Tom Brady and Atul Gawande: Designing a Different End Game

Tom Brady and Atul Gawande, two Bostonians with wildly divergent careers, both take the same approach to designing a different end game; they flout the conventional wisdom to achieve their objectives. For marketers wanting to change the trajectory of their brand, company, industry or career, these two prominent Bostonians show the power of doing things differently.

Tom Brady, the New England Patriots quarterback, has always been vocal about wanting a different end game, one that would keep him playing high-level football in his 40’s. So according to a recent New York Times Magazine article, Tom defies conventional training practices designed at building strength in favor of those that create more pliable muscles. He credits his unique training practice with sparing him from career ending injuries, ultimately enabling him to win 4 Super Bowls (so far).

Atul Gawande, Boston surgeon and best selling author, challenges the more medicine is better medicine dogma that runs deep in our American cultural veins. Gawande addresses the literal “end game” in his best-selling book Being Mortal, to propose a radical new approach on appropriate care in our last years. Rather than doing everything possible to ensure maximum patient safety and longevity, Gawande contends that instead, a doctor’s role is to ensure that people leave this earth in a way that respects their values and priorities.

To do this, physicians and family members need to understand what constitutes quality of life from the patient’s point of view. In one example, Gawande tells of a daughter’s surprise at her father’s definition of quality of life as “being able to eat chocolate ice cream and watch football.” Her father had been a professor emeritus so she assumed he would not have wanted to live unless it was as a fully functioning intellectual. It was this knowledge that helped her make an entirely different choice for her father when faced with a life and death decision by her father’s surgeons.

I wasn’t so lucky with my father. The idea that more medicine, more effort, is not always appropriate was a totally foreign concept to me for most of his illness (and most of my life). So the poor guy cycled in and out of the hospital to rehab a number of times, getting weaker with every visit. By the time a palliative nurse friend of mine, helped me to see the light, it was too late. Having made the decision to bring him home after our post-dinner talk, I received a call the next morning that he had died in the Rehab institution.

While I can take comfort that my father seemed to enjoy all the attention he received at the Rehab facility, I often wonder if he would preferred a different ending. With my 88-year old mother, I have an opportunity not to make the same mistake.

The lessons of Gawande’s Being Mortal and Tom Brady’s historic Super Bowl victory transcend their individual career choices. Their work is testament to the truth of Einstein’s definition of insanity–doing something over and over again and expecting a different result. These two different men offer the same valuable lesson about the need to challenge the status quo to achieve a different result.

In the pharmaceutical industry where my company, extrovertic, does most of its work, there is a lot of organizational dogma about how to drive sales. It includes “HCPs write prescriptions, not patients,” or the time honored “the sales representative call is the best way to reach physicians.”

I know a lot of talented and progressive marketers who are confronting these doctrines on a daily basis. It’s hard work to be the one constantly going against the grain. But the experiences of Tom Brady and Atul Gawande are proof that a successful end game is worth the fight.

Three Prescriptions for Patient Centricity

Patient Focused. Patient Centric. Patient First. There are lots of buzzwords companies use to describe their aspirations for a renewed focus on patients. But as my 8th grade Latin teacher once told me,

“The road to hell is paved with good intentions.”

Whatever phrase your company uses, here are three prescriptions on how to “walk the talk” of patient centricity in 2015 (and avoid a dance with the devil)

1. Fully infuse the voice of the patient into drug development. Historically, patient marketers are among the last to join pre-commercial or even launch teams. To be more patient focused, teams need to be staffed with patient experts early in the game.

And once in the game, patient marketers should make development of customer service and adherence programs the first order of business. As payers and patients have to increasingly make cost/quality trade-offs, it is critical that marketers can prove that their patient services actually make a difference in adherence rates, patient experience and clinical outcomes.

In fact, patient services already a factor into 3rd party purchase decisions. For example, according to a Duke physician I heard speak at a conference, Eliquis, a medication in the very crowded stroke prevention category, was chosen over competitors because the brand had the strongest co-pay assistance program.

Or just listen. Patients in clinical trials are already shaping opinions of the drug through their online conversations. An extrovertic social media analysis found an average of 30,000 patient conversations taking a place every month by patients involved a clinical trial.

2. Partner with providers and payers to meaningfully improve the patient experience at the point of care. HCPs, Integrated Delivery Systems and Payers are going to be judged on outcomes and patient experience. Pharmaceutical companies have the know-how and resources to help their customers meet the triple aim of improving patient experience, lowering costs and driving better outcomes. Take a look at all the governmental metrics requirements and pick a few to partner on.

It will also be important to have an expansive definition of point-of-care, both in terms of place where care happens and the people who provide the care. Care is now being highly distributed, it’s happening at home, at the retail pharmacy, at work, at Costco and at urgent care centers. And with the looming primary care physician shortage, care will be increasingly be delivered by nurses, physician assistants and even lay health workers.

And let’s not forget the increasing role patients are playing in their own health with the explosion of wearable technology and the whole quantified-self movement. The point of care is now everywhere and the smart pharmaceutical marketers will be conducting pilots to figure out how they can add to the patient experience.

3. Adopt a cross-channel patient experience framework to conduct marketing activities. A good patient experience is one that is consistent throughout every interaction, whether it be through a website, a phone call or in person meeting. Many of these touchpoints are managed by different functions in a pharmaceutical company, yet to the consumer it all comes from the same company. So the company has got to start acting like one company.

And this one organization needs to be reoriented towards driving patient satisfaction rather than driving sales. Driving satisfaction doesn’t mean revenue generation takes a back seat. There is a whole body of literature that proves that higher customer satisfaction scores result in higher sales and profits, in industry after industry.

But first the voice of the patient needs to be heard. This will require an integrated system of collecting patient feedback in a way it can be acted upon. For example, how well is the medical information call center doing in meeting patient needs? I would guess most marketers don’t know.

So take these 3 Rx’s and make 2015 the year that pharma companies turn patient centric talk into action. (And to my eighth grade latin teacher, Mr. Riggs, I really did “disce diligentius.”)

The Orphan Impact: Small drugs drive big changes

Seems everybody’s talking orphan drugs these days. No wonder, according to EvaluatePharma’s 2013 Orphan Drug Report, orphan drugs are estimated to reach 15.9% of total worldwide prescription sales by 2018. But the orphan drug impact goes beyond sales numbers. I believe that the patient centricity blossoming in the rare disease divisions will eventually spill over into the primary care divisions of pharmaceutical companies.

With the big blockbuster primary care drugs, development success lay primarily with company research departments. The halls of Pharma echo with stories of researcher heroics—how the lone scientist kept a molecule from hitting the drug dustbin only to become the next blockbuster.

But in orphan drugs, the heroes are as likely to be individual patient family members as researchers. In some cases the drug literally starts with patient families. Thanks to advances in digital technology and social media, orphan drug patient families play a major role in every aspect of bringing a drug to market, going far beyond traditional advocacy roles. Now individuals are able to leap tall barriers with a click of a mouse to accomplish superhero feats formerly reserved for massive organizations like the NIH and pharmaceutical companies.

Consider the role of patients, families and organizations in:

Disease discovery: Matt Might, a father whose son had a disease entirely unknown to science, leapt over barriers of scientific self-interest to find other patients and give his son’s illness a name.

A well-known blogger in his field, Matt’s post about his quest helped identify patients like his son across the globe. In the New Yorker article, which describes Matt’s disease naming odyssey, a Duke geneticist, who worked with Matt, sums up the new patient paradigm with this quote:

“It’s kind of a shift in the scientific world that we have to recognize—that, in this day of social media, dedicated, educated, and well-informed families have the ability to make a huge impact…Gone are the days when we could just say, ‘We’re a cloistered community of researchers, and we alone know how to do this.’ ”

Research direction: John Crowley funded individual scientists to fill the treatment void when he learned his daughter had Pompe disease. Ultimately John ended up partnering with one scientist to form a company that eventually was folded into Genzyme. And while his story is certainly one of the most dramatic (to the point of being the subject of a major motion picture starring Harrison Ford), John’s ability to drive the course of scientific discovery is becoming more commonplace in the rare disease space.

Product approval parameters: In June 2014, the Parent Project Muscular Dystrophy (PPMD) patient group, submitted the first ever-patient advocacy-initiated draft guidance for a rare disease to the FDA for Duchenne muscular dystrophy. Patients, through organizations like the PPMD, are now directly driving how Pharma should be conducting their research.
Because of the outsized role patients and their families play in bringing a drug to market, building strong patient relationships is a key marketing investment for orphan drug marketers. For example, Biogen Idec, deployed over 15 community managers to support people with living with hemophilia even before they had an approved product.
There are already signs of an “orphan drug spillover effect” on primary care marketing. Consider Sanofi’s community manager position in their Diabetes franchise. Or more recently, that Sanofi appointed a Chief Patient Officer. And this I believe, is just the start of the orphan drug effect.

Soon the patient centric tactics of Rare Disease marketers will be highlighted in “marketing excellence” meetings all over Pharma. Then questions will come during marketing plan presentations about “why can’t primary care teams start building patient relationships like their rare disease counter parts?” And before you know it, the small seeds of patient centricity will finally blossom throughout Pharma.

How design thinking can elevate the patient experience

Finding purpose in the mundane

What could be more boring than the traditional patient pamphlet?

Many times patient pamphlets are created without the most important ingredient, the patient. The traditional pamphlet is generally a collection of information that the health care marketer wants to impart to the patient. Little thought is put into what the patient wants to know. And even less thought is put into how the patient wants to physically interact with the pamphlet.

A little design thinking could change all that. One of the key principles of design thinking is purpose. Every element should have a customer-focused reason for existing. This requires a deeply rooted understanding of customers and how they interact with a particular object. It is this understanding that can transform the mundane into the marvelous.

One of the best examples I have ever seen is the in-room collateral for the Wanderlust Hotel in Singapore that I stumbled upon at an American Institute of Graphic Arts (AIGA) exhibit. The design team from Foreign Policy Design had a profound understanding of the prototypical Wanderlust guest. The type of guest who checks into the Wanderlust hotel is “curious and interested in discovering, engaging and immersing in new experiences.” They have a desire for personal growth through exploration.

Based on this understanding, the designers reinvented the “almost-useless conventional in-room directory” into a more useful travel tool. The in-room directory was morphed into an itinerary, full of useful local information including “area maps, train and bus maps, local shops and restaurants as well as thoughtful blank pages for notes and sketches.”

The reimagined in-room directory led to a redesigned check-in procedure. As the AIGA exhibit notes detailed, the itinerary “improved the check-in workflow, converting a laborious and dreaded check-in process into something fun, a talking point.”

This proves that one small design element can trigger a cascade of changes that lead to an improved overall brand experience. And the business results? The hotel has been featured in core travel publications including Travel & Leisure, has appeared on almost 500 blogs, and its room occupancy rates have risen.

And no wonder, “Creating a unique customer experience is one of the best ways to achieve sustainable growth, particularly in industries that are stagnating,” according to the consulting firm ATKearny. In industry after industry, higher customer satisfaction has been shown to drive sales and profits.

So back to the patient pamphlet. What is its core purpose? What is the problem that the pamphlet (or for that matter, the website, app or DTC ad) is trying to solve? What other problems does the patient have? Is there a role it can play there? How should it be redesigned?

What happens if the patient pamphlet is reimagined as an itinerary for better health, rather than merely a way to convey basic product information? Could infusing a higher-order purpose into a pamphlet set off a cascade of changes in all marketing activities?

The most overlooked marketing investment

Investing in your customers. That’s what companies, like YouTube, who have their pulse on the consumer do according to a recent article in Digiday. YouTube is helping their customers develop the content that will help them realize their dream of becoming digital stars. But the concept of customer investment goes beyond the digital world. Investing in customers is a business strategy well described in “Who Do You Want Your Customers to Become?” an e-book by Michael Schrage being offered by the Harvard Business Review.

Schrage says businesses can keep growing by asking, “Who do our customers want to become?” and helping them get there by strategically investing in customer capabilities. Invest in customers, because, as Schrage puts it, “your future depends on their future.”

Health care is no exception.

Think of the demands placed on physicians by the Accountable Care Act. To be successful in the future, physicians will need to become:

• Customer service experts since patient experience will drive reimbursement
• Data analysts as the practice collects patient satisfaction data
• Healthcare systems thinkers as practice ratings are dependent on the entire office visit experience, not just the physician interaction

The demands on patients have also increased. Take the experience of Peter Drier who practically become a forensic accountant to track down an unexpected $117,000 in charges associated with his neck surgery as recently reported in the New York Times. Or Matt Might who, according to an article in the New Yorker, had to supersize his social media skills to assemble a group of patients across the globe to give his son’s illness a name.
With the advent of the health care exchanges, Payers who once operated in the B-to-B mode have now found themselves having to develop the type of direct-to-consumer marketing skills pharmaceutical marketers acquired in the 1990’s.

There is no shortage of investment needs when it comes to pharmaceutical customers. Of course there is all sorts of regulation against practice building and incentivizing use. However, by applying a little creativity and keeping the end game in mind—improved outcomes and a better patient experience—the smart pharmaceutical “investor” will be able to eke out a competitive advantage with some well placed customer bets!

Bad Mom, Wonderful Woman: A Tale of One Health Plan

Improved patient experience. As a health care marketing professional, I see the topic everywhere. As a patient, though, it is often nowhere to be found. Here’s my Tale of One Health Plan. One day, one health system, two appointments, two dramatically different patient experiences. In one visit I was a “A Bad Mom,” in the other, “A Wonderful Woman.”

Bad Mom, Wonderful Woman

 

 

 

 

 

 

 

 

 

 

First the “Bad Mom.” At a Children’s Center” in an affluent hospital, my 15-year old daughter and I entered what looked like beige food court in a mall, little booths for each pediatric specialty ringing the room. Threatening signs dotted the walls cautioning against letting your children bounce on the furniture.

I approached a booth with a simple question. “What time was my appointment?” I had made the appointment for 3 pm but had received a confirmation call for 2:45. Asking one of the Booth Ladies, I was told, “I don’t know when your appointment is for, just sit and wait for the doctor.” This patient experience told me that the hospital’s time was more important than my own and that I could not be trusted to come to an appointment on time.

At 2:43, after eventually learning my appointment was for 3 pm, I decided to dash to the hospital coffee shop on the floor below. When I came back at 2:55, my teenage daughter was nowhere to be seen. Going back to the Booth to ask about my daugther’s whereabouts, the original Booth Lady didn’t even look at me, but told her companion Booth Lady, “I told the mother to wait for the doctor. This patient experience told me I wasn’t a person, but an individual filling a role, and doing it badly at that. Bad Mom, Bad!

Contrast this to my mammography later that day. Not only was I greeted by a friendly woman, I was given thorough instructions reinforced on a patient handout. I was then whisked away into a spa-like changing room, complete with honey colored wood lockers, thick terry robes and ethereal Spa music playing in the background. To top it all off, I got a bracelet commemorating breast health awareness month when I left. I was a “Wonderful Woman.”

Yes, this was the same health system. But no one had bothered to think through how an individual person might experience it’s different parts in her different roles: parent, patient and parental caregiver. I know a unified patient experience is possible.I increasingly use another health system in my area, the Summit Medical Group. The receptionists are uniformly friendly, even when you as the patient screw up. For example, one of the receptionists noticed I missed an appointment in another department and made a call to have them squeeze me in so I wouldn’t have to come back again. That patient experience told me I was an important individual whose time was valuable.

Now the medical care I receive in both systems is excellent. But if I needed a new doctor, I would go to Summit Medical Group. And I am not alone in judging a system by it’s support personnel. According to PwC Health Research Institute, 60% of consumers said staff attitudes are a key factor in evaluating their provider experience. The lesson here is to make sure the patient experience is understood and designed from the patient’s perspective. And that starts from the moment the patient picks up the phone to schedule an appointment.