“Patients don’t want drugs: they want better health outcomes.” This post on Forbes.com reminded me of a theory I’ve had for a while: it’s not just about the drug or device any more, it’s about the entire experience. As my Blue Fin colleagues have written, specialty products require innovation from the manufacturer across the entire patient journey. For long term success, it appears increasingly important that manufacturers apply this thinking across their portfolios.
Apple has become so successful that to “Think Different” is arguably to not buy a Mac, iPad or iPhone. I love this picture of a lecture theatre full of Macs and one highlighted PC. It’s the same on airplanes these days and at client meetings (in my recent experience, most attend with iPads and leave the PC in the docking station at their desk)
By controlling the hardware and software, Apple has been able to deliver an arguably superior user experience to the open systems offered by Microsoft and the PC manufacturers can suffer from not playing well together (ditto Google’s Android and the phone and tablet manufacturers). It seems unlikely that the many millions of people buying into the Apple platform are all choosing to pay more just because they believe the marketing message, or want to be associated with the brand. Regardless of why people are choosing Apple, it’s been an incredibly successful business model.
Another way to think about the Apple approach is as a system rather than a product. Don Norman, one of the luminaries of user-centered design, has a great post on systems thinking, or why what the user is buying is actually the service, not the product. Clayton Christensen calls this the “job-to-be-done” point of view – he has fascinating example of this with marketing milkshakes for a fast food company. In the morning, the job-to-be-done was providing a filling, slow to consume, not-messy morning meal for commuters, in the afternoon it was a completely different job: a small treat/snack for kids. Geoffrey Moore popularized the concept as “whole product” in the technology marketing classic “Crossing the Chasm”. What Apple did is to not just sell a mp3 player (the iPod) but also the software (iTunes) that made the process of acquiring songs and loading them on the player so much easier. Likewise the 500,000+ Apps for the iPhone have made the device so much more appealing than just a phone.
Taking the patient perspective, a simple framework emerges for identifying opportunities – examining the stages of prevention, diagnosis and treatment, what can be done to improve outcomes (and ideally reduce costs)?
Prevention: what can be done to stop a patient need medical attention in the first place?
This has the greatest potential impact on overall outcomes (and probably healthcare costs). Perhaps counter-intuitive, but contributing to prevention may identify better treatments, forge stronger partnerships with healthcare providers and payers, and build goodwill with patients, caregivers and the community. Examples include: apps, websites that provide education on disease states, and apps and devices that assist with monitoring health status so an intervention can occur before a more costly incident.
- TactioHealth offers one of the most complete and integrated dashboards for personal health tracking I’ve seen, with integration to wireless BMI scales, activity monitors and blood pressure monitors.
Diagnosis: what can be done to facilitate early, accurate, and more cost effective diagnosis?
With many diseases and injuries early diagnosis and subsequent treatment can be more successful and cost-effective than delays or misdiagnosis. Are their new approaches to testing that could be used? (Example: ultra-high speed camera to detect tumors.)
Examples include: apps, websites, devices that facilitate remote diagnosis and communication. If a patient can deliver the necessary diagnostic tests remotely this can speed diagnosis and treatment. Instead of calling a healthcare provider, could a patient place a video call? If MRI, or bloodwork are required what can be done to help find a testing location, schedule an appointment, organize transport, and gather results?
Treatment: what can be done to improve outcomes during treatment?
How can you make treatment more successful, quicker, easier to tolerate, less error-prone, easier to access, and less expensive to deliver? Examples:
- improving physical and financial access to treatment, e.g., increasing convenience (location, number, type) of dispensing outlets, ensuring adequate supply, ensuring product integrity, improving payer coverage, reducing out-of-pocket exposure. These are probably the areas that commercial organizations have focused the most attention on.
- reducing errors in treatment, e.g., app for calculating fluid requirements for burn victims, or ensuring the integrity of the supply chain
- making it easier to receive treatment , e.g., reducing side effects or their impact, simplifying and shifting administration from HCP to patient
- making it easier to tolerate treatment, e.g., improving facilities at site of care, or facilitating alternative site of care location while travelling (United Healthcare’s Health4Me app)
- making life easier for patients and caregivers , e.g., Lotsa Helping Hands – connecting with people in the community who want to help
- improving adherence, e.g., app for encouraging adherence
- improving monitoring and facilitating patient/provider communication, e.g., wireless glucometer uploads to private online database accessible by patient, authorized caregivers and HCPs, options for communicating with provider without making an office visit
For manufacturers, the lesson to be drawn from Apple’s success is: rather than a focus on creating and marketing individual drugs or devices, and leaving the rest in the hands of the healthcare system, how can you play a greater role and deliver improved patient outcomes? What other products or services could you provide (even if that is through a partnership, or only an impartial directory or introduction to the additional services) along the patient journey to improve outcomes? Identifying early opportunities that are aligned with increasing the success of the product is probably the right starting point, rather than fighting existing incentive structures.
In our work, we continue to see specialty products leading the charge in considering the whole product. With all the competitive and financial pressures being faced by drug and device manufacturers, a systems thinking approach offers potential for both improving patient outcomes and differentiation across the entire product portfolio. I look forward to learning about more examples.