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Do You Have Healthcare Extenders in Your Brand Plan for 2011?
Today’s emerging healthcare system lacks the supply of primary care physicians necessary to handle the escalating demand and need for care. Pharmaceutical marketers continue to hear that the role of the "physician/healthcare extender" is growing in importance as a key customer segment. What is this nomenclature of physician/healthcare extender? Why the increased importance? This new nomenclature includes the following: (1) advanced practice nurse, which can be a nurse practitioner (NP), clinical nurse specialist (CNS), nurse midwife (NM), or nurse anesthetist (NA); (2) pharmacist (PharmD); and (3) physician assistant (PA).
So, why the hype about these disciplines? Three key reasons are: (1) their growing number, (2) healthcare reform, and (3) their growing influence and the scope of their patient interaction and prescribing authority.
First, two dominant disciplines that make up the physician/healthcare extender community are the NP and PA. Recent surveys for the NP and PA demonstrate significant growth. The number of nurse practitioners in the United States increased from 90,000 in 1990 to 135,000 in 2008, according to estimates by the American Academy of Nurse Practitioners. Of these individuals, in 2010, 66% of NPs practice in at least one primary care site. The largest primary care site is private MD/DO practices.[1] Likewise, the number of PAs eligible to practice grew from 25,000 in 1991 to more than 72,433 in a 2009 survey, with 35% of them in a group physician practice and 38% in a hospital setting.[2]
The second reason for the increased focus on the physician/healthcare extender is the current healthcare reform movement, in which legislation is being proposed to expand the practice of the NP and PA in ordering nursing home care for Medicare patients. As of now, only physicians can sign home healthcare plans and certify Medicare patients for home health care. If approved, the Home Healthcare Planning Improvement Act of 2010 will allow Medicare patients to get the care they need from the clinician they prefer, which could be one of these physician/healthcare extenders. With more than 30 million people soon to enter the healthcare system, consisting of those who were previously uninsured and the first of a massive wave of aging baby boomers now eligible for Medicare, the resulting pressure on the American healthcare system will be overwhelming and unprecedented, particularly in primary care. The demand for primary care physicians will be like a tsunami, based on the very limited supply currently in practice as well as those in training. Herein lies the tremendous need for greater numbers of physician/healthcare extenders with expanding scopes of practice well beyond those that exist today. In fact, the Institute of Medicine recognized this need with a recent report calling for government and healthcare organizations to remove scope of practice limits that prevent nurses from practicing "to the full extent of their education and training."[3]
The last reason for the importance of this movement is the scope of prescriptions being written by NPs and PAs, who have some level of prescribing authority in all 50 states. NPs write approximately 556 million prescriptions annually, averaging 19.3 prescriptions per day, primarily for antihypertensives, antimicrobials, dyslipidemic agents, and diabetic agents.2 From June 2009-June 2010, NPs and PAs wrote 7.8% of US prescriptions, up 20.24% from the previous year; these scripts were valued at $20.2 billion according to IMS Health. With the ability of these physician/healthcare extenders to prescribe, pharmaceutical companies have greater opportunities to educate them about new product launches, new indications, new data, patient education, and even strategies for improving medication adherence.
According to PharmaVOICE, September 2010,[4] millions of prescriptions and millions of dollars are being influenced by this group of individuals who go largely untapped when it comes to communications, outreach, and education. Moreover, the magazine asserts that there is a vast under-documentation of NPs and PAs and their influence on disease management and clinical decision making.
A recent study in the Journal of Clinical Nursing[5] demonstrated that nurses with prescribing authority generally perceive their interactions with pharmaceutical representatives as positive, based on favorable impressions of their communication skills and personal interactions. However, the pharmaceutical representative was not their preferred method of drug information; instead, NPs preferred continuing education and conferences as well as discussion with colleagues. Therefore, the importance of peer-to-peer meetings as well as educational venues is essential to consider when designing the marketing tactics for these key customer segments.
In summary, based on the increasing number of advanced practice nurses and PAs, the current healthcare reform movement with more legislative changes on the horizon, and the increasing scope of prescribing authority for NPs and PAs, pharmaceutical brand marketers need to not only continue but also increase their focus on these dynamic disciplines. This focus includes gaining insights on relevant disease states and products, strategic initiatives, and subsequent tactical plans for advanced practice nurses and PAs. Based on the stated NP preferences, important tactics to consider are peer-to-peer roundtable discussions and educational series via various channels. These healthcare extenders are steadily increasing their influence on choices in pharmaceutical prescribing and healthcare plans. There remain additional marketing channel questions related to these disciplines. Should healthcare extenders be included in the same peer-to-peer programs as the primary care physician or have separate programs designed for them? Which marketing programs are the most beneficial to collapse with the physician vs keeping separate? Is now the time to create home healthcare or medical home marketing initiatives to recognize and capitalize on this emerging market segment by offering educational programs for physicians, healthcare extenders, and patients? Avant Healthcare Marketing understands these strategic questions and offers our tactical recommendations in peer-to-peer channels. ARE YOU READY?