Patients are
more
persistent
8
Current
Behavior
•!75% of adults fail to adhere to, or comply with physician prescribed
treatment regimens
•!Patients drop off therapy overtime
Desired
Behavior
Patients remain on therapy to managed their diabetes
Drivers
Patients are motivated to
beat diabetes Barriers
Patients cannot see short term
results and do not receive positive
feedback
Strategies
Show patients results by providing encouragement to them through tools,
educational programs and support services that help them better understand
how therapy keeps them healthy over time and reduces complications
Tactics
•!Co-programs with hospitals, payers and health systems
stressing the importance of adherence
John Feb
•!Nurse hotlines John Feb
•!Patient & caregiver education materials, provided through
physician offices
John Feb
•!Apps to track symptoms, vitals, medication intake,
progress, exercise and nutrition intake
John Feb
•!SMS reminders to patient/ caregiver cell-phones John Feb
•!Encouraging patients to share experiences online and offline John Feb
•!Engagement of patient advocacy groups around topic John Feb
Detailed tactics Approach Phase 1 Phase 2 Phase 3
Therapy choice: patient and
physician are close, patient can feel
safe knowing she will be looked after
Progression: patient and physician
are further apart, patient feels alone
and feels that she has no future

Conclusion
Combining the latest research methodologies and Real-World Evidence, and insights from physicians,
payers and patients will produce the most comprehensive, rigorous, and actionable Patient Journey
possible. Such a well-designed and thoroughly researched Patient Journey will give companies the basic
foundation for formulating a successful brand strategy. Beyond identifying the objectives for success,
companies must then use a systematic process for achieving success: outlining tactics, tracking progress
against those goals, and closing the loop by making adjustments to the plan as indicated.
biographies
Maneesh Gupta Senior Principal, Brand and Commercial Strategy
Maneesh Gupta leads the Patient Journey offering globally at IMS Consulting Group and has been
helping clients build and use Patient Journeys effectively for over eight years. His papers on the topic
and on launch excellence have been published in several industry journals.
Maneesh has over 17 years of experience in consulting, strategy, marketing and product
management. He earned an MBA, with a concentration in Marketing, from the University of North
Carolina, where he was invited to join Beta Gamma Sigma Honor society. Maneesh also holds a BSc in
Chemical Engineering.
He can be reached at mgupta@imscg.com
Heather von Allmen Senior Principal, IMS Health
Heather works closely with clients to help build rigorous and granular Patient Journeys through Real-
World Evidence. With over 30 years experience working with anonymized patient level data, she
specializes in designing unique solutions for analyzing and tracking complex patient flows. Her
research experience spans multiple therapeutic categories and markets, including
autoimmune/biologics; vaccines; HIv; HCv; and diabetes. Heather is a Phi Beta Kappa graduate of the
College of Wooster, where she earned a B.A. with honors in Sociology.
She can be reached at hvonallmen@us.imshealth.com
Simone Seiter vice President, IMS Consulting Group
Simone leads the Launch Excellence platform globally and supports clients in optimizing the
commercialization of brands. She has over 14 years of experience in consulting, strategy, marketing
and product management. Simone is a board certified dermatologist and has spend several years
working as a clinician before starting work as a consultant. Therefore, she brings in a critical mix of
clinical and commercial skills to Patient Journey engagements. Besides a Md in dermatology, Simone
has a business degree with a concentration in Healthcare Management.
She can be reached at sseiter@imscg.com

©2013 IMS Health Incorporated and its affiliates. All rights reserved.
Trademarks are registered in the United States and in various other countries.
T10PHARMWP0213© iMs Consulting Group 2014. All rights reserved. no part of this publication may be stored in a retrieval system, or transmitted in any
form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission of iMs Consulting Group.
PATJOWP0714
TM
About
iMs Consulting Group
iMsCG is the leading global consulting
firm focused exclusively on life sciences.
Our clients range from large pharmaceutical and
biotech companies to entrepreneurial companies
preparing for their first launch. We collaborate with
our clients to make critical business decisions, build
commercial excellence, and grow their businesses
in an increasingly challenging environment.
We believe we can help pioneer new approaches to
healthcare by understanding and challenging
current pathways. Our senior team is intimately
involved in every project, which means that clients
partner with the people who create and propose
the work we do at every stage of the process.
Seniors do not merely steward, they do.
Our depth of expertise across commercial functions
and therapeutic areas, our presence in local markets
across five continents, and privileged access to IMS
data enables us to support distinctive analysis,
provide global insights, and implement
recommendations that are unparalleled among our
competition.
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