CONSUMER INSIGHTS DATA AND CONSUMER INSIGHTS, DATA AND INNOVATION

Healthcare Innovation: Trends from the TrenchesWebinar #3

Our Presenters

Andrea J. Simon, PhDCorporate Anthropologist

Linda MacCracken, MBAVice President, Advisory Services Corporate Anthropologist

PresidentSimon Associates

Management Consultants

Vice President, Advisory Services Truven Health Analytics

What We Are All AboutWhat We Are All About

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

Today, Our Guest Will…Today, Our Guest Will…

Share new research insights about consumer gbehavior, 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.

What Consumers Are FeelingWhat Consumers Are Feeling

Confused Cynical Angry

What To Do?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?

Trends from the Trenches

Observations From The FieldObservations From The Field

Changing times make data really, really, important. Changing times make data really, really, important. How can we see leading indicators, not lagging

ones?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? Shall we trust it and let it help us change?

What Are We Looking For?What Are We Looking For?

In Healthcare Today, to thrive you must look for: In Healthcare Today, to thrive you must look for: Patterns emerging. Opportunities to leap frog over the rest to offer Opportunities to leap-frog over the rest to offer

innovative solutions before they become ordinary. N ith t d th t i ht Non-users with unmet needs that might open a new way

to deliver care ‘their way,’ not the old way.

If Times Are ChangingIf Times Are Changing

Hospitals, Physicians, Healthcare Services must Hospitals, Physicians, Healthcare Services must “create” new value in innovative ways.

Explore opportunities that could open new market Explore opportunities that could open new market space.

Include consumers, aka “patients,” in the evolutionary process.

From “Fix Me” To “Keep Me Well”From Fix Me To Keep Me Well

Data is critically important to show us how to better 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 going to shift lifestyles and consumer habits in new directions.

Consumers also have to “see feel and think” in new Consumers also have to see, feel and think in new ways.

Leading To Communication ChallengeLeading To Communication Challenge

How do you engage consumers and patients? How do you engage consumers and patients? How do you match the message and the story-

telling to their demographics and psychographics?telling to their demographics and psychographics? How do you measure impact?

Consumer Insights, Data & InnovationMay I Introduce You To Linda MacCracken

Consumer Insights, Data & Innovation

Key Questions Key Questions What Can We Know About Consumers to Shape Data-p

Driven Innovation? What Data Shows Us That Is Likely to Change in FFS to

FFV? What Innovation is Possible from Data-Identified

O ? Opportunities? Steps to Drive Value in the Trenches

Consumer Insight & Data FocusIs Trying Amidst a Perfect Storm 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 at Walgreens, CVS, Wal-Mart; Telehealth via Cisco, American 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.

Clearly Storm Survival Calls for An Aligned Team

I’ l d th h l i ’t i

Clearly, Storm Survival Calls for An Aligned Team

I’m sure glad the hole isn’t in our end…

Consumer Insights, Data-Driven Insights, and Innovation is a Team Sport 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

C t N C lt 8. Create New Culture

Organize Team Position on Change Drivers to Deliver Innovation

Change Process Key Factors

Create Urgency -Impact of newly insured T ti t f ti t it

Deliver Innovation

-Targeting a new type of patient or new care site

Pull Together Guiding Team -Action-biased champions in each discipline-Engage clinical delivery providers

Develop Change Vision & Strategy -Use facts to show change drivers: data-competitorsp g gy 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 celebrateP h d d f t ft fi t -Press harder and faster after first success

Create New Culture -How will this impact the Budget and Innovation celebrations? -Hold on to new ways of behaving and make sure they succeed

From All Consumers To Unique Consumers From All Consumers To Unique Consumers

What Can We Know About Consumers to Shape Data-W C W C S pDriven 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 Have Consumer Segment Focus on the Back of Your Hand

Consumer Views Make It Harder To Engage In Either “Fix Me” Or “Keep Me Well”Fix Me Or Keep Me Well

Source: Truven Health Pulse Survey

Shift In Consumer Focus for Strategic PlanShift In Consumer Focus for Strategic Plan Barrier: “Have” the Seniors–seek to engage non-Medicare patients for Fee

f V l /L lt St t for Value/Loyalty 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

Using/Teaching Unique Consumer Terms

G /S

Using/Teaching Unique Consumer Terms

Greatest/Silent “I will do as you say, doctor.”

Baby Boomers “Baby I was born to question you!”Baby Boomers Baby, I was born to question you!

Gen X “I’m glad to see you if I can see you

Millennials “OMG, I’m so . I’ll be, like, free on S d !!

Tuesday at 5:00.”

Sunday!!

Adapted from: Truven Health Pulse Survey/ Matching the Market paper

RETHINKING TRADITIONAL PATIENT BASE# of FROM INPATIENT

80AVERAGE:122 Dschgs

111 Dschgs/ 1000 pop86 Dschgs

/ 1000 pop

PeopleIn US(millions)

FROM INPATIENT TO OUTPATIENT

FROM ACUTE

50

60

70

g/ 1000 popOR 22K Visits/1000 pop 85 Dschgs

/ 1000 pop344 Dschgs/ 1000 pop

/ 1000 popFROM ACUTE (SLOW) CONTACT TO OUTPATIENT (FASTER) CONTACT

30

40

50 / 1000 pop / 1000 pop

12K Visits/ 1000 pop

17.5K Visits/ 1000 pop

28K Visits/ 1000 pop

46.6K Visits/ 1000 pop

(FASTER) CONTACT

10

20

0Millennial Generation X Baby Boomers Greatest/Silent

Source: Adapted from Matching the Market: Using Generational Segments to Attract and Retain Consumers, Truven Health

TAKING STOCK OF PRIMARY CARE PROVIDER CONNECTION9 f 10 PROVIDER CONNECTION9 out of 10

Older Adults have Adults have a PCP v. 4 out of 5 GenXers and 2 out of 3 Mill i lMillennials

2013 Pulse Consumer Research

~90% have had PCPs for 12+ months

PRIMARY CARE PHYSICIAN SELECTION FACTORS

How Do Consumers Make Decisions?SELECTION FACTORS

Greatest/Silent ~30% each for Quality & Communication & “Cares about me’”

Baby Boomers 33% Communication, ~28% Quality & “Cares about me,” ~7% Cost/Convenience each

28% t Q lit & C i ti 20% “C

32% Quality with ~21% Communication/’Cares ’

Gen X28% at Quality & Communication, 20% “Cares about me,” 12% Convenience & 9% Cost

Millennials 32% Quality, with 21% Communication/ Cares, 14% Cost & 9% Convenience

2013 Pulse Consumer Research

TAKING STOCK OF INTERNET CONNECTIONCONNECTIONSeniors

know more about about Physician Sites than Sites than use I

2013 Pulse Consumer Research

Internet

INTERNET USE SHOWS HEALTH INFORMATION MORE THAN SERVICE SEARCHTHAN SERVICE SEARCH

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 & better life: orthopedics & heart

Media channels matter; too risky to pick one

28Truven Health Pulse, 2013 Pulse Consumer Research

VIRTUAL AVERAGE ENCOUNTERS FOR CALL /

CONTACT CENTER CUSTOMERSVIRTUAL FRONT DOOR

CONTACT CENTER CUSTOMERS

14 Encounters 14 Encounters

IMPACT14 Encounters

9 Encounters

97% Insured

9 Encounters

6 Encounters

84% Insured

78% I d 6 Encounters 78% Insured

75% Insured

-Encounters from Truven Health CRM Database, 2013-Insurance status from Truven Health Consumer Research, 7/13

Move From All Consumers To Unique Consumers:Teach the Teams Teach the Teams

Leverage ‘generations in the workforce’ frameworks to shape ‘ i i h i b ’ f i h ‘generations in the patient base’ focus with your teams

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

potential service p 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 )

What Data Can Show From FFS To FFV What Data Can Show From FFS To FFV

What Data Shows Us That Is Likely to Change in W S U y C gFFS to FFV?

Service Selection & Choices

Service Scope & Site of Care Delivery

Key Business Questions of the Entire Team Key Business Questions of the Entire Team

What to Expect from the Data, Consumer to Drive Innovationto Drive Innovation

32

Changes In Coverage Will Drive Changes In UtilizationUtilization

33

30

S

0

10

20

Medicaid ESI Individual IN

MIL

LIO

NS

-30

-20

-10 Exchanges Uninsured

CH

AN

GE

I

-40

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

Exchanges drive the largest change BUT Medicaid’s number of people are generally sicker

Source: Truven Health Insurance Coverage Estimates

g g g p p g y

The Impact from Expanded CoverageThe Impact from Expanded Coverage261M

246M220M

Medicaid47M53M

62M

Private Group/Non-Group173M 172M

177M

Private, ExchangesUnsinsured

2022 Full Opt In2016 Partial Opt In2012

49M 27M21M 21M

22M

2022 Full Opt-In2016 Partial Opt-In2012

Source:  Truven Health Analytics Insurance Coverage Estimates 

Effects Will be LocalizedEffects Will be LocalizedExchange Enrollment, 2016 Medicaid Opt-In Enrollment, 2016

% Medicaid Growth, 2012 – 2016

100%+

60% - 100%

40% - 60%

% Medicaid Growth, 2012 2016Assumes States Opt-In

35

20% - 40%

< 20%

Prioritize The Newly Insured Needs For Demand Impact And Intervention Focus Impact And Intervention Focus

36

Profile FactorKey Findings: Comparison of Future Exchange Likely Adults to Current Privately Insured

(Group + Non-Group)Profile Factor (Group + Non-Group)Insurance History 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 e ercise lessHealth Risks Use tobacco at much higher rates and exercise less 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

Demographics 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

Biometrics Slightly lower BMI

Use of Healthcare Services Report lower rates of visits with medical and dental professionalsp p Have slightly higher rates of ER use and lower rates of surgeries

When Our Teams Say “We Need More Patients/ Volume” Volume …

Barrier: Getting the right patient, right volume‒not just any will do (think i t t i t t d d t ) margin, target payer mix, target procedures and repeat users)

Better: Getting the right prospect to the right service with the right care compliance for the right next service use

f Even Better: Ensuring capacity in primary care practices for appointments in next 3 working days for net new high(er) income/insured Boomers/GenXersvia the web connect contact center H i R lt T id tif i t l $1 2M f th t t Heroic Results: To identify incremental $1.2M revenue for the target physician practices.

Subsequently: Focus on Specific Consumers (to start)

When Our Teams Say: “We Need to Be Different” When Our Teams Say: We Need to Be Different …

Develop a program for Service Line Innovation: have leaders f d i / b d i i h h present fact-driven/consumer-based innovation to each other

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!

Coordination of Care Alone Presents a Huge Opportunity In A Fee-for-Value WorldIn A Fee-for-Value World

39

Care Coordination represents a $50B opportunity

Prioritize Local Chronic Disease Risk And Intervene With Highest-Risk ConsumersIntervene With Highest-Risk Consumers

40

Zip codes with highest combined IOC for selected chronic conditions. How are we serving this population?

Population segments with high IOCs for selected chronic conditions. serving this population?

What are the unique needs/attitudes of these segments?

Consumer Choices Invite & Compel New Innovations: Imagine Their Questions To Launch Your Possibilities

Do I want to work for an employer that doesn’t have insurance? Today’s Choices Tomorrow’s Choices

Imagine Their Questions To Launch Your Possibilities

Am I going to a doctor in my health plan?

Do I want to work for an employer that doesn t have insurance?

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 will I get there?

Do I need a referral?

Where will I get my

Skype?

How much does it cost from my pocket and is it worth it?

How do I respond to wellness incentives? Where will I get my

prescriptions from: Internet, hospital, drug store?

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 yrisk?

Focus In-Network Care Navigation In Top Services With Leakage Hotspots Services With Leakage Hotspots

42

14 00%

16.00%

6.00%

8.00%

10.00%

12.00%

14.00%

BREAST SURGERY

0.00%

2.00%

4.00% MASTECTOMY, PARTIALBREAST ASPIRATION & BIOPSYULTRASOUND, BREASTX-RAY - BREAST

G l R t i t t t AFTER di iGoal: Retain treatment AFTER diagnosis

Redirect From The Emergency DepartmentRedirect From The Emergency Department

National ED Highlights: Opportunities:

43

~62% ED Visits are Urgent; Why not redirect to cheaper care sites?

Redirect 20% ED visits saves $4B/ year

Redirect Super–Users to Community Health Centers: Care directed texts for 5+ visits/ year =$1.5M savings

Offer expanded office/urgent careBroward County, FLA Highlights: 62% of Total ED visits are Urgent; BUT 28% of Seniors ED visits are Urgent

Offer expanded office/urgent care capacity for children: Request urgent care from ED source

Set up Preventive Screenings: Send 61% of Adults (45-64 yrs) are Urgent 76% of Young Adults (19-44 yrs) are

Urgent

prompts to chronic care patients for preventive care

82% of Children (<19 yrs) are Urgent

From Data Insights To Consumer Engaged Innovations From Data Insights To Consumer-Engaged Innovations

What Innovation is Possible from Data-Identified W vOpportunities?

Segment, Segment, Segment to Identify Actionable Customer g , g , g yGroups to Engage in a Focused Way

Find Small Victories and Don’t Let Up

Build a Culture Favoring Many Marketing Innovation

Trends From The TrenchesTrends From The Trenches45

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) Pragmatics (GenXers/Boomers)

Personal Friend/Professional Sales/Direct Mail-Driven (Boomers/Greatest) vs. Friend/Web/Social Media-Driven ( oo e s/G ea es ) vs e d/Web/Soc a Med a veGenXers/Boomers)

Trends From The TrenchesTrends From The Trenches46

1. In 2014, 14 million Americans will gain insurance from the insurance exchanges and Medicaid expansion

2. In 2017, 34 million Americans will have gained insurance

3 Think local Using national numbers will ultimately leave hospitals 3. Think local. Using national numbers will ultimately leave hospitals underprepared for what will happen in their local market.

4. Rethink Sites of Care: The traditional Emergency Department should no longer be the first primary care stop for Medicaid enrolleeslonger be the first primary care stop for Medicaid enrollees

5. Think All Points of Patient Contact for 1-1 Engagement: Leverage targeted communication via email, direct mail, affinity groups, patient discharge and h El H l h R d lthe Electronic Health Record portal

Trends From The Trenches, cont’d.Trends From The Trenches, cont d.4. Prepare to take on risk. Providers will be expected to share in the

ibili f l i h l h responsibility of population health management. 5. 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.

6. Prepare sufficient capacity. Demand is still a function of coverage, so provide risk assessments & offer appropriate g , p pp pcare, such as medical homes, navigators and patient messaging.

7. Engage the newly insured personally. Providers should be connect virtually to improve compliance with attention to their priorities.y p p p

Steps to Drive Value (and survive) the Perfect StormPerfect 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 adoption rate non-user characteristics Think Partnerships/Speed to preference, adoption rate, non-user characteristics. Think Partnerships/Speed to 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 d d h b d ldata-driven growth based on target goals.

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 agreement about market focus resources.

From Big Data To People DataStorytelling Insights

From Big Data To People Data

Cannot Just Assume Services Continue as UsualCannot Just Assume Services Continue as Usual

People don’t want to focus on your Emergency p y g yDepartment.

They want to engage to convenient care – urgent y g g gcare, 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 M S lf S Wh I W I ? Give Me Self-Serve When I Want It?

To Thrive in Changing TimesTo 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 WILL Dilute The Ones You 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.

Big Data And Observational ResearchBig Data And Observational Research

To add power to the data perhaps we need to add To add power to the data, perhaps we need to add a bit of anthropology.W f d h h h h We found recurring themes worth sharing here.

Newly Involved Men In Healthcare DecisionsNewly Involved Men In Healthcare Decisions

Men were becoming more involved in the healthcare Men were becoming more involved in the healthcare decisions as they had to pay more out-of-pocket expenses expenses.

Internet Is Changing The Decision Process Internet Is Changing The Decision Process

People of all ages showed us how they were 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 then were not sure how to interpret the information they were finding.

Searching For Simple And Easy Searching For Simple And Easy

Nothing was simple Nothing was simple or easy, anymore.

Across Across demographic

tsegments.

“Paradox Of Choice”Paradox Of Choice

Abundant Options leading to the “Paradox of Abundant Options leading to the Paradox of Choice”

Not making decisions for fear that whatever they Not making decisions for fear that whatever they did decide would be the wrong decision.

Have Lost Ability To See The DifferenceHave Lost Ability To See The Difference

Common statement: “Aren’t all doctors and hospitals Common statement: Aren t all doctors and hospitals the same?” Shouldn’t they be?

Increasing Challenge Of RetailersIncreasing Challenge Of Retailers

Recurring theme: The ease and comfort of going to Recurring theme: The ease and comfort of going to a Walgreens or CVS to get care.

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

How Can You Apply This?

What Does This SuggestWhat Does This Suggest

Consumers are driving and can drive the changes. Consumers are driving and can drive the changes. Data is shedding compelling information and

insightsinsights. Put “flesh on the numbers.”

Engage And Communicate To InnovateEngage And Communicate To Innovate

1. Consumers are facing the “paradox of choice.”g p2. Help them choose wisely.3 Engage them earlier in the change process. 3. Engage them earlier in the change process. 4. Tailor your messages and messaging to who they are.5 Let them help create better solutions for themselves 5. Let them help create better solutions for themselves

and for healthcare delivery organizations and physicians.p y

End Where We BeganEnd Where We Began

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

We Hope Our Journey Has HelpedWe Hope Our Journey Has Helped

Our job was to help you “See Feel and Think” in Our job was to help you See, Feel and Think in New Ways — before you “do.”

Perhaps we can be of help to you as you begin this journey.

Next Webinar: Andrea Simon PhDFriday 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

b tabout:1. How to take data and ideas and envision new ways to

solve old problems‒simpler and better.solve old problems simpler and better.2. Take these ideas and turn them into testable innovations.3. Build this into a culture of innovation for your institution.y

For More Conversation And Information

Linda MacCrackenVice President, Advisory Services

Truven Health AnalyticsLinda.maccracken@truvenhealth.com

Andrea J. Simon, PhDCorporate Anthropologist

President, Simon Associates Management Consultantsasimon@simonassociates.net

ff 9 6@

Office 914-245-1641www.simonassociates.net

@simonandi and @andisamc