The New York Times is written using language that can be understood by an eighth grade student. I have an eighth grade student. He refuses to read my blog even though our collective tax dollars suggest he should understand it.

It is one thing to write at a level that an eighth grader can read. It is another matter entirely to try to understand what an eighth grader can comprehend. Never the two shall meet.

A few years ago when I began my blog, I had to figure out who my audience would be, and at what reading level I should I address my remarks. Most healthcare blogs are written at a level that supersedes my ability to decipher the message, and so I wondered, is it possible to take a complex issue and relate it in terms that would resonate with those of you who are kind enough to spend a few minutes with me each week?

A friend suggested that I write in crayon and she encouraged me to use a lot of pictures. Maybe I could write a pop up book that could also serve as a conversation starter. A coffee table book.

I demurred. And from my friend’s counsel I’ve learned that the most beneficial writing style is to offer something that combines the best of Mel Brooks with the best of whomever may be your favorite cynic du-jour. And that the most important takeaway is to make one point, a point so simple that even an eighth grader would understand. Not to infer that that is all you can understand, but I write at a level that even I can understand that about which I wrote.

And so my effort to explain the machinations of healthcare to myself, because that is the reason I write, continues. To quote the eloquent Mr. Brooks, “Mongo is just a pawn in the game of life.”

I think of myself as healthcare’s Mongo. I am also thought of as the guy who likes to drag the elephant into the room.  Mrs. Roemer tends to think that my mother, the original Mrs. Roemer, raised a particularly hardy breed of idiot.

Now, on to the reason we each arrived at this spot. Healthcare and its strategy. I refer to this type of strategy as a post-factual strategy, one where myths and irrationality hold sway over what is really going on.

The great thing about tying your business strategy to luck, is that luck is free. At least at the thirty-thousand foot level. You don’t even need to allocate the cost of a planning meeting. You simply send an email that reads something like this; “this whole consumerism thing may or may not work. Let’s see what happens.” If it works you are golden, and it did not cost you a cent.

If it doesn’t work, your a priori, preprogrammed response is to blame IT.

Luck’s bill becomes due and payable when it doesn’t pan out the way you hoped it would. When it comes to the business of healthcare—how healthcare is run—basing your firm’s survival on a monkey-see-monkey-do approach could work most of the time. Everyone is focused on HCAHPS; we should focus on HCAHPS. The hospital down the road has three MRIs, we should have three MRIs. Worry about big data even though we have little data.

As long as your competitors are in lock-step with your approach, your results are no better, or no worse (plus or minus) than the firms doing exactly what your’s is doing.

Unless–in case you have not been paying close attention, this is where I start to tug on the elephant.

And therein lies the rub. Each time someone enters a room he or she has a choice, “Do I turn the lights on, or do I leave them off?” When it comes to planning patient access, evidence suggests most firms choose not to turn on the lights.

The problem comes when someone in a competitor’s IT or marketing or innovation group asks a question. Asks this Question.

“What would happen if people could do what they want when they want using any device they want? His or her colleagues begin to sweat profusely. They get the same uneasy feeling that the CVS executives must have gotten when someone asked, “What if we stop selling cigarettes?”

That question, if acted upon, throws luck under the bus. The que sera sera business strategy is now in a world of hurt.

I studied math in college—well, I sort of studied it. Statistics, probabilities, possibilities, permutations. Linear algebra—it wasn’t all that linear.

A flip of a coin. A turn of an angry card. Luck is a game of chance.

Your firm’s business strategy does not have to be.

You may have attended a few of the meetings where these toss-of-a-coin, future of your firm issues are decided. Freshly minted MBAs with Pepsident smiles, a full head of hair and wearing skinny jeans. Visio presentations—PowerPoint is too 80’s for them. Zoom in. Zoom out.

“We’ve analyzed the big-data, and it tells us that our best strategy is to stay the course.” Those same MBAs are still wondering how an ice cube sunk the Titanic. The thing overlooked by the skinny-jeans crowd is that one cannot base an argument on big-data when one has no data.

If one were to survey patients and prospective patients about what access issues bother them they would have heard two replies; we want someone to know who we are, and we want someone to know how we are.

How and who—or is it whom?

But your system cannot deal with that. If you think of your hospital as a castle, your call center serves as the castle’s moat. It instills confidence and nullifies wariness. Your electronic moat is doing exactly what is was designed to do, protecting your firm from people from getting to you.

Your call center cannot answer ‘how’ or ‘who.’ And neither can your website. “Find a doctor?” No thank you. I want to schedule an appointment with that doctor. And that is when your Cisco servers start to gurgle. It is what happens when the temperature of the core of a nuclear reactor exceeds the reactor’s ability to cool the core.

Shift Happens.

And the thing is, the thing that is overlooked each time the healthcare savants and wellness Mensas gather in the board room with their Ouija boards, they discover that patients rarely use Ouija boards when selecting their healthcare provider.

Those people are trying to answer the question for themselves, “Will I buy healthcare from you?”

That is a two-hundred thousand dollar question—the lifetime value of a new patient. This is the same individual that your marketing department spent tens of thousands of dollars trying to entice that person to call your health system.

And that is precisely where your luck ran out. Your flip of a coin just came up tails 173 times in a row, it beat down probability and it beat down possibility. And the reason that happened is that patients and prospective patients and caregivers and family members have the ability to take common sense and turn it into string theory when it comes to understanding what your organization should do to meet their needs.

Everything your health system does needs one thing; patients. A young CEO asked his mother, “Where do patients come from?”

“They come from the phones,” answered his mother. “We call that access. And access begets engagement, and engagement begets satisfaction, and satisfaction begets patients.”

And so the CEO smiled, and he pictured flying phones bringing swaddled patients to his hospital.

The tag line on my bottle of Coke is, #ShareaCoke. I read it as Sharia-Coke. Perhaps nobody else read it the same way. But if you are Coke’s Marketing Officer, did you really want to take that chance?

Most days I feel like I am Alan Turing’s ghost. The reason I do what I do is to entice companies to do what they cannot imagine, and most times I do not have to apologize for that because they have not taken the time to imagine it.

There are a lot of idioms about horses. I may not know what an idiom is, but I went to Google, and I was good to go. You can lead a horse to water; hold your horses, don’t look a gift horse in the mouth. If you are a hippophile—one who loves horses, I shall leave it to you to find others. There is an idiom that states, “You can’t beat a dead horse.”

My rapprochement is, of course, you can, if it is the only horse available. And sometimes you should; my apologies to the horses who may have been following along up to this point.

I look at healthcare through puce-colored glasses. The healthcare business, on the provider side, is a world-class, 2.0 industry. No other nation can provide the services we provide. However, the business of healthcare, how we run it, is a 0.2 industry. Providing world-class services without being able to make it easy for people to acquire those services is ridiculous. Isn’t it?

There may be some of you who continue to wonder why you are reading a blog written by someone you believe to be a healthcare heretic; a witch. One way to help you cast aside such dispersions would be to drop a house on me—like in the Wizard of Oz. If it turns out that I am wearing striped socks and ruby slippers, and my legs curl up, you were right, and you may get on with your real work. Otherwise, may I entice you to humor me for another minute?

Running your business well comes down to doing a few basic tasks extremely well every time. Being successful requires that you execute those tasks at a level above and beyond how others execute those same tasks, and it requires that your customers believe that you are capable of doing that again and again.

Once you miss that opportunity nobody is going to award you a do-over. Several formerly grand firms missed their opportunity; Blockbuster, Radio Shack, and Sears provide grim reminders. Barnes and Noble seemed to have just realized that their boat sailed and left them tied to the dock. NPR announced that the former bookstore behemoth is considering turning their stores into wine bars. Maybe their business strategy is that after millions of their former customers buy books on Amazon that they will come to Barnes and Noble to read their books and enjoy a nice pinot noir with fava beans.

I cannot think of a single entity that has managed to put the toothpaste back into the tube after having missed their industry’s defining moment.

Healthcare’s defining moment is now. Or, never.

The 0.2 business model, the one reliant on call centers open only half as many hours as Comcast’s call centers is in for a rude awakening. The business model needs to leapfrog itself. Executives can try to multiply the model by 10 to get it to 2.0, or they can develop a strategy.

Healthcare 0.2 is:

• Stationary
• One-way
• Unintelligent
• Monday through Friday from 8 AM to 6 PM

Healthcare 2.0 is:

• Mobile
• Interactive
• Cognitive (Understand, Reason, Learn…URL)
• Cloud-based
• 24 X 7

if executives choose to forego the move to 2.0, perhaps they should consider hiring a sommelier.

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Certain phrases set off alarms for me. The one having the greatest impact begins with the words, “You can’t wear that…”

I may be a grammarian jihadist. The word can’t, makes me want to respond with, yes, I can. Today, I was forced to respond to the phrase, You can’t wear those shorts to the party.

Watch me. “They are wrinkled. You have to iron them.” She used the word iron as though it were a verb. As in, you iron; her, she, or it irons. I was not worried about the wrinkles. I am a guy. And since I was not headed to the award ceremony for the Nobel Prize, why would I be concerned about wrinkles? So why then am I the object of her sentence that used the verb iron?

Regardless of how I felt about the grammatical issues around can’t versus ‘may not’, and who, or should it be whom, was the object of the sentence, if you have been reading my blogging for a while, you know what happened next. I ironed my shorts.

And so that was the earlier part of my Saturday. Later today my fourteen-year-old son texted me this photo with the words, “For a dollar, you can guess where the photo was taken. If you are correct, I will pay you two dollars. Or, you can take two guesses for a three-dollar payment. And if you guess correctly, I will pay you four dollars.”

I learned later in the day that my son had offered the same odds to his friends through Instagram and Snapchat. He is running a numbers racket in suburban Philadelphia. I told his mom, the same lady who was worried about the wrinkles in my shorts, that he was simply testing his entrepreneurial genes. She probably thinks he got this gene from his dad, and she probably also thought his genes needed to be ironed. Neither he nor I was going to come out of this discussion on the right side of right and wrong.

It is his summer vacation. I will not tell you where the photo was taken, for if I did, and the store manager found out about it, instead of writing to you I would probably be taking lessons in parenting. As you can see, he and a friend of his built a fort, inside a big-box store, inside the part of the store where bulk the bulk packages of paper towels are displayed, 32 rolls per package; 16 on the bottom and 16 on the top—you do the math, let me know if you get a different number.

According to him, they constructed the fort by removing several dozen packages of paper towels from the center of the display, thus creating a hollow. Inside the hollow, they added chairs and a hammock, bought food and drinks, and they were good to go.

And management had no idea; it rarely does. And neither did the shoppers. Nobody knew what was going on behind the Bounty.

Personally, I think healthcare call centers were spun from fool’s gold with that same bit of capriciousness. Some in management have no idea that the call center exists. And if they were asked why they have a call center, they would be hard-pressed to come up with a reason much more in depth than, “Because people call us.”

And so I engaged twenty-five people. I gave them each one-minute, and I asked each of them to call their health system and speak with someone who can help them who could explain their bill. To be transparent, they did not have a bill. However, the exercise was not to get the bill explained, it was simply to get to a person who could explain their bill had they had one.

Twenty-one of those people spent those sixty seconds on their providers’ website. Collectively among them, they encountered more than three hundred phone numbers. None of them found the correct phone number within the allotted time. The remaining five participants tried Google. All five found a phone number, but only of the five found the right number. A four percent success rate–a little higher than my success rate as a ninth grader asking a girl to dance.

Not much of an ROI for building a call center. You could probably increase your ROI by building a fort made of paper towels.

Being a patient, a caregiver, a family member, or a referring physician can be exhausting. And so can trying to be a patient. It is exhausting because, in designing the means of access, nobody ever asked a patient or a caregiver or a prospective patient what those access points should be able to do. The access points, a health system’s website, and its call center were designed—and I use that term very loosely, by people who know about ones and zeroes, and by people who know about marketing.

They’ve never met one of your patients. Which explains the problem. Your health system, when it devised patient access, designed it using human design.

For patient access or patient experience or patient engagement or consumerism to be effective requires using human-centered design. It places the human at the center of the design. And here is the big point; the human who needs to be at the center of your system’s patient access design is not an IT wonk. Nor is it someone in your marketing group who has to rock her look in her Issey Miyake before she goes to her after work terrarium-making class.

The person who should be in the center of the design has a multiple-persona disorder; that person is a patient and a family member and a caregiver and a referring physician and a prospective patient. And that is why when you think about designing patient access you need to do so from the perspective of the personas of each of those individuals.

There is a term I’ve coined for people who get exhausted trying to have their needs met by your organization.

I call those people somebody else’s patients.

So there you have it. I’d write more, but I am on my way to make a sub-rosa move to spirit my son out of the store before he is discovered.

Nowadays you can’t swing a cat without hitting someone who has a newer and better idea about how you can fix your organization. More often than not, those ideas include the word design: user design and human design are two of the culprits.

And that is the problem. Every business process in every firm is the outcome of human design. Somebody—a human—designed it. And chances are very good that they did not design it well.

Instead of thinking, ‘How would I design this,” executives need to be asking, “How would other people—humans—want to use this process?”

To be effective at what they do, firms need to go from user design to user-centered design. They need to go from human design to human-centered design. When talking about what makes one business more effective than another business, one word, centered, makes all of the difference.

I’ll use healthcare to illustrate the point, but the same issues apply elsewhere.

If you have ever called your payer or your provider, you know what I am talking about. Whoever built the call center you called spent way more attention selecting the color of the carpeting that was installed than they did figuring out how to solve business problems.

The same logic, minus the carpeting, applies to their websites.

Nobody ever sat down with a patient and asked, “What do you want to do, and how do you want to do it when you contact us?”

Neither did CMS when it came up with its list of what constitutes a good patient experience.

If you are a healthcare executive, consider doing this. Sit down with a patient, and have the following conversation.

Executive: “What do you want to do when you call us?”

Patient: “I do not want to call you.”

You can take it from here. If you get stuck, let me know.

I had a meeting this morning with two very well-known healthcare executives. I had a meeting this afternoon with my dentist. It is unfortunate that the timing of the two meetings could not have been reversed. A tried to multiply my calendar by negative one, but that does not work with time travel.
You see, I have, or to be more accurate, I had four temporary crowns; my four front teeth. The crowns met a sandwich and the sandwich won. So there I was meeting these two executives for the first time, and I was wearing a smile that made me look like I could have been the grown version of the banjo-playing boy sitting on the bridge in the movie Deliverance.

Affixed to the back of a bus I read an advertisement from TD Bank—America’s Most Convenient Bank. Back in the day that Deliverance was just a dream in some producer’s eyes, banks were prohibited to cross state lines for fear that they would evolve into what they are today. As a result, banks started making baby banks—brand banking.

Back then, banks were like gas stations and convenience stores—hence the name—and they had to be close to where you lived. Location, not services, defined convenience.

Like healthcare.

The only thing healthcare has in common with the term convenience is the letter ‘c’.

Today convenience in banking means the ability to do what you want, every time you want to do it, at any time you want to do it, and using whatever device you want. So that is what banking did. Banking transformed itself from bricks and mortar to bits and bytes.

They did this because they knew that once they made it easy enough for everyone to stroke all of their financial data on a customized platform, and deliver services from that platform that people would not change banks.

Healthcare should be doing the same thing, but it isn’t. It could. It could also have big data if it collected all of the data people store on their healthcare apps and wearables, but it doesn’t. Whichever firms are the first to collect and analyze that data will not only win, but those firms will be the first to truly manage the health of the populations they serve.

But until then, if you are looking for convenience think about going to 7-Eleven.

What if we’ve been going about consumerism all wrong?

Sometimes we make a mistake. Sometimes the mistake makes us.

Doing long division and forgetting to carry the 3 is a mistake.

Our biggest mistakes often come from focusing on the wrong things; like watching the big chase scene in a James Bond movie and wondering what kind of a watch Bond is wearing. (It’s an Omega Seamaster.) We allow ourselves to get distracted from what is going on around us.

Not allowing customers and patients and members to interact with you when and how they want is a distraction.   And it is fatal.

Sometimes success comes from paying attention to the smallest details. Small details can be a deal breaker. I may have mentioned that I am a bit of a clothes hound. Two of my favorite clothiers are Paul Smith and Ted Baker; British designers. What I like about them is their attention to those small details. For example, they line their blazers with an interesting and attention-grabbing silk material. At least one of the button holes is sewn using a bright thread that screams, ‘Pay attention.” They even design the inside of their shoes and line the inside with a fabric comprised of pictures.

Small details help. Unfortunately, when it comes to healthcare, being able to answer the phone and meet a caller’s need is not a small detail. It is a fail-safe point. Miss this detail, and you have lost this person as a patient or member.

Consumerism and commerce without an experience that makes it easy for people to interact with you have a business value of zero. If you define easy as a remarkable experience for every person every time at any time using any device, it is simple to understand just how short your organization falls from the ideal.

I believe the best way to address this problem is by designing a concept I may have just invented; Customer Experience as a Service—CXaaS. If you do this, the other C’s, consumerism and commerce, will fall right in line.

If you don’t, they will simply fall.

Of course, you could keep doing what you are doing today, customer experience as a disservice.   But that hasn’t really worked. Has it?

I came up with the concept of healthcare CXaaS over the weekend—it was a slow weekend. I searched for it on Google and didn’t find anything. That tells me that it has either been tried and failed, or it has never been tried.

An advantage of a CXaaS strategy is that integration and implementation with business partners can be both omnic hannel and immediate.

I know it seems like I write every time I fly, but there is something about the entire customer service experience that compels me.

If the Donald were to ask me what I’d like to see come out of his first term, I would tell him to make TSA and the airlines work with Swiss efficiency and German timeliness and Thai customer experience.

But, what about ISIS? You ask. My guess is that if we asked for volunteers from Texas, big guys from the oil fields with pickups and a shotgun or two suspended from their truck’s rear window, that we could teach the ISIS boys to spell infidel in Yiddish.

The TSA pre-check line was closed. Only the government would make you pay for a service and then not provide it.

TSA. Even enough said? Not really. TSA has probably screened a hundred million people since it began. If I do a task more than once I reduce it to its bit parts and figure out how to make that task efficient and effective. I figure out how to do it correctly, and how to ensure that there is no wasted effort.

The TSA does not appear to have ever analyzed how to do what they do. The screening process and experience differs by agent, time of day, airline, concourse and airport. One would have thought the after doing anything a hundred million times that the process would, if nothing else, be perfect. Even if by accident.

But it remains a crapshoot. Bags, liquids, shoes, belt…Next week I am flying naked. Frisk me. It might be the best thing that happens to me that day. I wonder if I will want a cigarette afterwards.

We boarded the American flight two and a half hours after the scheduled departure time. I used the one hundred and fifty minutes to amuse myself. I went to American’s website. Looked them up on an agglomeration of social media sites, and Googled them Would it surprise you to learn that American has executives in charge of planning and strategy and customer service and customer experience and digital design and its call centers?

I had time to fire off a few emails to the handful of corporate email addresses I found. I asked paradoxically, “If you were to fire all of those people, would anybody notice?” It’s like asking whether it would make any difference if you were driving and a t the speed of light and turned on your headlights.

The gate agent announced that they were trying to expedite the boarding process. I announced loud enough for those around me to hear, “That boat has already sailed.”

Twenty-seven priority boarding categories were announced before those of us relegated to steerage class. Boarding had ground to a halt. Getting people to move down the ramp was like trying to pass a camel through the eye of a needle—I thought I would wax biblotic.

The woman in front of me was wearing tight, giraffe-print pants, pants that should have been outlawed in forty-three states. But here is where it gets interesting, at least in the places of my mind from whence I hear the voices. The shirt she was wearing was printed with the phrase, “Comcast means placing customers first.” I almost bit through my tongue when I read it. Do you see the irony, or am I just quite the cynic?

Airline mottos, prior to the jet age, were something like, “We love to fly and it shows.” My suggestion for American’s new motto is, “We don’t like you any more than you like us. So sit down and shut up.” It’s too long to get it to fit nicely on a T-shirt, but it gets points for sincerity.

In an attempt to ameliorate their employer’s poor service, the flight attendants distributed bags of peanuts. The Giraffe lady asked for, and received, two bags. There giraffe prints was about to be stretched even further.

Flying and healthcare. Do something for the first time and you expect a few bumps and bruises. Do it a few million, and if the experience still stinks, shame on you.

The health system of provider executive I spoke with this week said her system receives more than eight million calls each year. Among overseeing her system’s digital strategy, she also oversees its call center. When asked how effective she felt her call center was, she beamed with pride and said, “I rarely get a complaint.”

For those of you with whom I have not spoken, I should let you know that I never ask a question without having already done my homework. I had made several phone calls to her system and I wasn’t beaming. Head in the sand management.

Eight million calls is a lot. They should have discovered how to improve the experience after the first six or seven million. The same holds true for payers and PBXs. After doing anything eight million times you should be exceptional at it, should should be setting the world on fire with you efficiency and effectiveness.

Back to American Airlines for one second. The gate agent for my return flight, Dianne, Brandon, was unbelievably good. People waiting to board were commenting on how exceptionally cheerful she was.

Once I was seated, I found an American link to to write a commendation for Dianne. But the link’s form didn’t let me post a commendation. Perhaps the link was never tested, or had never been used before. If you happen to know anyone at American, please tell them about Dianne for me.

The circle of life.

If you have fifteen minutes, you can learn exactly what your patients and members and customers think of your health system and their health insurance firm.

I offer this as an exercise for your organization’s executive leadership because they are the only ones who can make a difference. And, they because they are the ones the most removed from understanding what patients and members and customers actually experience.

It is a casebook Catch-22 in its purest form. If they already knew the outcome of what I want them to do during this fifteen minutes and have not taken any steps to solve the problem, they would be negligent for having not solved the problem. If they did not know the outcome of what I want them to do during this fifteen minutes, they would be negligent for having not asked the question.

To complete the exercise you will need a:

• Board room
• Board or your executive leadership team
• Projector
• Laptop
• Phone—any phone will do

In this exercise, we will focus on providers, but it works the exact same way with payers. Note: the exercise must be done on a weekday before 6 PM.

Assemble the group; the board or your executive team. Login to the laptop and navigate to your website. Using your time wisely, try to schedule an appointment.

It did not work, did it? I knew that without even having to call the psychic hotline.

Half of all of your patients and family members and caregivers and prospective patients attempted to complete this step and one hundred percent of them got the same result you did.

Thirteen minutes left. Call your health system and try to schedule an appointment. Does anyone know what number to dial? (In order to actually schedule and appointment, it will take much longer than the thirteen minutes you have left, and it will probably take at least two calls. But in those thirteen minutes, you should get a pretty good feel for what it is like to be a patient or family member or caregiver or prospective patient.)

I do this exercise and others prior to speaking with executives. I pretend to be a new patient, new to the area, and someone who does not remember the name of my payer. The best results I achieved required thirty-seven minutes and two calls.

The CEO of a very large health system recently tried to schedule an appointment for himself by phone. He failed. He is now buying tens of millions of dollars of call center stuff. That will not solve his problem, but he did not want to hear that.

To those health systems that want me to award them partial credit because their website allows someone to find a doctor, guess again. People who go to the website for American Airlines, do not go to the site to find a flight. They go to the site to purchase a ticket.

Patients and customers who go through the trouble of going to your website or calling your firm do so for one reason—they want to do something.

Now that you know what it is like to be a patient or family member or caregiver or customer, think about redesigning how they experience your system.

“If this is a medical emergency, please hang up and dial 911.” May we waste a minute of our lives to dissect this phrase?  It makes me nonplussed. “Please hand up and dial.”  Did they add that bit of instruction because there are some people who dial without hanging up?

I think the phrase in on par with the pictorial instructions in restaurant bathrooms that show you how to wash your hands.  If you require that level of assistance, no amount of hints are going to help you.

When you arrive at the ED, there are always people on hand doing triage.  That is because the people going to the ED do not have the skills to decide for themselves what constitutes a medical emergency.

If asked, half of the people in the ED could not tell you how a thermos knows whether it is supposed to keep something cold, or whether it is supposed to keep something hot. (I am one of those people.)

Each of us has heard the same voice message when we call our doctor.  What bit of our medical training are we supposed to use to know what to do?  My qualifications to know who to call are limited to the following.  I studied math. I’ve been a patient. I know how to dial 911.  If answering that question requires more skills than what I have, I am out of luck.

Big segue.  Kim Kardashian meets healthcare.

I’m not sure exactly when it happened. Maybe it was at HIMSS, but I don’t think so. It’s been going on for decades. As a matter of fact, I don’t think healthcare got its marketing strategy from Kim, I think she got her’s from healthcare.

The Kardashian marketing strategy. Draw attention to yourself. Love me. Pay attention to me on social media. “Like me.”

Healthcare’s marketing strategy. Draw attention to yourself. Love me. Pay attention to me on social media. “Like me.”

Follow me on Facebook. And Instagram. And Snapchat. Read about ME. Like ME. And when you do, you’ll quickly discover that there is no there there.

It’s a marketing strategy that is all hat, and no cowboy. That dog don’t hunt.

If you disagree with me, tell me.

Whether your firm is a provider, a payer, or is in life sciences, this is how your patients, members, and customers view when you market to us.

• Billboards showing a photo of your urologists. NPR commercials referencing some procedure that makes your system the go-to system for that treatment. Television commercials that tell you, if you want to schedule an appointment, go to ourladyofonline scheduling.edu. And when you go to that website, you cannot even find the word ‘scheduling.’
• Television commercials trying to entice you to hire them as your payer. They feature Stepford wives and Stepford children having a picnic. Life could not be more wonderful. Until you file a claim. And then you learn just how wonderful wonderful can be.
• Miracle drug cures that you and your doctor just don’t know about. The same Stepford-wife approach, but using different wives. A thirty-second commercial extolling the benefits of the drug. Five seconds explaining the drug’s benefits. Twenty-five seconds warning you of the drug’s possible side effects. It could kill you, but you will have had a wonderful time at the picnic.

There is no there there.

The purpose of marketing is two-fold. To build brand awareness, and to acquire and retain new patients, members, and customers. But for your strategy to be effective, there has to be a cowboy underneath the hat.

Imagine, however that your marketing strategy was more aligned to Steve Job’s marketing strategy instead of Kim’s. What would your strategy look like?

When Steve marketed, it went something like this. “Do you want to carry every song in the world with you wherever you go?” Steve holds up a device that is smaller than a half-dollar. “Then buy this.” “If you want the Swiss Army Knife of electronic devices, then buy our iPhone.”

And here’s the kicker. If Steve said his device did something, it did it. His marketing commercial was not eighty-percent disclaimers. He didn’t make promises he couldn’t deliver. Steve never said, “You may or may not be able to send text messages on the new iPhone.” If anything, Steve over-delivered.

Healthcare marketing never over-delivers. So, what should healthcare marketing look like? How about something like these?

• “At ourladyofonlinescheduling.edu, if you call us about a need you are having, we will meet that need in a single phone call, at any time of day, and without transferring your call. And if you hate having to call us, at ourladyofonlinescheduling.edu, you can carry our entire system around on a mobile device; on any mobile device. And, you can do anything you want, at any time, every time. It will be as simple as using an iPhone.
• “At com, if you call us to learn how to file a claim, we will help you do it correctly the first time you call. If you call us to file a dispute, we will help you every step of the way. And we guarantee that your dispute will be resolved to your satisfaction the very first time you call us. No longer will we make you call and call and call until we wear you down and you simply give up—that was the old payersRus. And if you hate having to call us, you no longer have to. You will be able to do anything you want, at any time, every time. It will be as simple as using an iPhone.

If you are still confused about how to acquire and retain patients, members, and customers, I encourage you to show Warren Beatty’s movie Heaven Can Wait at your next board meeting.

In this scene, Warren Beatty, the CEO of a conglomerate that sells tuna, pitches the following marketing campaign to his board of directors.

“As everybody knows, we can tuna, and in netting the tuna, we kill a number of porpoises. Since they’re mammals of alleged high intelligence, there’s been an outcry. I would just like to ask you a question. We have a responsibility to thousands of shareholders of moderate means, less well off than the ecological groups fighting us.

If we were a football team, would you call this a winning season? Would you say we got a winning season? On balance, we’ve had an extremely good year. We’ve got a winning season. What do you do when you’re ahead? You don’t make mistakes. You don’t gamble unnecessarily. You protect your lead. You don’t pass from your own end. You make sure nobody gets hurt.

You got to use these guys in the next game. We won this game. We got to stay in shape for the rest of the game.

It’s like when everybody was supposed to stop eating grapes. I didn’t (stop) because I like grapes. A lot of guys will keep eating tuna.

What if we had a good-guy tuna company on the porpoise team? A lot of guys would buy that so their kids wouldn’t get mad at them. We don’t care how much it costs, just how much it makes. If it costs too much, we charge a penny more. Would you pay more to save a fish who thinks?

We handle all lawsuits that way. Let other teams build plants in the wrong places. Let the other quarterback throw a gurgle so newspapers get hold of it and stockholders don’t like it.

Let’s be the team that makes the rules, plays fair, that gets the best contract, that’s popular. Forget these nuclear power plants until we know they’re safe. That refinery, we’ll have to relocate it. It’ll cost us millions, but we don’t care, because we’ll come out ahead in the end.  That plastic stuff we’re making, we’ll have to stop. We’re not here for just one game. We’re going all the way to the Super Bowl! And we’ll already have won!

Healthcare needs to want to be the good-guy tuna company.

Or, let them eat grapes.

It’s a humid Sunday in Philadelphia. The air is thick enough to cut with a feather. The people in Phoenix like to tell us; at least it’s a dry heat. My reply; so is a convection oven.

Sunday’s are a day of rest. Sundays in June, your day of rest comes with an extra serving of humidity—hold the sprinkles. On Sundays in June, your serving of humidity makes you miserable. And when you are miserable, you want to be less miserable. And when you want to be less miserable, sometimes you think of eating something cool. In the Philadelphia area on a humid June Sunday when you are miserable and when you want to eat something cool you think of eating an Italian water ice—those of you in the Midwest may need to use Goggle to figure out what a water ice is.

When you order a water ice, you can order toppings for it. Sprinkles and Gummy Bears and jellybeans.

You cannot get a water ice with a topping of sweet potatoes or broccoli. And the reason you can’t is because people don’t want them. Sweet potatoes and broccoli ice are not why they got in a hot car on a hot, humid, June Sunday. That is how the water ice business model plays out.

And then there are the payers. And their business model.

Let’s take a brief look at their business model. Suppose it is a hot humid Sunday in Philadelphia. You had planned on going out for a watermelon water ice. But before you did that, you needed to file an insurance claim with your payer. You have to file a claim because the last time you went to get a water ice on a hot, humid Sunday, your water ice caused some of the jellybeans and Gummy Bears to freeze together. And when you swallowed them they blocked your airway and you had to go to the ED.

An emergency room physician removed the blockage, but she could not save your water ice; it had melted. The hospital sent you a bill for their services. You called your payer and explained what happened. But your health insurance policy did not cover a jellybean/Gummy Bear blockage.

Each of us has called our payer trying to find out what we are paying for, and why they aren’t paying. (You’ve got to admit, calling themselves payers is about as ironic as things can get.)

The phone conversation with the payer goes something like this. Although we are not able to pay your claim, even though we would really like to pay it, there are many other reasons for you not to cancel your insurance. With your insurance policy, you get all sorts of extra benefits. We call them toppings. For example, if you sprain your ankle on a Tuesday, and if you need an Ace Bandage, we do not charge extra if you want to get a different colored Ace Bandage—it’s a member benefit. We recommend a pink bandage for girls and a blue one for boys. Another topping we offer is a ten percent discount for people who are injured while traveling to outer space.

People who pay for health insurance do so every month. Payers like to call those people who send them money members; like what country clubs call the people who send them money every month. And just like country club members, health insurance members get a little membership card to put in their wallet as a testament of their membership privileges.

If payers were to survey their members asking why those members purchased insurance, those surveyed would reply, “Because when we file a claim we want you to pay it.”

Members don’t want toppings, no matter how good those toppings may be. The payer business model could be very simple. People send us money. And when they need money, we send it to them. But if that doesn’t work, maybe on Tuesdays, your payer can give you a water ice with a broccoli topping.