Healthcare Marketing, Digital Marketing and Market Access Strategy - John G. Baresky
Astellas Expands Therapeutic Portfolio With Gene Therapy Deal
Astellas ( OTCMKTS: ALPMY ) has announced it is acquiring Audentes Therapeutics ( NASDAQ: BOLD ) for $3 billion and plunge itself into the gene therapy market. Based in San Francisco, California, Audentes is a clinical stage research company centering on the development of AAV-based genetic medicines for people with significant and rare neuromuscular diseases.
Astellas is a global pharmaceutical leader
Astellas, based in Tokyo, Japan with a U.S. headquarters in Northbrook, Illinois, is Japan’s second largest pharmaceutical company ( Takeda is ranked at number 1). The current product portfolio of Astellas is defined by 4 categories and the addition of Audentes will establish a 5th with the specialty of genetic therapy:
- Genetic Therapy
Astellas employs approximately 17,500 worldwide; Audentes has less than 1,000 staff members.
Audentes has developed a robust pipeline of advanced gene therapies
Audentes' adeno associated virus ( AAV ) gene therapy technology platform and proprietary production process expertise is applied in programs spanning 3 modalities:
- Gene Replacement
- Vectorized Exon Skipping
- Vectorized RNA Knockdown
Audentes has committed significant resources to develop potential approval candidates although risk remains high in terms of chances of approval by the Food and Drug Administration ( FDA ) in the United States and the government regulatory agencies of other nations:
- AT132 X-linked Myotubular Myopathy MTM1 ( Gene Replacement )
- AT845 Pompe GAA ( Gene Replacement )
- AT702 Duchenne Muscular Dystrophy Exons 2, 1-5 ( Vectorized Exon Skipping )
- AT751 Duchenne Muscular Dystrophy Exon 51 ( Vectorized Exon Skipping )
- AT753 Duchenne Muscular Dystrophy Exon 53 ( Vectorized Exon Skipping )
- AT466 Myotonic Dystrophy DMPK ( Vectorized Exon Skipping / Vectorized RNA Knockdown )
Presently, the leading candidate for approval in the Auduentes portfolio is AT312 which could happen as early as mid-2020. Its clinical trial performance has generated good results in the treatment of X-linked myotubular myopathy (XLMTM) occurring primarily in male infants.
Astellas began exploring gene therapy marketplace in 2018
Astellas has already licensed a gene therapy candidate. In 2018 Astellas entered into a licensing agreement with Juventas Therapeutics for JVS-100. JVS-100 is a non-viral gene therapy expressed from stromal cell-derived factor -1 ( SDF-1 ) which is a naturally occurring signaling protein activating the endogenous tissue repair pathways.
Why is gene therapy such a hot marketplace for biotech and pharmaceutical companies to invest in?
Gene therapy is an advanced area of life sciences with potential to cure diseases by replacing missing or mutated versions of a gene found in a patient’s cells with healthy copies. Depending on the patient and the genetic challenge involved, gene therapy in some instances can resolve significant illnesses with one dose. Because of the advanced clinical technologies involved with developing and manufacturing gene therapies, they are quite costly and the processes to develop them are complex and highly coveted by pharmaceutical manufacturers.
Large and mid-sized pharmaceutical companies are always seeking to build their clinical and commercial capabilities. Many product categories are crowded with competition including:
- Gastraoesophogeal Reflux Disease ( GERD )
- Oral Contraceptives
There are numerous brand and generic drugs in each of these categories. While the patient population prescribed these products is in the millions and the medications involved taken on a daily basis for months if not years, pharmaceutical companies devote large sums to develop these products, then even more to promote them. Then conversely, they frequently discount the products through market access strategy measures to contract for favorable positions on managed care organization ( MCO ), prescription benefit manager ( PBM ) and health system formularies or group purchasing organization ( GPO ) listings.
While gene therapy and other advanced medications are costly and risky to produce, the investment to promote them following approval is less. The payout is larger as there are less competitors due to their high research & development and production costs plus the narrow indications they are approved for and reduced number of patients they are prescribed to results in significantly higher prices at time of launch.
Astellas is highly selective in its acquisition strategy
It has been almost 10 years since Astellas last made such a sizable acquisition. In 2010, Astellas acquire OSI Pharmaceuticals for $3.8 billion. With annual sales of approximately $12 billion and a market capitalization estimated at $33 billion, Astellas is solidly established in global healthcare markets and has the clinical and financial resources to cultivate a successful gene therapy portfolio of products.
Astellas versus the competition in the gene therapy marketplace
By adding Audentes’ research & development attributes and manufacturing capabilities plus its connections with patient groups, academic institutions and the biotech research community, Astellas assertively positions itself in the expanding gene therapy marketplace.
Roche ( OTCMKTS: RHHBY ) Novartis ( NYSE: NVS ) and Pfizer ( NYSE: PFE ) are presently the blue chip pharmaceutical manufacturer leaders in gene therapy. Roche acquired gene therapy company Spark Therapeutics for $4.8 billion in 2019, Novartis bought up AveXis, another gene therapy leader for $8.7 billion. Among Pfizer's many investments, they acquired gene therapy producer Bamboo Therapeutics for $645 million in 2016.
Reportedly Pfizer ( NYSE: PFE ) and Novartis ( NYSE: NVS ) have been hard at work building out their gene therapy development and manufacturing capabilities. Pfizer has allocated about $600 million to gene therapy production and Novartis slightly less at $500 million.
Potential gene therapy giants or acquisition targets
Upcoming gene therapy companies, which could substantially grow on their own if their pipeline candidates are approved, may also be attractive buyout targets. Some of the leading gene therapy companies of this caliber include:
- MeiraGTx Holdings PLC (NASDAQ: MGTX )
- Regenxbio Inc. ( NASDAQ: RGNX )
- Sarepta Therapeutics Inc. ( NASDAQ: SRPT )
- Solid Biosciences Inc. ( NASDAQ: SLDB )
- uniQure NV ( NASDAQ: QURE )
- Voyager Therapeutics Inc. ( NASDAQ: VYGR )
While it appears there are numerous contenders in the gene therapy market, their products are highly niche-focused so they have less or no competition within each of the therapeutic areas they are exploring to develop new medicines. The high rate of clinical trial failure also results in an ongoing reduction of competing agents throughout the product development cycle.
Even before the Astellas and Audentes deal is approved by regulators, the approval of AT132 X-linked Myotubular Myopathy MTM1 ( Gene Replacement ) will be highly anticipated by investors, company staff members and the medical community. Depending upon when the deal is approved and AT132 is approved, a combined torrent of activity will follow in addition to the ongoing work underway in the existing pipelines of Astellas and the other candidates in the Audentes portfolio.
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Amazon Combines Digital Savvy With Voice And Transcribing Technology To Drive Innovation In Patient Care And Healthcare Data Management
Conversation Converted To Digital Text Technology
Amazon ( NASDAQ: AMZN ) is introducing a new healthcare application which will integrate with patient electronic health records ( EHR ).
Conversations between physicians and patients are recorded and converted into text content that populates the EHR at point-of-care. EHRs are also referred to as Electronic Medical Records ( EMR ).
Healthcare Clinical And Cost Advantages
The application, known as Amazon Transcribe Medical, will enable clinicians and patients to have more direct and meaningful dialogue that is retrievable for review at a later time. During face-to-face interactions, doctors and patients can converse without the doctor having to continually interrupt their dialogue to enter notes in the EHR or recall the details later either by memory or handwritten note which are not always easy to interpret.
Amazon Technology In Partnership With Cerner and Suki
Amazon developed the application by collaborating with Cerner, one of the world’s largest EHR companies and a startup company, Suki, that specializes in transcription technology. Currently, the Amazon Transcribe Medical program can only be used by those healthcare provider organizations and EHR platforms aligned with Amazon Web Service ( AWS or “Amazon Cloud”).
Amazon Transcribe Medical was designed to work with Amazon Comprehend Medical, an application that enables developers to work with unstructured medical text rhetoric aligned with patient symptoms and associated clinical details including drug therapy doses, diagnoses and other pivotal, finite detail essential for a well-fortified EHR patient file.
Patient Information HIPAA Compliance And Data Accuracy
The application meets HIPAA requirements which is absolutely pivotal in all things related to patient data, privacy and security. The advanced technology and testing involved with developing the program also demanded a high degree of accuracy in terms of medical terminology, punctuation and other details relevant to clinician and patient conversations.
Microsoft, Google, Other Competitors
Advanced voice transcription technology is being pursued by numerous other healthcare software and technology companies. While Microsoft and Google have collaborations underway with various partners in this regard, there are many other companies developing solutions which could compete with Amazon, Microsoft and Google. They could launch independently or be acquired by one any one of these three companies or others to accelerate development of a marketable commercial product to be used by hospitals, health systems, medical practice groups or other healthcare provider organizations.
Besides Google and Microsoft, these are some other competitors in the medical transcribing space threatened by Amazon Transcribe Medical:
Dolbey, Entrada and Nuance already interface with some EHRs but having a complete clinical and commercial solution that can be utilized by an entire hospital or health system is something on an entirely different scale. Amazon, Cerner and Suki, with Amazon Cloud as an integral resource, have the clinical, financial and technical bandwidth necessary to provide enterprise-wide medical transcription EHR programs that will have wide impact on broad based healthcare provider organizations.
Voice Recognition Technology ( VRT ) And Transcription Technology
In healthcare and an array of other industries, advances in voice recognition and transcription technology are widely welcome and highly anticipated. These solutions speed processes, streamline recording and retrieval of information and bypass the keyboard interface which slows down processes and contributes to errors. As we have seen with smartphones, digital assistants, various remote control apparatuses and other uses of digital technology, the ability to control technical interfaces and collect, store, share data via voice is becoming a new technology standard in healthcare, businesses and homes.
Demands Of Clinicians And Healthcare Provider Organizations
As Amazon Transcribe Medical’s launch plans unfold, doctors, nurses and other clinicians, as well as healthcare administrative staff, will be eager to learn more about it. Amazon will be busy not only educating the market about it but also incorporating additional attributes into it to fulfill customer requirements and stay ahead of competitors. Companies like Microsoft, Google and others will spur their efforts to develop their own solutions to blunt momentum Amazon may build from the start.
Patient Information Data Companies
Allscripts, Cerner, Epic, Meditech and other EHR / EMR companies will have demands put on them by their customers in order to be able to accommodate VRT and transcription technology applications from Amazon and other organizations or develop equally sophisticated or better solutions of their own.
Unique Opportunities English-Speaking And Non-English Speaking Nations And Communities
For all players in the voice medical transcription space, there will be a race to develop solutions that accommodate multiple languages including regional dialects. Healthcare is a universally global industry and a great way to drive user adoption and sales revenue is to be able to market solutions in primary and secondary markets as well as emerging markets and third world nations.
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Novartis' latest acquisition drives the company into the center of an enormous healthcare sector with deep competition
Novartis ( NYSE: NVS) has announced it is acquiring cardiovascular therapy-focused The Medicines Company ( NASDAQ: MDCO ) for $9.7 billion. Novartis, based in Basel, Switzerland covets The Medicine Company’s “Inclisiran” agent; a small interfering RNA (siRNA) PCSK9 drug compound being evaluated for its promising ability to lower low-density lipoprotein (LDL) cholesterol ( also known as LDL-C or “bad cholesterol” ). It is not on the market yet but appears to be well-positioned for approval by regulators and is expected to have a favorable administration schedule of just 2 doses annually.
The cholesterol pharmaceutical market is thick with brand and generic competition from an array of heavy hitters
With the exception of Livalo and Praluent, each of these products are available through generic pharmaceutical manufacturers; some have been prescribed for decades:
- Alirocumab ( Praluent - Sanofi / Regeneron - no generic )
- Atorvastatin ( Lipitor - Pfizer )
- Fluvastatin ( Lescol - Novartis )
- Lovastatin ( Mevacor - Merck )
- Pitavastatin ( Livalo - Kowa - no generic )
- Pravastatin ( Pravachol - Bristol Myers Squibb )
- Rosuvastatin calcium ( Crestor - AstraZeneca )
- Simvastatin ( Zocor - Merck )
Novartis is a worldwide healthcare leader
Novartis is a Fortune 500 company ranked at 201. It generates approximately $52 billion in annual sales and employs overs 125,000 workers. Its top ten products each generate over $1 billion annually in sales:
- Affinitor / Votubia ( palbociclib )
- Cosentyx ( secukinumab )
- Galvus ( vildagliptin )
- Gilenya ( fingolimod )
- Gleevec ( imatinib )
- Lucentis ( ranibizumab )
- Promacta / Revolade ( eltrombopag )
- Sandostatin ( ocretride acetate )
- Tafinlar w/ Meknist ( dabrafenib + trametinib )
- Tasigna ( nilotinib )
The Medicines Company is a clinical development company with a strategy centered on researching compounds that have fallen short of expectations and not able to meet approval standards by the Food and Drug Administration and other regulators in earlier commercial product development ventures. They revisit the data and assess options to refine certain product attributes as well as clinical trial designs and related approval trial processes to determine if a product can be reinvestigated, entered into clinical trials once again and perhaps be approved.
Novartis planning for the future
Coincidentally, Novartis ( formed from the merger of Ciba-Geigy and Sandoz ) with a market capitalization of approximately $207 billion and The Medicines Company were both founded in 1996. Novartis has two primary business units:
- Innovative Medicines ( which will house Inclisiran if it is approved )
- Sandoz ( Sandoz manufactures generic and biosimilar or biogeneric products)
Novartis has been assertively working on transforming their organization into a pure pharmaceutical / biotech company. Earlier in 2019, Novartis spun off their blue chip consumer product brand, prescription drug and contact lens eyecare unit, Alcon, into a fully independent company ( NYSE / SXC: ALC) with a market capitalization of $28 billion. In 2018 it sold off its 36.5% stake in a consumer health product joint venture to their partner, GSK, for $13 billion.
Novartis a global player in billion dollar acquisitions
Mergers and acquisitions are almost routine in the healthcare industry. Novartis is well versed in the exercise. Some of their largest deals include:
- In 2018 Novartis made two acquisitions; AveXis for $8.7 billion and Endocyte for $2.1 billion
- Genzyme was bought by Novartis for $21 billion in 2011
- In 2008, Novartis began acquiring Alcon from Nestle for almost $60 billion in two separate transactions.
- Chiron was purchased by Novartis in 2006 for $5.1 billion
- Novartis bought Hexal AG for $8.3 billion in 2005
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SANOFI IS A GLOBAL LEADER IN PRESCRIPTION DRUG AND CONSUMER HEALTHCARE PRODUCTS
Global pharmaceutical leader Sanofi S.A. ( NASDAQ: SNY ) is reportedly weighing options to make significant changes to its commercial organization and its consumer products business unit. Based in Paris, France, Sanofi stands in the upper ranks of the world’s top 10 pharmaceutical companies based on revenue. Employing over 100,000 workers, it generates over $42 billion in annual sales and is ranked at #288 in the Fortune 500. There is speculation in the investor, healthcare and consumer product business communities that Sanofi may form up its consumer products business unit as a separate spinoff or enjoin it through a partnership with another company.
SANOFI CONSUMER PRODUCTS DIVISION
Sanofi’s consumer products division is sizable; its annual sales are just over $5 billion. It has an established portfolio of familiar over-the-counter ( OTC ) and health and beauty ( HBA) brand products including:
- Gold Bond
- Selsun blue
Based on its $5 billion dollar annual sales and brand franchises' worth along with associated assets and liabilities, it is estimated Sanofi’s consumer business unit could be valued as high as just over $30 billion as a standalone company. Spinning the consumer products unit off or engaging in a partnership with another company could reduce costs and free up cash for Sanofi to invest in other parts of its organization.
SANOFI CORPORATE STRUCTURE
Worldwide Sanofi has 75 manufacturing sites based in 33 different countries. Their leading markets are the United States, Europe and Asia. They organize their commercial enterprise based on 5 divisions:
- General Medicines and Emerging Markets
- Specialty Care ( Sanofi Genzyme )
- Vaccines ( Sanofi Pasteur )
- Diabetes & Cardiovascular
SANOFI'S CLINICAL AND COMMERCIAL GLOBAL MARKET PRESENCE REMAINS FORMIDABLE WITHOUT CONSUMER BUSINESS UNIT
Whether Sanofi spins off or enters a partnership with its consumer products division, it will have plenty of options to reinvest income generated from it. Sanofi’s non-consumer, prescription drug and biotech businesses span brand and generic formulations for rare diseases, oncology, hematological disorders, neurology, immunology / vaccines, cardiovascular and endocrinology. Some of Sanofi’s top prescription drug products are:
- Lantus / insulin glargine ( diabetes care / endocrinology )
- Aubagio / terifluonide ( multiple sclerosis / neurology )
- Lovenox / enoxaparin sodium ( anticoagulant / cardiology )
- Plavix / clopidogrel ( coronary artery disease, peripheral artery disease / cardiology )
- Toujeo / insulin glargine ( diabetes care / endocrinology )
SANOFI'S MULTI-BILLION ACQUISITIONS AND SALES
Sanofi has been steadily reforming its business model to build up its brand pharmaceutical and advanced healthcare product operations. The plans for the potential sale or spinoff of the consumer health unit aligns with their ongoing strategy. These are deals Sanofi has orchestrated in the last ten years:
- Baxter acquires Sanofi's Biosurgery Seprafilm product franchise for $350 million cash in 2019
- 2018: Ablynx, a nano antibody biotech company, is acquired by Sanofi for $4.8 billion
- 2018: Bioverativ, a hemophilia drug developer, is bought by Sanofi for $11.6 billion.
- 2018: Sanofi sells its generic drug unit Zentiva to private equity concern Advent International for $2.2 billion
- 2011: Sanofi acquires biotech leader Genzyme for $20 billion
Sanofi may use the proceeds generated from the offloading of the consumer products unit to pay off debt, invest more in existing pipelines or conduct additional acquisitions. Sanofi's market capitalization is roughly $117 billion and its debt load is just under $28 billion; jettisoning some of this burden would brighten its balance sheet.
Sanofi has been actively involved with fortifying the consumer products business unit. In 2017 it offloaded its animal health unit to Boehringer Ingelheim in a swap deal for their consumer products division valued at $20 billion. A joint-venture with another company would enable them to continue to collect revenue from its consumer brands while putting more focus on biotech, prescription drug and other advanced therapies ( it is also conceivable Sanofi could choose to sell the consumer unit outright to another company). The advantages of a spinoff arrangement are Sanofi could partition the consumer unit away from their organization, benefit from the initial sale of shares and also choose to be a shareholder in the new organization.
Sanofi is believed to be meeting with investment bankers plus other advisors and consultants to determine which option is best for them. No companies have emerged thus far as potential candidates for Sanofi to partner with or have expressed interest in buying the consumer unit outright.
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A strategic succession of executive leadership at Abbott
After 21 years as CEO, legendary pharmaceutical, diagnostic and medical device merger & acquisition strategist and corporate leader Miles White is handing over the reins of Abbott to his planned successor, Robert Ford, Chief Operating Officer and President of Abbott, Inc.
Stanford University and McKinsey alum
Miles White, born in Minneapolis, Minnesota, launched his brilliantly dynamic career beginning with his graduation from Stanford University ( Bachelors in Mechanical Engineering, 1978 and MBA, 1980 ) then signing on at the New York based blue chip management consulting firm McKinsey.
Abbott Laboratories, Inc.
White joined Abbott Laboratories in 1984 and rapidly ascended through the ranks to the senior leadership position of CEO and chairman of the board by 1999.
Once at the helm of Abbott, Miles moved forward with a series of strategic deals which re-shaped the global pharmaceutical, medical device and diagnostic industries.
Abbott acquires Knoll Pharmaceutical from BASF
In 2000 Abbott bought Knoll Pharmaceutical from German chemical and industrial conglomerate BASF ( OTCMKTS: BASFY ) for $6.9 billion. This deal was instrumental in Abbott and eventually spinoff AbbVie’s growth as it included the now multi-billion dollar blockbuster drug Humira (adalimumab - a TNF blocker). Humira’s worldwide annual sales have been as high as $20 billion. White outmaneuvered front-runner Eli Lilly ( NYSE: LLY ), as well as Bristol-Myers Squibb ( NYSE: BMY ) and Sanofi-Synthelabo ( NASDAQ: SNY ) who were also considered front-runners seeking to acquire Knoll.
It is something to contemplate how the growth paths of these 3 companies would have evolved had they acquired Knoll or how Abbott would have progressed without Knoll. A further consideration would be how BASF would have succeeded had they not sold Knoll. Humira's commercial success was not guaranteed, undoubtedly Abbott's and White's pharmaceutical business savvy which was carried forth and enriched by AbbVie's strategic capabilities enabled Humira to hit the ground running following its launch with effective market access strategy, a succession of additional FDA approved indications and sales drive outpacing competitors.
Abbott spinoff Hospira acquired by Pfizer
Moving on from the Knoll deal, White formed up Abbott’s older hospital products unit into a separate commercial organization that became the Abbott spinoff company known as Hospira ( NYSE: HSP ) in 2004. When it was introduced as a public company, Hospira had 14 manufacturing plants and sales of approximately $2.5 billion. Hospira was acquired about 11 years later for $17 billion by Pfizer ( NYSE: PFE ) in 2015.
MediSense diagnostic and blood glucose monitoring deals sets the stage for Abbott's long term success in global diabetes care
A second significant corporate maneuver was launched by White in 2004 as Abbott acquired diagnostics and blood glucose monitoring company MediSense for $1.2 billion. Quickly glancing ahead, Abbott and White transformed the MediSense acquisition with its FreeStyle and related product franchises into becoming a global leader in blood glucose monitoring despite numerous low cost competitors entering the sector.
MediSense's primary competitors in the diabetes care space, formidable global healthcare companies to say the least, did not fare so well. Johnson & Johnson ( NYSE: JNJ ) exited the diabetes care business by selling off their LifeScan diabetes unit in 2018 through a private equity deal to Platinum Private Equity. Germany-based Bayer ( OTCMKTS: BAYRY ) sold their Contour diabetes care franchise to private equity firm KKR and Panasonic Health in 2015. Switzerland based Roche (OTCMKTS: RHHBY ) significantly downsized its Accu-Chek diabetes care business unit between 2014 and 2018.
Kos Pharmaceuticals acquisition and the unorthodox deal with Boston Scientific to buy Guidant assets
Following the Knoll and MediSense acquisitions plus the Hospira spinoff; Abbott was back in the acquisition saddle by acquiring Kos Pharmaceuticals for $3.7 billion in 2006. Based on this buy, Abbott fortified their cardiovascular health oral pharmaceutical portfolio with two cholesterol agents, Advicor and Niaspan, which aligned well with Abbott's triglyceride product TriCor.
White and Abbott executed a finesse asset deal in 2006 when Boston Scientific acquired Guidant, a producer of cardiac pacemakers, implantable cardioverter-defibrillators, stents and other cardiovascular medical technology. Abbott purchased the vascular intervention and endovascular businesses from Boston Scientific and agreed to share the rights of Guidant's drug-eluting stent programs with Boston Scientific. Abbott paid Boston Scientific $6.4 billion in an arrangement comprised of $4.1 billion for the Guidant assets, a loan of $900 million plus Abbott acquiring $1.4 billion of Boston Scientific common stock. While it was an unconventional arrangement it allowed for Boston Scientific and Guidant to close their deal and avoid antitrust issues with regulators while Abbott was able to secure specific elements of Guidant's product line that it coveted.
GE and Abbott Diagnostics deal unravels
In 2007 White encountered headwinds as a proposed $8.13 billion deal to sell two diagnostic units ( in-vitro diagnostics and point-of-care) to GE fell through. White had partitioned the diabetes and molecular diagnostics businesses away from the transaction as they had more clinical and commercial upside in their future for Abbott to benefit from. Since GE and Abbott mutually agreed to walk away from the deal, no breakup fees were involved.
Advanced Medical Optics
Undaunted by the shortcomings of the GE deal, Abbott acquired Advanced Medical Optics or $1.4 billion in 2009. The deal instantly made Abbott a leading player in optical healthcare as Advanced Medical Optics was one of the top companies in Lasik laser vision surgery technology and cataract surgery lenses.
Solvay and Piramal acquisitions
White continued to outdistance the GE deal setback quickly with Abbott acquiring the pharmaceuticals business of Belgium-based Solvay Group for $6.6 billion in 2010. This deal was followed up by another acquisition in 2010 as Abbott bought Piramal Healthcare’s Health Solutions unit for $2.2 billion. As a result Abbott effectively became the largest pharmaceutical drug manufacturer in India.
At this point in Miles White’s vigorous tenure at Abbott he had completed an array of multi-billion deals that expanded the depth and width of the company’s marketplace and competitive scope. Moving forward from 2010 it became clear he was just getting started.
Creation of Abbott spinoff AbbVie in 2011
In October 2011, Abbott made a strategic decision to partition itself into two distinct commercial organizations, Abbott and AbbVie. Abbott’s business model would consist of diagnostics, medical devices, generic drugs and consumer products. AbbVie would be a pharmaceutical and biotech research and manufacturing enterprise that was launched as a publicly traded company in 2013 ( NYSE: ABBV ). Miles White would continue as the senior leader of Abbott while longtime Abbott corporate executive Richard Gonzalez would lead the new AbbVie corporation. AbbVie has moved forward with numerous deals of its own including its latest acquisition of Allergan for $63 billion in 2019.
Kalo Pharmaceutical and Russian drug company Veropharm acquisitions, Abbott Animal Health sale
White picked up the pace in deals again during 2014 in terms of buying and selling assets. In quick succession Abbott, retaining its NYSE symbol moniker “ABT”, acquired CFR Pharmaceutical Kalo Pharma Internacional S.L. for $2.9 billion and Russian drug manufacturer Veropharm for $410 million. This deal included three manufacturing facilities in Russia for Abbott to establish a presence in this enormous limited market access nation. On a smaller yet still strategic scale, Abbott sold off its animal health unit to Zoetis for $225 million in 2014.
Alere and St. Jude Medical acquisitions in 2016
White kept the pedal to the metal in mergers and acquisitions for 2016 as Abbott picked up Alere for its rapid point of care diagnostics products aligned with infectious disease, molecular, cardiometabolic, toxicology and other patient testing for $5.8 billion.
Abbott moved forward with another buy in 2016 that was almost 5 times the size of the Alere deal by acquiring St. Jude Medical for $25 billion. St. Jude was primarily built up as a company through a string of more than 15 acquisitions dating back to 1976. Its portfolio included patient care products such as implantable cardio-verter defibullators (ICD); pacemakers; electrophysiology catheters; vascular closure products structural heart repair products and neurostimulation devices as well as diagnostic and testing products for cardiac mapping and visualization systems; optical coherence topography (OCT) imaging systems and other medical technology.
Sale of Abbott vision care unit
Sharpening its business focus further, Abbott sold their vision care unit to Johnson & Johnson for $4.3 billion in 2017. Abbott had built up the vision care business with its acquisition of Advanced Medical Optics for $1.4 billion in 2009.
As chairman of the board, Miles White will still have an important role in Abbott’s affairs. As successor, Robert Ford is at the helm of a global healthcare juggernaut which White has grown from a $75 billion company into a $149 billion enterprise. As the future unfolds, patients, medical professionals, Abbott employees and investors will be expecting more great things from Ford's and White's leadership.
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Another vaccine breakthrough by Merck
Merck ( NYSE: MRK ) has announced its Ebola vaccine, Ervebo, has been approved by European regulators.
The product, which has already been deployed in its investigational format in the Democratic Republic of Congo ( DRC ), was cleared by Europe’s “Committee For Medicinal Products for Human Use ( CHMP )" and will be manufactured in Germany. Merck anticipates it will be able to start shipping Ervebo product to customers by the 3rd quarter of 2020.
Ervebo’s journey from development to approval
The development of Ervebo was a clinical research and product licensing journey. Canada’s National Microbiology Laboratory was the original developer of the immunization which it then licensed to NewLink Genetics of Ames, Iowa. When the 2014 Ebola outbreak was triggered, Merck licensed it and went to work on further developing the vaccine along with other collaborators.
Ervebo is an advanced product that is the result of rigorous research and development efforts. It is genetically engineered to express a glycoprotein from the Zaire ebolavirus so as to provoke a neutralizing immune response to the Ebola virus. Merck was able to not only fully prove the efficacy of the immunization but also demonstrate its ability to mass produce it at premium quality levels to assure reliability and safety of the product.
Until full commercial production is underway, the prototype / investigational formulation of the vaccine will continue to be deployed in Congo which has a population of about 92 million people through oversight by the U.S. Federal Government, World Health Organization ( WHO ) and vaccine alliance GAVI. Ervebo requires the administration of only one injection for it to be effective; another investigational Ebola vaccine being distributed in Congo to counter the Ebola outbreak is produced by Johnson & Johnson and requires two injections.
The U.S. Food and Drug Administration expects to review the product for potential approval to be used within the United States during the first half of 2020.
Ongoing Ebola outbreak threat
Why and how Ebola is such an enormous health threat
Ebola Virus Disease ( EVD ) is an uncommon and deadly disease in people and nonhuman primates. Viruses causing EVD are found primarily in sub-Saharan Africa. People can get EVD through direct contact with an infected animal (bat or nonhuman primate) or person; including the dead bodies of EVD victims.
Ebola virus has a harmful and often fatal impact on the ability for blood to clot. This condition is described as hemorrhagic fever virus as the clotting disruption it causes leads to internal bleeding from blood leaks in the small blood vessels of the body.
The Ebola virus creates further issues as it causes severe inflammation and tissue damage. Due to being so deadly as well as contagious, Ebola is a major challenge for the individuals it infects and furthermore is a ruthless danger for caregivers and medical professionals who not only care for the Ebola patients but must also take thorough precautions to protect themselves.
Ebola's Deadly History
The Ebola virus was initially discovered in 1976 near the Ebola River in DRC. Over the last 40 years, there have been several severe Ebola outbreaks. Previous to the current outbreak ( which is now ranked as the second worst to date) the West African Ebola epidemic resulted in about 30,000 EVD cases and more than 11,000 deaths between 2014 and 2016.
Merck is a global leader in vaccine / immunization development
The commercial development of Ervebo is another vaccine development victory for Merck who has had a long standing commitment to global vaccine development. Its HPV STD and Oncology vaccine, Gardasil, has saved millions of lives and generated considerable savings for consumers, medical professionals and payers.
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A pivotal element in global healthcare marketing initiatives
The global healthcare marketplace continues to evolve. Pharmaceutical manufacturers, medical device manufacturers and healthcare service companies have promising opportunities through emerging markets. These patient / customer bases are multiplying in population and in financial resources generating a greater demand and means for better healthcare.
Seeking new revenue streams dependent upon regulatory, clinician and payer factors
Pharma, device and health services firms, always seeking growth and new revenue streams, can look to these regions and countries to extend their reach and boost bottom lines. Comparatively speaking, many of these markets are experiencing exponential population and financial growth while numerous North American and European markets have matured and have slowing, flat or regressing clinical and commercial opportunities. Further challenges are presented by well-entrenched incumbent competitors able to maintain more than their “fair share” of the market.
Key growth drivers in emerging markets
A combination of factors improves the alignment of potential for growth of clinical and commercial opportunities in emerging markets. They include these and other developments:
- Commercial vibrancy based on greater import / export activity
- Political stability
- Improved educational resources
- Domestic / international academic healthcare interests
- Domestic businesses partnering with outside commercial organizations / investors
- Diversified economies expanding beyond agriculture and basic manufacturing
- Better access to information and technology via Internet, wireless, mobile
Changing healthcare needs
As emerging markets evolve, their healthcare challenges and requirements develop new characteristics. They encompass these and other factors:
- Birth rates climb and life expectancy lengthens
- Legacy illnesses / disease native to specific locales and regions decline but remain a threat in rural or remote areas
- New diseases and health challenges emerge based on a higher quality of living including alcoholism, diabetes, hypertension, obesity, sexually transmitted diseases
- Increasing populations increasing strain on metropolitan living / sanitary conditions and surrounding natural resources
Examples of emerging market nations / regions
Multiple continents and geographic centers host emerging markets. The primary emerging market leaders ( listed alphabetically ) are:
- South Africa
- South Korea
Setting the stage for clinical and commercial success
In established or emerging markets, growing from scratch or expanding from a sliver of market share and sales can be daunting and costly. By identifying and accounting for hurdles upfront, it’s easier to avoid bottleneck delays and cost overruns to maintain momentum. Strategic preparation focused on the specific attributes of a new market instead of a generalized approach will enable you to develop the necessary building blocks to succeed as your competition struggles.
Prioritizing the right potential markets from the start
The array of emerging markets requires selectivity and alignment according to your organization and its products or services. Prioritizing the best ones increases your chances of success and establishes a base of experience and education to succeed in future ones. Assuming commercial viability of your product or service has been confirmed based on these considerations; these are 6 pillars of strategy to build your growth on.
Pillar One: Embrace the regulatory environment, structure and process
Nations and regions have their own way of governing clinical and commercial healthcare activities within their borders. Do not assume your teams can learn on the go. Be certain you have staffed up with persons who have experience in the specific market you are centered on and have existing contacts within regulatory agencies, provider organizations and supply chain entities. This helps assure you navigate the approval process and can speed forward into the market once your offering receives clearance.
Pillar Two: Understand patient care topography
Treatment protocols and access to care can differ greatly within the boundaries of even small nations. Neglecting to engage even one or two centers of care like a remote hospital or clinic can cost you hundreds or even thousands of patients. If those entities are missed, your losses could multiply if their patient base expands due to marketplace growth changes and competitors exploit your errors. Stratify points of care and their nuances:
Be cognizant that an area can robustly change based on investment in manufacturing, shipping or other commercial activity. New business opportunities quickly attract new workers with healthcare needs to their locales
Pillar Three: Familiarize yourself with clinicians, protocols, customs
Established nurses, doctors, pharmacists and other members of the healthcare provider community need to be consulted early and often. This will accelerate your learning curve and help these future customers become intimately familiar with your company, its products and services and increase their comfort level. Do not rely on assumptions, syndicated reports or second-hand “expert” knowledge to base your strategy and tactics on. Even small disconnects will leave gaps competitors will fill quickly.
Be prepared that “new” is not always immediately perceived as better. Certain drugs, medical devices and procedure protocols have been in place for decades in many emerging markets. Think simplicity, utility and economy; generic drugs, basic devices, outdated apparatus and equipment retrofitted for improvised use to make do with whatever was available at the time and thus has become the standard for care.
Effectively introducing new therapies, devices and equipment accompanied by new methods takes time and money. Engaging the key clinician stakeholders and accounting for their personal, professional and organizational personas will make for a more productive introduction and quicker acceptance of your offerings. Distinct care, cost and overall outcome advantages must be featured in a value proposition meeting the requirements of each emerging market you enter and the decision making stakeholders involved.
Pillar Four: Unconventional or restrictive distribution and procurement processes
Emerging markets have their own unique ways to facilitate the flow of goods and services into and through points of care. Reflect on how wholesalers, distributors, suppliers, GPOs, dealers and other supply chain, logistics and trade relations entities differ within cities, states, nations and regions in established markets. This goes for evaluation, procurement, materials management and requisitioning processes and procedures within healthcare provider organizations. The primary difference is your organization has become familiar with these channels and routines.
You will now have to repeat this process in an emerging market. Be certain to act on it quickly because your competitors could thwart your success early on if they adapt earlier than you. The sooner you accept and adjust your processes in accordance with the emerging market’s structure and material flows the better your operations will perform and ease the way for customers to use your products and services.
Pillar Five: Contracts and pricing
While emerging markets usually possess a surge in economic prosperity, do not assume this translates to a maximum in your margin ask. It is also necessary ( and this should have been a part of your emerging market commercial viability assessment ) to understand the contracting, pricing, exclusivity and other features within each emerging market you choose to enter. The similarities between emerging markets may seem to mirror each other but even one financial requirement or clinical mandate may disadvantage your marketing, sales and pricing strategies from the start.
Supply chain players and provider organization processes aside, knowing the payer landscape inside and out for each emerging market you choose to enter is a pivotal advantage. By possessing this, you have the opportunity to lock in a new market with the assurance your products and services will flow freely in the direction of your customers and their payments back to you will be just as smooth.
Government-sponsored healthcare can be a norm in emerging markets you will have to account for. As emerging markets develop, government healthcare programs may improve while conventional payer business models become more common as outside companies establish their presence and introduce benefits plans to workers plus organizations native to the marketplace modernize their healthcare offerings. Updated or new healthcare plans offered by insurance carriers or employers will still need to meet the cost, coverage and feature requirements of government regulators.
Improvement of government payer healthcare benefits and the presence of more commercial healthcare insurance plans entering an emerging market are good building blocks to center market access contracts and pricing strategies on.
Pillar Six: Maximize competitive immunity
Throughout development and execution of your market access strategy, continually refine and reinforce your competitive position. Emerging markets are attractive to all players; many will deploy all means necessary to enter them including drastic price plays, unrealistic guarantees and other measures. Anticipate these threats from the start and be certain your contracts are well-secured and have sound contract extension / renewal strategies in place to minimize opportunities for competitors to penetrate your established base of market share and sales. Monitor government or provider policy changes that may disadvantage your position and move in advance to rectify any weaknesses these create.
Taking the journey into emerging markets can be a rewarding venture by avoiding the mistake of focusing too much on the raw potential of a new opportunity and not centering on intricacies involved to assess, develop and maintain successful market access strategies and tactics from the beginning. Launching a product or service in an established or emerging market can be costly and risky no matter how innovative they are. It is important the resources allocated to entering emerging markets ( time, money, staff and other provisions ) are deployed efficiently and effectively to minimize waste and maximize traction.
In emerging markets, it is imperative to account for the customs, needs and requirements of regulatory gatekeepers, logistical channels, clinical and commercial stakeholders to formulate an effective market access strategy -and do it better than your competition.
LinkedIn: John G. Baresky
Twitter: Healthcare Marketing Guy
A substantial private equity play
Reportedly Walgreens ( NASDAQ: WBA ) is exploring options to take itself private. Officially known as Walgreens Boots Alliance, the global pharmacy and consumer healthcare leader going private would create one of the largest leveraged buyouts in history.
A consumer retail, pharmacy, healthcare services, supply chain leader
Taking Walgreens private may involve an estimated range of $50 billion to $60 billion to execute the transaction. Most of the company’s global scope and scale are overlooked by consumers and even those in the healthcare sector:
- Founded in 1901, their present CEO, billionaire Stefano Pessina, owns about 16% of the company
- On a daily basis, Walgreens interacts with over 8 million customers in stores and online
- They operate more than 9,000 stores in the United States and more than 13,000 units worldwide in 11 countries.
- Walgreens owns 28% of AmerisourceBergen ( NYSE: ABC); one of the world’s largest drug wholesalers
- They are a minority share owner of Option Care Health; one of the largest home infusion providers in the nation servicing patients in all 50 states and administers over 2 million doses of various IV therapies per month
- About 78% of the population in the United States lives within 5 miles of a Walgreens store or a Walgreens-owned Rite Aid or Duane Reed store.
- Walgreens has an active partnership with Blue Cross Blue Shield affiliated prescription benefit manager Prime Therapeutics known as AllianceRx Walgreens Prime
- The company has select business collaborations underway with grocery retail giant Kroger ( NYSE: KR )
The company recently announced a corporate cost cutting initiative with a goal of $1.8 billion in expense reduction by 2022 -an amount that was increased from an original objective of $1.5 billion.
One portion of it consists of closing about 40% of its in-store clinics as it initiates new strategies to boost profitability. The clinics selected to close are those which are operated by Walgreens. The remaining store-based clinics operated through partnerships with healthcare provider organizations such as hospitals or healthcare systems will remain open. About 150 clinics are impacted by this and slated to be closed by the end of the year. Over 200 clinics will continue to run through the existing healthcare provider partnerships.
Opportunities to partner with an industry leader
This announcement triggered hospitals, health systems and other healthcare provider organizations located near the units with clinics designated to be closed to inquire about taking over those operations. TriHealth, a 5-hospital healthcare system in Cincinnati, Ohio has already moved forward for the opportunity to operate 7 of the in-store Walgreens clinics in their area.
Investment required for a Walgreens Boots Alliance private equity deal may involve several players
The estimated $50 billion to $60 billion required to take Walgreens private is quite a large sum. It is likely more than one investment firm would be needed not just for the funding but to share some of the risk involved. Private equity firm KKR already has a stake in the company from past deals with the organization. A key consideration in taking the company private is managing its current debt load which is about $17 billion. Reportedly Walgreens is working with investment banking advisement firm Evercore to assess what is involved to proceed further.
Does the prospect of Walgreens going private trigger someone else to buy them?
Based on its many attributes, Walgreens is an extraordinarily valuable company and potentially a target for another type of ownership change. It generates over $136 billion in annual sales. Conceivably another company could make a run at acquiring Walgreens before they went private. Key considerations for another retailer to buy Walgreens would include the financing of the deal itself, integrating the new organization and assuring profitability while servicing their existing debt and the new debt of the deal --which would have the added burden of Walgreens' existing $17 billion debt load.
Unique potential that demands a solid suitor
It is very unlikely their largest retail pharmacy rival, CVS, to even consider acquiring them based on antitrust issues and their recent acquisition of insurance company Aetna but there are several other potential buyers to think about.
Despite Walgreens' debt load and the scale of a deal, their consumer retail and pharmacy business savvy plus technology and logistics leadership are undeniably platinum assets not to mention excellent store locations and large share ownership of AmerisourceBergen.
Largest contenders would have to confront enormous operations and financial challenges
On the surface, there are some big retail and online players to consider. Once the fiscal and organizational details are looked at more closely, only a small number of companies are viable contenders:
Amazon is a viable long shot but several factors must be considered. They generate about $233 billion in annual sales. They are not acquisition or risk adverse. Walgreens would give them direct penetration into numerous retail markets and access to millions of everyday consumers and prescription drug customers. Amazon has already stepped out of its online-only business model through its acquisition of Whole Foods in 2017 for $13.4 billion and opening of Amazon Go stores. Walgreens stores gives them a strategic storefront presence without having to commit to larger retail footprints like grocery outlets or mass merchandisers. The Walgreens store concept is based on walk-in consumer convenience as are Amazon Go stores.
Amazon is seeking to widen its business in healthcare and fortify its PillPack unit. A Walgreens deal would be gargantuan even for them. It offers incredible opportunities as well as challenges which makes it conceivable for Amazon to at least mildly consider.
Kroger is currently collaborating with Walgreens on a few initiatives. Kroger recently announced it was moving forward with cost cutting initiatives. The combination of Kroger, the nation’s largest grocery chain, and Walgreens would be a formidable tandem. Kroger is the world’s third largest retailer with over $119 billion in yearly sales; they trail only Walmart and Costco Wholesale. Their combination is viable; it would reasonably diversify and complement their existing business models and customer bases.
Netherlands-based Ahold could be another contender based on domestic and global market potential. Ahold operates stores in numerous global markets as well as the United States. Their annual sales are roughly $73 billion. Picking up Walgreens would widen their business model and add revenue streams to their bottom line in the U.S. and Europe but financially it's out of their reach.
Grocery chain Albertsons ( NYSE: ABS ) generates about $60 billion in annual sales. Their acquisition of Walgreens would be a stretch but enable them to broaden their organization beyond the grocery sector and give them exposure into more geographic markets. The financial scale of the deal even without the $17 billion debt load is not something Albertson's can consider in their plans.
Costco ( NASDAQ: COST ) produces over $142 billion in yearly sales could pull it off but may not be the best fit in their business model. Acquiring Walgreens would indeed diversify their business model which could be a primary reason for them not to explore a deal outside of the scope of where they have had such great success. It would indeed provide them opportunity to augment their overall presence in consumer health and pharmacy sectors. Such an extreme departure from their winning commercial formula has its pros and cons. Financially Costco could have the fiscal horsepower to undertake such a deal but likely not consider the rewards to be worth the risks.
Target Corporation ( NYSE: TGT ) generates about $75 billion in annual sales --its relationship with CVS a major hurdle to overcome. Buying Walgreens would be a significant hurdle for them financially and involve another sticking point. Target’s pharmacy units within their stores are owned / operated by CVS. If Target were to acquire Walgreens, the CVS pharmacy ownership arrangement would someway have to be undone. Target Corporation is not going to entertain an acquisition of Walgreens.
Walmart ( NYSE: WMT ) is an interesting and qualified prospect for numerous reasons. A number of former Walgreens pharmacy executive leaders are presently working at Walmart headquarters within the U.S. pharmacy business unit. Walmart generates over $514 billion in annual sales. Walmart and Walgreens have been dueling over consumer and pharmacy sales for years despite their differing big box versus chain drugstore business models. Walmart has experimented with smaller footprint stores to efficiently and profitably gain access to more retail customers. Buying Walgreens would give them that access plus bolster their consumer health and pharmacy business.
Undoubtedly antitrust concerns would come into play but there may be enough differentiation based on the pairs' big store / mass merchandiser and convenience retail / pharmacy organizations that regulators would approve the combination.
There is a lot for Walgreens, its competitors, investors and potential suitors to consider. Based on this lineup, Amazon Kroger and Walmart are potential suitors; Costco a runner up based on a presumed reluctance to tamper with its unique and successful business model. The attractiveness of a present-day opportunity to acquire Walgreens is great, the long-term commitments and challenges still have to be considered. A takeover by public or private entities requires the new ownership to undertake swift, strategic action to boost Walgreens profitability without disrupting day-to-day operations and whittle down its $17 billion debt load; a tough prescription to fill.
LinkedIn: John G. Baresky
Twitter: Healthcare Marketing Guy
Stryker continues to advance its position in medical device, orthopedics and health technology
Stryker Corporation ( NYSE: SYK ) is acquiring medical product manufacturer Wright Medical for $4 billion. Wright Medical ( NASDAQ: WMGI ) was started in 1950; it manufactures an array of products aligned with orthopedics including fixation and fusion systems designed for ankles, elbows, shoulders, toes and wrists.
Wright Medical and Stryker overview
Wright's U.S. headquarters is located in Memphis, Tennessee; global operations are orchestrated in Amsterdam, the Netherlands and London, UK.
Stryker Corporation, founded in 1941 and based in Kalamazoo, Michigan, produces numerous categories of products used throughout the healthcare sector including implants used in joint replacement and trauma medical procedures; surgical equipment and surgical navigation systems; endoscopy and communications systems; patient handling and emergency medical equipment. Stryker also manufactures neurosurgical, neurovascular and spinal devices plus a variety of other healthcare specialty products.
Acquisitions a key element in Stryker's growth
Mergers and acquisitions continue to be a go-to strategy in the medical device and pharmaceutical healthcare industry sectors to catapult growth and reduce costs. Stryker acquired Mobius Imaging and Cardan Robotics in September, 2019, for $500 million. Since 2016, Stryker has spent over $12 billion to acquire these and other companies:
- Entellus ( $664 million )
- Hygia Health Services
- HyperBranch Medical Technology ( $220 million )
- K2M ( $1.4 billion )
- Mobius ( $500 million )
- Orthospace ( $220 million )
- Patient Safety Products
- Physio Control ( $1.28 billion )
- Sage Products ( $2.8 billion )
Stryker a robust contender in the Fortune 500 and healthcare business sector
Stryker continues to climb in the Fortune 500; currently ranked at #233 and employs over 36,000 persons. The combination of Stryker’s and Wright Medical's products will form a robust portfolio of devices, implants, equipment and technology for hospitals, health systems, surgery centers and other medical provider organizations. Their competitors include:
- Catalent ( NYSE: CTLT )
- DJO Global ( privately held )
- Getinge ( OTCMKTS: GNGBY )
- Hillrom ( NYSE: HRC )
- Johnson & Johnson ( NYSE: JNJ )
- Medline ( privately held )
- Medtronic ( NYSE: MDT )
- Smith & Nephew ( NYSE: SNN )
The two organizations expect to finalize their transaction by mid-2020 pending final approval by each organization and regulatory agencies.
LinkedIn: John G. Baresky
Twitter: Healthcare Marketing Guy
Far reaching effects of Measles
The results of two clinical studies centered on the lasting effects of the Measles virus reinforce the importance of immunization and other preventative measures. There is evidence the Measles virus not only exerts the symptoms of its illness upon those it infects but advances further into human immune cells and tampers with their “memory” attributes which can lessen their ability to rearm themselves and defend against other infections.
The two studies are:
Measles more complex than most realize
A pivotal concern with Measles is its impact upon children and their ongoing health as they mature through adolescence and into adulthood. The data indicates children infected by the Measles will possess weakened immune systems following their recovery from the disease. Further study will be required to learn more about how long and how severe post-Measles weakened immune systems persist.
The concept of immune cells losing their ability to fight infection has been referred to as “immune amnesia”. Measles beats up on white blood cell counts but even as a person recovers, their system remains compromised for an undetermined amount of time. The studies indicate immune systems retain their sensitivity and defensive response to Measles to prevent re-occurrence of Measles infection but lose their ability to recall the defensive postures developed over time to ward off other infections they have encountered.
Global emergence of Measles is a critical challenge
Unfortunately, for a variety of reasons, the World Health Organization ( WHO ) has estimated the incidence of Measles on a global scale has increased by 280%.
The United States is entering Flu season --yet the challenge of Measles is still underway:
- From 1/1/2019 to 10/1/2019, a total of 1,249 measles cases and 22 measles outbreaks were reported in the United States
- The numbers are critically important as they are the most cases reported in the United States within a single year since 1992 --and the second highest ranking number of reported outbreaks annually since measles was declared "wiped out" in the United States in 2000
- Among the 1,249 measles cases reported in 2019, 1,163 (93%) were associated with the 22 outbreaks, 1,107 (89%) were persons who were not vaccinated or had an unknown vaccination status --and 119 (10%) measles patients were hospitalized
- The emergence of a surge has serious implications as there is true potential for cases to multiply quickly; it presents a large scale health threat that had been minimized through decades of medical research, pharmaceutical manufacturing expertise, rigorous immunization schedule planning and vaccine administration
- Assertive and consistent information sharing must be maintained through broadcast and social media, clinicians, healthcare regulatory agencies, payers / health insurers and consumers to erase misinformation about vaccine safety and the pivotal importance of immunizations prior to advance of outbreaks in Flu, Measles or other preventable disease
Clinicians, government and consumers taking action
Moving forward, it is important that parents, pediatricians and other medical professionals take assertive steps to be certain preventative care healthcare regimens follow the complete schedule of recommended immunizations ( unless clinically recommended otherwise ) and this includes the Measles vaccine. Please find below details about the Measles vaccine and other immunization recommendations from the Centers for Disease Control and Prevention:
Twitter: Healthcare Marketing Guy
UnitedHealth Group Embraces Telehealth
Telehealth continues to build momentum in the United States; and UnitedHealth Group’s acquisition of Vivify Health exemplifies this trend and will help drive it further. Vivify, based in Plano, Texas ( a suburb of Dallas ) centers on remote patient monitoring technology. It enables individuals to be monitored while they are home and as symptoms, vital signs and other variables change, healthcare providers can be notified. This can prevent emergency room visits as well as facilitate a nurse visit to the home of the patient to care for them before conditions progress to a more serious state.
Vivify's Patient Care Attributes
Vivify utilizes mobile, cloud-based information technology and its own suite of healthcare software applications which encompass these and other capabilities:
- Biometric data monitoring
- Personalized care plans
- Text-to-speech configured to the needs of each patient
- Video education and conferencing
Some of the patient care issues Vivify technology supports includes:
- Chronic Obstructive Pulmonary Disease ( COPD )
- Congestive Heart Failure
- Pain Management
- Weight Management
Vivify Deployed With Healthcare Provider Organizations
UnitedHealth Group’s Optum business unit orchestrated the deal. Vivify, which was founded in 2009, is used by these and other healthcare provider and service organizations:
- Alignment Health
- American Medical Response
- Ascension Health
- Children’s Hospital of Colorado
- Interim Healthcare
- Memorial Hermann
- Ontario Telemedicine Network
- SCL Health
- Shannon Medical Center
- Trinity Health
- University Health Network ( Canada )
- University of Vermont
- University of Pittsburgh Medical Center ( UPMC )
- Vanderbilt University Health
UnitedHealth Group's History Of Acquisitions
The acquisition of Vivify is part of UnitedHealth Group’s ongoing initiatives to change its business model. They are going beyond being a healthcare plan / healthcare insurance firm or managed care organization and building themselves out as a healthcare provider organization. Recent mergers, acquisitions and investments it has made include:
- Surgical Care Associates ( $2.3 billion )
- DaVita Medical Group ( $4.3 billion )
- Reliant Medical Group ( $28 million )
- Equian, a healthcare billing firm ( $2.3 billion )
- A hearing aid health insurance company and a sizable investment into a physician staffing firm
As other plans, such Anthem and Aetna, have chosen to expand their covered lives, conventional managed care plans and PBM units, UHC has chosen a different route. By acquiring medical practices and provider organizations, UHC has more direct influence on patient care, treatment protocols and costs associated with them.
UnitedHealth Group's Business Model Expands
Through adding SCA and the other medical provider organizations to their business model, it provides different streams of revenue for UHC. It also improves their position to negotiate rates with other health systems and care providers. While United Healthcare has a long way to go to reach the scale Kaiser Permanente has in terms of being a patient care services provider, its investments in the provider sector seem to indicate they have a long term plan to strategically grow the provider side of their business.
Terms of the Vivify Health transaction were not disclosed. As an integrated healthcare enterprise, Vivify and United Healthcare can develop their own proprietary telemedicine solutions according to their specific requirements which other health plans and provider organizations will have to coordinate with outside partners. The acquisition of Vivify adds a new resource dimension to UnitedHealth Group which it can deploy in its own healthcare provider organizations to save money while marketing it to existing Vivify Health customers as well as new clients to increase revenue.
LinkedIn: John G. Baresky
Twitter: Healthcare Marketing Guy
Part Of The Walgreens Boots Alliance New Business Strategy: In-Store Clinic Closings Plus Grocery, Weight Loss And Healthcare Provider Partnerships
Walgreens ( NASDAQ: WBA ) will close about 40% of its in-store clinics as it initiates new strategies to boost profitability. The clinics selected to close are those which are operated by Walgreens; the remaining stores operated through partnerships with healthcare provider organizations such as healthcare systems will remain open. About 150 clinics will be impacted by the new strategy and closed by end of the year. Over 200 clinics will continue to run through the healthcare provider partnerships. Walgreens was proficient at operating their company-owned clinics but was not satisfied with their profitability levels and prefers to allocate resources to other more profitable ventures.
In-Store Consumer Clinic Care
Advantages Of Partnering With Healthcare Systems
Health systems, for example Advocate Health Care System in the Chicagoland area, have benefited from operating clinics in Walgreens stores. They are an extension of care services provided outside of hospitals and help to retain patients within the health system’s realm for other medical needs in the future. For consumers, in-store clinics are all about convenient access to care and for Walgreens ( or other in-store clinic operators like CVS, Walmart, etc. ) they seek to pull more customers into their stores which helps drives pharmacy as well other sales throughout a retail unit.
In-Store Clinic Competition
As an immediate care provider, in-store clinics do face competition on several fronts. Competing health systems often own / operate care clinics and there are metropolitan and regional chains of immediate care clinics which compete for the convenience care needs of consumers. Telehealth is an emerging competitor in the convenience care space with services provided through kiosk terminals, smartphones and other digital platforms ( tablets, laptops, etc.).
CVS And Walmart Always A Threat
Competitors like CVS ( NYSE: CVS ) and ( NYSE: WMT ) have been making some big splashes lately. CVS acquired health insurer Aetna and operates clinics and pharmacies in its own stores as well as mass merchandiser Target ( NYSE: TGT) stores. Walmart is expanding its patient care business with pilot programs in their stores including featuring primary and urgent care, labs, x-ray and diagnostics, counseling, dental, optical and hearing services all in one facility.
Walgreens Has Ample Locations, Brand Recognition, Multi-National Presence, Several Business Units
Walgreens operates over 9,000 stores in the United States and overall just over 13,000 worldwide in 11 countries. They also own 26% of giant drug wholesaler AmericansourceBergen ( NYSE: ABC ) and a minority share owner of home infusion provider Option Care Health. 78% of the U.S. population lives within 5 miles of a Walgreens store (or Walgreens-owned Rite Aid or Duane Reed store). Founded in 1901, Walgreens interacts with over 8 million customers per day in stores and online.
Walgreens Pivotal Cost Cutting Goals
A big focus of Walgreens new strategy is cost cutting and they have shared their goal of $1.8 billion in expense eliminations by 2022. This amount was increased from an original mark of $1.5 billion. Staff reductions, strategic outsourcing and assertive vendor contract negotiating are some of the key elements involved.
Beyond Cost Cutting And Into New Revenue Generating Options Or Even Bigger Deals
While reducing expenses is important, it is certain Walgreens has other commercial initiatives within their plans to increase sales and drive innovation both in retail consumer and healthcare sectors. The company is beginning a new initiative with weight loss leader Jenny Craig in 100 of its stores. Walgreens has established partnerships with Blue Cross Blue Shield PBM Prime Therapeutics ( AllianceRx Walgreens Prime) and have various initiatives underway in collaboration with Kroger ( NYSE: KR ).
Food For Thought; Is Walgreens Preparing For A Large Strategic Acquisition?
CVS / Aetna ( and Target pharmacies ) is a sizable combination as is Cigna / Express Scripts. The threat of Amazon ( NASDAQ:AMZN ) goes up and down the retail pharmacy, mail order pharmacy and big box mass merchandiser sectors; Amazon is assertively expanding it healthcare business enterprise which includes its online pharmacy business unit PillPack and recent acquisition of Health Navigator).
UnitedHealth Group ( NYSE: UNH ) continues to bulk up with PBM and MCO pharmacy and healthcare benefit plan capabilities and is expanding further into patient care services through acquiring various medical practice groups and a large scale medical billing service company.
Perhaps Walgreens Boots Alliance is slimming down and optimizing in preparation for it to make a large scale acquisition or perhaps has Kroger or Walmart expressed an interest in acquiring them?
LinkedIn: John G. Baresky
Twitter: Healthcare Marketing Guy
Amazon ( NASDAQ: AMZN ) continues to trek forward into the healthcare industry with another acquisition; Amazon has purchased a healthcare startup known as "Health Navigator".
Health Navigator, based in Chicago, Illinois, is a clinical healthcare information firm founded by an emergency medicine physician, Dr. David Thompson, which provides these and other solutions:
- After Care Instruction
- Clinical Documentation Support
- Coded Chief Complaints
- Diagnosis Engine
- Natural Language Processing
- Non-Commercial Research Database*
- Triage Engine
References for evidence-based clinical decision making
The *resource database features over 25,000+ Internet resources comprised of non-commercial websites linked to more than 2,800 clinical concepts?—?plus has over 7,200 references in the database of which quite a few are directly linked to the reference through a PubMedIC.
Health Navigator works with these and other applications or functional providers:
- Answering Services
- Digital Health Assistants
- Electronic Health Records ( EHR / EMR )
- Medical Call Centers
Some of Health Navigator's current client partners include Avizia, MDLIVE, Microsoft, NextGen and RUSH Medical.
As part of their enterprise-wide rollout internally and externally of healthcare innovation, Amazon will be deploying Health Navigator within its recently launched Amazon Care employee healthcare provider program.
Between its agreement with Oasis Medical ( a family practice organization based in Seattle, WA ) to serve as a provider for its Amazon Care employee health program, the acquisition of Health Navigator and its partnership with the Pittsburgh Health Data Alliance and with Cerner Amazon is not deterred from its healthcare mission despite the ongoing issue with its PillPack online mail order pharmacy unit and Surescripts.
As Amazon moves forward, it will be interesting to see how its actions are reflected within the realm of Haven Healthcare, its healthcare management partnership initiative with Berkshire Hathaway and JPMorgan Chase. The organization is seeking ways to improve quality of care while reducing cost.
Amazon is clearly investing a considerable amount of staff, financial and technical resources to support its own employee medical care program as well as develop commercial opportunities for the future. It is navigating multiple channels in healthcare, developing partnerships and making strategic acquisitions which for now are submerged threats to unsuspecting, less strategic competitors.
LinkedIn: John G. Baresky
Twitter: Healthcare Marketing Guy
Ongoing Strategic Digital Marketing Innovation Prevents Competitive Stagnation
Healthcare digital marketing initiatives need to stay ahead of the pace as patient care, technology and competitor innovation never stagnate. Even when digital assets are performing at peak levels and sales are robust, there is already room for improvement. These are 5 options to consider to fortify existing digital marketing attributes or establish new ones:
Video is a go-to norm now in healthcare websites being driven by ever-growing adoption and technology improvement across Facebook, Instagram, LinkedIn, Pinterest, Tumblr, Twitter, YouTube and other social media venues. Live, recorded or animated, use of video has proven to be directly proportional to higher engagement, user retention and satisfaction.
Assess existing video assets for updating or enhancement and focus on where new video assets can augment them and other digital marketing measures. Strategically direct time, financial and technical resources to maximize their effectiveness to drive sales.
Clicks don’t count when they don’t convert to meaningful interaction and sales performance; how demanding are you of your mainstay digital resources? Are you assertively evaluating visit duration, website visit pathways and bounce rate? Are your blog and parallel assets merely existing as standard website features or are they delivering value to users, cultivating productive engagement and driving sales?
Asking these questions and acting on them appropriately will uncover digital nuggets of opportunities hiding in plain sight. Those vast SEO reports contain valid, focused insights that justify going over them more than once. Be cautious not to change things up just for the sake of variety; strategically isolate specific elements for modification and enhancement then critically assess performance improvements.
Using automation to orchestrate buying, selling of online ads, television commercials, streaming modules, voice and video to digital-out-of-home media plus other applications is proliferating behind the scenes. Savvy healthcare digital marketing and advertising professionals are using it to make real-time decisions to embrace economic, effective outreach opportunities on the fly and generate trend data quicker for use with these measures and coordinate with other digital marketing assets.
Programmatic advertising is typically not an in-house competency for healthcare organizations, pharmaceutical and medical device manufacturers or service providers. Research its potential then evaluate how it may benefit present and future marketing and adverting goals. If there is a fit, assess the competency of your present advertising / marketing vendors and assess what others have to offer to succeed with programmatic advertising initiatives.
Consumer and commercial engagement of Alexa, Cortana, Google Home and Siri is exponentially multiplying and its on-demand, hands-free attributes have great utility in the healthcare setting. Exploring and piloting new voice search technology or fortifying existing voice search applications can push your digital marketing outreach and engagement levels ahead of the competition. Amazon Alexa, Microsoft Cortana, Alphabet Google Home and Apple Siri are investing heavily in voice search and interaction technology plus there is an array of other healthcare ventures devoted to exploiting its great potential.
Based on technology advancement and user adoption trends, proficiency in the sophistication of voice technology to engage patient, clinician and business stakeholders for healthcare digital marketing purposes is well on its way to becoming a norm. Voice search boosts user experience. Due to its prolific use, Google and other search engines are placing a higher emphasis on voice search optimization. This will likely pave the way for SEO performance and voice search ranking measurements in reporting tools and in the design of websites soon in the future. The time to act is now.
Twitter: Healthcare Marketing Guy
Johnson & Johnson
Johnson & Johnson ( NYSE: JNJ ) will launch an Ebola virus vaccine in the Democratic Republic of Congo ( DRC ) during November. An Ebola outbreak considered to be the second largest outbreak to date has been underway in the nation’s eastern provinces since 2018. Johnson & Johnson developed their Ebola agent in partnership with Bavarian Nordic ( OTCMKTS: BVNRY ).
Merck Ebola vaccine in DRC now
Merck ( NYSE: MRK ) already has their Ebola vaccine ( rVSV-ZEBOV ) deployed in the country; more than 200,000 doses of it have been administered. The Johnson & Johnson vaccine requires two injections eight weeks apart; the Merck product requires only a single administration of their product. Despite requiring an additional injection, the Johnson & Johnson Ebola immunization is still an essential addition to combat Ebola not only to sustain ongoing immunization initiatives in the DRC and other areas of Africa but also to have available in the event Merck’s product were to be in short supply.
Present Ebola outbreak
Why and how Ebola is such an enormous health threat
Ebola Virus Disease (EVD) is a rare, lethal disease in people and nonhuman primates. The viruses triggering EVD are located mainly in sub-Saharan Africa. People can get EVD through direct contact with an infected animal (bat or nonhuman primate) or person; including corpses of EVD fatalities.
Ebola virus disrupts how blood clots. It is known as a hemorrhagic fever virus as the clotting issues it triggers lead to internal bleeding; blood leaks from small blood vessels in the body. The virus also causes severe inflammation and tissue damage. Due to being highly contagious and potent, Ebola is a significant challenge not only for patients but for caregivers and healthcare providers who not only help the sick but must take assertive, thorough action to protect themselves.
Ebola's Introduction To Medical Researchers
The Ebola virus was discovered in 1976 near the Ebola River in DRC. Over the last 4 decades, there have been numerous Ebola outbreaks. The worst to date has been the West African Ebola epidemic, which generated nearly 30,000 EVD cases and more than 11,000 fatalities in 2014-2016.
Twitter: Healthcare Marketing Guy
Marketers say building engagement is their top priority with email marketing…
While numerous digital communication and promotion options exist, email continues to be one of the most preferred channels to promote brands and generate sales. Despite the demise of email marketing forecast years ago, it continues to be an attractive and effective tool in engaging audiences. Its performance and utility intrigues marketers and at the same time challenges them and their audience based on sheer volume and content relevancy.
These are 8 action items to gain critical advantages in your healthcare email marketing and sales initiatives…
Security / Privacy
All email marketing initiatives need to consider security and privacy — especially in healthcare. Be certain security updates in your systems and applications are up-to-date and installed as soon as possible when they become available. Take maximum precautions to ensure your audience and your organization are as protected as possible. Likewise, always be cognizant and fully compliant with any privacy standards which apply. Security and privacy issues are at the forefront of our Internet society and their significance is highly magnified in the healthcare sector.
Key Performance Indicators ( KPIs ) / Sales Goals Attainment
Sales goals and KPIs for healthcare email marketers are the equivalent to weather and crop reports for farmers. These should always be monitored closely and continually reassessed. Even if your lead generation, direct sales or other benchmark goals are being consistently surpassed, be certain they aren’t reaching a point of a “comfortable” plateau — the forerunner to potentially dropping. Always seek alternatives to further uptick performance. While some may consider these options to be “on reserve”, they can also be under-served leads which the competition captures before you do.
Continue to slice and dice your email marketing database to further define targeted healthcare audiences and subcategories within them. The respective customer personas in the subgroups offer prime opportunities to fine tune targeting, focus content and increase engagement. Reassess how you are segmenting your customer database resources to devise new engagement opportunities and truly refine your targeting to get the right content to the appropriate audience every time.
Deeply defined subgroups enable you to connect with new audience members or those in which you were not successful with through earlier attempts. You could end up sending less emails and be rewarded with better sales results and ROI based on efficient persona profile development and optimized database drill downs; go the extra step to personalize them for greater impact. It is important to be aware your company and its offerings, the subcategory members and / or the healthcare marketplace may have changed. New developments on either side always warrant updated considerations to revisit audience subcategory email database opportunities to maintain customer connections and generate sales.
Review what processes and tools you are using to develop and implement your email campaigns. Familiarity with a routine / email marketing tool may lead you to overlook better methods or platform technology to use. You may not be recognizing existing or new features your platform has which can make your life easier and email marketing efforts more effective.
There may be better platform options available to execute email marketing campaigns. New platform technical features enabling you to execute more options could deliver more for less. Carefully evaluate your current processes and setup; changes in procedures, utilization or technical resources can lead to significant operational, sales and ROI improvements.
Benefit From Opt-outs
Don’t abandon opt-outs as “lost causes” and leave it at that to move onto others. Use opt-outs to critique campaigns and deliverable details including targeting, frequency, content, touchpoint features, offerings, and other variables. Your targeted audiences are already receiving emails based on personal / professional communications; email marketing messages pile on top of those — no matter how earnest and legitimate your outreach is, it is still fighting for attention. Healthcare, among other characteristics, is a clinical, financial and technical marketplace; there are many stakeholders which share the same customers your email marketing and sales initiatives are targeting.
Sizable audiences’ segments are opting out merely to reduce clutter. Opt-outs are a great way to objectively learn to re-focus your campaign strategy. They also cultivate the importance of offering other ways for the audience to stay engaged with your company through social media or website follows and other sign-up opportunities which may start with an email but continue on in other digital venues. Be certain your content features these touchpoint features and channels to provide your organization and the audience ways to continue to be connected outside of the email realm.
Be Current And Relevant
The healthcare industry is continually changing. Develop and share content specifically relevant to your healthcare audience aligned with current events, new developments and your products / services. Use them to make the connection between the industry, the customer and your company; position your offerings as timely solutions to their needs.
Trending topic examples can be aligned to numerous healthcare industry sectors (health system, PBM, MCO, etc.), medical specialty (anesthesiology, cardiology, obstetrics / gynecology, etc.), condition (acid reflux, asthma, hypertension, etc.), payer (Medicaid, Medicare, DHA/ TRICARE, etc.), professional (health system CFO, CIO, CMO, etc.) or other defined interests. As healthcare assertively evolves; wide and narrow audience segments value timely updates enabling your company to be recognized as a front runner with answers to their challenges triggered by industry change.
Change Up Your Approach
A good healthcare email marketing strategy does not always include an offer, sale or other promotion. Informational content can be shared with your targeted audience and lead to sales without a “pitch”. The content can demonstrate your organization’s leadership / knowledge in a particular area; it is important to established positive notoriety, professional credibility in the healthcare sector.
Review the last 6–12 months of emails your organization has shared with a particular segment; if they are all “pitch-focused” with diminishing returns, it’s a good indicator you are fatiguing your audience and need to change up content to more effectively engage them. There is always a strong push for more sales and it’s easy to overlook redundant approaches which audiences will eventually associate with spam. Choosing a “non-pitch” approach to change things up is a good consideration. Personalize messaging whenever possible to reinforce audience engagement.
Mobile-friendly campaigns are part of successful healthcare email marketing strategy formulas which can also enhance non-mobile venue engagement. Content should be easily viewed / scrolled, quickly understood and acted upon through touchpoint features. Fortify your email / digital marketing with trigger email features pivoting on audience interactions is an example. Maximize quality design and content attributes to minimize steps and optimize messaging so processes are convenient for the audience to respond to favorably which increases direct sales, lead generation and other revenue-positive engagement opportunities.
These 8 actions are only the beginning. Connect them with your present and future healthcare email marketing initiatives to build engagement, sales and ROI. The more effectively your email marketing is executed will not only strengthen your position but also provide more encouragement for your trusted audience to disregard those from competitors.
Twitter: Healthcare Marketing Guy
UCB Covets RA Pharmaceutical Phase 3 gMG Candidate
UCB ( OTCMKTS: UCBJF ) seeks RA's ( NASDAQ: RARX ) Phase 3 rival to Alexion’s ( NASDAQ: ALXN) Soliris which has an indication for generalized myasthenia gravis ( gMG ), a chronic, debilitating neuromuscular disorder impacting respiratory and limb movement. Presently, Soliris is the only complement inhibitor for gMG.
The Phase 3 peptide Ra has underway for gMG is a once-daily, self-administered, subcutaneous C5 inhibitor called zilucoplan.
UCB Research Presently Underway In gMG / MG Category
UCB already has a Phase 3 MG product in the works, Rozanolixizumab (UCB7665), an investigational humanized monoclonal IgG antibody ( mAb or moAb ).
UCB AND RA PHARMACEUTICAL FINANCIALS
UCB focuses on neurology and immunology therapies; it is based in Brussels, Belgium with a U.S. headquarters in Atlanta, Georgia. Ra Pharmaceuticals is based in Cambridge, Massachusetts. The UCB deal covers the RA Pharmaceutical shares at $48 each; more than a 100% premium over its closing price on 10/9/19.
Twitter: Healthcare Marketing Guy
How can you up your digital marketing KPI game plan to put your organization's sales over the goal line?
For many healthcare, medical device and pharmaceutical product manufacturers and service providers, the 4th quarter is underway and the end of the fiscal year is approaching. Every minute and every dollar count more than ever.
It is time for brand, product and digital marketing teams to quickly drill down, get their bearings and make critical decisions. Individually and collectively, these primary marketing stakeholders need to ask business critical questions:
- Are we on task to achieve our goals?
- What is necessary to exceed our goals?
- We are barely making our goals, what are the best options to step up to acceptable levels?
- We are behind on our goals, what can be done to at least narrow the gap?
- If a measure is beyond saving, can it be ended quickly in time to avoid waste and perhaps reallocate resources?
- Based on present activity, how well positioned are we for 1st quarter 2020 and beyond?
These questions are not easy to answer and depending on how positive or negative revenue, sales and margin performance is, they may seem to be overwhelming.
For healthcare digital marketing initiatives, there are primary considerations to assess and opportunities to act on:
- Can PPC be tweaked to spark a boost in performance?
- Are email marketing measures satisfying KPI benchmarks?
- If not, is targeting, messaging, offering or other element(s) fixable?
- What is / is not working with website assets including UX, content, SEO and other attributes; even if fixes will not result in immediate returns, can they lift 1st quarter 2020 performance?
- Is content sharing optimized, average or languishing; what is being done to take advantage of unrecognized or under-utilized dark social opportunities?
- Due to 4th quarter budget limitations, what assets can be fully re-deployed and / or repurposed?
- What social media channels or other venues can be further exercised for additional lead generation purposes?
- Are marketing / sales collaborations synchronized, including Salesforce or other CRM platform resources, to be all they can be?
- What are the 3 most potent digital tools that Sales relies on and how can one or all three be sharpened?
- Can time, financial, technical resources be shifted so high producing options can outperform KPI expectations?
- What time, financial, technical resources could be shifted to salvage underperforming options?
- Can entirely new measures be deployed in time to make a difference in 2019?
- Are there opportunities to start 2020 digital marketing initiatives early so momentum is already underway prior to the New Year?