“This drug will sell itself, based on the data…”
I have heard this more than one time from more
than one client.
Sadly, for patients, this is rarely true. Much as we
all want our physicians to make impartial decisions
based on a thoughtful review of all published
information, the rate of clinical advances and the
demands of daily practice conspire to make fully
informed decision-making more of an aspiration
than a reality.
What’s more, so much of what we value in our physicians – the ;esh and blood, heart and soul, know-me-and-my-history humanness – may actually get in
the way of the best decisions being made. Humans,
according to Richard Thaler, the recent Nobel Prize
winner in economics, often act irrationally.
His work documents that we make decisions in
con;ict with our best interests. We do this particularly
when the feedback or rewards for good behavior
are invisible or pitched so far into the future that we
can’t see or feel the impact of our actions. Witness so
many of the behaviors that would improve general
health: eating a balanced diet, exercising regularly,
drinking moderately, taking medication routinely.
The data consistently show humans are fairly lousy at
making signi;cant change and sticking to it. I refuse
to reference this. It’s true.
It’s not easy to make change
As marketers, we’re generally not asking physicians
to eat more ;ber or run ;ve miles three times a week
(though many of them probably should). We want
them to appreciate the value of a new compound.
We want them to change their prescribing habits.
We want them to counsel patients through complex
Often what we, as marketers, want physicians to do
does not reward them in the short term. We ask them
to experience di;culty and discomfort in their own
daily experience so that outcomes for patients, for
the hospital, for the healthcare system will improve –
generally at some distant point in the future.
We should not be surprised when the data does
not sell itself.
Nor should we despair. For while Thaler gives us
numerous examples of humans – even highly educat-
ed humans – behaving irrationally, he also posits that,
armed with an understanding of human behavior,
those who design products, programs or policy can
in;uence better decision-making by being thought-
ful about how those choices are presented. Anyone in
this role, according to Thaler, is a “choice architect.”
We have not put “choice architect” on our business
cards, but at precisione;ect, we’ve actually been
disciples of Thaler’s principles for some time. We’ve
spent 40 years devoted to working with innovator
companies who are changing the standards of care.
From introducing the HPV assay that evolved the
screening of cervical cancer to the launch of the ;rst
drug-eluting stent to our current work to challenge
traditional approaches to colorectal cancer screening, we know that compelling data, while essential,
is just a piece of the intricate machinery required to
change minds and actions.
When we disassemble the web of connections, we
can identify distinct moments where we can apply
pressure towards a desired behavior. What Thaler calls
A tool for navigating behavior change
If you’re setting out to change the standard of care,
a single nudge isn’t su;cient. The progression of
disease, the complexity of therapy, the confounding
dynamics of hospital roles and responsibilities, the
social/psychological/economic issues for patients and
their families, all mean that choices – from prescribing
an oral chemotherapy to trialing inhalable insulin –
are the result of a series of microchoices made by the
whole cast of characters, from patients and providers
to pharmacists and payers.
We’ve developed a model, the Behavior Change
Strat Map, which charts all the behaviors that need to
shift for a new standard to be adopted. As we run the
model for a brand, four key phases – Map, Measure,
Monitor and Motivate – illuminate the path from
status quo to the embrace of innovation.
MAP. We start by charting the terrain. We identify
the key roles who can most directly or indirectly
in;uence behavior. Physicians and patients are often
central, but sales reps, pharmacists, payers, and o;ce
managers put in frequent appearances on the map.
We then plot the desired behaviors across the entire
disease experience towards the desired outcome.
The more ;nite and concrete we can be about these
actions, the better. Many behaviors can, and should,
be broken down into smaller steps.
MEASURE. If we accept that behavior change
doesn’t happen overnight, how fast does it happen?
By tracking progress at every critical juncture on the
map, we can start to understand the rate of headway
towards the end goal. More signi;cantly, by measuring movement (or lack of it) at each point, we can
begin to see gaps and surface opportunities where
a thoughtful interaction, pointed message or re;ned
user experience can in;uence a choice for the better.
Certainly digital tactics o;er a lot of fodder here. But
we’ve found there’s usually much more data available,
sometimes outside of marketing’s sphere – net
promoter scores, order rates, ful;llment trends, help
line requests, satisfaction surveys – a mix of hard and
soft metrics that pulled together can provide a strong
rationale for funneling resources towards a particular
;ash point on the map.
MONITOR. This critical step is designed to ensure
we’re being e;cient in our approach. Few brands
approach behavior change empty-handed. We overlay the brand’s current assets, tactics and programs
on the map to understand where resources have
been dedicated in the past. Do we have tactical
holes? Have we stockpiled e;orts against a behavior
change further down the path that is dependent on
an earlier shift?
MOTIVATE. We now have the dimensional coordinates in place. We’ve identi;ed the key behaviors
that need to occur, the players who may be dug in at
various points, the tactical holes and opportunities.
It’s time to return to Thaler’s ideas and ask, against
a series of discrete, concrete points on the map,
“How can we incentivize change of this particular
behavior?” Now we can be wildly inventive in how we
attempt to answer the question – with our nudges –
because we have very clear criteria against which to
The Behavior Change Strat Map is not a tool
for those looking for a silver bullet or nurturing an
unshakeable belief that clinical data will drive decision-making. But for those who love data (show me a
marketer who does not?) and are willing to employ it
not just to measure success but as a vehicle to nudge
it forward, The Behavior Change Strat Map becomes
a powerful, living GPS to greater brand health and
better care for patients.
Deborah Lotterman is chief creative o;cer
The wheels of a car in need of an alignment point in di;erent directions and e;ectively begin
working against each other. As a result,
the vehicle works ine;ciently, which
negatively impacts the driver’s experience and increases the ;nancial pain
he feels at the pump. If the problem is
ignored for too long, his ability to safely
operate the vehicle can become compromised. And when the car is operating
at a high speed, the misaligned tires
could have devastating consequences,
making steering di;cult and potentially
leading to a crash.
Think of wheel misalignment as an
analogy for the way that the various
stakeholders throughout the healthcare
ecosystem (the vehicle) now function to
serve the patient (the driver). Pharmaceutical companies, providers, regulatory
agencies, payers and PBMs are misaligned
or out of sync. From the patient’s perspective, they’re often working against
each other – and at the high speed of
modern-day healthcare, the end result
can be devastating to the patient.
Unfortunately, there’s no equivalent
to a mechanic’s tune-up to get the
healthcare ecosystem where it needs to
go. To successfully put the patient at the
center, all players need to start prioritizing
customer centricity, ensuring that they’re
delivering value to those stakeholders
and that the stakeholders’ needs are met.
In turn, the players can bene;t from increased e;ciency, less strain on resources
and ultimately increased revenue. If a
car’s wheels are realigned, the engine
can function optimally and gas mileage
improves, as does the driver’s experience.
Imagine if the whole healthcare
ecosystem actually put customers at the
center and designed their business mod-
els around the customer experience:
Would pharmaceutical companies
send reps streaming into doctors’
o;ces all day – or emails streaming
into doctors’ inboxes – if they really put
themselves in the doctors’ shoes?
Would providers make patients wait
and worry for six weeks before they can
secure an appointment and get their
health concerns addressed?
Would insurance companies and
PBMs roll out complex bene;t designs,
actively block the ful;llment of prescriptions, or delay surgical approvals to
Would regulators continue to impose
rules that make it hard for stakeholders
in healthcare to work together to help
In healthcare today, customer cen-
tricity often seems like an afterthought.
Patients are left to navigate lengthy
wait times, unknown costs, endless
paperwork, multiple referrals for di;cult
cases and approval roadblocks. They’re
required to steward their own healthcare
journey, advocating for their own needs
and researching treatment options in
messaging that practically requires a
medical degree to decipher. For exam-
ple, most patient-targeted prescription
literature is written for an audience
that resembles The Wall Street Journal’s
subscriber base, while the average
American reportedly reads at or below
an 8th-grade level.
The experience that other healthcare
customers have isn’t much better. An
oncology practice, for example, might
need to call ;ve di;erent numbers to
get reimbursement support for ;ve
di;erent products. Another specialty
practice might need to know a special
distribution system for each brand
that it prescribes. Meanwhile, doctors
struggle with insurer mandates to see
high volumes of patients to stay in business – despite jeopardizing quality and
negatively impacting patient care. And
payers often ;nd themselves wading
through pharma’s drug claims when
new data is released or a competitor
arrives on the market to arm themselves
with the necessary information for drug
The healthcare industry is, of course,
taking steps in the right direction. The IHI
Triple Aim, a framework developed by
the Institute for Healthcare Improvement
to optimize health system performance
in the U.S., promotes e;orts to improve
the health of the population, enhance
the patient experience and reduce costs.
Now, with doctor burnout at an all-time
high – 53 percent by some reports - and
the impending physician shortage, many
support expanding the Triple Aim to
become the “Quadruple Aim” to promote
customer centricity by ensuring that the
equation covers care for providers. Other
stakeholders, such as patients and caregivers who advocate for their own care,
also are clamoring for relief.
Though a daunting exercise, healthcare’s various stakeholders have to start
working together, and not against one
another. And when we get to that point,
we’re sure to move the needle on long-term costs. It’s like the car we discussed
earlier: When the tires are out of alignment, the car’s engine is forced to work
harder, gas is consumed more quickly
and tires wear unevenly. But when the issue is addressed, the wheels are working
in unison and the car is working more
e;ciently, the driver’s ;nancial burden
decreases and he stands a better chance
at enjoying the ride.
Bill Coyle is a principal and Pratap
Khedkar is a managing principal with ZS
Associates. This piece is an excerpt from a
longer article, “Here’s what real customer
centricity in healthcare looks like – and
why we aren’t there yet,” which appears
on ZS’ website.
means missed opportunities
for all stakeholders