Healthcare Innovation: Trends From The Trenches Consumer Data, Insights and Innovation Featured Speakers: Andrea (Andi) Simon, PhD and President of Simon Associates Management Consultants Linda MacCracken, VP, Truven Health Analytics and Adjunct Lecturer, Harvard School of Public Health In the 3rd webinar, Linda MacCracken will review data analytics needed for Fee For Service and Fee for Value consumer engagement in today’s rapidly changing healthcare industry. Linda will review pressing business questions which focus on data analytics as effective, innovative ways to improve customer intimacy and enhance margin. She will share a case study and give practical tools to help you and your teams find better ways to serve your customers. Andrea Simon PhD, webinar host, will introduce and conclude Linda's presentation with ways to tie data and information into valuable insights to help you better “see, feel and think” in new ways so you can “do” better in changing times.

1. CONSUMER INSIGHTS, DATA AND
INSIGHTS
INNOVATION
Webinar #3
Healthcare Innovation: Trends from the Trenches

2. Our Presenters
Andrea J. Simon, PhD
Corporate Anthropologist
President
Simon Associates
Management Consultants
Linda MacCracken, MBA
Vice President, Advisory Services
Truven Health Analytics

3. What We Are All About
“We don’t see things as they are. We see things as we
g
y
g
are.” ~Anais Nin
The
“The real voyage of discovery consists not in seeking
new landscapes but in having new eyes.” ~Marcel
Proust
Our Job is to help you “See, Feel and Think” in New
Ways—before you “do.”
y
y

4. Today, Our Guest Will…



Share new research insights about consumer
g
behavior, and key innovation needed in healthcare
marketing.
Review how Big Data analytics can shine new light
on innovation.
Return to the question about why consumer data
matters.

5. What Consumers Are Feeling
Confused
Cynical
Angry

6. What To Do?



Can you imagine and engage consumers that still, or
y
g
g g
,
finally, make your service “the place to get care” and “the
place to innovate” in healthcare?
Can you inspire your associates and physicians to “look at
analytics” to benchmark and drive new types of healthcare?
Can you bring in evidence to launch “innovative ways” that
add “real value” — not just engage around storylines?

7. Trends from the Trenches

8. Observations From The Field





Changing times make data really, really, important.
How can we see leading indicators, not lagging
ones?
What are the emerging trends?
Can we see real life behavior in the data itself?
Shall we trust it and let it help us change?

9. What Are We Looking For?

In Healthcare Today, to thrive you must look for:
 Patterns
emerging.
 Opportunities to leap frog over the rest to offer
leap-frog
innovative solutions before they become ordinary.
N
Non-users with unmet needs that might open a new way
ith
t
d th t i ht
to deliver care ‘their way,’ not the old way.

10. If Times Are Changing



Hospitals, Physicians, Healthcare Services must
“create” new value in innovative ways.
Explore opportunities that could open new market
space.
Include consumers, aka “patients,” in the
evolutionary process.

11. From “Fix Me To “Keep Me Well
Fix Me”
Keep
Well”


Data is critically important to show us how to better
engage, communicate and tell our stories if we are
going to shift lifestyles and consumer habits in new
directions.
Consumers also have to “see feel and think in new
see,
think”
ways.

12. Leading To Communication Challenge



How do you engage consumers and patients?
How do you match the message and the storytelling to their demographics and psychographics?
How do you measure impact?

13. Consumer Insights, Data & Innovation
May I Introduce You To Linda MacCracken

14. Key Questions




What Can We Know About Consumers to Shape Datap
Driven Innovation?
What Data Shows Us That Is Likely to Change in FFS to
FFV?
What Innovation is Possible from Data-Identified
Opportunities?
O
?
Steps to Drive Value in the Trenches

15. Consumer Insight & Data Focus
Is Trying Amidst a Perfect Storm

Perfect Storm of Consumer/Data Driven Innovation




Consumer decision-driven healthcare is more crucial that PCPs and Payers: PPOs
allow more choices among “Same Day” or “When You Want It” appointments.
Unknown provider competition is already in play: Private office-based care;
“retail health” at Walgreens, CVS, Wal-Mart; Telehealth via Cisco American
retail health
Walgreens CVS
Cisco,
Well and your mobile applications (iPhone).
Change commitment requires team engaged priorities, focal business questions
and agreement on key indicators.
Need teams with clinicians, administrators, pre/post care services,
marketing, finance and payment professionals to concur and align about
challenges, directions and initiatives.

16. Clearly Storm Survival Calls for An Aligned Team
Clearly,
I’ sure glad the hole isn’t in our
l d th h l i ’t i
I’m
end…

17. Consumer Insights, Data-Driven Insights, and
Innovation is a Team Sport
1.
Create Urgency
2.
Pull Together a Guiding Team
3.
Develop Change Vision & Strategy
4.
Communicate for Understanding & Buy-In
5.
Empower Others to Act
6.
Produce Short-Term Wins
7.
Don’t Let Up
8.
Create N C lt
C t New Culture

18. Organize Team Position on Change Drivers to
Deliver Innovation
Change Process
Key Factors
Create Urgency
-Impact of newly insured
-Targeting a new type of patient or new care site
T
ti
t
f ti t
it
Pull Together Guiding Team
-Action-biased champions in each discipline
-Engage clinical delivery providers
p
g
gy
Develop Change Vision & Strategy
-Use facts to show change drivers: data-competitors
g
p
-Develop vision for best future
Communicate to Educate & Get Buy-In
-Use generations among team/to target patients
-Hook team members and share stage
Empower Others to Act
-Remove barriers to allow delivery agents to make vision real
-Identify roles throughout team
Produce Short Term Wins/Don’t Let Up
-Create platform for successes and celebrate
-Press harder and f t after fi t success
P
h d
d faster ft first
Create New Culture
-How will this impact the Budget and Innovation celebrations?
-Hold on to new ways of behaving and make sure they succeed

19. From All Consumers To Unique Consumers
W
What Can We Know About Consumers to S p DataC W
C
Shape
Driven Innovation?


Approach Consumers By Segment to Engage Uniquely
pp
y g
g g
q y

Identify Key Consumer Drivers & Choice Options

Have Consumer Segment Focus on the Back of Your Hand

20. Consumer Views Make It Harder To Engage In Either
“Fix Me” Or “Keep Me Well”
Fix Me
Keep
Source: Truven Health Pulse Survey

21. Shift In Consumer Focus for Strategic Plan





Barrier: “Have” the Seniors–seek to engage non-Medicare patients for Fee
for Value/Loyalty St t
f V l /L lt Strategy
Better: Focus services to younger segments
Even Better: Identify segments tied to specific services with margin and
service use by household
Heroic Results: Outreach programs & ROI portfolio for each Service Line
and program to identify what programs bring in higher loyalty and revenue
Subsequently: Marketing budget is offered more resources for targeted
programs

22. Using/Teaching Unique Consumer Terms
Greatest/Silent
G
/S
Baby Boomers
“I will do as you say, doctor.”
“Baby I was born to question you!”
Baby,
you!
Gen X
“I’m glad to see you if I can see you
Tuesday at 5:00.”
Millennials
“OMG, I’m so
Sunday!!
S d !!
. I’ll be, like, free on
Adapted from: Truven Health Pulse Survey/ Matching the Market paper

23. RETHINKING TRADITIONAL PATIENT BASE
# of
People
In US
AVERAGE:
80
(millions)
122 Dschgs
g
FROM INPATIENT
TO OUTPATIENT
FROM ACUTE / 1000 pop
(SLOW) CONTACT
OR
TO OUTPATIENT22K Visits
/1000 pop
(FASTER) CONTACT
111 Dschgs
/ 1000 pop
86 Dschgs
/ 1000 pop
70
60
85 Dschgs
/ 1000 pop
50
40
30
12K Visits
/ 1000 pop
17.5K Visits
/ 1000 pop
344 Dschgs
/ 1000 pop
28K Visits
/ 1000 pop
46.6K Visits
/ 1000 pop
20
10
0
Millennial
Generation X
Baby Boomers Greatest/Silent
Source: Adapted from Matching the Market: Using Generational Segments
to Attract and Retain Consumers, Truven Health

24. 9 out of 10
f
Older
Adults have
a PCP v. 4
out of 5
GenXers and
2 out of 3
Millennials
Mill i l
TAKING STOCK OF PRIMARY CARE
PROVIDER CONNECTION
~90% have had PCPs for 12+ months
2013 Pulse Consumer Research

25. PRIMARY CARE PHYSICIAN
SELECTION FACTORS
How Do Consumers Make Decisions?
Greatest/Silent
Baby Boomers
~30% each for Quality & Communication &
“Cares about me’”
33% Communication, ~28% Quality & “Cares about
me,” ~7% Cost/Convenience each
Gen X
28% at Quality & Communication, 20% “Cares
t Q lit
C
i ti
“C
about me,” 12% Convenience & 9% Cost
Millennials
32% Quality, with ~21% Communication/ Cares,’
Quality
21% Communication/’Cares
14% Cost & 9% Convenience
2013 Pulse Consumer Research

26. Seniors
know
more
about
Physician
Sites than
use
Internet
I
TAKING STOCK OF INTERNET
CONNECTION
2013 Pulse Consumer Research

27. INTERNET USE SHOWS HEALTH INFORMATION MORE
THAN SERVICE SEARCH

28. CONSUMERS SEEK MULTIPLE CHANNELS FOR
HEALTH REMINDERS/ALERTS
S/
S



Regular mail matters as key
part of 35+-year-old
engagement
Match reminders with
targeted services to have a
better life: orthopedics &
heart
Media channels matter; too
risky to pick one
2013 Pulse Consumer Research
Truven Health Pulse,
28

29. VIRTUAL
FRONT
DOOR
IMPACT
AVERAGE ENCOUNTERS FOR CALL /
CONTACT CENTER CUSTOMERS
14 Encounters
14 Encounters
97% Insured
9 Encounters
84% Insured
78% I
Insured
d
6 Encounters
75% Insured
-Encounters from Truven Health
CRM Database, 2013
-Insurance status from Truven
Health Consumer Research, 7/13

30. Move From All Consumers To Unique Consumers:
Teach the Teams




Leverage ‘generations in the workforce’ frameworks to shape
‘generations i the patient b ’ f
‘
i
in h
i base’ focus with your teams
ih
Identify in each service which generation and types of patients
are served. Add to generation: married/coupled, with/without
children, age group, gender focus, and income/payer mix
/
Target generations/patient types for each currently related and
p
potential service
Identify target consumer connection venues: 1-1 messaging via
email, direct mail, newsletter enrollment, affinity group or
enrollment in Electronic Health Record (e.g., EPIC’s MyChart)
( g,
My
)

31. What Data Can Show From FFS To FFV
W
What Data S
Shows U That Is Likely to C g in
Us
y Change
FFS to FFV?


Service Selection & Choices

Service Scope & Site of Care Delivery

Key Business Questions of the Entire Team

32. What to Expect from the Data, Consumer
to Drive Innovation
32

33. Changes In Coverage Will Drive Changes In
Utilization
33
CHANGE IN MILLIONS
I
S
30
20
10
Medicaid
ESI
Individual
Exchanges
Uninsured
0
-10
-20
-30
-40
2010 2011 2012 2013 2014
2015 2016 2017 2018 2019
Exchanges drive the largest change BUT Medicaid’s number of people are g
g
g
g
p p
generally sicker
y
Source: Truven Health Insurance Coverage Estimates

34. The Impact from Expanded Coverage
261M
220M
246M
62M
53M
Medicaid
47M
177M
173M
172M
Private Group/
Non-Group
22M
49M
2012
21M
27M
2016 Partial Opt In
Opt-In
Private, Exchanges
21M
Unsinsured
2022 Full Opt-In
Opt In
Source: Truven Health Analytics Insurance Coverage Estimates

35. Effects Will be Localized
Medicaid Opt-In Enrollment, 2016
Exchange Enrollment, 2016
% Medicaid Growth, 2012 – 2016
Assumes States Opt-In
100%+
60% - 100%
40% - 60%
20% - 40%
< 20%
35

36. Prioritize The Newly Insured Needs For Demand
Impact And Intervention Focus
36
Profile Factor
Insurance History


Key Findings: Comparison of Future Exchange Likely Adults to Current Privately Insured
(Group + Non-Group)
50% likely to have been uninsured for more than 3 years or have never had insurance
Cost is dominant factor for uninsurance
Health Status

Higher levels of health deterioration, disability (aliased by income) and ADL problems
Health Risks


Use tobacco at m ch higher rates and exercise less
much
e ercise
Health risk levels not favorable
Chronic Conditions


Report mental health issues at a similar rate, but are much less likely to have seen a mental
health professional
Report similar levels for many chronic conditions, but lower rates for arthritis and heart disease





Fewer women, more in 18-44 age group
More likely to be of Hispanic origin
Less likely to be U.S. born or citizens
Less likely to be employed
Slightly lower BMI


Report lower rates of visits with medical and dental professionals
p
p
Have slightly higher rates of ER use and lower rates of surgeries
Demographics
Biometrics
Use of Healthcare Services

37. When Our Teams Say “We Need More Patients/
Volume
Volume”…





Barrier: Getting the right patient, right volume‒not just any will do (think
margin, t
i target payer mix, t
t
i target procedures and repeat users)
t
d
d
t
)
Better: Getting the right prospect to the right service with the right care
compliance for the right next service use
Even Better: Ensuring capacity in primary care practices f appointments in
for
next 3 working days for net new high(er) income/insured Boomers/GenXers
via the web connect contact center
Heroic Results: To identify incremental $1 2M revenue f th t
H i R lt T id tif i
t l $1.2M
for the target
t
physician practices.
Subsequently: Focus on Specific Consumers (to start)

38. When Our Teams Say: “We Need to Be Different”…
We
Different




Develop a program for Service Line Innovation: have leaders
present f
fact-driven/consumer-based innovation to each other
di /
b di
i
h h
Provide a forum to showcase cost-effective innovation to
Finance, Clinical Redirection to Population Health Team, Patient
Engagement to the Satisfaction Team
Establish Before/After Profiles to Demonstrate Success – or at least
outcomes and Lessons Learned
Engage Senior Leadership to champion innovation & again, get
their key data questions – for Round Two!

39. Coordination of Care Alone Presents a Huge Opportunity
In A Fee-for-Value World
39
Care Coordination
represents a $50B
opportunity

40. Prioritize Local Chronic Disease Risk And
Intervene With Highest-Risk Consumers
40
Zip codes with highest
Population segments with high
combined IOC for selected
IOCs for selected chronic
chronic conditions. How are we
conditions.
serving this population?
What are the unique
needs/attitudes of these
segments?

41. Consumer Choices Invite & Compel New Innovations:
Imagine Their Questions To Launch Your Possibilities
Today’s Choices

Am I going to a doctor in my
health plan?

How will I get there?

Do I need a referral?

Where will I get my
prescriptions from: Internet,
hospital, drug store?
Tomorrow’s Choices

Do I want to work for an employer that doesn’t have insurance?
doesn t

Should I buy my insurance on the exchange or pay the penalty?

Do I need to go to doctor, retail clinic, call or can I stay home and
Skype?

How much does it cost from my pocket and is it worth it?

How do I respond to wellness incentives?

Do I need a coach, or nutritionist?

What bonuses/credits do I get for my health activities?

What health reminder system do I need to manage my health and
y
g
y
risk?

42. Focus In-Network Care Navigation In Top
Services With Leakage Hotspots
42
16.00%
14.00%
14 00%
12.00%
10.00%
8.00%
6.00%
4.00%
2.00%
0.00%
Goal: R t i treatment AFTER diagnosis
G l Retain t t
t
di
i
BREAST SURGERY
MASTECTOMY, PARTIAL
BREAST ASPIRATION & BIOPSY
ULTRASOUND, BREAST
X-RAY - BREAST

43. Redirect From The Emergency Department
43
National ED Highlights:

~62% ED Visits are Urgent; Why not
redirect to cheaper care sites?

Opportunities:
Redirect 20% ED visits saves $4B/ year
Broward County, FLA Highlights:

28% of Seniors ED visits are Urgent

61% of Adults (45-64 yrs) are Urgent

76% of Young Adults (19-44 yrs) are
Urgent

82% of Children (<19 yrs) are Urgent
Redirect Super–Users to Community
Health Centers: Care directed texts for 5+
visits/ year =$1.5M savings

Offer expanded office/urgent care
capacity for children: Request urgent
care from ED source

Set up Preventive Screenings: Send
prompts to chronic care patients for
preventive care
62% of Total ED visits are Urgent; BUT



44. From Data Insights To Consumer Engaged Innovations
Consumer-Engaged
W
What Innovation is Possible from Data-Identified
v
Opportunities?


Segment, Segment, Segment to Identify Actionable Customer
g
, g
, g
y
Groups to Engage in a Focused Way

Find Small Victories and Don’t Let Up

Build a Culture Favoring Many Marketing Innovation

45. Trends From The Trenches
45
1.
Four unique customer segments using healthcare today:
q
g
g
y



Digital Natives with Low Use Rates who are PCP driven
(Millennials/Gen Xers) vs. Digital Immigrants with High Use Rates
who are Care Loyal (Boomers/Greatest)
Sustainability-Driven (Millennials/Greatest) to Cost Sensitive
Pragmatics (GenXers/Boomers)
Personal Friend/Professional Sales/Direct Mail-Driven
( oo e s/G ea es ) vs e d/Web/Soc a Med a ve
(Boomers/Greatest) vs. Friend/Web/Social Media-Driven
GenXers/Boomers)

46. Trends From The Trenches
46
1.
2.
3.
3
4.
5.
In 2014, 14 million Americans will gain insurance from the insurance
exchanges and Medicaid expansion
In 2017, 34 million Americans will have gained insurance
Think local. Using national numbers will ultimately leave hospitals
local
underprepared for what will happen in their local market.
Rethink Sites of Care: The traditional Emergency Department should no
longer be the first primary care stop for Medicaid enrollees
Think All Points of Patient Contact for 1-1 Engagement: Leverage targeted
communication via email, direct mail, affinity groups, patient discharge and
the Electronic Health R
h El
H l h Record portal
d
l

47. Trends From The Trenches, cont’d.
cont d.
4.
5.
6.
7.
Prepare to take on risk. Providers will be expected to share in the
responsibility of population health management.
ibili
f
l i h lh
Gain insight into the health of the population. Understand
underlying health issues, such as the prevalence of diabetes or
heart disease, in the population of newly insured patients.
Prepare sufficient capacity. Demand is still a function of
coverage, so provide risk assessments & offer appropriate
g , p
pp p
care, such as medical homes, navigators and patient messaging.
Engage the newly insured personally. Providers should be connect
virtually to improve compliance with attention to their priorities.
y
p
p
p

48. Steps to Drive Value (and survive) the
Perfect Storm

Perfect Storm of Consumer/Data-Driven Innovation




Data Profile Local Consumers & Their Preferences: Think Segments, Prioritize
Personas & Focus on Service Line Portfolio.
Responsively Position to Locally & Virtually Available Competitors: Research
preference,
preference adoption rate non-user characteristics. Think Partnerships/Speed to
rate,
characteristics
Market to Build or Buy by each Service Line
Prioritize & Rebuild Service Lines: Re-array service lines based on data-driven
criteria, target consumer and performance criteria. Prioritize consumer-engaged
data-driven growth based on target goals.
d
d
hb d
l
Need innovation platform for consumer-engaged business successes.
Relentless revisiting of the market data can align and cost effectively steer
agreement about market focus resources
resources.

49. From Big Data To People Data
Storytelling Insights

50. Cannot Just Assume Services Continue as Usual



People don’t want to focus on your Emergency
p
y
g y
Department.
They want to engage to convenient care – urgent
y
g g
g
care, evening/weekend hours, primary care, retail care
They ask, “Can you:
Help Me Get the Right Care at the Right Time
 Connect with Me Via Email, Text, Alerts, Phones, In Person
 Gi
Give Me S lf S
M Self-Serve When I Want It?
Wh
W I?


51. To Thrive in Changing Times

Remember that…
Consumer Insights Drive Creative Service Ideas
 Unique Consumers, Unique Markets and Service Venues
WILL Dilute The Ones You Had
Had.





New services need new stories.
Staff need to embrace and live the new consumer engagement.
Review analytics benchmarks and local market indicators to
retain your authentic market needs.
The New Healthcare is not a place or a thing but an experience.

52. Big Data And Observational Research


To add power to the data, perhaps we need to add
data
a bit of anthropology.
We f d
W found recurring themes worth sharing here.
h
h h
h

53. Newly Involved Men In Healthcare Decisions

Men were becoming more involved in the healthcare
decisions as they had to pay more out-of-pocket
expenses.
expenses

54. Internet Is Changing The Decision Process

People of all ages showed us how they were
searching for data to help in their decisions, and
then were not sure how to interpret the information
they were finding.

55. Searching For Simple And Easy


Nothing was simple
or easy, anymore.
Across
demographic
segments.
t

56. “Paradox Of Choice”
Paradox
Choice


Abundant Options leading to the “Paradox of
Paradox
Choice”
Not making decisions for fear that whatever they
did decide would be the wrong decision.

57. Have Lost Ability To See The Difference

Common statement: “Aren’t all doctors and hospitals
Aren t
the same?” Shouldn’t they be?

58. Increasing Challenge Of Retailers

Recurring theme: The ease and comfort of going to
a Walgreens or CVS to get care.

59. How Can You Apply This?
We Can Adapt To Changing Times

60. What Does This Suggest



Consumers are driving and can drive the changes.
Data is shedding compelling information and
insights.
insights
Put “flesh on the numbers.”

61. Engage And Communicate To Innovate
1.
2.
3.
3
4.
5.
5
Consumers are facing the “paradox of choice.”
g
p
Help them choose wisely.
Engage them earlier in the change process.
Tailor your messages and messaging to who they are.
Let them help create better solutions for themselves
and for healthcare delivery organizations and
p y
physicians.

62. End Where We Began
“We don’t see things as they are. We see things as we
We don t
are.” ~Anais Nin
The
o age discovery
“The real voyage of disco er consists not in seeking
new landscapes but in having new eyes.” ~Marcel
Proust
P
t

63. We Hope Our Journey Has Helped
Our job was to help you “See Feel and Think” in
See,
Think
New Ways — before you “do.”
 Perhaps we can be of help to you as you begin
this journey.


64. Next Webinar: Andrea Simon PhD
Friday February 14 At Noon EST.
“Healthcare Innovation: Mastering the Front and Back-End
of Innovation”
I will be conducting our next webinar and will be talking
about:
b t
1.
How to take data and ideas and envision new ways to
solve old problems‒simpler and better.
problems simpler
2.
Take these ideas and turn them into testable innovations.
3.
Build this into a culture of innovation for your institution.
y

65. For More Conversation And Information
Andrea J. Simon, PhD
Corporate Anthropologist
President, Simon Associates Management Consultants
asimon@simonassociates.net
Office 914-245-1641
ff 9
6
www.simonassociates.net
@simonandi and @andisamc
Linda MacCracken
Vice President, Advisory Services
Truven Health Analytics
Linda.maccracken@truvenhealth.com
@