Upstream marketing in healthcare means going to where the disease or condition starts. The analogy would be to go to the original source of the stream. I’ve long recommended epidemiology training to marketers for this reason: When you do “patient flow” analysis, you are already too far downstream. After all, a patient is someone with a healthcare disease or condition who is under care. By the time a person exhibits symptoms serious enough to seek care (or his/her disease is “discovered”), he/she is far down the disease river. Type 2 diabetes is a great example. There is no such thing as a “new diabetic”. Rather, there are only newly diagnosed people with diabetes. Ditto for most chronic diseases and acute ones, too (as we see with the emerging epidemic of ebola or longer term development of resistant TB and other bacterial diseases).
In Upstream Marketing, a great starting point is to find what I like to refer to as People [or Populations] At Risk, or “PARs” ©. We look at ethnicity factors – genetics, culture/life style, and environmental influences. We look at population’s attitudes towards healthcare and the disease, and their resultant behaviors. We get at the source, then follow it even further upstream – to why people do or think things the way they do that may impact their eventual health or the health of others. And we also follow it downstream. Once we have mapped the “streams” that form the larger river, then the lakes or oceans, we get a much better idea of the true potential of a solution that we, as healthcare companies, may help to create.
Take adherence. That is the big buzz for companies now: How to get patients to adhere to their medications. They look at healthcare behavior modeling, invent pills that can bing the patient when it is time to take them, or report to payers when they don’t. Tons of creativity, investment, and market research in downstream marketing are being spent. Even huge Patient-Centered Outcomes Research Institute (PCORI) grants begin with the word “Patient”. Adherence is still terrible. I’m not going to elaborate here, but I will give you a very big clue: The solution may lay in upstream, not downstream, marketing.
So what are some of the steps to Upstream Marketing?
1. Identify known and potential risk factors. Where not known or well defined, formulate hypotheses then target very specific, fast (and not expensive) marketing or other research try to prove or disprove them. In the process of proving them true or not, you are advancing upstream.
2. Look for individual or combinations of risk factors that would differentiate “high risk” from “moderate risk” and “low risk”. Further evaluate, segment, and model the high risk pool first, then move to moderate and low.
3. Next, address the needs of these risk pools from the perspectives of multiple stakeholders. For example, public health/government/policy and specialists will prefer to focus on high risk, but primary care prefers to focus on moderate risk, while advocacy may want to embrace all levels risk. Then, coalesce those diverse stakeholders around the greater need to look upstream, in its healthcare practices and policies, from prevention to treatment, and not only on medical guidelines that are focused on “downstream healthcare”.
4. Play (have fun) with asking, “What if’s“. Get out of your manufacturer-supplier mindset. Consider how social media, digital marketing and digital healthcare solutions could help with awareness, education, interest, evaluation/earlier risk assessment, and control. What would Google do? What would Samsung or Apple do? What would Gates Foundation do? What would the World Bank do? Use synectics to help challenge your thinking.
5. Decide where you, as a company, want to and are able to serve best. But don’t try to control the solution – share it! Consider alliances to better control the stream, whether they are other kinds of businesses, services, systems, payers, etc.
6. Use hypotheses to challenge the status quo throughout. Keep asking, “Why does it have to be this way; what can we do to redirect the stream or stop it from becoming a torrent? What if we did ABC or the market were (re)defined as XYZ?” Try small pilot projects to test assumptions that may not otherwise have information or data to help find the answers.
7. Earn the company some angel wings along the way. A company makes money by selling drugs, diagnostics, vaccines and/or devices and related services, but it also should consider the higher moral ground, and look into robust ways of helping society and publics to prevent illness or the disease. Most healthcare companies have social or common good programs, have foundations, support independent investigator research funding or build access programs. What about helping to direct some of those to truly serve the upstream needs of the market?
The UN asks member nations and the CDC offer guidance to all States to develop “Comprehensive Control Plans”. But when I look at these plans, too often I see the focus on downstream, not upstream, control. In 2009, I presented on ethnicity of cancer to the (US) President’s Cancer Panel. When asked what was the most important thing needed to improve cancer across diverse populations, I answered simply, “Stop childhood obesity.” That was a prime example of upstream healthcare thinking, and thankfully First Lady Michelle Obama took it seriously.
In 2010, colleagues at Johns Hopkins Bloomberg School of Public Health and I took on the challenge of figuring out how to prevent or stop liver cancer (which at that time was not seen as a serious cancer problem by anyone except Asians). I remember the reaction of the medical community. “Support transplantation,” said one leader. “Too many things cause it, you can’t solve it,” said another. “We need more targeted therapies,” was the response of many.
But three years later, based upon results of “upstream” research on liver cancer control in US, Europe, Middle East, Africa and Asia, the greatest opportunity in fact was not about liver cancer. By the time liver cancer is diagnosed in most countries, it is a matter of days and months, not years. Instead, we confirmed that the greater need and opportunity was to focus on preventing the spread of Hepatitis B and C. And the opportunity is indeed huge, as Gilead, Merck, AbbVie and BMS, among others, will tell you.
