Rational Tools Built for Irrational Patients

We think patients are rational. They're not. And that's exactly the problem.

In this episode, Bob Miglani and Jason Grossman sit down with Anny Goldman, a nurse, a chronic patient, a pharma insider, and a lecturer on medication adherence at Ben-Gurion University, for one of the most honest, grounded conversations we've had about why patients stop taking their medicine, and what pharma is still getting wrong.

Anny brings something rare to this space: she's not just studying the problem. She's lived it.

Here's what we get into:

• Why 50% non-adherence rates haven't budged in decades, despite billions spent on patient support
• The difference between intentional and unintentional non-adherence, and why one is far harder to solve
• Why your app, your portal, and your reminder notification are probably failing patients at the worst possible moment
• The five dimensions of adherence, and why the emotional and cognitive ones are the most important and the most ignored
• How shame quietly drives no-shows, drop-offs, and silent discontinuation
• Why designing for the bad day, not the good one, is the key to a successful patient program
• What GLP-1 drop-offs teach us about expectation-setting and goal alignment
• The case for predictive behavioral modeling to catch patients before they quit, not after
• Why pharma is great at launching and terrible at the marathon

This isn't a theoretical conversation. It's a playbook.

If you're a brand manager, a patient services leader, a commercial executive, or anyone designing a program meant to help patients stay on treatment, this episode is required listening.

The Patient Experience Podcast explores how pharma patient services leaders and patient-facing teams can navigate a growing patient confusion crisis as therapies become more complex and the industry moves Direct to Patient. Hosted by Jason Grossman, a 25-year pharma commercial, patient services, and marketing executive, and Bob Miglani, former Pfizer leader and CEO of Hoot, each episode delivers practical insights leaders can use and reps can apply in the field to better educate patients, build trust, and drive better outcomes.

New episodes are recorded live on Bob Miglani’s LinkedIn and published across major podcast platforms.

Follow the hosts:
Bob Miglani on LinkedIn
Jason Grossman on LinkedIn

Learn more at GetHoot.com.

Transcript

SPEAKER_03 0:00

Hello, this is Bob McGlani. I'm with Jason Grossman. And Jason and I are pharmaceutical managers of 20, 30 years of experience in sales, marketing, pricing, patient experience, patient access, patient services, commercial operations. And on this podcast, we're gonna share their latest and greatest insights to help you. Yes, you, the pharmaceutical leader, understand patient experiences and what's changing and evolving to help you deliver a beautiful experience for patients in your company, in your brand, and in your patient services program. So tune in and listen in and share and learn and ask us great questions. We look forward to hearing from you soon. Thank you. Hello, hello everyone. Good morning, good afternoon, good evening. This is Bob McLani. I am so delighted to be with you today. Welcome, welcome to the Patient Experience podcast. I'm your host, Bob McGlani, and we have uh uh Jason Grossman, senior commercial pharma life sciences executive for decades and decades. Uh hi, Jason, how are you? Hi, Bob, nice to be here. Nice to see you. We are so thrilled because the Knicks, the Knicks won last night. The Knicks won last night. It was a nail biter. If you don't know, if you're not in New York, New York has been mayhem because the Knicks won. It was a great game. I don't know if either of you saw it, but that's very exciting to me today because the Knicks won and we're super excited in New York here. We're also excited because we have a great guest, Annie Goldman, who is a patient engagement expert and pro, deep, deep pharma life sciences experience. Uh, and she's gonna tell us about her. But for you, for you, if you're watching this, what I want you to remember is this is live. This means, folks, you can ask questions, okay, real time. Second, second, it's relevant to pharma, to life sciences, to medtech, and it's going to be really deep about what really nudges patients forward. So that's what we're going to talk about. So I'm delighted to be here and with you all. Annie, welcome, welcome. Thank you for joining us. Tell us about Annie Goldman, tell us about how you got here, a little bit of your background, please.

SPEAKER_05 2:37

Okay, so thank you for having me, first of all. It took us some time to arrange this meeting, so I'm very excited to be here today. So, regarding your question, who am I besides me being Annie Goldman? Honestly, I think that it depends on the way on the day you catch me. So, because a few a few years ago, you could tell me that uh I am only a nurse, but today I can say that I wear a few hats. Uh, first of all, I'm a chronic patient. Actually, I prefer to say that I'm a chronic consumer of healthcare system, and I'm also a nurse. Several years I was working in the internal world in one of the Israeli hospitals, and for the last several years, I work in the pharma industry, so I wear different kinds of hats. So it actually depends on which day you will approach me with this question. And on top of that, I forgot, I'm a mother for children, and I live in Israel, and I'm also a lecturing, um, I'm providing lectures in the Ben Gorion University for MSC in clinical pharmacy, and I lecture about medication adherence among chronic patients, my passion. So that's maybe I can wrap it this way about who am I and how I got here. I think the best way will be to get back to my maybe um um years when I learned to be a nurse. One of the most I would say emphasization in our studies were was how we need to train the patient and how we need to educate the patient. And you know, reality and theory are not going hand in hand. That means that whatever I learned, actually I didn't really see it come up in practice because education alone doesn't lead to a change. And I saw it on myself and I saw it among other patients that I was taking care of, and that led me to really pursue and to investigate it, the gap between the theory and the practice, and I think that's what led me to come up and being a patient engagement lead or to have anything to do with the behavioral science and how people really think. Are we logical? Are we rational? Uh, what really drives us? So I will say it my personal experience uh led me to this point.

SPEAKER_03 5:15

I love that. I love that. Um, you know, all of us have been in pharma. You know, I worked at Pfizer for 23 years, you were at Takeda, um, and and then Jason certainly had been a number of companies from you know Gen and Tech and so on. Um, I think one of the things we often sort of think about in pharma is that, and typically we don't find that in pharma, right? Annie, we don't find people like Annie, who's a nurse who looks at the patient experience from a patient's perspective as much, right? They're they're more executives, right?

SPEAKER_05 5:49

So so it's really I know some, I know some, but uh you're right. I don't know, I don't know a lot of people who have this, I would say, mix of different perspectives on different worlds.

SPEAKER_03 6:01

Yeah, yeah, yeah. I love that. So tell us in your experience, so you've been, you know, again, pharma and life sciences and and hospital systems as well as a patient. What do you think has changed from the patient's perspective in the last, let's say, five years? Like what's different now?

SPEAKER_05 6:19

I think you're touching the most important five years. Because, you know, actually, I would say differently from one side, I want to say that patient have not changed. Yeah, the patient themselves, because the disease or the illness stayed the same. Like diabetes is still diabetes, and the complication with diabetes are the same complications. But what really changes the environment, the world that surrounds the patient and the people that need to adapt the new changes. And I think that one of the biggest, I would say, accelerators for the change in the healthcare system was COVID. COVID pushed everyone online almost overnight, like the old appointments, the messages, the follow-up that used to happen in clinical settings suddenly came to screen and it stuck. So we are continuing giving uh treatment and care for the patient through the screen, okay? And within about a year, video visits went from something only a small minority of physicians were used to use to something that almost everyone does it today, okay? And right on the heel of that, AI walked into everyday life. So I would say that's the second change that happened in the last five years. So now people often arrive having already searched, read, and prepared their questions, and they are much more equipped, I would say, to have this interaction between patients and the physicians or any other healthcare provider. So patients today maybe are more informed and less passive than in the past, yeah, but they're also much more overwhelmed because there is endless information and endless opinions. With AI, we also know this hallucination, and you really need to know how to use an eye, and I'm not gonna speak about that. And a lot of the patients are not only looking for facts, and that's important, maybe part of it, because today patients are also looking for reassurance for someone that will tell them, listen, what you're feeling makes sense, you're not alone. I had the same experience, so it's not only facts that we are chasing, and actually, AI is very good in providing that, but we also need that emotional support that's still provided by people. Um, and when it comes to real trust, I would say something like I call it the buzzword in the AI area, the trust. I think today trust and comfort uh especially is difficult in a difficult moment for the patient, still should be provided by the human touch. The technology, and I don't want to say just an eye but in general, technology is not there yet. So we started that kind of change. I would say the acceleration in digital in a healthcare environment, and we are still on that, I would say, wave. It's not over yet.

SPEAKER_01 9:18

Yeah, Bob, I got a follow-up question for Annie. So Bob and I spend a lot of time talking about patience adherence, and um what are the some of the challenges that patients have going into offices? So three of those challenges we've identified, and I'd love to get your your um opinion on them, and also are we're missing anything. So financial, clinical, and emotional challenges patients have as they walk out of offices after talking to a physician, getting a diagnosis. So I'd love for to hear your thoughts on those three, and if there's anything that we're missing.

SPEAKER_05 10:04

You mentioned financial, clinical, and what was this third one?

SPEAKER_01 10:08

Emotional.

SPEAKER_05 10:12

So uh I think you're nailed it. Like those three are definitely are challenging, but they're not the only one. Um, and I would like I would give you my perspective, but I need also to say that it's all backed up with the literature and uh and uh I would say evidence, because uh we know that also skills play a role. You need to have the skills, so you might have the knowledge, you might have the money, okay, and you might have the key, and you might have the capabilities, but uh sorry, but and you have the motivation, like you know what you need to do. The clinician explained it to you, your physician, your nurse, whatever, but you don't have the the skills to do it. On the other side, we also have uh the motivational, maybe you mean motivation as part of the emotion, but if not, I would say motivation as a standalone and opportunity. So there are a lot of things that should be in place and uh in order for behavior to happen, okay, but also we can refer to this question specifically about the challenges for adherence in a different way. Because when I answered to that to this question right now, I addressed to what are the factors or what are the elements that should exist in order for medication adherence to exist in a patient. Okay, but we also aware to the fact that there are a lot of factors that uh impacts patient capability and their decision to go through with this, and we divide it to five dimensions. Actually, it's a very, I would say in my area, it's a very well-known uh model to divide different factors into five sub-dimensions. One of them will be sociodemographic uh parameters of the patient. Actually, they don't really impact on patient adherence, but they are there. And we have this uh healthcare system parameters with uh communication with the physician, accessibility of the treatment, and to the physician itself play a role, and we also have the treatment uh characterization is it subcutaneous, is it per os? Does it have adverse event, lack of effect, when it kicks in, uh the stigma that goes with it, and etc. And we have the illness uh perception is it uh asymptomatic versus symptomatic disease, life-threatening or not life-threatening disease, and other dimension of illness perception, and we have the patient cognitive parameters which relate to patient beliefs, expectations, previous experience, uh assumptions, uh, and etc., which for me are the most and most important challenge, okay, the most important factor, which is the most difficult to handle, to approach, or to really to provide, I would say, effective intervention. Because when you look at non-adherence, you can divide it into intentional and non-intentional non-adherence, and intentional non-adherence is the hardest, I would say, uh um not to crack to crackle if I use the correct English.

SPEAKER_03 13:36

Yeah, that's right, that's right. But uh, so so let me ask you, Annie. So in pharma, do people today uh are they approaching patient adherence, patient starts in the right way? I mean, you've outlined a pretty robust framework here, right? And my sense is is that in pharma, people are not that deep into this. They're kind of like, because then we would have you know patient adherence programs that are effective, and we don't today. So, like, you know, how is pharma, how do you think pharma is viewing patient engagement starting, you know, starts as well as you know, venomens and adherence and so on. How are they viewing it today? And how should they be looking at it?

SPEAKER_00 14:31

That's it. I'm sorry, just a second.

SPEAKER_03 14:33

This was happening when you have live, of course, JJ. That's always that situation, you know. Yeah, hey, this is live TV, right? This is live TV. Yeah, yeah, yeah.

SPEAKER_04 14:49

I I I assume something like that will happen, and unfortunately, that might be the last time.

SPEAKER_03 14:54

That's okay. So Bob, I'm sorry, can you repeat the question? I guess the question is, Annie, is like you've you've presented a very robust model for patient parents. The question I have is I don't know if pharma is thinking that deep about it. So, executives in pharma, how should they be looking at it? Because right now, what I see are pretty basic patient support programs, you know, a call center, a brochure, just basic support. And the truth is, is that it's very deep. It's it's it's a lot more um uh nuanced, as you explained. So, how do you think pharma should pharma executives who are watching this right now, pharma leaders, what should they be looking at when they evaluate or how what should they change, Annie? What should pharma leaders change in the way that they design patient engagement programs?

SPEAKER_05 15:45

So um, wow, it's a big question, and I will try to answer it. And please, if you're feeling that I'm drifting away, stop me, because I tend to do that. So, several things. I would want to start that uh like I'm not a I cannot speak on behalf of whole pharma, but in general, I would say that in my discussion with my colleagues and my friends from pharma, I do know that we have a very good intention. So, first of all, we have a will to help really patient to succeed with their um medication journey, I would say it. So we're all familiar with the patient journey, and then actually I like to speak about medication adherence journey that they have a very clear steps like initiation, uh initiation, persistence, and maintenance. And then, of course, there's a stop of treatment or drop of treatment from different reasons. And uh, when we speak about what pharma is doing and what she needs to do, and etc., I also want to say that pharma is not working in a silo or in a world that every opportunity is doable. We have regulations, we have uh uh strategy, we have uh local rules, uh, we have different kinds of treatment, different countries that have all of that mentioned uh above, different uh landscape, I would say, that provide that uh help us to provide patients with the support. So there is a lot of differences, and we are striving to do something that is really scalable, something that we can provide to all of the patients. So I would say there is a lot of uh um challenges that pharma needs to deal with. So I just want to put it on the table because it's not because we don't want to, it's because so many things restrict us from doing that. But let's assume that we can do everything, okay? Let's let's uh have this imaginary world. I do think that we need to focus if we are if the problem that we want to solve is uh medication adherence to treatment for the long term, if that's the problem, because there are many things that we can uh uh solve or try to solve in patient services, but if we are focusing specifically on medication adherence, then we need to do medication adherence journey to understand what are the factors that impact patient decision to take the treatment at that specific moment of time, and we need also to remember that those factors change over time, over the journey. The factors that impact patient decision at the beginning are not the same after half a year or after a year, the factors are changing, but the patient always reevaluates his decision about taking or not taking the drug. And you can tell me, Ani, but what about the habits? Habits creation, patients who take treatment over years, do they don't have habits? They do, they have habits. I don't know how strong that habit is, but but when we do something that we are not choosing to do, and we are not choosing to be patients, we are not choosing to be sick, and we imposed to take treatment, it means that I will always ask myself, do I really need it today? Can I skip it? Can I postpone it? So those questions are always in my mind, maybe not on an everyday basis, but every time changes happen in my life, yes, specifically in my healthcare status, I will ask this question again, and that's why when I think about pharma and what we should do, we are very good in starting things, like we are in sprint, for example, health apps, right?

SPEAKER_03 19:40

Constantly making health applicate apps to help patients in their diabetes journey or whatever journey they are. Uh, but I think you said this early. So, yeah, you know, those kind of you know, uh uh uh interventions and support programs may not be so effective because some patients, you know, may not like. I mean, can you give us some examples, Annie, where you see the disconnect between you know the kind of journeys that we're building in pharma to what the reality might be?

SPEAKER_05 20:09

Uh yes, I can give you examples without naming anything, any company, and etc. But it's all online if you want. But before I give you a specific example, I just want to also tell you that uh, because I started to answer your question about it, um, and I said that we are very strong to start something. Yes, we are launching on patients in the beginning, we are helping them with the costs, we are helping with the access, we are training them, and etc. But over the try, over the time, the support uh diminish. Okay, and for a second, I want to uh compare it to maybe to oncology patients. What happened with that oncology patient that uh I would call it got cured from the disease, he becomes the recovered patient. I will call it. Maybe it's not the very correct English to say this way. I know there is a terminology that goes with it, but sorry, I forgot it for now. But what happens in our life is that we support the patient while they are sick, yes, and when they recover, the support vanishes, and even the expectation of the surrounding from our work, from our family is like you you are survival, like you don't have the disease anymore. Start acting like you are a regular person, yeah. Yeah, but actually, in that point of time, patients still need a lot of support. The same happened with the medication. We give the support in the beginning, but we diminish it after a while. And I think that drop of treatment and discontinuation of treatment doesn't happen only in the four on the first six months, it continues to happen ever since, maybe in different range, but it's still there. And for example, I will tell you. uh one of the uh one of the patient support programs that i was participating as a nurse back all days is that we came and we only trained the patient like the patient received injected injection for self-injections uh for self-treatment at home and the whole patient support program was to come to train him to give them the skill to give him to give them the brochure right that the belief was that knowledge and the skill is enough so maybe it's enough to get the first step to start something but it's not enough to maintain it and my main point is that we need to be there for the marathon as a pharma to support the patient not just in the beginning but through the whole their journey and we need to create i would call it the maintenance maintenance touch points I like that no I think it's very powerful so let's talk about some examples and what what worked what didn't work and what have you seen as examples in terms of uh you know patient support programs that are you know we talk about apps for example we know that you know some apps are very effective and others are not and I think you mentioned it when we spoke about this notion of rational versus irrational you know we have uh in our in our boardrooms in our conference rooms in pharma we're designing beautiful presentations and we're talking about this amazing investment that we're making in an app that would help patients do something and it's very rational everything sounds very logical and you know and then when it goes to the real world they fail uh and so because patients are irrational as you said so talk to us about some examples and you can you cite some examples for us share some stories yes I can share some stories so um I'll give you an example um so before the example I need like to uh say something about apps because apps has its pros and cons and it has a limitation because apps today most of them I would say most of them are one way street like the patient required to fill in some kind of data and I speak about apps some kind of data that relates to him and uh he gets some kind of output okay sometimes also depends on the feature of the apps and one of the most I would say profound features of the apps and that's actually how all the healthcare apps started in the adherence area is apps that remind the patient to take the treatment yeah so let's for example take this feature that calls reminders okay so logically rationally I would say if you forget if that's your problem I will give you a solution I will I will give you reminders that will prevent you from forgetting logically yes did it happen in reality yes there is a lot of application that has this kind of feature but in reality what happens with the patient is that the patient when we uh when even he sets the alarms for the reminders imagine yourself when you have time to sit with the application is what you when you're free you are calm you're not stressed you're sitting down with the application you see the manual and you schedule your reminder and then uh the next day it kicks in and it reminds you listen Bob now you need to take the drug but now Bob is stressed you're standing in front of the in refrigerator you're looking on this injection and you think to yourself oh my god can I do it if I will do it wrong what will be the side effect of that should do I really need it maybe I can live without it make can I maybe I can try to handle my disease without all of this the fear and the anxiety and the stress and the uh how do I say it um I forgot that word never mind yeah uh fills me in yes and then uh emotion lives in the irrational part of us yes what moves me at that moment is my emotions whatever I want to do at that point of time it calls present bias I want to avoid this discomfort of having this injection so the alarm that I have that tells me Annie this is the time that you need to do it I want to dismiss it because it's not relevant for me. What I want my app is to tell me listen Annie it's you are starting a new treatment it's probably very stressful for you many patients might feel an anxiety at this point of time yes we can support you by giving you this and that and that so by addressing my emotions make the tool much more personal to me and relates to my potential irrational decisions that I might make due to my emotions that drive me.

SPEAKER_03 27:20

That's be I actually love that. So just hold that point really important point. So we're saying here and I I love this is that um what we're doing is building very rational um clinical um support systems and what we have to think about is the emotional part of it where the actually it's that space where the patient makes the decision is not very irrational it's very irrational and based on emotion and so we must find new I mean this is the challenging part annie because it's very soft I mean in boardroom and conference rooms you can't talk emotions right like this is in pharma I've worked in pharma it's like no we're not going to talk emotion we're gonna talk logic and science and data and what you know medical legal regulatory approves right and so this is the hard part of patient adherence and patient starts and and patient engagement is like it's so soft it's quality and pharma is you know driven by data and science and so where you right so how do you like you know how do you how do you how do you square that I just want to say just a second that it's not only pharma you're asking about pharma but in reality it's not only pharma it's how the healthcare system behaves because I will give you very like simple example I don't know if you're familiar with this teach back teach uh model of training patient.

SPEAKER_05 28:55

So it means that you're teaching him how to inject how to swallow how to do something not never mind what you teach them and you want him to tell you back what he understands. And if you see some gaps in his understanding you reteach him or re-educate him again. So everything that I mentioned right now doesn't have any place to motion. This is how we were thought to handle this we need to teach as a system we give like we assess the uh educational or informational gap we provide the relevant information we make some clearance that the patient really understand it and if so then we did a good uh task like we fulfilled it okay never ever no one told me Annie listen when you teach the patient ask him how does it feel how does he feel about it does he feel capable of doing that from one to ten how confident he feels that he can do it by himself what can prevent him from doing that that's not part of teach back teach yeah it's not let me ask a question about that it's it's everywhere and the the reason for that is because it's the easiest way first of all it's the easiest and the logical way the rational way right so Annie you know we talked about financial we talked about clinical and form is really good at that right what we just described is the emotional aspect pharma and physicians in particular who are stressed in their own right because they only have a couple of minutes to talk to patients right give them the information and in you know nine times out of ten the patient's eyes are glazed over because they just they they're they're realizing the gravity of the situation they're getting for the physicians with their diagnosis and those physicians aren't taught in medical school and it's really innate within some people who have that emotional intelligence to be able to recognize that the patient is not understanding because they're emotionally distraught how does pharma how do people like Bob and I and yourself help physicians first of all realize that there is this third element and help them help their patients with that element actually you know I think about this question and first thing that comes to my mind is it pharma responsibility to teach physician I think the problem is not there. It starts even earlier in the education I will give an example for that so today uh and I speak about Israel okay because I I actually I can speak broadly so I will start with Israel medication adherence behavior studies are not part of the curriculum it's it doesn't exist. The only place when the where there is a real course about it is the one that I'm teaching in one of the Israeli universities and it's for pharmacists not for the physicians.

SPEAKER_03 32:30

Oh wow having said that I also need to say that uh long time ago uh the there was there wasn't still a lot of emphasis on communicational skills of the physicians a lot of uh I would say uh simulation training how you handle different challenging situations with the patient so there is a realization in the healthcare system about the communication skills that are required so you're not only expected to be professional uh physician that knows to do the diagnosis and provide the accurate treatment you also expect it to be much more empathic much more active listener with emotional intelligence and etc and this is something that is already taken I would say even not now as I told you a long time ago it was already implemented it's it's still part of the curriculum of the physician but when you ask me this question probably you are speaking about physician that became physician many many years ago and now how we how we assess them or how we help them maybe maybe the so I would say um maybe it's a bit controversial but I think it's it's maybe easier to change patient's aspect or patient role in the physician patient interaction that will lead to different uh reactions from the physicians because today patient goes everywhere they learn everywhere we know Reddit we know Facebook all of these platforms they're not exist for the patient that need only emotional support or only information patients use this platform to brainstorm with the other patient like me someone who've been in that exact situation and they prepare themselves for the meeting with the physician and they learn to be more assertive they take uh I would say control over their situation and that actually impose on the physician to react differently so maybe through the patient the physician will adapt because he's also human yes we are all humans and we adapt ourselves to the communication styles that in front of us yeah yeah so you're seeing is that you don't think doctors can change per se but they can be done but you're asking how pharma can yeah pharma can't yeah no i'm saying no I'm not saying it can't ever we can try everything but I don't my as my answer lies on the assumption that I don't think that it's pharma's duty to teach communication for the physicians I'm not saying we can't I think we can we can first of all we can intend everything we can uh we can um um how do I say it we can recognize this as recognize this as recognize physician communication as a problem yeah that pharma wants to solve needs to solve think to solve somehow then we will still think about the strategy and the taxi tactics to do that but it's not the focus to teach physician communication i think that's the role of the education of the country and etc so forever pharma has been enabling physicians through marketing efforts to help educate their patients although they're not teaching them how to educate they're enabling them through the literature and having spent many years in the field and given out many patient brochures in every office you go in there's a brochure for every disease state you can think of um why do you think pharma hasn't kept up with the last sentence I couldn't hear it so why do you think pharma hasn't kept up with the change that the patients have gone through since COVID the education that that they're giving themselves and the the websites the Facebooks the Reddits that they're going to where it could be you could you can find the opposite of every argument no matter what argument it is but why hasn't pharma kept up with helping the physicians to educate where it's still just a brochure in most cases i'm not I'm not sure that it's uh entirely correct uh we also a pharma invest in digital I would say solution not only for patients but also for physicians it's definitely there but farm as I mentioned previously restricted by many other I would say um not other restricted by uh the regulation and the legal parts and the fact that we need to be factual with the physicians there's like a real not mantra but there is a way that we need to communicate with the physicians so that it will be ethical and uh compliance uh compliantly from the farmer perspective we cannot say um uh think that things that might perceived as uh not not ethical or not morally for from from i'm thinking more from a tool perspective right we've given them brochures more from a tool perspective right the internet and ai have you know slowly crept into our lives but pharma still supplies physicians paper brochures to hand to patients uh i'm not sure no i i'm not sure about it it's not i don't look it's from my experience i'm not working directly with the physician so it's a bit hard for me to answer but from my knowledge we are moved from brochure because brochure is a a hardcore solution for patients and it still exists because the patient needs it also there are patients who are not digitally oriented and it's still required to provide them this kind of way of conveying information but there are also digital tools that provide it to physicians I can give you give you many examples for that uh we have a digital uh not digital we have uh different websites for physicians only that have different tools that support them to educate patients in much easier way because for example today we consume information uh more in a video way in uh in a podcast like we're doing right now less by reading articles so we also provide this kind of solution to physicians that will support and help them to convey their message to the patients but I want to say that the way I articulate my question was from your prior question your prior question was related to how we help physicians to be more emotionally oriented when we communicate to patients that part I still still think is missing we can provide and we do provide with physician with with different channels with and different tools to convey clinical information yeah but we are less there when it relates to teach the physician how to talk how to convey that information to patient I hope I made clear no i i think let's let's let's uh I I'd love to zoom out for a moment and let's let's talk directly to a new product being launched today okay so you're in a pharma company that's very excited to launch a new specialty therapy and you're getting ready how are you thinking Annie and Jason talk to us about what are the two or three things you're thinking about to launch a successful product and of course to be in the marathon Annie right to keep it going right so how would you be thinking about what is your advice give us your advice to a pharma executive who is launching a new product what's your advice in terms of getting those patients to start the treatment it's a complex treatment there's infusions required there's blood being drawn it's a very complicated journey so what is your your playbook Annie and Jason for for for for this executive launching a new brand oh that's a very good question thank you for asking that I would say that first of all or maybe I would call it several let's say rules okay yes so uh the first one for me will be to make the very first step crystal clear and easy to implement you know what sorry I will go back even first of all is to include patient in the development phase and that's something that already happens actually it's not only because pharma wants to behave this way it's because regulations already push us to do that so it's very well acknowledged the fact or actually it's very well acknowledged the place that patients have and the say that they have even in the development phase of the new products so it's not only the safety and the efficiency but the patient voice patient future experience also counts so that's number one and let's say it's done we are we are doing or at least we're trying to do it but after the launch first thing will be to make the very first step crystal clear actually there was a very interesting uh uh um work in behavioral science maybe I don't know uh don't remember all the details but they took uh two groups of people that they wanted to motivate them to go to vote for the primary for the city you you understand me yes so one group resort uh received uh invitation that says on this day on that address come and vote and put your voice and the other group received another brochure that say on this day and this hour this is the map how you need to vote you can scan it to your uh uh Google Maps or whatever and it will take you over there come and vote and when they compared from the two groups where the highest rate of voting

SPEAKER_05 44:00

Was it was with the much more elaborated? So the simplest and the clear crystal clear we make the start. That's the first way to succeed in lunch. I always say that we need to start with the right leg to give them everything in place to make it easier to remove frictions. Okay, that's the other the other part. We need to think about not only what kind of information is required in this and that point of time. We also need to think what are the frictions that the patient needs to deal with and to do all of the effort to remove them as much as we can, as much as it depends on pharma, because once again we are working in a healthcare system, and the system itself also should think about it.

SPEAKER_03 44:50

Yeah, the friction I've seen sometimes is um these portals. So patients are often driven to EHR portals or some sort of portals or apps, even we talk about apps a lot, and they have there's a username and password, and most people don't remember the username and password for these apps, and then they abandon signing in. So you're right, the friction is actually we have to think about we can't just think about the beautiful solution, we have to think about the problems that they would encounter and really design that journey uh in a way that looks at friction. So I think it's very powerful. So, yeah, please continue to remove friction. So we've got here.

SPEAKER_05 45:27

And I would also say that we need to design our services or our solution for the bad days because when everything is good, then it's good. They don't need us, they need when we say that we give patients support, support it's when something is not so well. So we need to think about what are those bad days, what are those bad experiences that the patient might have, but I mean uh uh hardness, uh loneliness, frustration, uh fear, things like that. We need to think about those bad days and design our solution for those specific days.

SPEAKER_03 46:08

Yeah, yeah, design those solutions high, yeah, and we need to remove the shame.

SPEAKER_05 46:15

That means if someone misses uh the treatment, for example, we make we need to make it easy for him to come back without making him feel judge judgmental because uh one of the I would say reason there we go.

SPEAKER_02 46:35

Did you just give her a scissor? Okay, she's a nurse, she's a nurse, and she's a nurse, yeah.

SPEAKER_04 46:44

I'm a nurse, I can give a first first help. I can give it. Oh my god, how I'll be concentrated.

SPEAKER_05 46:51

So, what I was saying about the shame is that uh if you look in the literature about no show, one of the reasons that the patient doesn't show to the appointment with the physician is because they are ashamed and they feel that they're gonna be judgment, they're gonna be judged by the healthcare provider due to the fact that they didn't follow up their orders. I'll give my mother, for example. I told her, Listen, when you have a follow-up with your physicians, you told me the date, when did they come? I told her, Why didn't you go? I didn't do what he told me. I don't want to hear about how bad I am, how I'm not uh like uh compliant, and etc. So she's not showing up. And it's just my mother, but it's supported by uh vast literature about this, so shame plays a very big role. And the last one I would say I would say is that keep a real person within reach for the moment when it gets back, because today we're all into digital, we're all into AI. I think that maybe in the future, not from far from today, but in the future, when this child will be at my age, or maybe even a bit younger, just digital solution will be sufficient. But for people like me and my parents, we still need to have a hybrid model. And when I say hybrid model, hybrid solution, it means that I have a real person in rich when I need him.

SPEAKER_03 48:18

Yeah, yeah. Well, so I want to talk about that for a second. So when you mentioned your mom, you know, for example, having shame and you know, in that first visit, the other problem we've seen is that when in the in the visit itself, the patient, it's that white coat syndrome where the patient is like, Oh my god, I don't know what's going on. And then they are in the parking lot to go back home. And they said, Oh, I forgot to ask the doctor this question. And this is really, we see this all the time, is that within the within the 30 minutes or an hour after the patient leaves the visit, we've seen this. The spouse, you're having a conversation with your spouse, your your husband, your wife, and they say, Did you ask the doctor this question? They say, Oh, I forgot to ask. I mean, I have we have three children in our home, and I take the doc the kids to the doctor sometimes because my wife is a doctor herself. So I have a little bit more flexibility doing you know, live streams and all this good stuff. But uh, I so I take the kids to the doctor's and I and then I and the doctor explors explaining the condition to me. And I said, Can you please just tell my wife? Because I'm going to be, I'm an idiot, I'm not that smart. How can I have this explanation to my wife? And then when I go home, she said, Did you ask this, this, and that? I'm like, Oh my god, I forgot. So, you know, building a system that takes into account that not just the shame in the beginning, but also in the middle and towards the end of, hey, I forgot to ask. I should have asked. It's that regret of not understanding your treatment, your condition, your issues, and then being, you know, then I have to go back to see the doctor six months. And then there's all then there, then we wonder why the patients don't start the medicine. So I think you're you're very important. This is very important. This is very useful. Jason, do you have anything to add that in terms of designing programs? This has been really useful. And thank you for these, you know, it's five. I listed five here. Um, so Jason, do you anything else you want to add that might be or perspective here?

SPEAKER_01 50:30

Yes, therapies become more and more complicated, and they become or go down to more and more personalized medication. Uh, take the the um the T cell products, right? Um where it's you're taking the actual blood out of patients, removing cells, adding medication to that through manufacturing, and putting their own blood back in. There's a whole nother dynamic that goes into educating the patients, educating the physician about the back end process, um, especially in oncology now, um, and designing a system that um can accommodate getting to centers to get the blood taken out, like athesis centers. Um, and going along with what Annie said, um knowing what the challenges are that are going to be for not only the patients but the offices, having to schedule those patients across many visits and the the um the communication piece that has to be put in place by the manufacturers, the pharmaceutical companies, to help not only the office but the patients understand where their medication is in the patient journey process and if it's actually can get back to them and be and the medication be re put back into their bodies. Yeah, so it's the communication piece as we get into more personalized medication, um, going from manufacturer to ACP and manufacturer to HCO to, I'm sorry, to the patients, that triangle of communication, um, which is not something that um that pharma in the last 30 years has built around. So it's a new paradigm shift for personalized medicine.

SPEAKER_03 52:45

Yeah, and you know what you say is Jason being very important doctors are being overwhelmed themselves. There's not enough doctors, as we know, there's not other healthcare providers, and the challenge becomes is like all the not so not just one pharma company that makes a specific drug, it's all pharma companies are relying increasingly very heavily on the doctor for you know patient support programs. And the good news, the doctors are overwhelmed because they're like, take a number. I've got 18 companies that are saying the same thing, and 18 different companies are just have the same kind of product. I mean it's different. And you know, ASCO recently, right? All these beautiful, great therapies are being announced, great research and in cancer, which is wonderful, but the challenge remains the same. It's only a handful of oncologists that still have to think about all of these different therapies and how they're going to get these patients, you know, to come back six times, do this, do this, do that. And so it's a really challenging, and I think my sense is that there's a lot of pressure on doctors today as pharma looks to the doctor to help them roll out these therapies. That's why we're seeing a lot of therapies fail. Even they're great, they're great drugs, but their go-to-market is failing because they haven't designed the system, as Annie and and Jason, you know, you guys are talking about, is like, how do we design it for this emotional journey and a very complex journey, right? That's the thing. It's an emotional journey, it's a complex journey, it's not just an information problem, right, Annie? So we have a lot of information today, right? Like you said. So tell us, so if I if I zoom out here as we as we close up in the next few minutes, I want you to give some advice. I want you to tell a story. Uh, Annie, give us a story, give us a piece of advice for you know the pharmaceutical adherence. Let's just focus on adherence. So we talked about launch, you know, launching, and we talked about that framework. What would you say is the framework if let's say a patient stops taking their medicine um in month seven, month nine? I don't know, let's pick a month. How should a pharma executive be thinking about designing a program for adherence? I mean, I know it's a very broad question because you have to really go deep in the in the in the therapies and understand the journey a little bit, but give us a little nugget that might be useful for a pharma manager designing an adherence program today.

SPEAKER_05 55:21

So if I will be treatment and therapeutic agnostic, just speaking generally, yes, I think that uh the way that uh I would say the change that happens today in the healthcare system with all of the AI supporting tools like uh uh AI that helps the um I forgot the name to make a recognize the patient who might have sick, like uh how did I say it? Um probability the prediction, yeah.

SPEAKER_01 55:55

Sorry, sorry, the prediction came from my head.

SPEAKER_05 55:58

So prediction, when we speak about prediction in a clinical world, it means that we will be able to take patient different parameters of many patients, regardless of how it's done. I'm not gonna deep dive into how, but in the end, the system can flag out the patient who potentially might get sick for from that disease, and it put it will put her effort into preventing that. That means the communication and all of the efforts that will be done by the physician and by the nurses will be to convince the patient to change his lifestyle in order to prevent somehow the potentially uh potential disease. So those the markers that we usually collect for that are clinical markers, the blood uh um workout the blood test, the scan, the extra. Yeah, yeah, yeah, yeah. But when you speak about adherence, we speak about behavior, behavior, yes. But the logic is the same, it means that you can you should uh the infrastructure of the system that supports the patient, regardless if it's going to be used as a portal or as an application, usually it's application, so let's stay with it, should be grounded on uh a solution that can collect patient behavioral uh I would say um scrums and to calculate it into prediction of the future patient behavior, which means drop of treatment. It doesn't matter at which point of time, as I said previously, the reason might change, but there are scrums, or I would say digital not digital, digital behavioral scrums that patient leave that can be calculated into uh uh system that will classify patients based on their uh potential to drop off treatment. So, in in in general, I'm saying we will be able, if not even now. I think there are already solutions in a pipeline that will be able to predict patient drop-offs. And for those patients, that means you don't need to provide one suit fits all, you don't need to provide human touch for everyone, you don't need to call up for follow-up calls with every patient once in a month, like a Schweizaric clock. It means that you will know who is the specific patient that's going to drop off, you need to attend him proactively, and that's maybe another switch that should happen, and the systems and the technology enable that is that we will become much more proactive, reaching out to patient, and the and the treatment will become between the visits because today we have visits several months, another visit. Yes, usually it's reactive, patient comes because someone told him or because something changed, and that's it. And it's gonna be more between the visit, more proactive, but not blindly for everyone the same. It's gonna be proactive due to those predictive tools for patient behaviors.

SPEAKER_03 59:10

Yeah, yeah. No, that's actually I see that as well. Um, in some of the work we're doing, we're looking at you know why patients are dropping in certain months, and so what we're trying to do is to look at designing interventions. We know it's right, so data are there for certain products that have been on the market. Let's say there's a nine-month you know drop at some point, so then months six, seven, and eight, there has to be some priming to the patient, which is like seeding certain certain you know triggers or certain messages, so that the to uh to alert the patient to be aware of that potential behavior that makes the patient drop off on month eight or nine. So that's that's the way we're thinking about it.

SPEAKER_05 59:52

I think I think what you're saying actually is uh pretty simple and it's already it's already, at least I would speak about myself, it's part of the way I construct patient support services in the past, even so, because this is what exactly what I meant when I say patient adherence journey. You need to take the patient journey on the treatment and to understand where gonna be the pain points that will make him drop. So, in the beginning, I will give an example. Uh, if there is a treatment that kicks in after uh a month of treatment, you need to that means that there is a potential that if the patient doesn't be aware of that, doesn't remember that, or didn't understand the message, after two weeks of treatment that he expects to see some kind of result, and there will be no result, he might drop off and say, It doesn't help me, and I know this kind of patient, I've been there. That means, as you said, we need to say, okay, this is gonna be a reason for drop-off. That means we can prevent it by setting expectation in the beginning. The same goes, for example, after half a year, and I will speak from personal experience, okay. Personal experience, that's very important. I was treated by, I told you, I'm a chronic patient, also, so you don't see it on me right now, but I was an obese person, and uh I was treated with GLP1 injections. So, one of the problems with GLP1, regardless of the name of the treatment and the company, really, I want to be fair, is that the patient when they uh lose weight, they drop off treatment because they reached the goal. So you know that usually it takes x months to lose that weight, and you know that after that you can expect drop-off, yes, and that means you can prevent it by having a discussion with the patient, not lecturing them, but have a discussion about what do he thinks, what are their goals, how he wants how he thinks to keep it, what is the role of the treatment in those goals? What do you think about the treatment? Do you think you need to continue with that? What are you afraid of? So, those kind of questions that are based actually, and it'd say but on a motivational interview, uh uh, those are the questions that allow us to discover new world, allow us to discover, and I would say, even to uh reject some of the assumptions as we as healthcare providers have about our patients because non-adherence to treatment it's not personality, it's not like this person is non-adherent and that one is, it's not a genetics. Medication adherence to treatment is a dynamic thing that happens and changes all the time among all of the patients. Today I'm very adherent, today I am very not adherent. Depends on my surrounding reality.

SPEAKER_03 1:02:55

Yes, yes. So, in that case of the GLP one that you mentioned, I think this is a very interesting case because it's not just about weight loss, but also about diabetes sometimes. Certain patients it's just an example, but yes, yeah, no, no, but I'm saying is on GLP1s, you lose weight plus your diabetes, your A1C might be controlled, and then you lost weight, you say, Okay, I feel good, I feel fine.

SPEAKER_04 1:03:17

I can come back to diet.

SPEAKER_03 1:03:18

I can't diet, yeah, right, right. And then and then their A1Cs go out of control, right? And then, of course, their weight, but it's this is a very important point is that there's a silent, you know, sort of drop-off, there's quiet quitting, and this is this is a serious problem to address.

SPEAKER_01 1:03:36

But Rob Bob, it's it's outside of lifestyle drugs. Lifestyle drugs, you get to see the results, but outside of lifestyle drugs, where you're not necessarily seeing like cholesterol drugs or heart medication, you're not seeing, you're not feeling the effects, and that's what and he talked about. Oh, I don't need this because I don't really know what's going on. The numbers say it's my it's working, but is it really the drug? Right.

SPEAKER_05 1:04:09

So uh actually, it's not just the lifestyle. I think uh the point here is the I mentioned previously the dimension of the disease. When you have asymptomatic disease, the need for the treatment is low, it doesn't exist. That's why we say that the hypertension is a silent killer. We don't feel it, we don't think we need a treatment for that because we feel well and there is no need to take the treatment versus psoriasis, for example, which is uh uh a disease that impacts our self-esteem and it's shown to everyone, so the need is very clear. So uh the decision is driven by the uh equation of the necessity versus concern, and it's not my invention, it's uh Professor Rob Horn model, but it works because I practice it every day in on myself, actually, and I see it among the patients that we are uh yes taking care of. Uh I'm not saying just in pharma, but I told you that I'm lecturing in the in the university, and we are having uh real patients in the project. So it works.

SPEAKER_03 1:05:21

Well, she's I want to kind of wrap up here. Um, you know, I know Annie, thank you for for joining us. I know it's late uh in Israel right now, and uh that's why you have you know your your parent duties uh as well. And so I totally appreciate that. I know Jason and I both appreciate that as parents of children, and so um I think it's very important. I want to just give the last few seconds here as we close up. Any final remarks, Jason? Any final comments you'd like to make? Um, I think this has been a really interesting, great conversation, but give us your advice for pharma uh brand managers launching a new product. Today or Lily or struggling with adherence. Give us give us your quick advice and then I'm gonna uh turn it to Annie and then we'll close up.

SPEAKER_01 1:06:08

Sure. Um thank you, Annie. Uh it's been truly insightful. And I just want to echo what Annie talked about. It's been going into, or believe going into building um uh a new brand, it's the pain points, it's understanding the patient journey and then understanding what those pain points are, uh, and to partner with the ACPs in whatever journey that they're on in helping to educate the patient. Yeah, no, I love that.

SPEAKER_03 1:06:45

I love that. And for me, I will just and I'm gonna turn it over to you just to say, um, Annie, um, what are your final thoughts? But what I learned today was fantastic, Annie. Thank you. It's it almost is like the title of the talk here is you know, you know, irrational and rational. Patients are irrational, human beings are irrational. And so maybe we should be thinking more irrational irrationally when designing you know patient support programs. So, Annie, I turn it over to you for final thoughts.

SPEAKER_05 1:07:15

I think uh so first of all, thank you. I really enjoyed it very much, actually. You opened me an appetite for this. Thanks. Uh so uh two things. Uh, one is that uh medication adherence or medication non-adherence is a problem that we actually stuck with, it's something that was exist from centuries actually, and uh studied for profoundly in the last 100 years, last era I would say, but the numbers don't change. So, just to give an example, the report of WHO about adherence states that 50% of patients are non-adherent. If you will look at the last uh uh research in the area of medication adherence, you will see most or less the same numbers. That means that we are not really moving the needle. That that's something that we need to think about. It's like technology moves forward, everything moves forward, AI, whatever. But when we need to do something that relates to patient behaviors, we're a bit stuck. That's number one, and number two, and I think that's maybe one of the things that I want all of us to think and remember is that non-adherence, I call it uh another pathology because it's not a it's not a pathology, but it's a manifestation of behavior. But we should treat it as a disease. We need to be able to assess it, first of all, to be to acknowledge it exists, it's a disease that we need to treat. We need to be able to assess it, to give a differential diagnosis. That means not only that my patient is non-adherence, but what kind of non-adherence you have, intentional, non-intentional, instrumental, and what are the reasons for that? What caused it? What is the root cause of that? So having the full assessment and having the tools to do the intervention, because I think we are still in some cases, we are not assessing it correctly. So, how can we do the intervention? So we are trying to give the tools to the physician, to the patient, whoever, but we need first of all to be aware to the problem and to be able to assess it correctly, and then to have the tools. And last thing is that non-adherence exists among every therapeutic area, among every treatment, regardless if it's subcutaneous injections, if it's effusion, or even if it's a per os treatment, because many times in my life I was asked why per oce treatment has a drearance problem, it's just a pill, you need to swallow it. What's the problem?

SPEAKER_03 1:10:10

There is a problem. Yeah, no, that's absolutely right. And there's a lot of work to be done, so it's there's a lot of roles and opportunities for everyone in patient services and uh patient engagement. But I've had a terrific time uh speaking with Jason here and Annie. Um, really wonderful. I've got wonderful insights we're going to be sharing over the next few days here. Um, you can look at the recording, but I just want to say thank you very much, Annie Goldman. Uh, it was a terrific conversation. Really appreciate it. Jason, thank you for always being here and supporting us and uh the beautiful conversations we've had. So, Annie, thank you again. And uh and really appreciate you calling in this late hour from Israel and uh interrupting family time briefly, but really appreciate you being on the thank you for the opportunity. Thank you very much. Thank you. Well, have a great day, everyone. This is Bob saying good day, good evening, good night. Thank you. Talk to you later. Bye, Jason. Bye Annie, thank you.

SPEAKER_01 1:11:11

Bye bye.