Advanced Practice Providers: A Forgotten Market Segment

After heading into a clinic and filling out the required forms, the assistant calls you back. “Wait in room number two,” the assistant says. Once there, a medical assistant enters and takes your vitals, leaving you with the confidence a qualified person will see you soon. A short while later, that individual enters – a clinician in a white lab coat. Your knee-jerk assumption is that this is a physician. But this is not an MD. This professional is an advanced practice provider (APP).  

Despite the fact that advanced practice providers i.e., nurse practitioners (NPs) and physician assistants (PAs) see their own patients, Doctors of Medicine (MDs) are viewed as having the most influence on how a disease is managed. Thus, tend to receive the most attention by the therapeutics industry. While companies should market their treatments and support solid educational content to MDs to increase awareness, they should not forget APPs. In contrast to popular belief, APPs are not bed side care providers but rather independent clinicians who often take the lead in the management of both acute and chronic diseases. APPs are commonly viewed as more patient focused. In fact, a national survey found that NP listening skills were superior to MDs’. Frequently missed is that they see high volumes of patients – averaging 1.2 billion patients annually. They also prescribe medication, writing 30% of U.S prescriptions.

For almost 20 years, Snowfish has been carefully monitoring this phenomenon and has actively reached out to over 400 APPs to better understand their scope of practice, how they collaborate with physicians, and their needs from industry. Overall, Snowfish concluded that not only is the APP role not going anywhere, but it will continue to grow in size, independence, and influence. APPs want outreach and content that is tailored to them, not just repurposed material developed for physicians. Yet, we continue to observe a considerable gap between these statistics and the level of interest and investment in APPs by industry. This was reiterated in a recent article in MM&M where a resounding call was made to therapeutics companies to get out of their “bubble” and adjust their promotional and educational communications in recognition that APPs practice well outside the realm of physicians.

Therefore, we were very encouraged to learn about a unique firm, RNsights. RNsights helps pharmaceutical and medical device companies better understand the nurse practitioner, physician assistant, and registered nurse market. Additionally, they help companies to develop educational programs for APPs that will truly meet their needs. Snowfish recently sat down with Tom Ullian and Kristen Holstead of RNsights to learn more about RNsights and some cutting-edge data that they have released on the APP landscape in their NP PA Prescriber Insights 2020 report and to gain an understanding of the continually evolving scope of practice.

 Why Care About APPs?

In RNsights’ recently released report, they found that 60% of NPs/PAs see their own distinct set of patients, 30% of U.S providers are NPs/PAs, and by 2030, NPs/PAs could make up 45% of providers.

As previously mentioned, APPs prescribe medication. Contrary to popular belief, APPs and physicians have similar prescribing rates (1.3-1.5 medications per visit in primary care). In taking that a step further, RNsights reports that NPs/PA’s in reality prescribe more frequently than MDs for some drugs and therapeutic areas as well as during e-visits. According to Kristen, these include “monoclonal antibody disease modifying therapies and psychotropic medications.”

APPs are a critical and growing population of the healthcare landscape. With this in mind, industry misses an important market when they neglect APPs.

What’s the Deal with Incident Billing?

 Incident billing, when APP billing is attributed to their collaborating physician, underestimates the true role of the APP. According to RNsights, “over two-thirds of NPs who work with physicians bill at least a portion of care as “incident to” the collaborating physician.” Kristen remarked that as a result of incident billing, “it really is hard to differentiate exactly who is making the decision [and] doing the prescribing.” The problem of incident billing prevents data companies from distinguishing who is making the decision to prescribe.

This in fact is a big part of the misperception amongst industry professionals. It clearly obscures the fact that APPs are indeed making decisions. While APPs often provide team care with physicians, ample evidence shows NPs/PAs frequently make autonomous treatment decisions, and often influence the physicians in their practice. In fact, in a recent market research project RNsights found that 95% of oncology APPs interviewed have an influence in the decision-making process, and nearly three quarters (73%) described a “collaborative” role in deciding treatment plans for the patients that they share with physicians. For these patients, MDs and APPs often rotate visits, and APPs frequently prescribe or adjust medications. Numerous APPs also described their own set of patients with independent visits where they “can make changes without approval,” and used phrases such as “autonomous” and “peer relationship” when referring to their relationship with the physicians in the practice.

To solve the problem, Kristen encourages companies to consult “NP associations [as they] do a good job of tracking the trends.” Possessing national sample surveys, these organizations can compare trends and better control for incident billing.

What About Identifying and Engaging APP Key Opinion Leaders (KOLs)?

 Kristen asserts the extreme importance of KOLs, especially in the APP landscape. APPs want to hear from their own and APP KOLs, according to Kristen, will help to “cut through the clutter” and encourage peers to view industry materials. When engaging with APP KOLs, Kristen encourages therapy companies to create content by and for APPs. Kristen posits that “nurses … really need their own separate marketing strategy that addresses their community’s needs.” In her experience, webinars have provided the best return on investment.

As a company, RNsights often fields request from clients to help engage with APP KOLs. In addition to providing adequate statistics, Tom also stresses the fact that programs must have the right messaging for APPs. In contrast to physicians, APPs are much more patient-centric. Too often, presentations to be delivered by APP KOLs come at it from a MD perspective.

Tom asserts that “the role of the NP is just different from the role of the MD in terms of how they approach patients and [APPs are] much focused more on the patient centered journey.”

Snowfish has a wealth of experience with KOL Identification and Mapping. With over 20 years in the business, Snowfish has been providing KOL insights long before the industry considered it a service. We have identified APPs within multiple specialties for commercialization opportunities such as research, speaking, and publishing.  Now that you understand the value APPs deliver it is imperative to work with the leaders in the field.

Common Mistakes Companies Make When Trying to Engage APPs  

According to Kristen, when dealing with APPs, companies often lump them in with physicians or with nurses.” However, APPs do much more than nurses. Thus, companies should develop a specific marketing strategy tailored to APPs. Likewise, APPs are offended when companies use dated terms such as “physician extenders” and “nonphysicians.” Kristen posits that when APPs hear those terms, they feel overlooked and misunderstood, which prevents them from building relationships with companies.

Certain Therapeutic Areas Where APPs Have Caught On

Dermatology and Oncology are the top areas that have experienced a huge growth in the recognition of APPs. According to Kristen, “dermatology and oncology are definitely one of the top areas or the top specialty areas where people are seeing a huge growth in APPs” and their recognition.

The Role of APP Professional Societies in Influencing Opinion

Kristen explicates that societies, such as the American Association for Nurse Practitioners, “conduct multi-million-dollar awareness campaigns and are working to secure a full practice authority in every state.”

The Future of APPs and How Industry Should Continue to Adapt Its Approach

 Kristen and Tom emphasized that APPs have changed dramatically over the past decade. The Pandemic has even accelerated independence through telehealth. In the future, by 2030, we could see APPs make up 45% of providers.

Snowfish would like to thank Kristen and Tom for sitting down with us to discuss this critical market segment. When it comes to APPs, Kristen puts it best, “[companies are] missing out on a big percentage of drivers and a growing percentage of the prescribers [when they neglect APPs].” So that’s probably the biggest message they can take away.”

Melissa Hammond, MSN, GNP is Managing Director at Snowfish. For nearly two decades Snowfish has been heavily engaged in helping the life science industry to understand how to optimize stakeholder relationships. Please reach out to us to learn more.