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Pharma's New Normal: Engaging with HCPs In Uncertain Times

Face-to-face interactions between pharmaceutical companies and HCPs ceased overnight in the face of the COVID-19 pandemic. Amid this crisis, we had to quickly adjust to a new norm of interpersonal relationships. Join Avant Healthcare for an enlightening conversation with Dr. Chris Bojrab, board-certified psychiatrist and Distinguished Fellow of the American Psychiatric Association, as we look ahead to the future. We’ll discuss how pharma can demonstrate empathy for HCPs navigating uncertain times while continuing to educate on important clinical data and new products.

Key takeaways:

  • Discern strategies for pharma to adapt education and engagement with HCPs who are navigating periods of complexity or crisis
  • Identify ways to provide HCPs value, even when standard engagement methods become inconvenient or irrelevant
  • Learn how to develop effective medical education in the face of our “new norm,” due to COVID-19-related changes to the pharma/HCP relationship

Webinar Transcript

Dan Limbach: Hello, everybody. I'm Dan Limbach, producer of the PharmaVOICE Webcast Network. And I'll be your moderator today. Welcome to our event, entitled Pharma's New Normal: Engaging with HCPs in Uncertain Times, brought to you by PharmaVOICE in partnership with our good friends at Avant Healthcare. We have an outstanding crowd today with executives from across the industry. Thanks to everybody for investing the time to attend. We'll do our very best to make it worth your while. Before we get started, I want to take a moment to acquaint you with a few features of our technology. Your GoToWebinar control panel will give you access to several functions. If you can hear me, but are experiencing problems logging in to see the slides, you may want to try logging in using a different browser and we recommend the latest versions of Chrome and Firefox. Tablets and smartphones also work if you have the free GoToWebinar mobile app and a current OS.

For any other issues, use the robust help options in the control panel, or visit, or you can send a message using the questions function in the control panel and we'll do our best to help you out. We're taking questions from the audience today, and you can participate in the Q&A session by asking questions at any time during the presentation and then we will get to those questions after the formal presentation is over. So to submit a question, just type your question into the questions text area in the control panel and click the "Send" button. We'll also have an audience poll during the presentation. So get ready to participate with that. You are going to be seeing and hearing a great deal of useful information today, and you don't have to memorize everything during this live event or take copious notes. We are recording this session and we will send you a link to the on-demand archive in about 24 hours so you can review the event at your leisure.

Now that we're through with the housekeeping details, let's dive into the program and go to the next slide. We have a very knowledgeable pair of experts with us today to help us understand how to make the transition to decentralized trial. Awesome. To about communicating with health HCPs, we're happy to welcome Chris Bojrab, MD, DFAPA and President of Indiana Health Group. He's joined by Arun Divakaruni, PhD, Chief Science Officer at Avant Healthcare. Both panelists have extensive industry experience, and we are fortunate to have them with us today. It's going to be a very interesting discussion. Arun is going to start things off today. Take it away.

Arun Divakaruni: All right. Thanks, Dan. My name's Arun Divakaruni. I'm the chief science officer here at Avant Healthcare, who's a company that specializes in medical education. I also have laryngitis today, so I picked a perfect day to come down with something. So if my voice is cracking a little bit, I'm not in middle school, as you can clearly see by my picture, is just my voice is a little hoarse. So if there's something you miss, please submit a question and I'll be happy to address that. I lead a team of 30 plus scientific strategists, marketers, and content creators who help our biopharmaceutical clients tell their story across a variety of digital in-person and increasingly now, in today's times, the virtual platforms. We help our clients tell compelling scientific narratives and express them across a multichannel ecosystem to achieve their particular brand goals.

And we are all really fortunate to be joined here by Dr. Chris Bojrab, who's the president of Indiana Health Group, which is the largest multi-disciplinary behavioral health practice in Indiana. Dr. Bojrab is a distinguished fellow of the American Psychiatric Association and a board certified physician who treats children, adolescents, adults, and geriatric patients. In addition to a very busy clinical practice, he maintains an equally busy lecture schedule delivering more than 100 presentations, teleconferences, and CME seminars over here Thank you, Dr. Bojrab, for joining us today.

Chris Bojrab: Thanks for having me.

Arun Divakaruni: And before we pick your brain up, I'd like to review with everyone just what we can expect out of today's webinar. We'll be talking about adaptation strategies in this period of heightened complexity in our healthcare system. Our healthcare system is already complex to begin with and the pressures of this COVID-19 outbreak have exacerbated some of those. We will look for ways to provide the value to healthcare professionals at a time when most of our traditional strategies and engagement methods have become irrelevant or inconvenient. And we'll talk about what makes for developing effective medical education amid this pandemic, which I believe has fundamentally changed the pharma HCP relationship.

So I think a good place to start is about what the future will look like. And the good doctor says that the virus makes the timeline. And all the modeling situations that we have to date suggest that this is going to be with us for a while in one shape or another. I think we've heard some very good news this week about vaccine development. And this disease will likely not be one like HIV, where it's impossible to develop a vaccine, but one which we have to wait for one. So, Dr. Bojrab, I'm going to ask for some free medical advice from you as a psychiatrist for all of us. Could you just briefly comment on what this uncertainty means for our psyche and how we should be thinking about our own mental health?

Chris Bojrab: Certainly, and in a very general way, I think it's fair to say that the brain does not like uncertainty. Our brains are essentially association engines. How we learn, how we function is basically taking things in from the environment and comparing them to things that are stored in our brains and comparing those to our existing schemas and protocols for things. So we don't tolerate uncertainty. It tends to provoke a lot of anxiety in people. Our brains are used to working really hard to try to make things fit into a certain paradigm. This is the reason that people see faces in clouds or faces in tree bark or in tortilla shells and so forth.

And there is an inherent attraction towards the familiar. It's part of the same dynamic of why people they had abusive relationships that even though we can cognitively know this is bad, there's something comforting and attractive about that, which is familiar. So just uncertainty in a very general way is difficult for people to deal with, but especially uncertainty that crosses several domains of a person's lives, including their ability to earn an income and the effect that that has on their ability to support their family, concerns about their own health, or their family members health. So, yeah, this can almost be seen as the perfect storm of uncertainty in a lot of different ways, both personally and within our community as well as globally.

Arun Divakaruni: Sure. Any advice that you would have for us on how to manage that stress and anxiety?

Chris Bojrab: I always try to urge people to try to keep things in perspective that this is not the worst thing that's ever happened to us and that this is survivable. So you can really get caught up in listening to pundants on different sides of the political spectrum in terms of how dangerous this is or how seriously this should be taken. But I think just like we do with every other aspect of our day, we should pay attention to those things that present dangers and try to make reasonable efforts to minimize those dangers. So it's impossible to completely eliminate risks. So I think we have to become increasingly comfortable that this is another one of these risk benefit ratio scenarios we're going to have to continue to evaluate as we make decisions for ourselves and our family and for our employees.

We have to keep in mind that nothing in life is without risks. So it becomes more of an issue of how do we take appropriate risks, or how do we make sure that we're not pushing the envelope too far as I've been telling several people. One of my favorite posters was, "Before you try to beat the odds, make sure you can survive the odds beating you." And I always encourage people to move cautiously, but you do have to move. So the early bird may get the worm, but the second mouse gets the cheese.

Arun Divakaruni: There you go. And part of that staying safe is a lot of us continue to be under shelter-in-place orders. And so I wanted to hear from the audience, I feel very fortunate to be able to work from home. It's not easy sometimes. And that's a huge departure from the way that things once were. And I was just wondering from the audience, for those of you who are working from home, what have you found most difficult relative to the pandemic?

Dan Limbach: Yeah. So let's just give our audience a moment here to look at the possible answers and pick their selection. They're coming in at a pretty good clip now. All right. So let's say last call, close the poll, and I'm going to share the results. So the top vote getter was lack of social interaction and it was followed closely by balancing work and domestic responsibilities. What do you think of this guys? Are these results about what you were expecting to see?

Arun Divakaruni: Dr. Bojrab, I'll let you comment first.

Chris Bojrab: Sure, yeah. I think, Arun, as you mentioned, I think on any given day, any one of these could be top of mind for us. I know in our own practice, one of the first things that people were concerned about as they were starting to close the schools was childcare and education and how that impacted not only the kids, but how that impacted parents. And in fact, closing schools from an epidemiologic standpoint is one of the most important things we could have done for safety, because not only are you decreasing the density of the school children and of the faculty and staff at schools, but that has a secondary effect on driving a lot of people out of the workplace to stay home in terms of caring for their kids. So it may have been an unintended consequence, but still important.

There's a lot of fear and loathing around the COVID virus itself. This is still a young pathogen to us. We're still learning more about it. But certainly, if I had the chance to respond to this, I probably would have said the things from the top vote getters are probably what concerned me more now, too, with the professional uncertainty or insecurity is running a practice with 50 some clinicians and 20 some support staff. Just worried about my colleagues and the people that I work with and their ability to continue to work and provide services to patients, and then how we balance the patient's need for safety versus their need for treatment. The lack of social interaction has been quite difficult for us all. So, yeah, I think any of these are really fair game in terms of the topping the list on any given day for the most difficult thing to manage through the pandemic.

Arun Divakaruni: So, me being an optimist, I always tend to look at what's the good that can come from this first. And from a scientific perspective, I don't think I've witnessed in my lifetime the public and private scientific ecosystem work with the singularity of purpose in order to overcome this virus. I think these numbers that we pulled earlier this week are a bit dated already. But there's a massive global consortium working towards not only a prophylactic vaccine, but treatments that we can have immediately.

But at the same time, there's been a tremendous amount of disruption, particularly in our clinical trial infrastructure. And most of those delays are in oncology, which would tend to make sense as many patients with cancer are immunocompromised and then also in the diseases of the central nervous system. So, Dr. Bojrab, as somebody who practices data-driven medicine, can you comment on the disruption to our clinical trial infrastructure and what that means for new medicines, new options, new information to improve patient care

Chris Bojrab: Well, as somebody who's only had minimal participation in clinical trials, I may not have the most expert opinion. But to the extent that I have some experience in that area, I would say that given the complexities of doing clinical trials and all of the moving parts and the degree to which the activity of one person involved relies on what is being done by other people, I'm sure that for people that are running clinical trials right now it's just a disaster in terms of the interruptions of the protocols and how many protocols are going to have to find ways to deal with the exceptions based on timeframe and not getting people in or not being able to collect lab work and so forth. So I think I'm happily as someone isolated from those realities or those constraints that are being placed on companies that are involved in doing clinical trial work.

 And I share your optimism. I'm a huge science nerd. And I think science is one of the best things that we have going. I think the beauty of science is that unlike so many other aspects of our society right now, science welcomes criticism, it embraces controversy and it's a meritocracy. People that are doing good science are more concerned with getting the closer and closer approximation to the truth, realizing that none of us has the cornerstone on big T truth. So to see that industry, to see this science machine turn its focused on to COVID-19, I think is impressive. And I was shocked the first time I saw this slide, as you were putting the deck together to see just the number of companies and institutions that are really driving a lot of their efforts now. So I think these are the better angels of our nature. These are the times where we can find common ground and say, "How do we really pull together for the common good?"

Arun Divakaruni: Yeah. And importantly, I think not only that the scientific machine, as you put it, put to good use, but also communication is a really important part of that. And thinking back to when Dr. Fauci announced the initial remdesivir data from the White House, I would urge all of our attendees to see if you can go and find that clip because it is a masterclass in scientific communication. Takes a very complicated subject, approaches it with clarity in language, clarity towards who the audience is and does a beautiful job with that. So I think it's incumbent upon us as an industry to be able to communicate with that level of not only scientific rigor, but authority, particularly as it relates to some of these new treatments, because they're not always clear cut and the answer isn't always black and white.

Early insights suggests that COVID will have a lasting personal and professional effect on HCPs. I think there's four main classes of how this is going to affect our healthcare system. We have the pandemic itself, which is overwhelming hospital departments. We have morbidity and mortality from the disease itself. We have new and emergent mental and physical health effects issues like diseases of despair and increase in stress. We know that patients aren't going to clinic with the same frequency as they did before. Other diseases aren't sheltering in place, so we have issues with diabetes and hypertension. And then there'll be long-term loss of opportunity issues, so with mammograms and cancer screenings, those sorts of things. So we're seeing this crest and different waves of stress on the healthcare system that will immediately and in the future manifest as other health issues. So, Dr. Bojrab, I was wondering if you could comment on the newer worsening impact that this is having on maybe your patients or what you're seeing in practices in your area.

Chris Bojrab: Yeah. In one way, I'm not sure that our patients in a behavioral health care practice are significantly different than patients in general. I think everybody, really all of us, are dealing with the same types of stress and anxiety over the uncertainty of the future over what's happening in our lives, and whether that's our work lives, our family lives, our health life. So I think it's important for us all to take heat to some of these issues such as you making good decisions when it comes to how long do I put off an appointment with my primary care, or if I've been referred to a specialist, is that something that can wait, or is that something that I need to proceed with?

Certainly, these types of interruptions or even things as mundane as putting off lab work or maybe not going in and talking to somebody about a potential change in a medicine that can have a lasting impact on management of chronic diseases, like they referenced on the slide that you hopefully all could be seeing things like diabetes, hypertension, any kind of chronic illness can certainly have interruptions in our ability to effectively manage it, just because of that disruption in the physician-patient relationship, or in the caregiver-physician, or caregiver-patient relationship.

And then again, long-term loss of opportunities. So cancer screening. I know my wife had just commented to me that she was overdue for her colonoscopy. Earlier with the slides again, she was overdue for her colonoscopy. She was scheduled to have that in December. But because of the holidays, she thought she would put it off till the spring. And now, she's feeling it is a little bit further behind or further overdue than what she thought.

Arun Divakaruni: Sure. And that's manifesting in a business problem for people as well. And this is some data that was pulled up last week from Strata Decision, and it shows the estimated volume loss by service line across a number of different areas from ophthalmology. Even if you look at oncology, they're down significant percentages. So on one hand, we have doctors and nurses and other healthcare professionals on the frontline of this disease that are burned out, that are tired, they're scared, they're sleeping on their garage because they don't want to bring the disease home to their family. On the other hand, we have some doctors like surgeons, for example, in areas where it's not endemic yet, who are sitting on the sidelines because of the I think the right and proper decision to postpone or delay elective or non-urgent surgeries.

So, Dr. Bojrab, I was wondering if you could comment on what as marketers we need to be cognizant of when engaging with doctors during a time of business stress? I'm thinking of some of these social media posts by celebrities who say like sheltering at home is in jail or a music mogul talking about sheltering while on his $150 million yacht. The last thing that we want to do as an industry appear tone-deaf too in a time of stress to physicians.

Chris Bojrab: Yeah. And I think this is a really difficult ask for our partners in industry. Because on the one hand, we certainly don't want to just to have a loss of contact or communication between industry and representatives and clinicians. But it's a really sort of the eye of a needle to thread almost to decide for this individual customer how are they going to want to be approached. On the one hand, I think all of us get a little bit tired when everybody in our lives, every institution in our lives is trying to either feed us information about COVID or tell us what we should be doing about COVID. So getting a recommendation from my primary care doctor through our patient portal, that makes sense. I welcome that. I'm not sure if I need my 401(k) company, or my banks, or my retailers sharing with me their ideas on what we ought to be doing.

Arun Divakaruni: Absolutely.

Chris Bojrab: So I think we put industry in a hard spot where we don't want to become intrusive, and we don't want us to have providers feeling that people are just coming in and giving them the same information they're getting in other places and it's just one more thing to take up time during the day. But at the same time, you hate to just have people drop off the map and say, "Well, I guess I'll be back around when all this clears." So I think a lot of it is maybe transitioning or in some ways decentralizing some of those types of decisions further down into the field.

So this is scary from an organizational status, I'm sure. But I think you really have to trust your representatives to know their customers, to know those clinicians, to say, "This is a person where I can come in and have this type of interaction with, and this is somebody who's going to just... where I'm going to do myself more harm than good if I try to go in there right now, or this is a person where they don't need me to show them my latest slim jam or my latest marketing piece on something that's been out forever." So I guess one general theme would be this notion of decentralization of trusting the people that you have hired and trained to know their customers and know how the best nuanced way to have those communications.

Arun Divakaruni: That's really interesting. And we'll talk about that in a little bit. But I first wanted to touch on just one area where we may see some permanency in how medicine is delivered. And, over this time compared to last year, we've seen a natural unexpected decrease in visits to the clinic, the same time we've seen an expected increase in telehealth. And I was wondering from your opinion, Dr. Bojrab, do you think that this pandemic was the catalyst that telehealth needed to become a more permanent fixture in practices? I know you successfully pivoted a lot of your work to telehealth. Do you see that remaining in the future after let's say this pandemic dies down and burnout in this state of uncertainty anymore?

Chris Bojrab: I think it certainly could. And again, I may have a different perspective than physicians in other fields. As a psychiatrist, it was relatively easy for us to pivot into a telemedicine model with it. There's not a lot that we do that requires laying hands on of patients. So it was pretty easy for us. One of the things I've really been surprised and pleasantly surprised by is how well other specialties that are traditionally much more hands-on have still been able to provide services to patients via telemedicine. And it hearkens back to this memory I had in medical school when I had an older physician that was teaching us physical diagnosis. And I still remember to this day, one of the things that he told me is that when he was in training, there was this poster in his classroom that said, "Doctor, listen to your patient, they're telling you the diagnosis."

So I think it does help us in some ways get back to our roots and think more about the path that we don't have to just rely on our new whizzbang technology all the time and physical exam that an awful lot of what we do as physicians is listening to our patients and listening to their stories and listening to their symptoms in terms of trying to come up with diagnoses and treatment plans. So in some ways, I hope it's been a good refresher for those of us that have been out of training longer while it certainly is great to have access to expanding technologies over time. And I would never want to live in a place where we didn't have that type of development going on that we're perhaps not quite as reliant on it as we came to think that we were.

So I do think that when this is all said and done that we will still see a much greater, a much expanded presence of telemedicine. I think ultimately, it's going to come down to the payers. If insurance companies will continue to permit clinicians to be reimbursed at the same rate that they are for in-office visits, then I think you'll see this continue, not as much as it's being done right now, but I think at much greater rates than you had before. So I think a lot of it's going to be driven by payers. I think this reminds me in some ways one of my favorite quotes from Albert Einstein when somebody asked him about what he thought the impact was going to be of the discovery of nuclear power.

And he said, "The release of atomic energy has not created new problems. It's just made much more pressing the need to solve old ones." So I think in the same terms in terms of the technologists that we have for working in a more distributed way or working remotely. So I do think that this was a very painful lesson, but perhaps a good lesson in different ways of doing business and different ways of expanding our reach and our ability to interact with our patients and with others in the healthcare system.

Arun Divakaruni: Yeah. And hopefully, it can be an opportunity to once these problems come to life to have some meaningful solutions to them. And I think that also goes to what the relationship is between pharma and the physician. And I personally believe that now this is the time for our industry to really embrace customer as centricity customer experience. So we're living through unprecedented economic times right now, but we have some analogs from about 10 to 12 years ago. And there has been a lot of business analysis done at the time to show what companies were more resilient during an economic downturn. And the data, no matter who it comes from, consistently shows that those companies who put customer experience and customer centricity as a central business driver had a shallower downturn, rebounded more rapidly and outperformed laggers by about 300%.

So it's important for us as marketers, as pharma marketers to look to see what are happening in other areas, and are there lessons that we can learn? So one of my favorite examples I think is what Zappos is doing right now. And I've been working with biopharmaceutical companies for a while now and customer centricity isn't something that we've really widely discussed or adopted as an industry, maybe in some pockets. But we overindex on bringing value to our customer by creating innovative and convenient products through scientific education, but I don't think that that's enough anymore.

So you have a company like Zappos who is world renowned for their customer service, selling shoes and apparel. And today, they're pivoting to help their customer with anything. It doesn't matter what it is, you can call the Zappos customer service line and it's done their specialty and logistics and figuring things out. They will help you with a problem, albeit whether like what type of clothes I should buy my children for the upcoming weather, or where can I find masks. And I think they're indexing on this idea that they're not trying to push products, they're just trying to be helpful. And when somebody stands you up at a time when there is uncertainty, you'll likely be there for them when that uncertainty is over. So I really think that this is narrowing in on a human trait rather than just this push messaging that we've all become accustomed to in terms of selling our medicines and our products.

So I think today what this fundamentally does to us, to your point, Dr. Bojrab, earlier, is that the lesson is that helping is the new selling. And our most important currency as marketers is offering valuable information and services. So it's really important to see where your product, your service, your medicine, your company fits into the context I think that you elaborated earlier that this is a time for uncertainty in healthcare professionals, both in terms of what the future holds for their patients and what the future holds for their business. You recently told me about an interaction that you've had with a representative for a particular company who was bringing to life these values. Could you briefly expound on that for our audience?

Chris Bojrab: Yeah. As we were talking through the content of this presentation, I was reflecting on the interactions that I've just had personally with some of the different representatives from industry that I work with on a routine basis. And I was sharing with Arun that probably one of the more positive interactions I've had or set of interactions that I've had during this time was with a rep that just really seemed very skillful at navigating those types of situations and reading what is needed. And she has a very naturalistic approach to our communications. So she manages to be an excellent sales person without ever making me feel I'm being sold.

So I think when somebody like that contacts me and reaches out to me either to provide some detailing information, even though the product that she represents is well established and not a new product and there's not much new data out there on it, it feels very comfortable. It feels very welcome. She provides interactions, she keeps it focused on, "What can I do to help you take care of your patients?" And I think that's probably the best central strategy because, unfortunately, I think as physicians, maybe we become a little bit jaded. And when a representative walks into our office and says, "Listen, this is really just all about your patient," it doesn't really matter what's good for me, or what's good for the company. This is all about what's good for the patient.

And that may be an absolutely genuine expression of their belief, but it certainly leaves itself open towards feeling like, "Okay, now I'm in a sales position, now somebody who's just trying to feed me a corporate line." I think most of us that interact with industry can look at these relationships and say, "Listen, you have a perfectly valid reason to be here and you have a perfectly valid reason to try to sell me on your product," that these are not mutually exclusive goals that we have here. And so for you to come in and say, "I don't really care if it's about my job or my company, it's all about your business, or it's all about your patient," that certainly at least raises the specter of somebody not being genuine with you. And frankly, it can be a little insulting. I would much rather have a rep come in and say, "Listen, we think we have this really good item, that's really good process, that's really good product. And if this overlines with your needs and can help take care of patients, then everybody is a winner."

I think that's a perfectly valid place to come from. And I think sometimes companies or reps shy away from that. So I've always liked that approach of, "What can I or what can we do to help you take care of your patient?" I don't expect my sales reps' primary interest in what what's going on with my individual patient. What I think is more appropriate and reasonable is to say, "Listen, how can I help myself help you and help the patient and help my company?" Boy, then we're all on the same page there. So I think that authenticity of what everybody's roles are, what everybody's goals are, what people want, I just think that keeps things in a much more comfortable, realistic and trusting place in terms of that type of relationship management.

Arun Divakaruni: Yeah. And it's almost like you're talking about the sales representative becoming a brand representative. And if that brand of that company, that product, whatever it may be is anchored in one of authenticity and helpfulness, it'll help you care for your patients. And so to do that, I think effectively, you have to establish a listen-and-learn agenda, talk about... Well, you talked about decentralization and really understanding the customer on their particular level. So we're seeing personalization of information and services across our everyday life, from Amazon to the TV that we watch. But this can be difficult in this time, Dr. Bojrab. But you're very busy. There's a bunch of stress that's happening for your patients and your business. How do we establish this rapport at a time when we may be only can catch you for five minutes during a lunch break?

Chris Bojrab: Yeah, it's an ongoing challenge and I'm not sure... In some ways, it's really reflective of how things have always been. It's like this is just the latest thing to distract us and this is something that has actually pulled us out of offices to a much greater extent. But how do you balance that need to have a contact to accomplish your job, to meet your responsibilities versus not poisoning the relationship with your customer? And again, I may not be the most representative person to ask because I'm a soft touch, I'm very industry-friendly. I do a lot of work with industry, I do a lot of consulting with industry. So take what I say with a grain of salt as somebody who is not maybe the center of the bell curve in terms of approachability as a physician.

But what I do think is that it feels much more comfortable and I'm much more likely to engage with somebody if they're respectful of the nature of our relationship. So if I get an email or a text message from a rep that I've known for a long period of time and they're just checking in, it feels more like a communication I would get from any other friend. If I get like one email or one text message from somebody that's just recently started calling on our office, just either reintroducing themselves or reminding me about something, that's fine. But when I start getting a ton of emails or a ton of text messages from somebody that I don't have that kind of relationship with, it really places an unpleasant magnifying glass on that to say, "Wow, now I feel..." You can go from, "Okay, this makes sense and that's fine," to, "Wow, this really feels intrusive." There's really an acceleration on that curve.

So I think people being respectful of the nature of their relationship, or even talking within the other members of their organization to say, "Listen, if we're being tasked with targeting this or that healthcare provider with this frequency of contacts, let's give some thought about which one of us might be in a better situation or a better position to do that, who has that type of relationships that we can, for lack of a better term, push a little bit harder without it feeling intrusive to the person." And again, it gets back to that notion of decentralization. Those are really decisions that are probably best made by the individual representatives, as opposed to maybe even district managers, but certainly area managers, or territorial managers, or the company at large.

Arun Divakaruni: Sure. So during this time, I think when we're faced with periods of a lot of uncertainty, futurecasting is very difficult. And so I think it's pointless to speculate what the next six months or even next six years are going to look like, rather I think it's incumbent upon us to look at those areas of the pharma-doctor relationship and find those things that are a constant, that we know are important because they've been historically been important and they're important for patient care moving forward. So, Dr. Bojrab, I was wondering if you could walk us through the areas that we discussed that we think are going to be even that much more important in the future.

Chris Bojrab: Yeah. And I think you've done a really nice job of capturing the core of what should come out of this relationship between representatives and healthcare providers. So the things that really won't, or shouldn't, or can't change are covered by the things you've mentioned, awareness around new medicines or data. If you're in the unfortunate position to be bringing to market a brand new product during this time of the pandemic, wow, my heart goes out to you, that's a really hard task. But those are perhaps the people with whom we most need that contact right now if you're bringing something new to the table for us that we need to know about what this is, who or what the pluses and minuses are, what's the availability, what's the mechanism of action. So that absolutely would top my list for novel things should get more of my time and attention right now.

I think the second point about connecting with other physicians for advice and guidance is increasingly important. I've always maintained that the number one way to change physician behavior is by putting them in touch with people whose opinion that they report. So the importance of key opinion leaders, and key opinion leaders, as maybe you're seeing them from your standpoint on the local basis, so if somebody comes into my office and says, "Listen, I'm going to have this nationally known speaker in town," yeah, I'm certainly going to be interested in that. But what I may be even more interested in is if that representative takes the time to find out whose opinion locally I really respect. And to say, "You know what? I would really love to hear what Dr. Jones has to say about this, or I would really love to hear what nurse practitioner Smith has to... What is he or she doing in their practice as it relates to this medicine, or how do they think about this?"

So I think that is still one of the higher impact things that we can do. And as we're all being barraged with static information that we're getting via email or getting via social media, I think that can be a diamond in the rock to say, "Okay, this may be harder to accomplish, but those types of interactions are probably more meaningful." Continuing education and accreditation certainly are always important to us. We're always on the hunt for CME, but to be honest with you, that's becoming easier and easier to get in static ways and to get for free through a journal or other mediums. Certainly, the large professional society mediums are largely on hold for right now. So that might be temporarily more of a need, but I think as this resolves, access to continuing education, that's probably becoming a little less important among these bullet points.

Access to the company expertise, I'm somebody who spends a lot of time meeting with and talking with medical science liaisons. And I think increasingly, people are placing a higher value on the types of interactions or discussions that they can have with a medical science liaison. So having representatives who work well with and are familiar with and can integrate their activities with their medical science liaisons, I think is very helpful. And certainly, the need for sampling is always there and has become more complicated as so many of us are working remotely.

My fantasy is that someday we'll have more uniform ways of addressing sampling, something similar to like a CoverMyMeds that are response for prior authorization. I would love to see a single uniform tool for requesting samples in these times when we can't have access to our representatives in the same way. Of course, I'm also sensitive to the fact that be careful what you wish for. You don't want to create something that is so convenient and so easy for customers that it detracts from the part of the value that you bring to the office.

Arun Divakaruni: Sure. And I think if we look at those constants and we apply them to... You said that your heart goes out to folks who have to launch a new medicine during this time. And what we're seeing right now is some... Particularly, I'd say in oncology, based on some very progressive policies at the FDA and us getting better and better at understanding the molecular drivers of oncology, somebody who has a biomarker-driven lung cancer today, the biggest threat to their life is that disease, maybe not necessarily COVID-19. So I think what's really important for us as an industry to do is to evolve our branded and unbranded content to meet the needs of the moment. So, particularly, when we're talking about new entrance, awareness is clearly important and understanding of the data, how it stacks up against other potential options, but also information of how to access it.

You mentioned reimbursement for telemedicine, those sorts of considerations are increasingly more important now. For maybe something that's later on in its life cycle, where we have more information from phase four studies about specific disease population, drug interactions, best practices on managing patients, dose modifications, where we have that information because medicine has been studied for so long, those things are very contextually important to administering care. So, Dr. Bojrab, I was wondering what principles of life cycle management do you think we can apply to figure out what's the content that drives value to have those personal interactions you were talking about?

Chris Bojrab: Yeah, I think you've given a nice overview there because I think that the type of things that healthcare providers are looking for in terms of information that can be communicated to us through industry certainly changes based on the length of time a medicine has been around. When things first hit, it's bright and shiny and new. And again, the local reps are aware of this. These are my go-to people for people that are going to be first in line to start using something. And I know these are my group of people that are not going to try this at all until they've seen what it's done in the market for six months.

And so be mindful of where you're spending your energy. Don't try to go beat on the person that never ever uses a new medicine until it's been on the market for six months or a year and put more of your... Don't ignore them completely, but put little of your effort there and focus more of your effort on the people that are more early adopters. It's the old saying about when the judge asked somebody why they robbed banks, so they said, "Well, Judge, that's where the money is." So I think early in the life cycle going to your folks that are more likely to be early adopters, going to your folks who locally are decision drivers, or when somebody says, "Hey, I want to know this because these other customers or these primary care physicians are asking what you're doing with this medicine or what you think of it" I think that's how you have a lot of impact.

So you go over mechanism of action, you go over why this is different, and then the next subphase is getting to accessibility, cost, copay reduction strategies, sampling patient assistance programs to fertilize those seeds that you've planted, and then monitoring the patient. Sometimes the bigger challenges come through the later stages of like on the graph of maturity and decline as you approach the end of life of a patent to say, "How much energy should I put into continuing to maintain this?" And of course, I realized that a lot of this is driven just from the top-down as they determine what percentage of your bonus comes from which products you're carrying in your bag and that understandably has an impact on the way you do your messaging and how much of those efforts or times you devote for each of those products or in each of those ways.

But as Arun and I were talking about a couple of days ago, the birthday party that I had when I was 5 was very different from the birthday party I had when I was 10, which was very different from the birthday party that I had when I was 21, which was very different from the birthday party I had when I turned 50. Right. So just we want to need and value different things at different courses of our lives. I think you can think about the medicines in a very similar way.

Arun Divakaruni: And I'll say that my birthday party this year is going to be a virtual birthday party. And I do think that it's incumbent upon us as companies to move away from traditional, push digital channels like banner ads and headquarters-driven emails to your point, Dr. Bojrab, and maybe embrace that frontline to see what is it that our customers really need to know and become a conduit to help doctors connect with each other, connect with content on their own time. That's the way that most of us consume at least television these days. And when there is a big game changing announcement to make sure that anybody can access that information the way that we're used to accessing information in our personal lives as well. So you're a pretty tech savvy guy, how do we help maybe other doctors who are slower on the tech adoption curve to embrace these technologies as a way to get information?

Chris Bojrab: And I always try to caution myself as somebody who is very tech savvy and who really loves technology. I try to remind myself that not everybody feels that way about technology. And so when I think about what technology means to me, it may be very different than what technology means to other people. So if I go up a level and try to take the 10,000 foot view, I think it's important to remember that we're not talking about technology for the sake of technology. We're talking about technology as a vehicle to provide easier, cheaper, and more widely distributed choice to clinicians.

So whether or not a physician or a healthcare provider in general prefers to receive that information in a live interaction or broadcast, or I'm going to mark this webinar on my calendar, or if we make things available, archiving information, making things available on demand that people can easily figure out where to find it and go and access it when they want it or when they need it, or writing that middle ground of having live presentations that are either one-on-one or one to a few, so I think that one of the best parts about technology is that it makes it easier and cheaper to provide more of these avenues and then you're expanding choice for your customers.

And I think really that's probably a more uniform value to people. I think most people like more choices. So you don't have to worry about what their choice is going to be. But if you can leverage the technology to increase your ability to provide those choices, I'm really very saying one about that use of these expanding technologies, recognizing that I like it just because it's shiny and has a button, but that's not everybody's interest, or other people more interested because of the expansion of the choices.

Arun Divakaruni: Yeah. And choice is one of those things too that is both a positive, but it can also be... or maybe optionality then. It can also be a problem for some folks. Because with too many choices, sometimes we get caught in a little bit of analysis paralysis. And I think that's an unintended byproduct of some of the really great things that we're seeing in the scientific community today, like real time publishing, access to information very quickly. I think we'll get back to the point where we start peer reviewing journals and all of that stuff. But for the immediate time, I think when there's a lot of uncertainty about how a particular patient's treatment regimen may be either protective or deleterious during the time of the widespread viral infection is something that's maybe not necessarily unique to any particular fields and affecting every fields.

So from people who are living with cancer or taking medicines that cause them to have viral reactivations, for example, to even in cardiology where when it was initially discovered that the spike protein of SARS-CoV-2 to bound to the ACE protein in the lungs, there was a lot of speculation of whether ACE inhibitors or ARBs would be protective or deleterious. And one of our clients has a medicine that's used by rheumatologists to treat inflammatory disease. And that medicine, like many of those in his class are specifically designed to taper their response for rheumatic conditions. And that's why they're effective, that's why they work. But at the same time, I think doctors and patients were rightly concerned about what to do in an outbreak of viral disease. And particularly, with medicines like this, abruptly stopping treatment can lead to a rebound effect that may be worse than the potential risk of contracting COVID.

So with a lot of information that's out there, it's placed in very many different places. So one thing that at least I found helpful in my personal life is like curation apps. And so you can curate your news on Apple News, you can curate your music on Spotify. And I think there was a real opportunity for one of our clients to curate all the information that was out there, put it into context with that medicine's prescribing information and safety information that was known today and use a virtual speaker program to disseminate that and create enduring digital platforms. So doctors and patients have all that information in one place to make an informed treatment decision.

This activation is ongoing, so I don't really have some hard metrics for it. But in the busy life of a doctor, I think this is one way that pharma can help add value and be helpful during a very difficult time. So at that, I know we're butting up on our hour. Dr. Bojrab, thank you for joining us today. Thank you to the audience for attending and everyone stay safe and be well and we will be able to answer some questions.

Dan Limbach: All right. So throughout the presentation of the segment of the webinar, we all heard and have seen a lot of great information and there's a lot more to do with this topic. So make sure you send in your questions now if you want us to go into greater depth than anything that you've heard today. This is all as a popular segment of our web seminars and we have a lot of great questions already. So you can still submit yours, and we'll look forward to seeing those. All right, let's get to it. Shall we? The first one is we often catch HCPs on the fly, meaning between patients over lunch, things like that. How can we achieve similar call volumes with virtual visits or is that a thing of the past?

Arun Divakaruni: Well, I'm going to punt that over to Dr. Bojrab. But what I would question is, is called volume, the metric should be measuring, or should we be measuring a meaningful interaction? So, Dr. Bojrab, I don't know if you want to comment on that.

Chris Bojrab: Well, yeah, I think your point that the meaningful interaction is a much better benchmark, but it's much harder to quantify.

Arun Divakaruni: Absolutely.

Chris Bojrab: So, unfortunately, I'm sure everybody out there is saying, "Well, that's all well and good," but at the end of the day, they want to know how many calls I made. And honestly, with a lot of the reps to call me, I ask them as they request to do a virtual detailer, virtual contact, I obviously just flat out and tell them, I say, "Listen, I don't really need anything. But if you're getting some pressure from above, if this checks a box for you, I am more than happy to do it. But otherwise, I'm fine." So, yeah. So I think we realized that that industry is really been trying to figure out how to continue to monitor these interactions. But again, I think it gets back to that notion of trust the people that you've hired and look at the numbers in general. So I think this is a time for less micromanagement rather than more.

Dan Limbach: Excellent. All right. The next question is a big one. And I'm going to ask you for the 60-second answer. What are immediate, medium-term, and long-term strategies that pharma can adopt in this environment?

Arun Divakaruni: The biggest short and medium and long-term solution is to think of and then adopt a customer-centric mindset. And that's all about putting yourself in the customer's shoes because that's going to change immediately. Let's say if you look at some analogs of companies who I think are continuing to thrive during this pandemic, who business has been upended, when you think about customer centricity in terms of let's say Apple computers, you go to an Apple store and you would have a best-in-class retail experience. Now, because retail stores are closed, they've done a very good job of pivoting their stuff, their customer experience to be a meaningful virtual customer experience.

And I think that's probably the biggest thing that I see in the short and medium-term, that we need to create properties of value to physicians that give them valuable information. But also to Dr. Bojrab's point, create those connections between doctors that are removed now by the lack of physical meetings. ASCO was supposed to be in Chicago this year. And that's a time that not only do I get to go and learn about new medicines in oncology and it's a very exciting conference now, but it's also a time that I get to catch up with a lot of old friends and colleagues in person. I don't have that anymore, and neither do many of the oncologists there. So how do we create avenues and digital places that to Dr. Bojrab's point open up choices and optionality and the type of information that they're getting, the types of interactions that people are having?

Chris Bojrab: And I would just add that in terms of thinking about the short-term, the intermediate term, and the long-term, I would focus very little on the short-term. I think the possibility of you damaging relationships in the short-term because of maybe less than well-considered efforts is probably higher than the degree of improvement that you could make in that relationship. I remember when I used to moonlight in an ER, one of the ER doctors that I first worked with gave me a great piece of advice, which was, "Don't just do something, stand there." So that idea of not rushing into things just because you think, "Oh my gosh, we got to be doing something right now." I think that the relative downside versus the relative upside is higher there. So I would focus more on the intermediate term and longer term.

We know the companies are not going to go away. We will remember you when we get back to the office. And I think that there's always that capacity to do more harm than good. So everybody needs to take a step back, to take a breather, "Hey, we're all figuring this out," and focus more on not damaging existing relationships than trying to step in when somebody else has got a lot of other things on their mind and do something to fundamentally change or improve relationship. That's not where you're going to get your best bang for your buck.

Dan Limbach: Excellent. Thank you for that. So we're going to try and squeeze a couple more questions in here. The next one is, what are some best practices for conducting virtual advisory boards with HCPs?

Arun Divakaruni: So, Dr. Bojrab, do you want to comment on some advisory boards that you think have gone well and then I can provide a company perspective? I think at Avant we've done quite a bit over the last few weeks and can shed some light on that.

Chris Bojrab: Yeah. I think some of the things I've participated in over the past couple of months that have been done on any of the virtual platforms are really good. You want to have good audio and video and I think the technology is getting better for that. The smaller groups, I feel much more engaged with a group of maybe 10 or 12 people as opposed to sitting there and just being the passive receptacle of information with a group of 200 people. So I think that's one thing that I would love to see more being done with.

Arun Divakaruni: Yeah. And that's what we're seeing to smaller groups. Breaking up time at a traditional advisory board, you're there for a couple of hours and you have that break of human interaction. You lack that over the computer screen. So it becomes a little bit more taxing in a sense because you can't always read people's microexpressions. So frequent breaks are good. I'm thinking about online, offline, so perhaps assigning some work to do beforehand. And then limiting online time is a strategy that some people are exploring now and that tends to be successful. I will say that when it doesn't work well is when you try to just take the same playbook and make it virtual. Our interactions as human beings through GoToMeeting or Zoom or whatever it is is different, fundamentally different than it is when we're meeting in person. So you have to tailor not only, let's say, even the moderator skill to that, but also tailor the format and the platform that you're using.

Dan Limbach: Okay, perfect. So before we get to the last question, if anyone in the audience still has a question or comment for our experts, just send an email to the address on the screen and that's, and we'll make sure it gets to our experts and they'll be able to get back to you. Okay. So the last question, and this is a really good one, this is kind of the rubber hits the road question. Given all the clutter, what vehicle works best in attracting a physician's attention?

Arun Divakaruni: I would change the question and not worry about the vehicle or the channel, but worry about the story. What is it that you're telling them that's of significant value? And I will say that what we know from other channel, or from other areas is that the story drives the channel, not vice versa. So, yes, there are a number of different channels at our disposal today to reach HCPs. I'd say we have in-person relationships from... Let's call them brand representatives now. And Dr. Bojrab talked a lot about, we know what's the way for those interactions to work to, I would say, the emergence of each HCP specific social networks like Doximity and Sermo and all of these things that have become hyper-relevant today because of our physical distance.

So it's not so much that what channel it is because there's a number of channels at our disposal. We just need to know where to put the information. It's what is the right type of information. Is this the time for another push banner ad for a medicine that's been on the market for a really long time, or is it the time to give doctors access to information and experts that put that medicine into today's medical context? Dr. Bojrab, did you want to expand or agree, disagree?

Chris Bojrab: No, I would agree. I think people are at their hearts, storytellers and story-listeners. So thinking about how you craft that narrative and I think that covers up a lot of other faults either in terms of specifics about the message or specifics about the messenger. So I think if you try to think about what makes things a good conversation to have with anybody, that probably always serves us well in terms of paying attention to in what ways we're trying to communicate with one another.

Dan Limbach: Excellent. I've always heard it's the message, not the medium. So I'm in lockstep with both of you. So that is all the time we have for Q&A. I hope you all enjoyed this event and have taken away some new insights. And if any of your colleagues have missed this presentation or you want to review it again, it will be available as an archive in about 24 hours. You will get an email with a link to that recording. So I'd like to, once again, thank our friends at Avant Healthcare for partnering with us on a great event. I'd also like to encourage you to look for future web seminars and events by visiting So we're just at the close. Arun, I think you maybe have 15 to 30 seconds of voice left. Do you have any final thoughts or words of wisdom for our audience?

Arun Divakaruni: I just wanted to tell everyone stay safe, be well. And if you want to talk through any of the strategies in deeper detail, please feel free to contact

Dan Limbach: Excellent. I think we got the last word your voice is going to have for us.

Arun Divakaruni: There we go.

Dan Limbach: Thank you for soldiering on with us on this event. It was very informative. And to everyone in our audience, thank you for your time. Enjoy the rest of your day. The event is now over.

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