Brand Awareness Is Worthless: Patient Awareness Is Valuable

One of the strange things about tsunamis is that the most damage is always the result of the second wave, a wave that catches survivors of the first wave by surprise.

If I was a healthcare executive I would have spotters positioned along the beaches looking for wave number two. Instead, many appear to be taking on Mad Magazine’s Alfred E. Neuman’s “What—Me Worry?” attitude.
And here’s why. Ask to see a copy of your health system’s strategic plan. That may be naiveté on my part, but let us pretend that such a document exists. In it you should find a section about where the industry is headed, how that effects your organization, and what your organization is going to do to either take advantage of it or to defend itself from it. I’ll give you a few moments to read those sections…

You couldn’t find that part of the plan, could you? If you went back five years you wouldn’t have any more luck finding that same information in your system’s 2010 strategic plan. Your 2010 strategic plan should have mentioned something about possible threats to your business, possible threats about continuing to remain relevant. And included in the discussion about threats should have been a discussion about consumerism—healthcare’s four-letter word.

I challenge you to name a single, provider-driven, impactful innovation to the business of healthcare in the last fifty years. An innovation created by providers to improve their business model. Can anyone recall leaving a strategy meeting and thinking, “Wow, that should shake things up.”

Large retailers held those meetings five years ago, and they came out of their meetings with a plan to bring three things to healthcare; disruption, efficiency, and cost management. Those companies include Wal-Mart, CVS, Whole Foods and Target. And how have providers reacted? They have not.

Now for the bad news. Those same organizations have held more meetings, and what is about to hit the streets is wave two of the tsunami. And that wave will deliver even greater disruption, more efficiency, and even better cost management.

I don’t know the figures for the number of patients seen by CVS, but I am willing to bet that their growth rate and acquisition of new patients is worthy of envy. And since more people are not getting ill, all of those patients must be coming from somewhere. Retailers are gaining share in a market of excess capacity. The Minute Clinic model has demonstrated that it’s patients are brand-agnostic unless patients are seeking specialized care.

Is there a better brand name on the planet? Minute Clinic—service in a minute. And they compete for patients against organizations that have Eight-Week Clinics—service when we have an opening.

CVS did not have to build a single new facility to take millions patients from providers and PCPs; they simply reallocated floor space. Heck, they hardly even advertise, and millions of people gladly drive one or two miles for on-demand healthcare.

So, if I am an executive at CVS or Walgreens, what is the next great question they should be asking themselves? I think it is this—“How can we deliver more care to more people without requiring people to come to our stores?” That is wave number two.

The other issue overlooked by provider executives is that 75% of people are very loyal to their retailers. Their loyalty to organizations from which they purchase their medications is even higher because their healthcare insurance is tied to a specific drug retailer.

Consider this for a moment. People think of Uber as a taxi service. Uber’s valuation exceeds $40 billion dollars. And guess what?  Uber, the taxi service, does not own a single car. That same taxi service does not employ a single driver. It does not care whether gas prices go up or down because it does not pay for a single gallon of gas. It simply puts drivers and passengers together and lets them sort out the market. does not own a single hotel. OpenTable does not own a single restaurant. What those organizations own are ideas, ideas that put buyers and sellers together easily and in real time.

And while firms like CVS are disrupting the traditional way of purchasing healthcare, health system executives still think of the term customer as another one of those four-letter words. Note to health system executives: do not concern yourselves with how many letters are in the word, concern yourselves with how to embrace the word.

Every health system that added valet parking did so for one reason—to attract and retain patients. Upgrading your cafeteria and adding a valet service are not examples of innovating your business model.

Beefing up your marketing department will not enable your health system to compete against the second wave. Most health systems cannot even tell you whether marketing’s efforts added a single patient to their system last year.

The time to innovate was last year, and the year before, and so on. My immediate advice to provider executives would be to do one of two things; hold an innovation retreat and do not let anyone leave until everyone in the room thinks, Wow, that should shake things up. Or, grab your Speedo and some suntan lotion, and wait for the second wave.

What If T-Mobile Ran Patient Access?

So, I’m driving to pick my daughter up at her friend’s house, a friend who lives nine miles away. I fire up the GPS on my T-Mobile; estimated drive time of seventeen minutes.

The route is mostly back roads, and as soon as I reach the backest of the back roads I am informed, “GPS signal lost.” After having my way with the recording, I continue to drive. And drive. And you know the rest. I head to places with higher elevations, find a signal, and am directed to roads that even I know have nothing to do with where I am headed. My route is again transferred to another, and so forth and so on.

I am talking to myself, and yelling at drivers who look like they know where they are going. Squirrels on the side of the road point at me, and double over in laughter—I hope they choke on their acorns. After an hour and two minutes, I arrive at the house, upon which my phone chirps, “You have arrived.” I started screaming epitaphs in front of the squirrels.

An hour and two minutes is four minutes longer than I spent the other day trying to schedule an appointment with a large east-coast health system. The person with whom I spoke the longest had a pulse equal to that of a hibernating bear and, had he been a household pet, he would have been put down purely for aesthetic reasons.

I find it helpful to trace everything back to a seminal point like just prior to when the random swirls of gases in the chartless universe got together and formed the earth; or not, depending on which side of the Darwin bed you sleep.

From the side on which I sleep, the seminal point for patient access can be traced to the phone. If the people manning your health system’s phones cannot meet the basic needs and solve the problems of its callers, very little else matters because the callers will call somebody else.

Hammers, like phones, are very evolved tools. They haven’t changed for years. And why would they change?  Nails haven’t changed.  Nails have been the same forever. Therefore a hammer’s necessary features were worked out long ago. A heavy metal head and a handle. All you need, and nothing you don’t. Phones are also very evolved tools. The primary difference between a hammer and a phone is that if you do not have capable people on both ends of the call, you would do just as well speaking to a hammer.

A Life Sciences Solution For Consumerism: Beer, Mustaches, & Tuna

Consumerism is a topic that you either get or you don’t.  Those who get it, get it right away.  I’d have more success speaking with a turnip about it than with those who don’t.

Consumerism is a catch-all phrase for a number of healthcare initiatives that more often than not are nothing more than polite country club discussion across all of the healthcare sectors.  Without recasting consumerism, population health management and accountable care will be ineffective.  Without consumerism, complying with the Affordable Care Act and boosting Star ratings will be very difficult.

I spoke recently about implementing consumerism with the president of one of the largest life sciences firms, the president of one of the national pharmacy chains, a EVP of one of the three largest payers, and with several senior provider executives.  The conversations are all the same–either they do not even know where to start, or they started without knowing what they are doing.

The two biggest questions people have of healthcare to make consumerism work are knowing, “Who am I?” And “How am I?”

If you do not know who I am and how I am you cannot offer me care that is accountable and you cannot manage my health.

Warren Beatty stared in the movie, Heaven Can Wait.  Beatty played the role of a professional football quarterback who died in a car accident and was reincarnated as the CEO of a large conglomerate.  The business was in a lot of trouble because of the shady way it conducted itself.  The business owned a tuna company.  It kept its costs low by scooping up whatever happened to be swimming past its nets.  It caught a lot of tuna, and a lot of Dolphins.  The Dolphins died just like the tuna, and the company received a lot of bad press from killing Flipper.

During a board meeting, Beatty’s character announced that the company had to find a way to catch tuna without killing any more Dolphins.  He told the board, “We are going to be the good-guy tuna company.”

Life sciences, the small molecule people, are the furthest removed from patients. That is just the nature of their business. Even so, that is no excuse for not having a consumerism program.  Currently, life sciences’s entire approach to consumerism is to run television adds entreating people to tell their doctors to prescribe a particular medication.  Ten seconds of young, smiling healthy people follow by twenty seconds of a pleasant sounding person warning viewers that the product could cause everything from the death of their dog to hair loss to suicide.  That approach doesn’t leave many people feeling warm and fuzzy.

But it doesn’t have to be that way.  Life sciences could be the good-guy tuna company.  All that is needed is a strong executive and a vision.  Permit me to share one such vision with you.

As many of you know, I had a heart attack thirteen years ago.  As a result, I take the usual medications for heart disease.  I don’t know which firms produce them, and none of those firms know who I am.  I visit my cardiologist once a year, and I work very hard to ensure that I do not have to visit him more often.  It seems like there could be a better way to manage that aspect of my health. Somebody makes my meds.  Blue Cross pays for my meds.  CVS dispenses my meds. And, Penn Medicine prescribes my meds.  

The circle of life.  It is a closed loop. Every organization does their part.  And none of those organizations has a clue about my health.

I watched a TED Talk yesterday about an Australian, who while drinking beer with his mates one November evening, pondered that fact that while their are many social groups to combat women’s health issues, that there were no groups combating diseases that affect men.  And so, he started a group to combat prostate cancer.  

His goal initial goal was simple.  In the first decade of this century, he got guys to grow 1970s-style mustaches to signal their of awareness of prostate cancer.  Buy the end of its first year, four hundred and fifty hirsute Aussies had grown mustaches.  In Australia, a mustache is referred to as a “Mo,” and as a result he called his group “Mo”vember which is a portmanteau of “mo” and November.

Then he decided that the group should raise money to help improve the screening and treatment of prostate cancer.  He asked the executives of the major life sciences firms to support his group, but none of them did.  Fosters, the Australian beer company was the only firm to back the group.  To date, he and his mustached friends have raised over several hundred million dollars, and Movember is global.

Guys, beer, and upper lip hair have become a powerful force for wellness.  Ideas do not have to be complicated to be effective.  After all, some guy just started a company selling untucked shirts–I am willing to bet that there was a lot of beer involved somewhere in their launch process.

Health sciences firms can do more to improve care and to drive wellness than simply running feel-good commercials.  So, knowing that millions of people want to be healthy and to stay healthy, what if a life sciences firm or a payer or CVS did the following?  What if a firm created the Facebook version of health–“Healthbook”™?

Think about it.  Facebook has been moderately successful.  Half of the world’s population already knows how to interact with a Facebook-like social media platform.  Although there are hundreds of social media sites for a variety of illnesses, they are a bunch of trees looking for a forest.  Be the forest.  Decide to be the good-guy tuna company of your industry.  Design and build Healthbook™.  Give it a remarkable user interface that delivers a remarkable user experience.  Let patients and healthy people connect with each other about what works and what doesn’t.  Make it something they want to go to to manage their care and their wellness.

Do this and all of a sudden millions of people start to think that some big pharma company is using its size and capital to do more that simply running Stepford Wives commercials.  Payers, instead of being viewed as the death-stars of healthcare, could be seen as doing something other than denying claims.

Why Is Your Car Healthier Than You?

Last week I received an email from my dentist letting me know that I was due for a check up and that I could schedule it on their website by clicking the inserted link.

Yesterday I received a postcard from my eye doctor asking me to schedule my annual eye exam, and letting me know that if I scheduled it in the next two weeks I would receive a twenty percent discount on either contacts or a pair of glasses.

Today I received an email from Chem-Lawn reminding me to schedule my fall fertilizer treatment, and an offer to receive a thirty discount on next year’s service if I prepaid for it this year. I received a similar email regarding the health of my car.

Everyone wants my business.

Well, almost everyone.

And they are not only making it easy for me to buy from them, they are unabashedly flaunting me with rewards for buying their services. Why are they doing this? They want to prevent me from having bad teeth and bad eyesight, a lawn full of weeds, and an unhealthy car.

Healthcare isn’t able to communicate on a personal enough level that it is interested in my weeds or teeth. While healthcare has many proactive initiatives, healthcare has not figured out how to connect those initiatives to you and me at a level that causes us to act. We act when we are ill.

Healthcare’s strategy is straight out of the 1970s; mailers, billboards, Stepford Wives-like commercials, and outbound telemarketing calls. If you do not understand history you are destined to repeat it. How well is that working?

And that about sums up everything you need to know about why, under its present course, healthcare is at least a decade away from being able to do anything more that just talk about population health, accountable care, and wellness.

Just saying you are a digital healthcare company or a population health company does not make it true.

Healthcare marketing needs a do-over.

There are probably tens of millions of people who would pay a healthcare provider or payer or national retail pharmacy to manage their wellness. But there is not a single firm selling wellness.

Until then, healthy people will keep getting sick. The only good news out of all of this is that when we get sick we will have good teeth, great vision, weed-free lawns, and cars that work well enough to allow us to drive to the doctor.

Understanding Patient Personas In 1 Easy Step

kind of a big deal

I’ve been in one too many meetings where it has been obvious to me that when I use the term ‘persona’ that it is not resonating the way I hoped it would. Sometimes the people in the room think I misspoke, adding an ‘a’ to the word that did not belong. That is when I get the turnip in the headlights stare.

Normally I would not waste a blog over a single letter, but that little ‘a’ has a lot to do with why so many companies are in left field when it comes to effectually implementing consumerism, access, and engagement.

For without personas, you are left with people. All of them. And sorting our what they need with regard to population health, accountable care, and wellness is impossible.

And because I think best when I think simple, I am going to present a simple analogy that will allow everyone to understand personas and how they relate to healthcare.

USA Today; the newspaper. I do not think anyone actually pays $2.50 cents for it, but if you travel, you get it for free at most hotels. So let’s look at who travels. Pretty much everyone; people of all shapes and sizes and interests.

And so, for USA Today to be viable, it has to offer something of interest to a very wide range of people with differing interests and through different channels. In their wisdom, USA Today decided that if it wrote about news, sports, life, technology, travel, and opinion, it would have enough varied content to interest everyone at least for as long as it takes to waddle through the Holiday Inn’s continental breakfast.

So, here is everything you need to know about the application of personas to healthcare. Every health system, including yours, has six to ten, different groups of people into which everyone who needs to interact with your system can be placed. The premise behind creating personas is that each group has something about their needs and interests that differ a little from another group, even though many of their requirements and expectations will be similar.

The purpose of understanding personas has nothing to do with marketing or selling. It has everything to do with connecting, and with connecting in the way with which they want to connect and with meeting the expectations of the members of each different group. People looking for a human connection in a way that understands their needs. (A call center is not a human connection. Nor, is a website.)

A patient persona is a fictional representation of an archetypal member of the group. The persona is not a statistic; it is not a demographic. Your personas may be informed by data, but they are not confined by data. Think back to USA Today. Think of the entire paper as the population you serve, and the individual sections as the personas. The editor has to know what the fictional sports fan wants to get from the paper that is different from what a fan of lifestyles may want.

For starters, let’s create the following creating these basic personas:

  1. Inpatients
  2. Outpatients—see, that wasn’t too difficult
  3. Family Members & Caregivers—you may wish to break this into two separate groups
  4. Referring Physicians
  5. and…drumroll…Prospective Patients—the largest group

I implore you to hold off breaking down personas into service lines and areas of specialization until you first work out these five personas. Yes, the needs of a cancer patient are very different from an asthma patient, but remember where your organization is now in its ability to handle even basic telephone access.

Everyone is in at least one of these groups. Many people are in more than one group. Some of these groups are more focused on care, while others are more focused on buying your services.

The determinant of which group a person belongs varies over time. For example, an outpatient, at some point in his or her life becomes an inpatient. Let’s call that variation over time the patient’s health journey—more on that later.

Unfortunately, the way patient and customer access works today, all of us have to waddle through the very same, one-size-fits-all path to our health system and our payer. What makes it even worse is that that path was built way back when Al G. Bell invented the phone.

Now, once you get going on personas, to get your best result, you need to incorporate how all of the different access channels come into play; calling, using smart devices, and social media. The experience you create and the functionality you deliver should be consistent across channels. And when you think about designing the experiences for the channels, the number one thing to keep in mind is that the channel of choice for the vast majority of people is mobile. Start designing the experience for mobile, and branch out from there.

If you did not find this helpful, you can delete the blog by installing BleachBit.  The BleachBit software can be downloaded for free from Hillary Clinton’s website.

I’m Paul Roemer, and I approve this message.



If You Ask Customers For Feedback, You May Not Like What You Hear

kind of a big deal

I’m a chapter ahead of how most people look at the world.

If life can be funny, the Internet is hilarious.  In the last several years, The Internet has created an entire culture around the need to be liked, and to show others how liked you are.

Ebay is an example where not telling someone that you liked their product can get you hate mail.  When you purchase something, you have the opportunity to let others know that the vendor was very good and that you liked their product.  I do not do that. I do not give someone a like simply for doing his or her job, but I do get emails pleading for my imprimatur of approval.

Uber is another good example of our need to instantly know that we are loved.  That, however, is a service where I will rate the driver, in part because I know that for the drivers to keep their job they have to maintain a high rating.  I also do it because they designed their system such that I do not get my receipt emailed to me until I complete the rating.

Social media is the same way.  Facebook has given way to groups like Instagram and Snapchat so people can get liked faster.  Post a picture of what you ate for desert and everyone in your network will let you know what a good choice you made by sending you a like.  People who don’t send you the instant gratification that you deserve run the risk of being defriended, or even worse, abused.

Healthcare has one example of how ridiculous collecting likes has become.  While Epic does not have a place on its homepage for you to show your love, it does have a place on its Facebook page.  If you search for Epic on Facebook you will find that 5,987 people like it or them, I’m not sure which term is correct.  Lemmings drinking the Kool-Aid.  These same people are allowed to decide whom our next president will be.

(I was at HIMSS this year and I did not see a single person wearing a t-shirt with the words “I love my Epic” printed on it.)

Rumor has it that the current administration is considering issuing an executive order that will require people who use Facebook to like everything their friends post about themselves in order to improve everyone’s self-image.

We have become a nation of sycophants.  I do not do instant gratification.  Go ahead, abuse me.

If you are a fan of the movie Bambi, you may recall that Thumper’s mother told him, “If you don’t have something nice to say, don’t say anything at all.”  I think that same message applies to people and organizations that want you to tell you that you like them.  The thing is, they do not want to know that you do not like them.  For example, on Epic’s Facebook page there is no thumbs-down icon for you to click, just a thumbs-up icon.

So here is why I am writing about our incessant need for gratification.  A friend emailed me a link to a story about a pediatricians’ offices in Lee County, Florida. The doctors were dropping patients because the parents of some patients posted negative ratings.  If Comcast dropped customers simply because people rated Comcast poorly, Comcast would not have any customers.

When I dislike a service I receive, I feel obligated to let someone know.  If the provider of that service had the temerity to drop me as a customer, I would feel the moral imperative to let everybody know.

Physicians, especially pediatric physicians, may not understand just how involved it is to get their child to and from a doctor’s office.  I posted this diagram recently showing that there are as many as eleven processes a parent must complete to take their child to the doctor (

Moms and dads are busy.  And the least you can do after you have asked for their feedback is to not rub their faces in it by dropping them.  A bad experience is your problem, not theirs.

Healthcare Consumerism Lessons From Monty Python :) 

If a business problem cannot be explained by looking at something from Monty Python, in my opinion, it is not worth solving.
 My go-to film for explaining all things related to healthcare is Monty Python and the Holy Grail. Just to get the juices flowing, let’s set the stage with a few lines from the movie: 
King Arthur: I am your king.

Peasant Woman: Well, I didn’t vote for you.

King Arthur: You don’t vote for kings.

Peasant Woman: Well, how’d you become king, then?

[Angelic music plays… ]

King Arthur: The Lady of the Lake, her arm clad in the purest shimmering samite, held aloft Excalibur from the bosom of the water, signifying by divine providence that I, Arthur, was to carry Excalibur. That is why I am your king.

Dennis the Peasant: Listen. Strange women lying in ponds distributing swords is no basis for a system of government. Supreme executive power derives from a mandate from the masses, not from some farcical aquatic ceremony.

Arthur: Be quiet!

Dennis the Peasant: You can’t expect to wield supreme power just ’cause some watery tart threw a sword at you!

I am healthcare’s Dennis the Peasant, and, yes, you can become a consultant by having strange women in ponds throw swords at you. At least it worked for me.

Staying with our theme of mediaeval British oppression of the working class, in the 14th century, the part of Ireland ruled by the English had various forms of demarcation. One of those forms was a castle moat that separated the castle. The separation was called the English Pale. Going to the other side of the separation, away from English Rule was referred to as going beyond the Pale. So see, if nothing else, you’ve learned something new today.

Is it beyond the pale to think that the business of healthcare can handle words of three or more syllables? Words like engagement and consumerism and innovation? Although the word innovation starts with the letter ‘i’, many times there is no ‘you’ in innovation.

Permit me the chance to try to explain what I mean by using the following example. If you’ve ever bought a pair of reading glasses, you know that you do not need to know your prescription. Al you have to do to find the right pair for you is to stand a foot away from the sign with themes sages printed in various sizes of lettering, and keep trying on different powers of glasses until you can read the text saying, “If you can read this, you have found the right pair.”

Pretty simple. Until you get your eyes examined. That is when you learn that you see differently from each eye. That tells you that the reading glasses you just bought with the same strength for each eye are no what you need.

The quick solution is not always the best solution.

And so it is with healthcare consumerism and patient and customer access. Almost every health system in the US has opted for the easy solution to deal with patient access and engagement.

• Business problem: people call us

• Business solution: build a call center

Problem solved. Not so fast Skippy. And this is why you find yourself searching your deleted emails for the one from Dennis the Peasant. Moi.

If you think having a call center is the solution to your patient access problem, stop reading this and call your health system and try to schedule an appointment. And it only gets worse from there. Access begets engagement. And engagement begets experience. And bad experiences are why patient leakage on the front end of patient journeys is a hundred times greater than it is on the back end.

Your call center does more to degrade patient acquisition, patient retention, and care management than almost any other business process in your organization. But it’s an easy solution to a complex problem, and it allows you to check the ‘problem solved’ box and it frees you up to wrestle with all of the other gnarly problems you have.

And so, to complete the circle of life analogy from Monty Python to the English Pale to healthcare, I am listening to Pink Floyd as I am writing. And the Floyd are British.

Guard: Who goes there?

King Arthur: It is I, Arthur, son of Uther Pendragon, from the castle of Camelot. King of the Britons, defeater of the Saxons, Sovereign of all England!

Guard: Pull the other one!

King Arthur: I am, and this is my trusty servant Patsy. We have ridden the length and breadth of the land in search of knights who will join me in my court at Camelot. I must speak with your lord and master.

Guard: What? Ridden on a horse?

King Arthur: Yes!

Guard: You’re using coconuts!

King Arthur: What?

Guard: You’ve got two empty halves of coconut and you’re bangin’ ’em together.

King Arthur: So? We have ridden since the snows of winter covered this land, through the kingdom of Mercia, through…

Guard: Where’d you get the coconuts?

King Arthur: We found them.

Guard: Found them? In Mercia?! The coconut’s tropical!

King Arthur: What do you mean?

Guard: Well, this is a temperate zone.

King Arthur: The swallow may fly south with the sun or the house martin or the plover may seek warmer climes in winter, yet these are not strangers to our land?

Guard: Are you suggesting that coconuts migrate?

King Arthur: Not at all. They could be carried.

1st soldier with a keen interest in birds: What? A swallow carrying a coconut?

King Arthur: It could grip it by the husk!

Guard: It’s not a question of where he grips it! It’s a simple question of weight ratios! A five ounce bird could not carry a one pound coconut.

King Arthur: Well, it doesn’t matter. Will you go and tell your master that Arthur from the Court of Camelot is here?

Guard: Listen. In order to maintain air-speed velocity, a swallow needs to beat its wings forty-three times every second, right?

It may be easier to teach a coconut how to migrate than to make it easy for your patients to access your health system.

Regards, Dennis