Category Archives: Behavior change

Companies in Healthcare: What Could Make You Disappear??

The healthcare industry is changing at an incredible pace. That means winners and losers. New companies emerging and existing companies going away. What could make your company disappear?

To be clear, by “make your company disappear” I don’t mean some super-powered ray gun or a natural disaster that would ‘poof!’ make your company suddenly vanish, dissolve, or fade away.  I’m asking seriously what could make your products, services, or company irrelevant, obsolete, or undesirable?

And I apologize. I know disappearing can be an unpleasant thing to think about. But it’s really important to think about, especially when you’re doing well. As you know, there is a plethora of products, services, and companies that were once great, and then succumbed to forces that made them disappear.

In today’s healthcare environment, just consider the impact of Meaningful Use or the MEDTECH Act; the shift toward value-based reimbursement or growing influence of GPOs; the proliferation of wearables and monitoring devices; and the health plays of leading tech companies like Apple and Google.

Any of these forces can position a few as market leaders, necessitate radical restructuring for many, make other companies disappear, and launch countless new startups to replace them. You want to stay strong. Be proactive. Don’t be one of the disappearing companies or a victim of circumstances.

First consider your company’s relationship with the market and healthcare business environment. Start with these five questions:

  1. What change in the market can make my products or services irrelevant, obsolete, or undesirable?
  2. What technological innovation can make my products or services irrelevant, obsolete, or undesirable?
  3. What shift in consumer behavior can make my products or services irrelevant, obsolete, or undesirable?
  4. What policy or regulation can make my products or services irrelevant, obsolete, or undesirable?
  5. What competitor can make my products or services irrelevant, obsolete, or undesirable?

Your answers should help you look beyond the present, see threats to your long-term viability, and proactively make plans to preserve your company’s existence and well-being. Think big picture, not just about what might replace your offerings, but what might integrate your technology into something bigger, like smartphones have integrated the functions of MP3 players. Consider too getting input from KOLs and customers to give you a more well-rounded perspective and greater certainty in your conclusions.

Now take a look at your own internal practices and beliefs, that if unchecked, can prevent you from being agile and responsive, and ultimately make you disappear. But don’t do this assessment unilaterally, get feedback from your team. Drawing on the innovation work of Dartmouth professor Vijay Govindarajan, think about these three traps that can make even highly successful companies flop. Do any apply to you?

  1. Major investments in systems or technologies can make it prohibitively expensive for you to move to newer and better tools. But the longer you stay with what you have, the harder it is to switch. Some call this the “sunk costs” fallacy.
  2. Fixation on what brought you success blinds you to new things that can threaten or displace you. You don’t see it until it’s too late. Then you respond with desperation. Sometimes “if it ain’t broken, don’t fix it” just does not apply.
  3. Hyperfocus on today’s marketplace can lead you to ignore new trends and market forces, and future opportunities and threats. You may be too wrapped up in the business to focus on the business. You’re all about today, and lose out on forward thinking.

Combine your answers to the first set of questions about your company’s relationship with the market and external environment, with your assessment of traps based on internal practices and beliefs. Be honest.

Stay strong. Don’t disappear!

Med Tech Product Managers: Persuading Your Management To Support Your Innovation

innovationJames is an experienced product manager at a large device company. He has a winning new population health idea supported by a strong business case.

James knows his new initiative will pivot the company well for the future of value-based reimbursement. He also knows that maintaining the status quo will be a death knell as the fee-for-service paradigm gradually disappears.

James has solid ROI projections and trend analytics to back it all up. He also knows his idea fits and delivers on the CEO’s stated vision for the company’s future.  He has pitched the idea up the management chain internally on several occasions.

The problem is James is not getting the support he needs from upper management. He gets heads nodding but no action. No commitment. Overall lukewarm reception.

Why? Because even though what James is proposing is sensible, timely, backed by facts, and aligned with the corporate vision,  it requires going in a direction that is unfamiliar to the company. It is perceived as an unknown. It is therefore seen as risky business.

What should James do? It doesn’t make sense to simply repeat the same arguments and expect a different result. He already made the best case he could. But he knows the window for competitive advantage is slipping away.

James needs other voices to give his bosses enough confidence to say yes and invest in what they know is a good idea and necessary for the company’s long-term viability, despite their concerns. These other voices need to be strong enough to overcome fear of change, fear of moving into an unfamiliar space.

James doesn’t need a large quantity of voices. Survey numbers won’t make his case more persuasive. The status quo thinking he needs to overcome is not rational. He needs to strategically manage relationships with his internal customers. Persuasion at an emotional level if required.

Specifically, James needs smart, influential people that genuinely share his thinking and who his bosses will listen to with open minds. That means select key opinion leaders and perhaps several important customers who will voice their agreement with three things: 1) The underlying premise about healthcare’s inevitable shift toward population health management and value-based reimbursement. 2) The recommendation to take proactive action now in order to be positioned to serve healthcare customers in the impending new business reality without losing viability in the current fee-for-service environment. 3) The reality that not taking action is the riskier choice.

The insights and recommendations need to be delivered carefully and strategically to be heard and take hold. Even if these influential voices are only echoing what James already said, when management hears it from them, it has a different impact.   It shifts the perception of risk away from stepping into new territory, and toward missing the boat by not moving forward with Jame’s idea.

There’s a lot of science and research behind how and why this works from studies of persuasion and decision-making. But bottom line, and like-it-or-not, James needs to marshall additional resources to persuade his upper management to move forward and with sufficient investment. The end result is management’s initial fears of change are allayed, they feel reasonably confident that they are moving forward in the right direction, and most likely, they say yes!

Patient Engagement: What Is It Really?

patient_engagementWhen a patient worries about their health condition, is that engagement? What about when a patient tracks their condition with wearables? Is a provider required for patient engagement to happen? Or is it only engagement when a patient is taking action to improve their condition?

A few years ago, health IT strategist Leonard Kish called patient engagement the “blockbuster drug of the century.” At HIMSS last week, there were numerous presentations on patient engagement and countless vendors offering patient engagement solutions. Yet, there is still no clear agreement as to what exactly patient engagement is, what it does, and how to measure it.

Let’s try to fix that. This first post in the series will focus on what patient engagement is.

We’ll start by defining what a patient is. (Interestingly, the word “patient” originally meant ‘one who suffers’ according to Wikipedia). The most common definition of a patient is simply someone receiving medical care. Note there is a connotation of passiveness in the notion of receiving care. The other relevant point is that receiving care requires interaction with someone who is providing the care. That means patient engagement requires a provider, not just a patient alone. So to be a patient, all someone needs to do is accept care from a provider.

What is engagement? I see engagement in degrees, from caring to understanding to acting. A patient is minimally engaged by virtue of caring about her health. She is more engaged when you actively work to understand her health. And she is deeply engaged when she is taking action – doing things – with the intent of improving her health.

One more component to add: Most patient engagement definitions include: a) participation, use of resources, and interaction with a provider, b) a goal of positive health behaviors, and c) an end result of health management or health improvement.

Put in all together and we have this definition of patient engagement:

Active participation of a person in their health and healthcare, which includes using resources, working with their provider, and taking action to understand, manage and improve their health condition.

How does this definition work for you? Any suggestions for improvement?

Now that we have a good working definition, we can move on to what patient engagement does, and how to measure it. Stay tuned!

Customer or Money: Which Comes First in Med Tech?

As a strategic-thinking med device marketing or sales professional, you know it’s all about putting the customer first. But how do you get your company executives behind you if they’re solely focused on hitting the quarterly numbers and only paying lip service to being customer-centric?

This was the focus of a session I presented yesterday with Mark Kesti at the first Medical Device Marketing Summit, put together by the inimitable Joe Hage.

The goal was to stir up fresh thinking and provide both practical and contrarian tools to win greater company support for practicing customer intimacy and putting the customer first in marketing and communications work. The participants were seasoned and smart. Lively discussion generated good, practical ideas.

Here are five key takeaways:

  1. First means first: Putting the customer first literally means just that- putting the customer first. How? Give the customer a voice when it matters. That translates into giving the customer a voice before you decide on what products to invest in, before you determine technical feasibility for your device or software, before you put your messaging together, and before your sales force hit the streets.
  2. Problems not solutions: When you do give your customers a voice, be sure you’re not asking them to design the solution. That’s your job. Ask them to talk about what is and isn’t working, what problems they want solved, and what a better end state would be like. Don’t ask them what the product should be or what your marketing should look like. NTJ (not their job)!
  3. Direct connection: Get your technical people – scientists and engineers – involved with customers early on. Let them hear problems, concerns, likes and dislikes directly from the customer, not mediated through a report you give them. Help your technical team to experience customer pain points as much as possible. This is where qualitative research methodologies shine.
  4. Money metrics: Not all dollars are equal. Some come at the expense of long-term customer relationships, like through hitting your numbers by heavy end of year discounts. In companies committed to customer intimacy, the lifetime value of a customer trumps hitting quarterly numbers every time. Caveat: Shareholders may not agree. You have to balance the sometimes conflicting needs of two masters in that case: shareholders and customers. Ideally you have shareholders who see the value of long-term gains.
  5. Behavior before beliefs: Let’s say your CEO, doesn’t believe in putting the customer first. He’s all about the money and that mindset pervades the culture. You can beat this too. But don’t try to change his beliefs at first. Get his behaviors to change. Pitch putting the customer first as all about making more money. Speak in ROI terms. Because it’s true. Putting the customer first does make more money.

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More here:

3 Powerful “B4’s” that Put First Things First in Winning Innovation

“But We’ve Always Done It That Way” – Zen, Zero-Based Thinking, and a Fresh Approach

How to Get to Breakthrough Innovation: Desirability First!

Population Health: The “Make or Break” Behavior Change Promise

A key promise of the population health phenomenon, so important to payors, providers, and suppliers is this: We need the public to get healthier. That requires participation. If payors pay, people will take advantage of free preventive services to get healthy.

Here’s how the Kaiser Family Foundation put it in their recent Health Reform overview (see bold): A key provision of the Affordable Care Act (ACA) is the requirement that private insurance plans cover recommended preventive services without any patient cost-sharing. Research has shown that evidence-based preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating them before they develop into more complicated, debilitating conditions, and that some services are also cost-effective. However, costs do prevent some individuals from obtaining preventive services. The coverage requirement aims to remove cost barriers.

The reality is that while cost is a barrier for some people, it’s not the only barrier. It may not even be the main barrier. Now you might be thinking, if preventive services have been proven to improve health and save lives, why would people NOT make use of them, especially when they’re free? What other barriers might there be?

In my two decades of experience working with CDC, CMS, FDA, and many public health efforts, behavior change is the holy grail. And maybe the hardest to achieve. The main barrier I believe is not money, but motivation. People will find all kinds of reasons (beyond costs) to NOT sign up for free preventive services, including: 1) I’m not sick, 2) I don’t need whatever those services are, 3) I’ll do it later.

Prevention has alway been a tough sell. The fundamental benefit promised is that something bad (illness) will not happen down the road. Many people don’t see that as compelling or personal relevant in a life with so many demands in the here and now.

The solution requires: 1) increasing immediate personal relevance, 2) making it simple to do. As my friend and colleague Peter Mitchell, head of Salter Mitchell’s MarketingForChange practice, says, make it fun, easy, and popular. Building on that, I like the FEFE acronym- Fun, Easy, Fast, Effective.

Research trends in the science of persuasion, behavioral economics and decision-making, social psychology, and marketing science, provide convergent evidence that motivating health behavior change and utilization of preventive services is no simple task, and requires far more than data, information, and logic.

Bottom line, population health players need to employ multiple approaches to motivate behavior change, and to not assume that a logical (and free) offer will do the job.

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FYI, here are a few more resources on motivating health behavior change:

Motivating Health Behavior Change: Three Dangerous Assumptions to Avoid

Getting People to Do What You Want: Two Paths to Persuasion

Ability-Motivation-Opportunity: Marketing’s Winning Trifecta

Behavior Change: It’s NOT Just the Person!

 

Motivating Health Behavior Change: Three Dangerous Assumptions To Avoid

Behavior change is becoming more and more important to device manufacturers, health IT companies, pharma, and life science firms, as they expand their offerings into disease prevention. Whether aiming to get people to eat healthier, exercise more, participate in screenings, take meds as prescribed, monitor insulin levels, or conduct self-exams, successfully motivating behavior change isn’t easy.

The good news is that health behavior change has been a major focus in public health for decades, and there are a lot of lessons that health care businesses can apply.

One key lesson is recognizing and correcting the fundamental assumptions that derail most efforts to motivate health behavior change. Here are three of the most pervasive and insidious assumptions.

  1. Assuming people don’t know better: Many companies wrongly assume that the barrier to behavior change is lack of awareness. Therefore the thinking goes, if we just give people logical reasons for why people should change their behaviors, they will see the light and mend their ways. Typically these logical reasons center on reducing risks of morbidity and mortality (does that sound exciting or what!?). The reality is that more often than not, people are already well aware that certain behaviors are bad for them. Ask any smoker or obese person; they recognize their habits are harmful, and they know they should quit smoking or cut calories. Lack of awareness is usually not the problem. Therefore, behavior change campaigns aimed at increasing awareness will always fall short.
  1. Assuming people behave as they believe: Consider your own life. Do your actions consistently reflect your beliefs about what is and is not healthy? Or is there a disconnect? I gave a guest lecture today to a great group of grad students studying public health communication. To make the point that people’s behaviors don’t always match their beliefs – what psychologists call cognitive dissonance – I asked how many regularly sleep 8 hours a night, eat nutritiously, and exercise vigorously. Only a handful of the students raised their hands. While they all believe they should get good sleep, eat well, and work out, very few behave that way. (And these are young people making health promotion/disease prevention their profession. They really know this stuff!). Human nature is such that we don’t always do what we know we should do. We unfortunately have the ability to sustain high levels of belief-behavior inconsistency. Campaigns that are predicated on the idea that people’s health behaviors will align with their beliefs about health usually fail.
  1. Assuming big negatives trump little positives: It seems so obvious. If you sell CPAP devices, you may think: How can people possibly not use their CPAP machine?  They could stop breathing and die in the middle of the night! Similarly, if you work for an insurance company or hospital, you may think: How can people at high risk of heart disease possibly not choose low fat, low salt foods? They could die of a heart attack! Same with medication adherence. Same with breast self-exams. Clearly, stopping breathing or having a heart attack are big negatives. But they are only possibilities. The comfort of sleeping without a face mask and loud machine is a definite. A small positive but a definite one. Likewise, the definite pleasure of a rich dessert can eclipse the possibility of a heart attack. Never underestimate the allure of immediate pleasures.

All these mistaken assumptions are rooted in what I call “us” centered thinking. The solution is to adopt “them” centered thinking. Put your customers in the middle, not yourself. That’s the first step toward successfully motivating health behavior.

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More resources on health behavior change here:

Getting People to Do What You Want: Two Paths to Persuasion

Be Like Vegas!… and 6 Other Tips to Increase Wellness Program Participation

 

Be Like Vegas!… and 6 Other Tips to Increase Wellness Program Participation

Why aren’t more members signing up for our free health programs!?!

The 3Es behavior change framework offers a fresh approach to solving the problem of low enrollment in valuable health programs. Education, Engineering, and Enforcement are the components of the 3E framework, which traditionally has been used in the Injury Prevention field (CDC is a leader here). It’s time for others to harness its power as well.

A simple example: If we want people to drive slower, we can convince them why (education), we can add speed bumps (engineering), and we can ticket them (enforcement).

Another example: If we want people to quit smoking, we can convince them why (education), we can establish no-smoking zones everywhere (engineering), and we can fine them for lighting up in public (enforcement).

A third example: If we want people to participate in our Wellness program, we can convince them why (education), we can integrate Wellness into other membership activities they have to do with us (engineering), and we can charge higher rates to non-participants (enforcement).

OK, the last example may be a bit oversimplified, but you get the point. Now let’s dig deeper. Seven key takeaways:

1. Health Behavior Change is Hard

Doctors, insurers, and public health agencies all want people to adopt specific behaviors that will help those people be healthier. It may be taking meds as prescribed, losing weight, avoiding injuries, or a host of other behaviors that ostensibly benefit the individual, the organization, and society at large.

But sometimes the target behavior is simply getting people to check out a program that can help them, like CMS’s Health Insurance Marketplace. Or insurers getting their members to sign up for free Wellness programs. Typically, participation is disappointingly low. Program developers, marketers, and outreach specialists that create and run these programs are astounded by the number of people that don’t sign up for their offerings.

What’s going on??

2. Compare Company/Customer Perspectives

Insurance company: Our Wellness program is designed to help our members. It can improve their health and save them money. And it’s free. All people need to do is go on our website and enroll. Why aren’t people signing up like crazy?

Customer: Why would I do a Wellness program with my insurance company? They’re number crunchers, they don’t know about wellness and prevention. Anyway, it’s probably just a way for them to cut my benefits and make more money.

These contrasting perspectives indicate a serious relationship problem. As an industry, health insurance companies rank among the lowest in customer satisfaction in 2014, according to the American Customer Satisfaction Index (about the same as airlines, the US Post Office, and cell phone providers – but better than cable companies!). If satisfaction is low, trust is likely to be low too. This means insurers start pitching their Wellness program with a credibility deficit.

3. Don’t Make Assumptions

Insurers and others presume that members should value their Wellness programs. This is mistake #1, and for a couple reasons.

First, members need to know about the program in order to decide if they will enroll in it or not. You telling them about the program does not mean they know about it. All it means is you provided them with some materials.

Second, for members to care about your Wellness programs requires them to: a) understand what Wellness is, b) value Wellness,  c) want to enhance their Wellness now, d) want help in doing it, and e) want that help from their health insurance company.

Figure out what your Value Proposition is: Determine exactly what makes your Wellness Program unique and valuable to members. And from their point of view of course.

4. Go Beyond Convincing (aka “Education”)

It’s one thing to get members to take time and seriously think about your Wellness programs, commit to trying them, signing up, etc. And a small segment of members (the “low hanging fruit,” so to speak) will do just this. All they need is the opportunity.

Consider your own life. Let’s say you own a Toyota and your local dealer was offering a “Car Wellness” program with all kinds of helpful information so you can take better care of your car. To take advantage of their free program designed just for Toyota owners, simply go to their website, enroll, choose classes, attend, etc. You want your car to be in good shape and last many years. Would you do it? (I’m not talking to the car buffs here!). If not, why not?

There are a lot of answers to why not. Most people will say time and money, but that’s far from the whole story. We spend on what we care about. And we don’t always think through things and make rational decisions.

That’s you’ll need to go beyond the traditional and assumption-filled Education strategy, and bring in Engineering and maybe even Enforcement.

5. Be Like Vegas – Embrace “Engineering!”

In Vegas, slot machines are ubiquitous – they’re in bathrooms, by airport gates, everywhere. The environment is engineered to entice people to play. In fact, people need to go out of their way to not gamble.

Because Engineering changes the environment or product, it doesn’t require people to make any choices. The behavior just automatically happens (like slowing down over speed bumps or signing up for a default Wellness program as part of overall enrollment). Evidence suggest that this passive or automatic approach is usually more effective than those that require more active decision-making.

The key Engineering question is this: How can you make participation automatic? How can you make it so it’s easier for members to participate with your Wellness content than it is to not participate?  Really think about this. List your assumptions, which can then be validated or corrected.

To start, understand the member experience, so you can identify the best Wellness touch points from a timing point of view. For example, maybe when people newly enroll as members they are so inundated with information, that Wellness Programs are the last thing on their minds. But when they get their surprise hand-signed Welcome card from you (right?) a few weeks later, they may be very receptive. What are the best touchpoints for engaging members in Wellness?

Consider bundling the process of enrolling in Wellness Programs with other sign-ups. But don’t just focus on getting them to enroll. Focus on getting them engaged. Here are some suggestions to think about Engineering from the perspective of marketing content: Consider small tidbits of Wellness tips that can be included in every single interaction with members. Think about integrating invitations for your Wellness program at times when people may find them more relevant. Put heart health tips on EOBS for cardiology visits, add smoking cessation tools on rate cards that show the differential for smokers, put cold and flu prevention tips on Back to School pieces. In short, meet people where they’re at.

6. Make Them Participate: Enforcement

Enforcement is the “hammer” strategy (or “carrot” if designed well). If members don’t enroll or participate in your Wellness programs, it’s gonna cost them. Could be on the front end, could be on the back end. This approach requires policies or regulations that you then enforce.

Enforcement means you have clear boundaries, expectations ,and consequences. Most people don’t love enforcement, but at the right time and place, and in combination with Education and Engineering, it is a strong motivator of compliance and behavior change.

7. It’s About Them, Not You.

Bottom line, tailor your Wellness programs to fit the lives of your members. Don’t expect them to mold their lives to fit your programs.

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Good overview of the 3Es: The Three Es of Prevention: Education, Enforcement, and Environment

Good example: Railroad Safety

 

Health Behavior Change? Try the “Wrong Reason” Approach

Health behavior change is a major challenge for hospitals, providers, med device companies, health insurers, etc. It’s been a topic of well-meaning and often paternalistic debate for centuries- how do you get people to do what’s good for them?

The prevailing – and not very effective approach, is to try to logically convince them. Make a rational argument as to the benefits of changing their behavior and the risks of not. Assume people will digest the information you provided. The light will go on! People will stop the bad behavior and start the good behavior. After all, it makes so much sense, how could they not agree and do what you say?!

We all feel that way when we are doing the persuading. It’s human nature. Whether it’s trying to get a kid to put on sunscreen, an overweight person to stop eating so much, or a patient to upload their blood pressure readings to their doctor, we often persuade with the logical “right reasons.” Which rarely works.

Why? It doesn’t meet people where they’re at. From their perspective, it pushes your agenda, not theirs. It presumes and may even require people to care about what you care about and believe what you believe.

The alternative is to figure out what already motivates them, what they  already care about, what they already believe -then find the common ground with what you want.

Example: Want to promote better nutrition? Maybe most people won’t be motivated by your logical argument about reducing their risk of morbidity and mortality (as exciting as it sounds!). But maybe what you may consider “wrong reasons” – like looking hotter or saving money or fitting in socially, will do the job.

“Wrong reasons” are really the right reasons when they motivate people to do good things. Then, once they’re doing the healthier behavior, they be open to your more rational point of view.

More here: http://www.researchworks.com/YMM_2012/ResearchWorks_YourMarketingMinute_HowToChangeYourEndUsersBehavior_TwoPathsToPersuasion.html