In the September 2019 Business Insights column (“Clinical Nutrition: A New Market Opportunity”) we discussed the category of “clinical nutrition” products, which are most often used in hospitals and skilled nursing facilities, collectively referred to as the healthcare institution market. 

Clinical nutrition products address specific patient medical needs or requirements, typically disease management or prevention. Regulated by the FDA, they include multiple regulatory categories such as medical foods, dietary supplements, foods for special dietary use, and sometimes conventional foods. In addition to the institutional market, clinical nutrition products may be used in the health practitioner channel, in home care settings, and may also be available at retail.

The healthcare institution market is large and lucrative, but the cost of entry and other barriers are often greater than dietary supplement and ingredient companies expect. For instance, the distribution network is unique, as hospitals are members of group purchasing organizations (GPOs); internally, there is a formulary committee and a plethora of decision makers and influencers. Each of these and numerous other issues must be addressed. Thus, it is important that the product is viable before embarking on this journey.

Professional Opinions
An early step in determining the viability of a clinical nutrition product is to ascertain if healthcare professionals will endorse it. It is also important to get their perspective to enhance product positioning, claims statements, and other marketing and product development factors. Building practitioner awareness and gaining their support of a well-formulated and properly researched product will facilitate their endorsement and recommendation to patients. Targeted practitioners may include primary care physicians, specialists (e.g., chiropractors), ancillary team members (e.g., dietitians, pharmacists), and an array of other decision makers and key influencers.

The following is a summary of suggested marketing research to be conducted with healthcare professionals prior to commercializing clinical nutrition products.

Assess the Situation with Existing Data & Insights
This first step entails a review of the current market and available data for the product and indication. If the product or concept is new, you may need to benchmark with competitive products, as available. This may include any relevant consumer insights, claims and substantiation, healthcare practitioner awareness of the product or active ingredient(s), and current practices when managing or treating the targeted condition.

It is a good idea to conduct preliminary interviews with a few practitioners and consumers (about three each) who have used the product or similar products. For simplicity’s sake, interviewees can be identified from existing sales data. The results of these initial interviews will be useful in developing or refining the product concept, positioning, and tentative marketing/educational materials to be utilized for subsequent in-depth research.

Conducting Market Research with Healthcare Practitioners
Healthcare practitioners can certainly influence patient trial of a new product as well as increase compliance for continued usage. However, educating health practitioners on use of a nutritional intervention can be costly. Prior to launching a product, it is imperative that a well-developed and executed plan be in place. To gain these insights the process involves simply talking to a representative group of practitioners about the product.

There are several ways to accomplish this. One very effective tool is conducting one-on-one in-depth qualitative telephone interviews with practitioners who are recommending or are receptive to nutritional interventions. Ideally, identify a few current recommenders of your or similar products to include in the survey. These interviews need only be 30-45 minutes in length and the focus is usually on two areas, current practices and the product or concept.

Understand Current Practices
When exploring their current practices, first determine their approaches to patient care. This would include what medication, diet, lifestyle, and other products or practices are used to help manage patients diagnosed with the targeted condition. Identify pros and cons of each treatment approach, identify what’s working and what’s not, and why, and identify shortcomings and unmet needs. 

Next, determine types of medications and/or nutritionals they recommend for the condition or health issue. Try to identify pros and cons of each specific medication/nutritional prescribed or recommended. Identify what’s working and what’s not, and why. Inquire as to what type of clinical evidence convinced them to begin recommending a nutritional. Ask how they prefer their patients acquire nutritional products. 

Depending on the medical condition, it is important to know if the practitioner refers patients with the targeted condition to other medical specialists. This may include, for instance, dietitians/nutritionists, certified diabetes educators, as well as physician specialists.

Evaluation of the Product/Concept
At this point in the interview, introduce the product or concept. This is usually done with a one paragraph description of the product, its benefits, how it works, how it is administered, where it can be purchased, and the price. After the interviewees review the concept, get their initial reactions/thoughts about the product. Ask if they have any patients currently using this or a similar product. How believable are the benefit claims, how unique is your product compared to other products? Then ask how likely they would be to recommend the product, followed by what would convince them to be (even) more receptive to recommending. Finally, discuss compliance. If the practitioner were to recommend the product, how likely do they feel the patient would be to purchase and to use the product as recommended.

Based on insights gained in this study, recommendations can be made to enhance the product concept as well as education and other marketing materials used to inform healthcare professionals and other high priority audiences.

For instance, one of our clients identified the need to rewrite their dietary supplement claims substantiation document to become a Product Rationale (White Paper). This document provides the foundation for thinking about, creating and writing all materials pertaining to the product. It contains the scientific rationale for product formulation (including ingredient name and ratio, mechanism of action, and the benefits derived from the product). It details the research program underpinning product efficacy and claims. It describes the intended population and benefits they can expect from use of the product. Finally, it includes expert opinion (derived from a review of the literature) to show “significant scientific agreement” about benefits and claims. 

Keep in mind that even though healthcare professional recommendation and institutional distribution will enhance patient trial of a new product, the patient is the final decision maker. For those patients being discharged from an institutional setting, it is unlikely that the costs of clinical nutritionals will be covered by insurance or other third-party payers. Thus, desirable product attributes become increasingly important for continued usage. Key attributes include believable benefits, acceptable sensory characteristics, value, etc. Therefore, as a next step, consumer market research is typically conducted to further refine the message, assuring commercial success.  

There are numerous new methodologies for conducting qualitative and quantitative consumer research. Even though it is beyond the scope of this column to address consumer research, I advise marketers to heed negative insights. I have seen several products fail after the marketing team chose to ignore consumer feedback. If the product concept isn’t a “winner” in consumer research, find out why and if possible, try to fix it. While there may be examples of highly successful products that failed in consumer research, there are many more failed products that were just not viable.

Insights from marketing research affect all elements of the marketing plan and provide direction in developing materials to educate healthcare practitioners, garnering their support for successful clinical nutrition products. 

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Gregory Stephens
Windrose Partners

Greg Stephens, RD, is president of Windrose Partners, a company serving clients in the the dietary supplement, functional food and natural product industries. Formerly vice president of strategic consulting with The Natural Marketing Institute (NMI) and Vice President of Sales and Marketing for Nurture, Inc (OatVantage), he has 25 years of specialized expertise in the nutritional and pharmaceutical industries. His prior experience includes a progressive series of senior management positions with Abbott Nutrition (Ross Products Division of Abbott Laboratories), including development of global nutrition strategies for disease-specific growth platforms and business development for Abbott’s medical foods portfolio. He can be reached at 267-432-2696; E-mail: gregstephens@windrosepartners.com.