Post on 19-Apr-2018
Patient Segmentation
Peter Simpson
Principal
February 2014
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Why Segment?
Fairly obviously because different type of customers have different:
• Needs
• Channels of communication
• Price points
• Perceptions and bias
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Why Segment?
In your case you have to manage:
• Presentation
• Attendance
• Follow up
• Compliance
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We All Segment
Demographics
Non-verbal cues
I hope this guy is helpful!
Can she solve my problem?
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Segmentation in Daily Life
• Nuanced and subtle
• Verbal and non-verbal
• Instinctive
• Experiential
• Based on our needs– Rational
– Emotional
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Connection – An Important Word
• In the end, everybody seeks connection– Family
– Romantic
– Group
– Professional
– Common interest
• Everybody has concerns about the resources for living
• These ancient behavioral drivers are relevant today
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Rational, easily discussed, subject to
persuasion and modification, easily put
into words
Powerful,
latent, not
easily
expressed, not
negotiable,
source of
emotions
Maslow’s Hierarchy of Human Needs
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Segmenting Patients
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Compliance is Multi-Faceted and Complex
• There is no one or easy solution
• Compliance remediation consists of identifying psycho-behavioral segments where remediation is cost-effective
• For those amenable segments there are effective and practical solutions
Disease
Severity
Psycho-behavioral Segments
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Consumer Decision-Making in healthcare
Assumptions are often made that consumers are rational
Therefore if we provide them with information to inform them and tools to help them, rational healthcare decisions follow
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So if healthcare consumers make rational decisions, why do people:
Skip medications?
Eat foods that they know are not good for them?
Have pets when they know they are allergic to them?
Postpone seeking help when they suspect that something may be seriously wrong?
Continue “screwing up” even when they end with very bad things?
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Logic, Rationality and Control
• Humans will swing between group acceptance and autocontrol throughout their lives
• Humans are very good at being logical
• Logic proceeds from a premise (beliefs, assumptions)
• Recent research suggests that our brains supply beliefs and assumptions into our logical process faster than we can discern, edit or validate
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The Brain
Cerebral Cortex
Amygdala
All decision making involves
the Cerebral Cortex and the
Amygdala. Stimuli are passed
to both via the Thalamus and
then separately from the
Cerebral Cortex to the
Amygdala. The input of both is
important to any decision
outcome
Thalamus
13
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Patients Logic is Generally Very Good
Logic
Assumptions
Experience
Heuristics
Resources
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Drug Compliance and Rationality
• Non-compliance is not necessarily irrational or harmful
• Examples of highly rated cures (in the past)
– Purging, puking, poisoning, puncturing, cutting, cupping, bleeding, blistering, shocking, heating, freezing, sweating and leaching
– Fen-phen, Vioxx, Thalidomide, Pentylenetetrazol (and about 70 others)
• “If their memories were better they would trust us even less” (Chapin, 1915)
• What is non-compliance?
– 80% compliance is generally sufficient to adequately control blood pressure (Vetter, 1985) and eradicate strep throat in children (Olson, et al 1985)
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Unspoken Assumptions
1/3 of consumers do not fully believe their physician has their best interests at heart when prescribing
1/3 (mostly the same people) do not always take their medicines as prescribed
Only 1/2 believe their physician is financially independent of the Pharma companies
Less than 1/5 would trust a health insurance company to make the right decision about their health
1/2 believe that Pharma companies are more concerned about making money than helping people
Source – Segmedica Consumer Confidence Surveys….Representative US
sample n=2400
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Our Decisions are Very Contextual!
I’ll take the
cheapest Policy!
Take me to the best
Hospital!
Do you have a
Generic?
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When “consumers” become patients, health decisions take on even more importance
Patients are often scared or under stress
People around them such as family and friends are worried
about them too
Patients want to be ‘fixed’ making it
difficult to weigh the risks and benefits of
treatments
Information is asymmetrical even in the
internet age – patients are at a disadvantage in
medical knowledge, although does not
always preclude from making poor decisions
For those that look for information, there can
be information overload, with indeterminable
reliability
Multiple decisions with unknown but
life-changing consequences are
often involved
Decisions are often made in unfamiliar settings, i.e.,
a healthcare setting, under time pressures, the context of highly
charged emotions
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Some Common Unconscious Process (Heuristics)
Heuristic Definition Example of Effect
Anchoring The tendency to rely too heavily, or "anchor," on one trait or piece of information when making decisions.
Drug X gives me unpleasant side effects, therefore drug X must be bad for me and I will not take it. (Patient anchors adherence decision on knowledge of side effects)
Availability A phenomenon in which people predict the frequency of an event, or a proportion within a population, based on how easily an example can be brought to mind (e.g. using anecdotal evidence to “prove” an entire proposition)
A person argues that a medication is harmful after hearing a news story where someone was admitted for an adverse reaction. Even though it may be unusual, it is most available info
Representativeness Judging the probability or frequency of a hypothesis by considering how much the hypothesis resembles available data as opposed to using mathematical calculations.
Drug X was not able help my friend, therefore drug X must not be able to help anyone, including myself.
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Some Common Unconscious Process (Heuristics)
Heuristic Definition Example of Effect
Loss Aversion The disutility of giving something up is greater than the utility associated with acquiring it
Preserve what health I have rather than risk adding a side effect to my life to acquire future health.
Hyperbolic Discounting
Disproportionately giving priority to the present over future outcomes
In chronic prevention the theoretical long term benefits of medication do not outweigh current costs/risks
Representativeness(Gambler’s Fallacy) –
Judging risk based on appearance of trends rather than base-rate info.
Drug X was not able help three of my friends, therefore it must not be able to help anyone, including me.
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It’s more important to know what patient has the disease than what disease the patient has
Sir William Osler
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Segmentation Techniques
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Traditional Qual/Quant Approach
• Qualitative Interviews to direct the design of a Quantitative survey leading to statistical modeling
• Large amounts of data are collected
– Behaviors
– Attitudes
– Demographics
• Latent Class Cluster techniques are used to derive “latent” segments that cannot be found by univariate means
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What’s Wrong with Behaviors and Attitudes?
Behaviors and attitudes are conscious and transient
• They are subject to self edit
• By the time you come to execute on them they have changed
We need to segment on variables that are truthful and enduring
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Why Needs Based?
Attitude/Behavior Based
Behavior is what we seek
to change
Attitudes are:
• Transient
• Self edited
• Difficult to execute against
Needs Based
Personality based
Non-negotiable
Relevant
Triggers for emotional connection
Enduring
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Needs Based Segmentation Design
Needs Variables presented in a discrete choice model
Demographics
Attitudes
Behaviors
Needs Based Segments
Profiling
variables
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Simple or Sophisticated? The Central Choice
Behavioral
Simple
Quick
Profile lists
No guidance on why
people behave as
they do
Needs Based
Sophisticated
Takes time
Profile individually
Tells us why people
behave as they do
and how to change
behaviors
Behavioral and
Attitudinal
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Seven Principles to Use
1. Involve all stakeholders from the beginning
2. Design from the implementation backwards
3. Initial qualitative should be focuses on needs analysis
4. Rigorous design
5. Expert analysis
6. Apply judgment
7. Implement wisely
Segmentation Case Study
The Dyslipidemia Case
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The Dyslipidemia Case
• A statistical modelling analysis of 1200 patients
– 500 diagnosed and treated
– 500 diagnosed and not treated
– 200 at risk
• Qual/quant format
• Needs based
• Choice Model driven
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Segmentation Drivers
• A range of product attributes were
identified through the qualitative
research and conversations with
the Dyslipidemia Brand Teams
• These attributes were scored by
respondents in a cascade model
• Using Latent Class Cluster
Analysis, it was found that these
17 attributes were the key
discriminating needs variables in
determining the segments
Need Product Attribute CategoryRational – reduce overall cholesterol
Emotional – long and healthy life – fulfillment
of ambitions
Aggressively treats all of my key cholesterol
elements
Efficacy
Ditto Overall effectiveness Efficacy
Emotional – feeling I did not do irreparable
harm to myself - guilt
Reverses build up of plaque in my arteries Efficacy
Rational – reduce overall cholesterol
Emotional – long and healthy life – fulfillment
of ambitions
Is proven to reduce the risk of a heart attack Efficacy
Ditto Reduces LDL Efficacy
Ditto Best in reducing triglycerides Efficacy
Ditto Raises HDL Efficacy
Emotional – fear of drugs Is safest to take with my other medication Safety
Rational – desire for current health Minimal side effects Safety
Emotional – fear of drugs Has the most research and data supporting it Safety
Ditto Has been on the market a long time Safety
Rational – now a single treatment can help
me
Is the first treatment that effectively treats all
my cholesterol issues
C/C
Emotional – fear of drugs (perceived less is
better) – taking twice a day implies my
condition is more serious
Has once-a-day dosing C/C
Rational – now a single treatment can help
me
Combines two proven cholesterol
medications into one pill
C/C
Emotional –need to conserve resources Is available as a cheaper generic C/C
Ditto Costs less than $1 per day C/C
Ditto Has a money-saving coupon available C/C
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Overall effectiveness
Aggressively treats all of my key
cholesterol issues
Reduces LDL
Best in reducing triglycerides
Raises HDL
Reverses build up of plaque in my
arteries
Is proven to reduce the risk of a
heart attack
Minimal side effects
Has been on the market a long
time
Has the most research and data
supporting it
Is safest to take with my other
medication
Has once-a-day dosing
Is the first treatment that effectively
treats all my cholesterol issues
Combines two proven cholesterol
medications into one pill
Is available as a cheaper generic
Has a money saving coupon
available
Costs less than $1 per day
The Needs Variables Clustered into Three Distinct Groups of Variables – Safety, Efficacy
and Cost & Convenience – This Sharpness Arises from Using a Choice Model
Safety
Efficacy
Cost/Convenience
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Overall effectiveness
Aggressively treats all of my key
cholesterol issues
Reduces LDL
Best in reducing triglycerides
Raises HDL
Reverses build up of plaque in my
arteries
Is proven to reduce the risk of a
heart attack
Minimal side effects
Has been on the market a long
time
Has the most research and data
supporting it
Is safest to take with my other
medication
Has once-a-day dosing
Is the first treatment that effectively
treats all my cholesterol issues
Combines two proven cholesterol
medications into one pill
Is available as a cheaper generic
Has a money saving coupon
available
Costs less than $1 per day
Latent Class Analysis Shows Four Distinct Consumer Segments (n=1202)
Each blue diamond
represents the center of
the segment’s position
according to the latent
class cluster analysis
run on the needs
variables shown
Segment 4
Segment 1
Segment 2
Segment 3
Safety
Cost/Convenience
Efficacy
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Individual Respondents on 4-Segment Consumer Positioning Map (n=1202)
Each dot represents an
individual respondent’s
position according to
the latent class cluster
analysis run on the
needs variables shown
Safety
Cost/Convenience
Efficacy
Each segment shows as
a density of patients
with a halo of patients
whose needs are least
focused
The red dots indicate the mathematical center of each segment and are shown relative to the size of the segment.
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Segment Names & Overview
Segment 1
Long-term
Wellness
Segment 2
Live for Today
Segment 3
Overwhelmed
Segment 4
Reassure Me
What do they
want?
Long-term
wellness
Wellness today Solve my other
problems first
Reassure me
that the cure is
worth the risk
How do they
operate?
Self-informed
Guided by
physician
Long-term view
Guided by self
Live for today
Overwhelmed
Doesn’t trust
physician
Other priorities
Need a leader
Prevaricates
Doesn’t trust
physician
Emotional
Modality
Confident Impulsive Depressed Skeptical
What are their
major drivers to
act?
Desire to have
long-term health
and functionality
Satisfies today’s
emotional needs
None directly
related to
cholesterol
Confidence in
drug/healthcare
provider
What are their
major barriers?
None directly
related to
cholesterol
Not thinking
about the long-
term
Cannot deal with
one more issue
in their lives
Skepticism of
drugs and
physicians, fear
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Motivators and Barriers to Action Illustrate the Differences Between Segments
Motivators (in green) & Barriers (in red) Interpretive, not statistically significant
Long-term
Wellness)
Live for
Today
Over-
whelmed
Reassure Me
Wellness X
Functionality in Life X X
Longevity - Family X
Appearance - Obesity X X
Trust in Physician X
Strong relationship & Communication with Physician X
Currently on Treatment X
Partnership/Marriage X X X
Current Symptoms X
Concern About Long-Term Effects of Disease X
Time X
Long-Term is Not Important X
Feeling Rushed at Doctor’s Appointments X
Skepticism and Distrust of Physicians X X
Not Remembering or Understanding Doctor’s Advice X
Feel the Need to Lead in Physician-Patient Relationship X
Not Aware of the Consequences of Disease X
Lack of Healthcare Insurance X X
Cost X X
Current Addictive and Unhealthy Behaviors X X
Lower Rate of Diagnosis X
Not Currently on Treatment X X
Believe all Drugs have Side Effects X
Not Believing that Rx’s are Necessary for Health X
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Motivators & Barriers Interpretive, not statistically significant
Long-term
Wellness
Live for
Today
Over-
whelmed
Reassure Me
Wellness X
Functionality in Life X X
Longevity - Family X
Appearance - Obesity X X
Trust in Physician X
Strong relationship & Communication with Physician X
Currently on Treatment X
Partnership/Marriage X X X
Current Symptoms X
Concern About Long-Term Effects of Disease X
Time X
Long-Term is Not Important X
Feeling Rushed at Doctor’s Appointments X
Skepticism and Distrust of Physicians X X
Not Remembering or Understanding Doctor’s Advice X
Feel the Need to Lead in Physician-Patient Relationship X
Not Aware of the Consequences of Disease X
Lack of Healthcare Insurance X X
Cost X X
Current Addictive and Unhealthy Behaviors X X
Lower Rate of Diagnosis X
Not Currently on Treatment X X
Believe all Drugs have Side Effects X
Not Believing that Rx’s are Necessary for Health X
Positive
Negative
Motivators and Barriers to Action Illustrate the Differences Between Segments
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What Did We Learn?
• Relationships– People with high levels of self actualization (Maslow) have a
motivation to prolong life and functionality
– People with low levels of actualization are focused more on today’s problems
– People with a lack of confidence or high level of anxiety and distrust prevaricate between the disease and cure
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Qualitative Segmentation
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Qualitative Segmentation – When and Why?
• Small HCP specialties or rare disease states, where a minimum 600 patients cannot be sampled
– Examples:• Rheumatologists (3,300 in practice)
• Endocrinologists (3,500 in practice)
• Genetic disease patients
• Etc.
• Budget and or timeline too short
• “Respondents” are institutions, not people
• Project is to deepen an existing segmentation
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Qualitative Segmentation – Guiding Principle
• Usually requires a “quantitative backbone”
– A web survey or scoring questions within the interview
• The in-depth qualitative work substitutes for mathematical modeling
• The interview guide needs to be highly structured and interviews need to be consistent
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Example of a “By Eye” Cluster Model
Grieving Process Denial Anger Bargaining Depression Acceptance
Family Affairs Unable to consider Early stage
consideration
Active
arrangements
Arrangements
completed
-
Relationships Initial alienation Independent
operating
Rebuilding Unity Unity with
acceptance
Finances Unable to consider Struggling Strategy and
information
seeking
Active
arrangements
Under control/Was
never an issue
Clinical
information
Unable to consider Passive receiver Active seekers Active
communicator
Superior performer
Depression and
Anxiety scales
High - - - Low
Terminal Patients
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Example of a “By Eye” Cluster Model
Grieving Process Denial Anger Bargaining Depression Acceptance
Family Affairs Unable to consider Early stage
consideration
Active
arrangements
Arrangements
completed
-
Relationships Initial alienation Independent
operating
Rebuilding Unity Unity with
acceptance
Finances Unable to consider Struggling Strategy and
information
seeking
Active
arrangements
Under control/Was
never an issue
Clinical
information
Unable to consider Passive receiver Active seekers Active
communicator
Superior performer
Depression and
Anxiety scales
High - - - Low
Terminal Patients
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Combining Physicians & Patients Segmentations
• Physician and patient segmentations can be design to fit together and matched
– What kind of physicians see what kind of patients and how do they manage them?
– One tactic that can arise is educating physicians to recognize patient segments and optimally manage them for compliance and adherence
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Segmenting Physicians & Patients Together
• Segments physicians and patients in a single, integrated model
• Groups according to likelihood to prescribe and likelihood to comply
• Segments by the relationship between physicians and patients
• Discovers segments made up of a variety of factors –behavioral, psychological, demographic
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Example of HCP-Patient Segmentation
MD Likes Product
MD does not Like Product
MD Likes Product
MD Does not Like Product
Effective “selling” to Patients Ineffective “selling” to Patients
Patients Confident Not-Confident Confident Not-Confident
Likely to be prescribed and take. May be non-compliant
Unlikely to be prescribed and will any case be non-persistent
Likely to be prescribed, less likely to take. May be non-compliant
Unlikely to be prescribed and will any case be non-persistent
Tactics Promote compliance
Market product and promotepersistence
Promote more effective patient management and compliance
Market productand promote more effective patient management andpersistence
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Number of Segments
• Large datasets will produce multiple solutions
– 2,3,4,5,6,7,8 and up segment solutions
• Segmentation is an approximation
• The fewer segments we choose the more of an approximation the model is
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Segmentation “Tightness”
Resp ID#
Seg 1 Seg 2 Seg 3
1 100%
2 100%
3 100%
4 90% 10%
5 80% 10% 10%
6 50% 25% 25%
7 33% 33% 34%
Example Confusion Matrix
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Checklist of Essential Outputs
• Segment Descriptions using profiling data as well as segmenting data
• Vector Maps
• Typing tool
– Full algorithm
– Decision tree logic (if applicable)
– Defining variables and coefficients
• Confusion matrix
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The Essence of Segmentation
• The essence of segmentation is not finding the most complex statistical solution, it is about framing the study in the most economical and elegant way to discover real groups that make sense and can be executed against
• Two tools for developing superior segmentations are:
– Needs analysis
– Cascade questioning
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Summary
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Segmentation
• Segmentation is a useful tool but…
• …it must be carried out in a specialized and disciplined way
• They come in all shapes and sizes
• You can have different segmentations for different purposes
• Key things to remember…
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Segmentation
• …needs based is the most fundamental approach, but everything depends on your purpose
• Do not think if it as a routine “market research” assignment
• Team involvement, crystal clear thinking and forward vision are all essential
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To learn more and share ideas and experiences around the healthcare consumer register for VISION 4.0
One day conference June 17th Bridgewater, NJ Marriott
Chair – Charlotte Sibley
Keynote – Dr. Jeffrey Brenner of the Camden Healthcare Coalition and 2013 McArthur Genius Award Winner
Completely free to all manufacturing/insurance companies
Will include attendees from Health Insurance, OTC, Nutraceuticals
Sign up at Segmedica.com or Vision-4.0.com
VISION 4.0 Understanding the Healthcare Consumer
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Segment 1 (Small)
Segment 2(Ind./Less Prog)
Segment 3(Ind./More
Prog.)
Segment 4(Cent./More
Prog.)
Segment 5(Large Teaching)
# of beds 100 beds or less 101 -406 101-629 123-561 Range 537 –1003
Location Primarily rural Primarily urban Mix/slightlymore rural
Primarilysuburban
Primarily Urban
Public perception IntimateFamily
Immediate resource
Mid-sizedExpert
Perhaps inconvenientInstitutional
TitanicExpertSavior
Last resort
Patient perception FriendlyCommunityConvenient
Good attentionLike the doctors
BureaucraticLots of time – do I see a doctor?
Food’s good
AweFearHope
Customer service FriendlyCommon
background
ProfessionalPatchy
DistantPatchy
Hospital Segments: Summary
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Linguistic Analysis: Hospital Segmentation
Segment 1: physician/medical
is central to discussions
Segment 2: drugs and
physicians are highly
associated – also close to cost
Segment 3: quality and data
are central to discussions
Segment 4: strong
association with the hospital
and less focus on physicians
Segment 5: Close to
data/processes and in-
between hospitals and
physicians