The #Powerof1Million changes everything

Last week, I got an email from 23andMe announcing that they had “genotyped more than one million people worldwide,” and that I was number 85,552. Big news for a company that has weathered a lot of ups and downs, particularly in November 2013 when the FDA demanded that they stop providing health information.

As number 85,552, I had signed up prior to the health information shut down, so I was privy to my health information. Luckily, as it turns out, my health information didn’t contain any earth shattering news. My ancestry results however were a big surprise.

Even with my unexpected genealogy results, my 23andMe results didn’t have a big impact on me personally. However, professionally, as a health care communicator, I believe that the fact one million consumers are willing to be genotyped is a big deal.

As their press release states, “Today, 23andMe has the world’s largest database of re-contactable individuals who have consented to participate in [genetic] research.” Talk about empowered consumers.

And 23andMe is just one of the many emerging services and products aimed at putting more health information into the hands of consumers. Consider the Scanadu Scout, a device that sends blood pressure, heart rate, temperature, and blood oxygen levels to a consumer’s iPhone.

I believe that the colossal amount of health information now available to consumers ups the ante for health care communicators in three ways:

The ability to explain complex health information in simple ways is even more critical than ever before. Having a commitment to health literacy built into a company’s DNA will be the cost of doing business in our data rich world.

Factoring in the consumer’s emotional increases in importance. Understanding the impact health information can have on a person’s emotional state can be the difference between effectively communicating and sending a consumer into a downward spiral of fear and confusion.

Helping consumers turn knowledge into action is vital. Providing concrete next steps to help consumers act upon what they have learned turns reams of data into potentially lifesaving information.

As health care communicators, our ability to help consumers process the avalanche of health care information coming their way can make a real difference in people’s lives. For a robust understanding of what is coming down the pike, read Eric Topol’s latest book, “The Patient Will See You Now.” The book is a veritable canon on the trends in personalized medicine. As 23andMe’s #Powerof1Million announcement makes clear, the future is closer than we think.

My Madeleine Albright Moment

I signed up for 23andMe a few years ago for professional reasons. This was before November 2013 when the FDA told 23andMe to stop providing health results. As a health care marketer, I admired how the company’s whimsical pink and green infographics made genetics both appealing and understandable.

When I mentioned to friends that I had signed up, many said that they wouldn’t want to know if there was some disease lurking in their genetic code. I’ll admit that a chill went through my body as I thought, “What if I find out something really bad?” Luckily, my repressed WASP upbringing allowed me to shelve any looming unpleasantries in the back of my mind.

When the 23andMe test results came, nothing really bad popped up. My results weren’t that earth shattering and made sense based on my family history. I was higher risk for Venous Thromboembolism (VTE) and Atrial Fibrillation.

At the time, I largely ignored the ancestral results. They were pretty lame, telling me what years of sunburnt skin told me: I was 99.9% Caucasian. As for country of origin, I knew that I was a U.K. mutt with a small German streak.

Several years went by, and 23andMe continued to email me with updates. One day in April, I happened to click on one all the way through to the ancestry data.

And that was when I had my Madeleine Albright moment: 19% ASHKENAZI.

When my mother was later tested, it revealed that she was 49% Ashkenazi, totally unbeknownst to her. We hypothesize that my maternal grandfather, Irving Crook, was probably Jewish. He came to America from England when he was 6 months old. But that didn’t mean he was of English descent. England was most likely just a stopover for his Eastern European parents escaping persecution. We will probably never really know, and most likely Irving didn’t know either.

How does this change my life? Not much. I still sing in the church choir and help organize our annual Fish & Chips dinner. However, the bigger question is what impact did my health results have on my behavior? The biggest change is that I now get up during long plane rides to help prevent blood clots, something everybody should do anyway.

I recognize that for many people, the 23andMe health results can have major consequences. Had I gotten more devastating news, it could have sent me down a rabbit hole of unnecessary, expensive and potentially dangerous medical testing. As Atul Gawande says in his recent Yorker article, “Overkill”, “Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions.” I also realize that not everybody is equipped to deal with bad news like Angela Jolie, who upon learning she had the BRCA gene, chose prophylactic surgery.

But despite these caveats, I think the author of “The Patient Will See You Now”, Eric Topol is right, the personal data genie is out of the bottle. In the opening pages of his book, he makes the following bold statement:

“We are embarking on a time when each individual will have all their own medical data and the computing power to process it in the context of their own world. There will be comprehensive medical information about a person that is eminently accessible, analyzable and transferable. This will set up a tectonic power shift, putting the individual at center stage.”

It is true that our health care system with its practice of defensive medicine and misaligned economic incentives has the power to distort good data into bad unintended consequences. This fear drives the cry for a more measured approach to personal health data transparency. We end up like the little Dutch boy with his finger in the dike, trying to hold back the flood of health care information.

However, the time and effort is better spent helping this free flow of personal data transform our flawed health care system into a more patient oriented system. That’s why education and good health care information are even more critical going forward. Don’t withhold information, teach people how to deal with it.

Overcoming the DTC Fear Factor

FDA gets on the “Less is More” bandwagon

The “Less is More” approach is gaining traction in health care. Fear is what often causes people to gird themselves with potentially unnecessary health care interventions: fear of getting it wrong, of missing out, of being criticized, of dying. Atul Gwande details the bravery required to challenge the medical status quo in his recent book Being Mortal. Gwande does a great job of debunking the myth of “more care is better care” when it comes to end of life treatment.

Now “Less is More” is being applied to health care communication. The FDA is overcoming the DTC Fear Factor and casting aside unnecessary risk information with the intent to drive superior patient comprehension. The FDA has issued draft guidelines that require less, not more, risk information in the Consumer Brief Summary portion of DTC print ads. PharmaGuy provides a comprehensive (and as always, entertaining) review of the proposed guidelines in his February Newsletter.

But the FDA is not using the editing pen wily-nilly. Knowledge born of research, is taking the edge off of their DTC Fear Factor. Upcoming research includes a study on the risk information presented in television ads. The objective is to see whether listing only the most actionable risks leads to better comprehension than the usual mind-numbing laundry list.

Certainly the FDA has reason to fear getting the level of risk information wrong. As Daniel Carpenter, a Harvard professor who studies the FDA posits in a Health Affairs article, the FDA is driven by it’s “desire to safeguard its reputation for protecting the public’s health.” The FDA’s “Less is More” approach certainly has its critics. Public Citizen criticized the FDA for its proposed August ’14 guidelines on how pharmaceutical companies should present risk information to physicians

This new “Less is More” approach to risk information demonstrates that the FDA is willing to undergo reputational risk to do the right thing for patients by presenting the information in a way patients can understand and act on. There is substantive evidence that links lack of patient understanding with negative health outcomes.”

So what is the likelihood of pharmaceutical review committees embracing the “Less is More” philosophy regarding risk information? Certainly the new review FDA guidelines will help, but as anybody who has sat through a review committee meeting can tell you, there is wide latitude in how FDA guidelines are interpreted. Many opt for the most conservative approach.

My guess is that review committees won’t get over their DTC Fear Factor anytime soon. There is just too much reputational risk. And it is hard to blame them. The media’s knee-jerk reaction is to attribute any misstep to a nefarious motive on the part of Pharma.

Overcoming the DTC Fear Factor will require Marketing Departments to do the hard work of proving that using fewer and simpler words to describe a product or disease state results in better comprehension. Just as the FDA Researchers helped their Reviewers get over the DTC Fear Factor with data, Pharma marketers will need data to bolster the courage of their Review Committees with solid research.

However, conducting research brings along its own “Fear Factor.” What if the language causes consumers to overestimate the efficacy or underplay the risks of the product? So why bother? In the past, trying to boost outcomes by improving communication comprehension was a “nice-to-have,” despite the compelling health literacy case.

But now, the Affordable Care Act makes reimbursement dependent on outcomes and patient experience. So ensuring patient comprehension is critical to the financial viability of Pharma’s direct customers: physicians, hospital systems and health plans. So follow the dollar. Customers care, so pharma marketers should care too.

Complexity is easy in Pharma communication, just go to the label. Eliminating the DTC Fear Factor in Pharma will take hard work. However, in health care, the “Less is More” train has left the station. Time to put fear aside, join the FDA and jump on the “Less is More” bandwagon.

Customer Experience: Consistency is key

Recently, I heard a radio ad as I was driving to work about the “spa-like” patient experience of getting a mammogram at my local hospital system. While it sounds like an over-promise, having been a patient there, I can tell you it is not.

My experience at the mammography center started with a warm greeting by a friendly receptionist. I was then whisked away into a spa-like changing room, complete with honey colored wood lockers, thick terry robes and ethereal music floating in the background. The scent of eucalyptus hung in the air. To top it all off, I got a pretty faux-pearl bracelet commemorating breast health awareness month.

But rather than float happily away, I was mad.

My experience with the very same hospital system earlier in the day couldn’t have been more different, in a negative way. I thought, if this hospital system can even make a mammogram pleasant, why was the earlier pediatric appointment for my daughter so maddening? For that appointment, I entered what looked like beige food court in a mall, little booths for each pediatric specialty ringing the room, each manned by a booth lady. Threatening signs dotted the walls cautioning against letting your children bounce on the furniture.

I approached a booth. When I simply inquired whether my daughter’s appointment was for 3 pm or for 2:45 I was told, “I don’t know when your appointment is for, just sit and wait for the doctor.”

Yes, this was the same health system.

The negative pediatric experience overshadowed any good will that surely would have blossomed from the spa-like mammogram. And this is where most patient/consumer experiences fall short: consistency. No one had bothered to think thru the entirety of the journey a patient may have in the health care system. In my case, playing different roles: parent, patient and parental caregiver.

A study by McKinsey & Company of 27,000 American consumers found that consistency is the key to customer satisfaction. The study, which spanned 14 different industries, found that focusing on the entirety of the customer experience rather than isolated events in the journey has the potential to measurably impact customer satisfaction and raise revenues up to 15%.

Given the impressive McKinsey numbers, what is preventing companies from providing a uniformly positive customer experience? In my experience advising companies in health care, it often comes down to one word: silos. Organizational silos prevent a holistic view and tracking of customer interactions across a company. Based on the experience with my local hospital system, it is pretty clear that the Mammography Center and the Pediatric Department do not share much at all.

For Pharma companies, customer experience is increasingly viewed as “the next big thing,” for differentiating products in highly competitive categories like diabetes, hepatitis C and the upcoming battle amongst PSK9 drugs for high cholesterol.

Makes sense. The Accountable Care Act links patient experience to reimbursement, so the traditional pharmaceutical customers­— HCPs, Hospitals and Payers—are now interested in how pharmaceutical companies can help them improve the patient experience. And patients themselves, accustomed to higher service levels in every other aspect of their lives, will begin to expect more from Pharmaceutical companies.

However, Pharmaceutical companies are notoriously siloed. So much so that I even know of one company where two separate customer experience projects were initiated by different departments. So imagine how difficult it will be to get people to line up behind any sort of uniform tracking approach!

Any customer experience or patient centricity effort that does not address the organizational barriers, therefore, is doomed to failure. And as I can tell you based on my experience with my local hospital system, no matter how much you advertise the positives; the inconsistencies will always pull you down.

Dorothy

Purple Cow or Bull in a China Shop?

How to make change stick

A colleague once generously called me a Purple Cow.

I say “generously” because he used the phrase as Seth Godin did, to mean someone/something intrinsically different. As a Pharma marketer, I constantly pushed for new marketing approaches. However, much of the time I tried to drive change, I probably behaved more like a bull in a china shop than a remarkable purple cow.

In fact, the Pfizer Health Literacy principles were launched internally two times because I had not fully involved my marketing colleagues the first time. After the initial launch, less than 25% of the patient literature coming out of my own department adhered to the principles. When even the people you directly supervise refer to a pamphlet written according to health literacy principles as using “dog food language” you know you haven’t done a good job socializing the concept.

As the founding partner of extrovertic, a health care consulting firm focused on delivering innovative marketing solutions, I continue to seek out new marketing approaches. However, I now appreciate the importance of involving others and managing the change process. So extrovertic has enlisted the help of a former colleague of mine, Susan Domotor, an expert in change management, to help extrovertic clients to successfully implement the change they seek to build their businesses.

According to Susan, studies show that business initiatives rolled out with less than adequate focus on the employee aspects of the change have about a 30 – 40% success rate” (Blanchard, IBM). As I found out in rolling out the Health Literacy Principles, this translates into significant amounts of wasted time and money.

Here are Susan’s top three recommendations for getting your colleagues to embrace the change you seek:

1. Create a strong business case – A business case helps people understand the importance of the change, conveys a sense of urgency for what you are trying to achieve, and generates a sense of ownership for a successful transition. A strong business case answers three questions: Why is the change necessary? What is the change? How will we achieve the change?

2. Ensure that Leadership is visibly engaged and is driving the change – Visible leadership support is critical for success and it cannot be delegated because employees will only commit to efforts that are driven by their leaders.

3. Develop a focused Communication Plan – An effective communication plan is critical to influencing employee behavior. The plan must create understanding for the initiative; provide employees opportunities to question, digest, and internalize the change; and as the initiative progresses, celebrate successes, share best practices, and capitalize on opportunities to highlight the performance and behavior that are valued in the new way of doing business. It is important to build the communication plan before kicking off your initiative. You can modify it along the way.

Change is being continually foisted on the pharmaceutical industry. Chances are that no matter what your job function, it now involves change. Whether it is to instill a new patient-centric mindset into your organization or to get your colleagues to embrace multichannel marketing for physician outreach.

Lucky for me (and patients struggling to understand health care information), my colleagues gave me a second chance. After the re-launch, over 95% of the patient pieces produced met the Pfizer Health Literacy Guidelines. But with a strong change management plan, you don’t have to count on being lucky, just being prepared.