SM 180A CME Report Summary

Report Summary: Educating the Market: Creating Value Through Support of Continuing Medical Education

Educating the Market: Creating
Value Through
Support of Benchmarking Report
at-a-Glance
Featured Study Participants
Continuing Education North American and European
Segment
• Alcon
• Amylin
• AstraZeneca
PROJECT BACKGROUND • Baxter
• Boehinger Ingelheim
• Bristol-Myers Squibb
In today’s age of public concern over the state of the healthcare • Celgene
system, physicians are faced with escalating pressure to • Daiichi-Sankyo
demonstrate competence and achieve adequate patient outcomes. • Eli Lilly & Co.
• Genentech
One method for improving performance in these areas is • HemoCue
physician participation in ongoing professional development and • Janssen-Cilag
Continuing Medical Education (CME) activities. • Merck
• Merck Serono
• Novartis
CME requirements vary significantly between states, regions and • Novo Nordisk
countries, and, for a multitude of sources providing CME, the • Ortho-Clinical Diagnostics
• Pfizer
sole criterion for obtaining official credit is attendance. Of
• Roche Labs
course, physical attendance alone does not necessarily translate • Sanofi-Aventis
into retention of information, much less the implementation of • Sepracor
• Talecris
effective new practices. The current arrangement thus begs the
• TAP
question of whether the accumulation of CME credits has much • Teva
impact on competence or performance, and, if not, are current • Vianex
CME programs capable of serving their purpose of improving • Wyeth

physician performance and patient care. With limited Third-Party Provider Segment
information on actual return on expenditures in support of CME • AMK
activities, and to ensure that investments provide the desirable • AXDEV
• Indegene
impact on healthcare practitioner behaviors and patient • Indicia Medical Educations, LLC
outcomes, pharmaceutical and biotechnology companies are • Invivo Communications
anxious to understand the value of CME support and adopt the • Medimix International
• WentzMiller & Associates, LLC
best strategies to fulfill its potential.

Best Practices, LLC © (919) 403-0251 1


This benchmarking study was conducted to identify the most Industry Analysis
important current trends and future directions of CME in the This research was based on benchmark
North American and European marketplace. The research survey data and executive interviews of 30
participants from 26 pharmaceutical,
examined a number of areas, including what structural forms biotechnology and medical education
are used to deploy CME, optimize budgets and best deliver companies.
content. In addition, the study looked at the current global
landscape of CME, as well as the rapidly evolving role of E- Information Types
CME. Managers and executives can use the key benchmark • 13 Information Graphics
metrics, executive insights and recommendations of this report • 25 Data Graphics
• 315 Metrics
to map a path to future success in support of CME.
• 23 Executive & Manager Narratives

Report Length
STUDY METHODOLOGY
• 65 pages

Research for Educating the Market: Creating Value
Through Support of Continuing Medical Education was based on benchmark survey data and
executive interviews of 30 participants from 26 pharmaceutical, biotechnology and medical
education companies. This Best Practices, LLC report provides a comprehensive look at how
pharmaceutical and biotechnology companies deploy CME to ensure that their investment yields
the desired impact on physician behavior and, therefore, patient outcome. The report, which also
incorporates third-party input from seven CME vendors and eight medical associations or
teaching hospitals, offers benchmarks, insights and best practices in key areas such as:

• Geographic delivery of CME
• Structural management of CME
• CME investment budgets for North America and Europe
• Planned versus spontaneous CME investment
• Functional responsibility for CME
• CME delivery in North America (company directed versus 3rd party, etc.)
• CME delivery in Europe
• Background & experience of CME employees
• Tenure of CME employees
• CME delivery modes for North America and Europe
• Use of E-CME in North America and Europe
• Effectiveness ratings for CME delivery activities in North America and Europe

SAMPLE FINDINGS
Among the findings that emerged from this research are the following:



• Decentralized Structures Reflect Balkanized CME Landscape: Decentralized
Management Structures proliferate across the CME landscape where language
differences, learning style differences, and local market variation create hurdles for
centralized management structures.

• The Internet is Quickly Growing in Relevance as a Delivery Mechanism: E-
CME is on the rise, fostered especially by the fractured CME marketplace in Europe.
Generational differences present short-term obstacles to E-CME growth. However, the
Balkanized state of CME support accelerates use to educate smaller markets.

• Face-to-Face CME Delivery is Most Common, Despite Some Face-to-Face
Formats Most Often Being Rated Least Effective: CME program heads must
manage a “resource, targeting and quality paradox”: the most highly used CME
delivery forms are often the least efficient and were lowest-rated for information
retention. Smart CME leaders target to reach physicians at the right time with the right
CME programs.

• Basic Management Tools Provide Disproportionately Positive CME
Impact: CME is still in its early stages throughout North America and Europe.
Consequently, basic management tools – such as strategic planning, performance
measurement, program reviews, continuous improvement cycles and management by
objective – are emerging as part of the CME toolkit that have a disproportionately
positive impact.

RESEARCH BENEFITS
1. Access scarce benchmark data that doesn’t exist elsewhere, including processes for
developing CME employees.
2. See examples of how the CME landscape varies over different markets, regions and countries.
3. Learn what criticisms currently exist regarding the framework and financing of CME, and
how organizations are working to make improvements for the benefit of the CME function.
4. Understand the pros and cons of various structural trends proliferating across different
markets.
5. Discover how leading companies utilize budgetary resources to align key priorities with target
physician groups.
6. Discover effective use of councils and community practice to accelerate learning across
countries, therapeutic areas and brands.
7. Find out how companies are evolving their methods to target ready to change physicians.
8. See how leading companies utilize an integrated mix of targeting, programming, multiple
delivery channels and frequency to achieve positive CME outcomes.



9. Learn how top companies incorporate the rapidly evolving delivery channel of E-CME to
maximize reach and user preference.
10. See individual program leader responses on their top lessons learned, best practices and
functional management in regards to CME.

SAMPLE BEST PRACTICE AND DATA SECTION

Cultivate E-Learning to enhance reach, convenience, cost efficiency and
performance tracking abilities.

The Internet is quickly growing in relevance as a delivery mechanism. As already mentioned, E-
CME is flourishing: today it is responsible on average for delivering between 10 and 25 percent
of global CME content; CME leaders estimate that this percentage will double over the next
three to five years. Already, adopters are delivering as much as 75 percent of CME content
through the Internet in the U.S. and 50 percent in Europe.

Figure 7.9: The Internet is Growing in Relevance as a Delivery Mechanism

One factor driving higher E-CME usage is that younger physicians entering the industry are
more open to receiving E-CME, whereas older physicians are more resistant to the format. As



earlier generations of physicians retire, the younger, more Internet-savvy physicians who replace
them figure to bolster future demand for CME to be presented via this delivery mode.

Web-based delivery also offers a platform that accommodates multiple learner preferences. One
interviewed Director stated: “Through the Internet…you can have online delivery, you can have
available downloadable PDF, you can have available a live lecture,
“I don’t want to imply
you can have available case vignettes, you can have available that the Internet is the
interactive activities; you can hit so much through that vehicle.” He answer to everything,
but if you’re looking for
continued: “I don’t want to imply that the Internet is the answer to
effective ways to do
everything, but if you’re looking for effective ways to do something something in a cost-
in a cost-efficient manner that you can easily garner appropriate efficient manner…the
Internet is the way to
metrics, the Internet is the way to go.” go.”
-Interviewed Director
In addition to its appeal these different learner preferences, the
Internet provides short cuts for targeting physicians who are broadly
distributed across the spectrum of readiness-for-behavioral-change as a result of CME. Stated
one interviewed participant: “What you’re doing is trying to look at where these people are in
their behavior change, and then develop sequential learning models because there’s one thing
about trying to target the pre-contemplative guy versus the guy who’s ready to take action.
There’s also data that shows physicians will self-select where they are. So, if they’re given a
menu, they will self-select where they think they are, as opposed to you trying to research all the
data and figure out where they are.”

Moreover, continued the participant: “You give a whole series of programs and they can self-
select; ‘I’m pre-contemplative and I think I’m doing everything right, what are these people
“The Internet provides trying to tell me? I’ve got to go over here and look and see
a very flexible format where I’m falling short,’ and they’ll self-select that. At the same
for mass
time, they may self-select, ‘I like listening to lectures, so I’m
customization in terms
of self-selection for going to click on that and listen to the lecture and watch the
learner preferences as slide.’ Another guy may say, ‘I’m pre-contemplative, I don’t
well as readiness to
change.” understand why they’re telling me I’m not practicing correctly,
let me go see. And, I love print, so I’m going to print out this
-Interviewed Benchmark
Participant monograph.’” In summary, the Internet provides a very flexible
format for mass customization in terms of self-selection for
learner preferences as well as readiness to change.

The dividends E-CME could bring to the European market are immense. E-CME guarantees a
consistent platform from which accredited material can be conveyed on a global scale to
physicians – a critical step in bridging gaps in cross-border communications, resources and
markets. However, E-CME usage in Europe lags behind that of the United States, where average
United States usage is twice as high.



Figure 7.10: E-CME Delivery in Europe & North America

Also worth noting, as it is a probable cause for the slower uptake of E-CME in Europe, is that
even fewer countries accredit long-distance learning than require CME. Interestingly, European
uptake of E-CME may be faster in remote areas, where access to live CME is less frequent, than
in large population centers. This fact points to a possible solution for reaching markets that
provider presently neglect in their effort to manage limited resources while adhering to existing
regulations, and illustrates how E-CME will likely play a role in creating an optimal channel mix
for distribution of CME in the European market.



Figure 7.11: Defining Optimal Channel Mix for European Market

REPORT STRUCTURE AND ORGANIZATION
The project findings are organized into an executive summary, a series of four topical chapters,
and an appendix. Following is a description of each section:

• Executive summary: Explains the survey methodology, identifies participating
companies and reports key findings.

• Topical chapters: These chapters provide, by subject, a depiction of survey responses,
discussion of key trends identified from an analysis of the data and write-ups of best
practices harvested from in-depth interviews.

o Current Landscape of CME – Includes sections on the North American
CME Landscape, the European CME Landscape and Criticisms of the CME
Framework.
o Current CME Structural Trends – Discusses Decentralized, Centralize
and Hub-and-Spokes Structural Models, Leveraging Budgetary Resources,
Planned Versus Spontaneous CME Programming and the Use of Councils and
Communities of Practice.
o CME Evolution Models – Investigates the Behavioral Change Models being
applied to CME, Tactics to Align CME Deployment with Physician Change



Readiness, Utilizing Multiple Message Frequency to Enhance the Outcomes of
CME and Metrics to Determine the Effectiveness of CME.
o CME Functional Management – Discussion of Where CME Oversight
Lies in Both North America and Europe, the Utilization of Single Distribution
Channels for CME Management, Managing CME Content to Create
Consistency and to Separate the Promotional from the Educational in CME
Programs, Optimizing CME Delivery Channels, Cultivating E-learning and
Building Talent, Depth and Competence with Limited Resources.
o Current Trends and Future Directions of CME – Emphasis on the
Forces Driving the Current Trends in CME and Reported Areas for
Improvement in the Future Planning and Development of CME Programs.
o Best Practices and Lessons – Highlights lessons learned and advice from
benchmark participants pertaining to the development and utilization of CME to
achieve optimal return on investment.

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TABLE OF CONTENTS
Executive Summary ....................................................................................................................... 4

INTRODUCTION.............................................................................................................................. 4

RESEARCH APPROACH ................................................................................................................ 5

PARTICIPANT DEMOGRAPHICS................................................................................................... 5

DEFINITIONS AND ABBREVIATIONS............................................................................................ 8

REPORT STRUCTURE AND ORGANIZATION.............................................................................. 8

KEY FINDINGS................................................................................................................................ 8

Current Trends and Future Direction of CME ........................................................................... 11

CURRENT AND FUTURE TRENDS IN CME GRANTS FUNDING .............................................. 13

VOICES FROM THE FIELD .......................................................................................................... 17

The Current Landscape of CME ................................................................................................. 19

THE NORTH AMERICAN CME LANDSCAPE .............................................................................. 20

THE CME LANDSCAPE IN EUROPE ........................................................................................... 20

CRITICISMS OF CME FRAMEWORK .......................................................................................... 20

Current CME Structural Trends .................................................................................................. 23

DECENTRALIZED MODEL ........................................................................................................... 24

CENTRALIZED MODEL ................................................................................................................ 25

HUB-AND-SPOKES MODEL ......................................................................................................... 27

LEVERAGING BUDGETARY RESOURCES ................................................................................ 29

CME Evolutions Models .............................................................................................................. 36

CME Functional Management..................................................................................................... 42

OPTIMIZING CME DELIVERY CHANNELS.................................................................................. 46

BUILDING TALENT DEPTH, BREADTH AND COMPETENCE.................................................... 55

MANAGING CME CONTENT ........................................................................................................ 60



TABLES AND FIGURES
Table 1.1: Participating Companies, North America ..................... Error! Bookmark not defined.

Table 1.2: Participating Companies, Third-party Vendors ............ Error! Bookmark not defined.

Table 1.3: Project Participants, Medical Associations and Teaching HospitalsError! Bookmark not defined.

Table 1.4: Benchmark Class Representatives by Title .................. Error! Bookmark not defined.

Figure 2.1: Voices from the Field: Why Pharma Funding is NeededError! Bookmark not defined.

Figure 2.2: Opportunities Exist to Provide Grants......................... Error! Bookmark not defined.

Figure 2.3: CME Programs Get Funded Most of the Time ........... Error! Bookmark not defined.

Figure 2.4: Access to ACE Funding Will Remain Difficult .......... Error! Bookmark not defined.

Figure 2.5: Obtaining Grants Expected to Become Tougher......... Error! Bookmark not defined.

Figure 2.6: Obstacles to Grants Funding Going Forward .............. Error! Bookmark not defined.

Figure 3.1: Epicenters Driving CME ............................................. Error! Bookmark not defined.

Figure 4.1: Decentralized CME Structures Proliferate .................. Error! Bookmark not defined.

Figure 4.2: Decentralized Model, Europe...................................... Error! Bookmark not defined.

Figure 4.3: Decentralized Structure, Pros and Cons ...................... Error! Bookmark not defined.

Figure 4.4: Centralized Model, Europe.......................................... Error! Bookmark not defined.

Figure 4.5: Centralized Structures, Pros and Cons ........................ Error! Bookmark not defined.

Figure 4.6: Hub-and-Spokes Model, Europe ................................. Error! Bookmark not defined.

Figure 4.7: Hub-and-Spokes Model, Pros and Cons...................... Error! Bookmark not defined.

Figure 5.1: CME Investment Levels Vary Between Markets ........ Error! Bookmark not defined.

Figure 5.2: Balance Planned & Spontaneous CME Programs....... Error! Bookmark not defined.

Figure 5.3: Voices from the Field: Generating Grants Needs AssessmentsError! Bookmark not defined.

Figure 5.4: Use Assessments to Set Strategic Agenda................... Error! Bookmark not defined.

Figure 5.5: Engage CME Practice Communities to Accelerate LearningError! Bookmark not defined.

Figure 6.1: Change Models are Being Applied to CME................ Error! Bookmark not defined.

Figure 6.2: Targeting CME for Ready-Changing Physicians ........ Error! Bookmark not defined.



Figure 6.3: New Formula Emerging to Optimize CME Impact..... Error! Bookmark not defined.

Figure 6.4: Improving CME Performance Impact ......................... Error! Bookmark not defined.

Figure 7.1: Medical Affairs & Communications Have CME OversightError! Bookmark not defined.

Figure 7.2: North American Distribution Channels are Centrally ManagedError! Bookmark not defined.3

Figure 7.3: European CME Distribution Channels are Centrally ManagedError! Bookmark not defined.

Figure 7.4: Medical Affairs & Grants Groups Lead North American CMEError! Bookmark not defined.

Figure 7.5: Marketing & Medical Affairs Lead European CME ... Error! Bookmark not defined.

Figure 7.6: Face-to-Face & E-CME Dominate in North America. Error! Bookmark not defined.

Figure 7.7: Face-to-Face Delivery is Dominant in Europe ............ Error! Bookmark not defined.

Figure 7.8: CME Delivery Channel Effectiveness vs. Use............ Error! Bookmark not defined.

Figure 7.9: The Internet is Growing in Relevance as a Delivery MechanismError! Bookmark not defined.

Figure 7.10: E-CME Delivery in Europe & North America.......... Error! Bookmark not defined.

Figure 7.11: Defining Optimal Channel Mix for European MarketError! Bookmark not defined.

Figure 7.12: Develop a CME Strategy to Best Manage Limited ResourcesError! Bookmark not defined.

Figure 7.13: Few People Work in CME Groups............................ Error! Bookmark not defined.

Figure 7.14: Half of Partners Do Not Provide Training to Staff.... Error! Bookmark not defined.

Figure 7.15: CME Staff Tenure and Hiring Requirements ............ Error! Bookmark not defined.

Figure 7.16: Building CME Talent Depth Key Need in Europe.... Error! Bookmark not defined.

Figure 7.17: Most Effective European CME Services................... Error! Bookmark not defined.

Figure 7.18: Most Effective North American CME Services ........ Error! Bookmark not defined.

Figure 7.19: Field-Based Assessments Reveal the State of Clinical Practice in the Local
Market............................................................................................ Error! Bookmark not defined.

Figure 7.20: Third-Party Vendors Deliver Most European CME.. Error! Bookmark not defined.

Figure 7.21: Third-Party Vendors Dominate North American CME DeliveryError! Bookmark not defined.



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SM 180A CME Report Summary

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