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The seemingly routine process of identifying and locating prescribing physicians is becoming a critical industry function
It would seem to be an easy question to answer: who are the healthcare providers working in the US? Somewhat more difficult, but still attainable: where are they and how can they be contacted? More difficult still, but the question with consequential answers: what are they doing, and what are they prescribing?
Getting the right answers to these questions has become considerably more consequential for pharma marketers and compliance officers in recent years. Of course, linking prescribers with prescribing behavior has been a vital function for years, and, as a service, is a key revenue stream for the major pharma data houses—IMS Health, SDI and Wolters Kluwer. And, simply to send a letter or make a phone call to prescribing physicians, pharma companies or their marketing agencies have used lists of physician names, addresses and office affiliations for years. But now, with state-level (and, soon, national) aggregate-spending rules, manufacturers need to have well-organized databases of their interactions with prescribers, or face regulatory penalties.
“A pharma company might have started with a good, clean list of prescribers, but very quickly, it becomes out of date as physicians move or change their business affiliations,” says Jack Schember, marketing director at SK&A Information (Irvine, CA), a Cegedim company and a leading data-management firm. “Relying on one’s sales staff to keep the data current is problematic. Thus, pharma companies that want to keep their records current and effective have come to rely on data verification services like ours.”
SK&A’s analysis of its data verification process shows that 10-15% of prescribers (depending on specialty) move or change affiliation annually (Table 1). “In a couple years, you can lose as much as a third of the accuracy of the database,” he says.
There are some 850,000 MDs or doctors of osteopathy with records on file at the American Medical Assn. (Chicago). To that can be added 150,000 nurse practitioners (many of whom are prescribers), 90,000 physician assistants, 250,000 hospital administrators, and tens of thousands of dentists, optometrists and other healthcare professionals. The total universe is around four million. Keeping track of all these professionals—or just slicing the dataset for selected groups of specialists—can be quite a job.
For decades, the main tracking source was the American Medical Assn, which doesn’t sell its lists directly, but rather licenses them to selected DBLs—database licensees. There are eleven DBLs currently (see Table 2).
AMA has a Division of Survey and Data Resources that actively updates its databases. One common misconception that it is eager to dispel is that it only tracks AMA members; in fact, it tracks nearly any licensed physician, including medical students, foreign-trained physicians seeking US licensing, and, for those performing historical analysis, records on physicians in the past. Practicing physicians maintain an electronic account at AMA and update their personal information; professional certifications are validated with appropriate schools or agencies. An updated database is made available to DBLs weekly.
“We’re processing 41 million records annually, employing nearly 75 people who access over 2,200 data sources,” says Tammy Weaver, director of database investigations at AMA. “Also, it’s worth noting that we make extensive use of the database ourselves—we send 57 million communications to physicians every year.” The list is also approved by the Joint Commission and the National Committee for Quality Assurance (NCQA)—more or less official arbiters of healthcare certifications.
Mark Frankel, VP, database products at AMA, notes that DBLs are vetted by AMA before a license is granted; the review includes analyzing data-security provisions and the financial stability of the organization.
AMA’s 2009 annual report specifies that the association grossed $47.5 million from its database licensing activities.
“The AMA list is the gold standard for physician access,” says Terry Nugent, VP at Medical Marketing Service (MMS: Oak Dale, IL), which has been an AMA DBL since 1929. “They put considerable resources into keeping the data current, because of their professional responsibility.” MMS then licenses data to its customers, typically for a one-time use because a re-use would entail another round of updating to avoid wasted effort. “As much as 20% of a list can go bad between one use and a next one; rather than manufacturers trying to maintain these data, it’s easier and more cost-effective for us to do it for them.” He adds that “horror stories abound” of manufacturers attempting their own mail (or e-mail) campaigns and being thwarted by old data or bad lists.
A basic list (available at MMS or at other AMA DBLs) is the name, professional specialty and mailing address of a healthcare professional—the essentials for a direct-mail campaign. Customers pay extra for slicing the data by criteria like geography, or for adding fax numbers, or any set of identifiers, such as National Prescriber Identifier (NPI) or DEA license number. Of particular interest these days—and something that is not available from AMA directly—is an e-mail address. AMA DBLs and other list managers have developed alternative sources of e-mail addresses of up to 600,000, and they are said to be 100% permission-based.
MMS guarantees up to 97% delivery of direct mail pieces. Interestingly, price does not seem to be a key differentiator among list managers—the base price is in the $75-100 per 1,000 names range, with discounts for using larger volumes of names.
Where AMA DBLs do differentiate themselves is on the services tied to list usage. MMS says that it mails millions of pieces annually to physicians, and has systems in place to do this cost-effectively and productively, with processes such as managing multiple mailings with successive messages or offerings to improve the effectiveness of a campaign. Recently, the company opened its “NOWW” (Names On-line Without Waiting) service, which allows subscribers to access lists directly via the Web.
At J. Knipper and Company, SVP David Merkel says “simple sales of the AMA list is only a small fraction of the company’s data related business; a great deal is directed at developing appropriate data structures which enable clients to run highly effective direct marketing campaigns”. Knipper’s multichannel-marketing campaigns link points of outreach to corresponding response data at a very granular level. “As communication channels vary by cost, and response is based on the personal preferences of a physician, analyzing the performance of a campaign in real time provides the highly cost-effective, rapid success rates that we deliver to our clients,” he says. The company also runs complex sample-management programs, including a Web-based program called MySampleCloset.com.
SDI combines list-management services with its extensive analytics of prescribing behavior. One of the company’s ancestors (Verispan) started the Vector One service that links prescriber and patient data in the late 1990s; in 2004, it expanded this to include longitudinal data that tracks a patient’s treatment history over time—a service called Vopex. Vopex, in turn, is available from several other AMA DBLs.
Redi-Direct sells the AMA database through one of its subsidiaries, Redi-Data, which also markets consumer data. Sister companies of Redi-Data include StayInFront, a vendor of customer-relationship-management (CRM) solutions, and Redi-Mail, which performs mail (and e-mail) fulfillment services.
The other way
Notwithstanding AMA’s official status and physician access, there appears to be plenty of room for non-licensees to successfully compete. These competitors use their own resources to compile and validate physician data; the compilation process, depending on how it’s performed, can create new market-data opportunities.
SK&A Information uses what might be called a brute-force approach: Over the course of a year, it telephone-verifies data on physicians and their practices twice, employing a data center in Irvine, CA with dozens of verifiers. “This isn’t a typical call center operation,” says SK&A’s Schember, noting that the verifiers work on healthcare nearly exclusively, and are trained to obtain key information on physicians’ group practices, insurance acceptances and rep-visit policies.
“Manufacturers want as much of these data as we can get,” he says. One of the latest trends SK&A is tracking is the use of electronic medical records (EMRs) in physician practices—data that doesn’t necessarily point directly to actual prescribing patterns, but could provide insight to how those patterns might ultimately be analyzed. SK&A has found that EMR use is highest in Minnesota (82.6%) and lowest in New Jersey (27.9%), and averages (in September 2010) 38.7% among all physicians.
SK&A was acquired last year by Cegedim Dendrite (Bedminster, NJ)—now Cegedim Relationship Management. Cegedim, based in France, has marketed a physician database called OneKey, which is especially strong in Europe. With the acquisition, SK&A’s data are now being merged with OneKey to provide a global healthcare provider database.
According to Bill Buzzeo, VP and GM, Compliance and OneKey Solutions at Cegedim, the telephone-verification system of the company will now enable bidirectional updates of pharma clients’ CRM systems: within 48 hours if a change comes from the pharma company to Cegedim for verification, and even quicker as OneKey automatically updates the CRM database at a client.
SK&A Information is by no means the only non-AMA-licensee in the list business. Another recent entry is Healthcare Data Solutions (Lake Forest, CA), which offers a growing list of databases of prescribers and other healthcare professionals. Chris Lundgren, VP of sales and marketing, says that the company streamlines its telephone-verification activities by polling multiple data sources and the Internet itself to identify changed addresses or affiliations, and then uses a data center it runs in Lincoln, NE, to perform the verification. “We have the most up-to-date information available,” says Lundgren.
Among these data sources are pharmacy benefit managers (PBMs), from which prescriber and prescription data are obtained. That, in turn, enables the company to offer some market analytics that might not be on the scale of the big data houses, but could be adequate for smaller pharma or biotech companies just beginning their commercialization process. “We pride ourselves on our flexibility to give clients prescriber and market data in the form that best suits their needs,” he says.
Health Market Science (King of Prussia, PA) is another list provider not connected to the AMA DBL system. The company maintains a “HMS MasterFile” of over one million healthcare providers, and claims proprietary technology to improve the quality of physician databases by using metadata about sources of information to qualify the information it collates. Another service build on the HMS MasterFile, PxDx, provides information on “physician to physician” relationships in hospitals and other healthcare settings, according to the company. The HMS MasterFile can also be accessed via an online version, CompleteView OnDemand.
MedPro Systems (Mt. Arlington, NJ) polls state licensing authorities regularly to compile its MedProID service, which allows clients to validate physicians and other healthcare providers, as well as their employers, for medical claims processing, sample management systems and other regulated activities.
Having developed or acquired demographic data on prescribers, the list managers are now developing added-value services layered on the basic identifiers. One lively area of development is in electronic media; besides various work e-mails, list managers are also compiling personal e-mails, smartphone usage, social-network participation and other facets of the online experience. All of these access points are said to be permissioned by the physicians (or, conversely, that opt-out instructions are complied with), but left unsaid is whether the permissions have been granted to an originating organization (say, a medical book publisher) or to the list manager directly.
AMA itself is the repository of two types of opt-outs from lists (e-mail or otherwise): the “No Contact/No Release” designation, by which physicians can specify that their AMA Masterfile data is not to be released, or that physicians are not to be contacted (via mail or telephone) via their Masterfile listing. Additionally, AMA’s Physician Data Restriction Program is a measure to prevent physician data from being matched up with prescribing data. AMA says that some 30,000 physicians have specified “no contact” in their AMA datafile; 27,000 have signed on to the PDRP, and 500 have specified that their AMA data is not to be released at all.
Outside such restrictions, however, the types of data being compiled seem to be limited only by the imagination of list managers. New categories include:
The next level up from these services are the ones that match physicians with prescribing patterns, which in turn leads to evaluations of key opinion leaders (KOLs), decile-rankings of physicians by their prescribing activity and a host of other sales-related activities. While some physicians have long objected to such monitoring of their professional activities (and this is what led to the AMA Data Restriction program), there is a clear health-system benefit to knowing how well new medications are being taken up, or by what extent products that have been counterindicated for some conditions are still being prescribed. And more: another data analytics house, Qforma (Santa Fe, NM) has used physician data, with identities verified by SK&A, to compile the “Most Influential Doctors” list, broken down by therapeutic specialty and region, in a consumer-oriented list published by the USA Today newspaper. PC
BOX: What Is There to Know About Docs?
A conventional list-management service provides names, phone numbers, addresses and (maybe) telephone numbers or e-mail addresses of desired individuals. But today’s data-driven marketing capabilities, combined with the intense focus that the pharma industry has paid to physicians, produces a lot more information about them. Generally, these identifiers can include:
Although the pharma industry is naturally one of the biggest markets for these data; it isn’t the only one; database providers also service insurance companies, publishers, business services vendors, medical education providers and marketing services agencies (who in turn serve all the others as well).