It seems to me that consumers prefer health plans that offer choices – I know I do. Which led me to ask myself the question:  how do healthcare consumers (me included) choose healthcare products and services, and what types of information might be useful to them in support of decision-making?  This all gets to a study I found from the University of Oregon that tries to answer these questions. The authors specifically looked at how consumer knowledge concerning costs and quality affect healthcare decision-making. As the authors of the study found, communicating healthcare cost and quality information effectively is challenging. One particular challenge they found is that healthcare consumers are more interested in the quality of health care than in its cost, and many perceive a low-cost provider to be substandard. The study also suggests that even consumers who pay a larger share of their health care costs themselves were likely to equate high cost with high quality.

This bias is a barrier (among others) to a good quality-cost choice (i.e., a high-value choice), but it is not at all counterintuitive. We all seek the best combination of quality and cost when buying everything from groceries to cars, but the implication that we tend to choose the more expensive option in healthcare is worrisome. Why do we have a habit to associate price with quality in healthcare? Is it that we lack the right information, especially about quality? Although public reporting of quality data is legislatively mandated, there is some question to its value and accessibility. This implies that patients need information on their level – information they can understand to help them make effective choices.

Based on the fact that quality and cost data are available, it is not the lack information that keeps us from making a sound high-value healthcare choice. So, what does? Do different presentation formats affect decisions? The answer should be an obvious “Yes”.  The study found that “many reports use technical language when they label quality indicators and report different aspects of quality on different pages, making it almost impossible to assess overall quality. “ In fact, the authors found that when a quality signal is not strong, “cost information is less likely to be interpreted and used in the way it was intended” or not used at all. They also found that even more is at stake when presenting data on both cost and quality through ineffective reporting strategies. When quality and cost information that is hard to understand are presented together, it causes people to make choices opposite to the ones intended.

The recipe for success is simple. Reporting strategies need to capture the consumers’ attention while helping them use the data. These are the kinds of reports that interpret the data (not just report it) and make it easy to see that a doctor who provides higher-quality care than other doctors does not necessarily cost more. From a report format perspective, this means presenting cost data alongside easy-to-interpret quality information and highlighting high-value options. This is exactly what the authors did and found this technique improved the likelihood that consumers would choose those options.

As a healthcare marketer, this study reinforces the fact that presentation of information needs to be clear, strong and unambiguous, especially when it comes to presenting the key pieces of information that people use to make decisions. My bottom line takeaway is that simplicity should be a key goal in every design and unnecessary complexity should be avoided.

I finished filling out my NCAA tournament bracket two nights ago. I am happy to report that this year I didn’t choose teams based on the names of schools that I like, or the false belief that I’d be able to predict the upsets. This year I went along with the same selections my husband (who knows a lot more about college basketball than I do) made in his bracket.

But, it got me thinking about the psychology behind choosing teams. Whether it’s the NCAA tournament, horse racing, or car racing, there are a lot of people out there (including me) who use their own unique methods to select winners.

In fact, this very idea is discussed in an article entitled How to make NCAA tournament bracket picks when you don’t know a thing about college basketball . Here is an excerpt that I love because it validates the selection methods that I’m sure many people employ when choosing teams:

“It’s entirely possible to pick your brackets based on the color of team uniforms or proximity to close relatives. Some individuals pick blindly while holding a pencil far above the page and letting it drop on a selection. Others choose teams based on Las Vegas betting lines. Some select teams by whether one mascot can beat up another team’s mascot. Whatever the method, pick one style and stick with it throughout the brackets. Go with your gut, not your heart and you just might get lucky.”

While this example above is by no means scientific, it did get me thinking about the fact that there isn’t always just one correct path to reach a goal. If you think about it in the context of marketing and reaching patients, behavioral science tells us that we have to look at patients as more than a number. We have to recognize that while a group of people may share a common disease, they also may have very different behavioral drivers and barriers, each requiring a unique approach to influence behavior change.

While I wouldn’t select my path for reaching patients in the same way I have been known to approach my NCAA tournament bracket, the important thing to remember is there isn’t always just one right path to reach a goal.  

Go Tar Heels!

We all have stress. Let’s face it – whether you are a working mom juggling a family and a job, a stay at home parent, or just a person fully dedicated to every endeavor you take on – you have stress! It’s inevitable. But, it’s how you face that stress that matters.

Having studied behavioral theory for years, I’m constantly reading articles and reports on the interrelationship between one’s environment and health behaviors and outcomes. Theorists have studied the relationship between stress and how people in turn cope with these stressors. But rarely do I think about what I study in the context of my own life. 

Recently, however, I got to thinking…how do I cope with stressful events?

When faced with a challenge, a subconscious, automatic process is often set in motion. Most people do not choose to be in denial over a grave diagnosis. Rather, a person diagnosed with a serious illness may automatically enter a state of denial. This is a coping mechanism that helps this person deal with the bad news. In the world of behavioral science, this is a kind of emotion focused coping.

Emotion focused coping helps a person deal with and ameliorate the negative emotions associated with the stressor, as opposed to actually taking steps to deal with and solve the problem at hand. This is not to say that all emotion focused coping is negative. Other examples include humor, venting, and crying, all of which can help a person feel better and more able to face their problems. The key is employing a combination of coping strategies that also includes more positive, problem focused techniques, such as goal setting, information seeking, and problem solving, to take steps to actually reduce the stressor.

Like I’ve said, for most of us, the way we cope is automatic. We deal with challenges by employing techniques that work for us and using those we’re comfortable with. However, many of us could probably benefit from adding some more positive techniques to our coping toolbox. The only way this can truly happen is to make coping a more conscious, active event.

Positive coping is often an acquired skill, and is not something that usually happens without the help of others, which is where MMC’s team of behaviorists comes in. Patients who are dealing with lots of difficult treatment decisions and changes in quality of life probably don’t feel they have time, or have the interest, to learn new ways to cope. The key is helping patients integrate new ways of thinking and behaving into their lives without making it an arduous, and obvious, task. At MMC, we employ techniques that help those we touch become more skilled at tackling obstacles to help them attain the health outcomes that we know they desire – even if they are in denial.

Touch technology is awesome, especially for cell phones! Physical interfaces, in general, are how we should interact with our electronic devices, just ask any Wii owner (remember the Power Glove?). What may be coming is next is even better.

Consider these three attributes…

1. Mass
2. Thickness
3. Vital signs

Now, consider these questions…

1. What if your phone could shift its weight in your hand?

   It could tell you a lot and you would not even have to look at it. Mass (weight) redistribution could be used to augment digital content by having you feel where the content is. One example would be in a navigation scenario where your phone would shift its weight (right or left) to help guide you to your destination.

2. What if your phone could become thicker on one side versus the other?

   Aside from the practical built-in stand functionality you could use to watch a video, the thickness of a phone (in total or one side over the other) could be used to augment digital content by having you feel how much content there is (quantity). When you download Marienbad My Love with 17 million words or Slaughterhouse-Five at a slim 49.5K words, you would know how much content was there. Or, if you are panning an image, the thicker side would contain the greater part of the image.

1. What if your phone had a breathing rate or heartbeat?

   This sounds like a virtual pet and it some ways it is. When you think about it, a virtual pet responds to calling and to touching; can be trained, you buy it stuff and dress it up (sounds like a phone to me); and it complains when it needs care. In this case, your phone could give you feedback to indicate digital content priority by a faster “heart beat”, like when your girlfriend or boyfriend sends you their picture.

“Humans should not get more technical; technology should get more human.”

This statement (paraphrased) by Fabian Hemmert is obvious, but after watching this Technology, Entertainment, Design (TED) Talks video, it will have substance you can hold onto (pun intended).

I read this post a few months ago and it has haunted me ever since.  In it, C.J. Baker vividly articulates the feelings of frustration and anger that many patients with diabetes often feel:

“My problem is this– I know the end results. I know the risks. I know what dialysis and amputation and everything entails. I know. I’ve seen. I’ve treated…I work in medicine and will start school this May to pursue the dream of being a physician. But I’m the worst patient…

“The problem is I JUST CAN’T BRING MYSELF TO TEST, BOLUS, AND DO WHAT IS RIGHT!! I don’t test, and have a long history of doing so. I hate being consumed by it 24/7. I hate needing to plan everything and manage everything on my own. There are very few ailments (chronic, even) that require the patient to do ALL THE WORK.

“I sadly find relief in a visit to the ED with admission. Why? Because I get a break from it all. I might feel a little crappy. But I get a break….

“I don’t want to tick anyone off, but mild to moderate cancer seems a better bet. Why??  … You know what’s going on… the doctor manages the problem at hand… remission exists and even if it returns, the patient still got a break… cancer pt’s are given some sort of “credit” by the public… diabetics are just “fat” … diabetics can “control” and “cope” with the problem… cancer patient’s don’t have some magical blood count number that they have to check every few hours and make sure it’s perfect… cancer pt’s have support by the medical community…   the list goes on and on… yeah, cancer kills… but in my opinion, in a far less cruel and mysterious “maybe gonna happen but it’s ALL UP TO YOU” kind of way…

“I’ve tried to do well. But amid it all, bad blood sugars still creep in and tick me off… I hate to test. I hardly bolus until I get thirsty. To do better just makes me feel worse in general. I need to take care of others and my job requires me to be physical at times (lifting patients). I can’t afford to “deal with the pseudo low until my body re-adjusts” type of feeling. That, and I hate that feeling.

“I’ve tried everything I know. I’ve tried keeping meds in weekly pill boxes to help me remember. I’ve tried a pink glucometer to make me excited and/or happy about testing. I’ve tried gold stars, log books, “kudos calendars” … you name it. But it only lasts a week or so. Then I’m back to my depressed opinion again. I’d rather ignore it.”

In no other chronic disease is so much of the burden of success directly related to patient actions. In other words, the doctor can do everything right, but unless the patient steps up to care for herself, the outcomes are not good.

As this patient illustrates, knowledge alone is not enough. She knows what she should do, but is understandably overwhelmed with all that good self-care entails.

She’s not alone. There are approximately 21 million people in the US with metabolic diseases that are similarly Overwhelmed.  For suggestions on how to reach them, read this.

Two news items regarding search arrived relatively at the same time. One is a search technology being developed by the Yahoo’s Barcelona research lab called Time Explorer (check out the research paper). The other is about how search may start to be designed with the search-as-entertainment paradigm (check out the slides and the research paper). Both of these search ideas were recently presented at the Human Computer Interaction and Information Retrieval (HCIR) workshop in New Brunswick, New Jersey.

First, Time Explorer is a search engine that returns results in a timeline that stretches into the future as well as the past. The results appear on the timeline, which shows when articles were published. However, if the user moves the timeline into the future, results are positioned at any point in time to when the text might have referred. For example you could check the predictions of an article that was published last year.

Second, researchers believe that the entertainment value of search is an untapped user experience. The research was conducted at the Swansea University in Wales and the University of Erlangen in Germany. Researchers found that users, while searching casually, were less interested in getting away from search results. This may explain why people like StumbleUpon.

What gets me excited is that by bringing these technologies together there is the possibility that I may never have to write another blog and I would be entertained while not writing it. I would simply search for my next (future) blog, copy and paste it today and be done.

Maybe I should blog about it and see if I my prediction comes true.

How cool is that!

We lift weights to improve strength, run laps to maximize conditioning and tailor our diets to ensure our bodies of nutrients needed to perform. All are areas worthy of attention not only for our overall health, but for both our internal mindset and external appearance. The fact that these elements are regular fixtures of our day-to-day routine is of little surprise (it’s more surprising if they’re not part of our complete breakfast). What is a bit awe-inspiring, however, is how frequent our brain is passed over as a body part that stands to benefit from a little exercise.

Our brains are complex; easily the most complicated and mysterious feature of our bodies. It’s also easy to overlook the brain since it’s a part we (and others, hopefully) can’t see and have no way of truly tangibly attributing the impact we can make regarding its performance. To state the obvious, without proper communication from the center of our nervous system, arms won’t lift, feet won’t push and mouths won’t open. Then shouldn’t it seem like the obvious thing to do to have a plan we can follow geared toward optimizing the performance of our single feature that’s at the controls of everything we do?

Outside of the routine digestion of words, thoughts and visuals, most of us exhibit little conscious effort toward injecting the brain with some extra muscle (have we ever really thought of reading a comic book or speaking with Aunt Edna as brain fuel, anyway?). Yes, the statement about us using only 10% of our brain is false; we use all of our brain, some just use it better than others. Or do they? Could it be that some just settle for the brain capacity their given, which is the equivalent of eating a bag of popcorn before it’s popped? Sure, it still has some of the taste and will fill your belly, but it lacks all of the buttery goodness and flavor if we actually put it in the microwave for a minute (sorry, bad example for a ‘health’-related topic).

A recent article in Smart Money examined a growing trend of flexing our mental muscles  – known as brain plasticity – in places like brain gyms and through activities typically associated with the, shall we say, less chiseled. From phone applications to video games to whatever else fills the $265 million mental-fitness-product market, more and more are setting out to improve their health and strength through brain training that works just like weightlifting: undertake difficult and unfamiliar activities that force new connections to be formed. Memory, attention span, stress and aura are just some of the attributes that stand to be affected by a mental fitness program, not to mention more obvious benefits like sharpened response times, better problem solving ability and heightened awareness.

Academics warn not to expect too much too soon from these products, but brain stretching brings to the surface some underutilized points of potential for pharma marketers. From metabolic management research, we already know behavior can be changed by better understanding a patient’s mindset, improving the odds of adherence to a prescription or helping curtail unhealthy behavior, such as smoking. Providing doctors with the tools to more easily identify those mindsets, however, is an area where the concepts of gaming, interactive exercises and smartphone applications might provide doctors with the behavioral insight needed to improve their patient’s lives. Even without a doctor’s presence, custom-built programs and challenges specifically for helping guide a patient’s thought process regarding a condition or treatment can be effective in driving motivation and communicating in ways physicians can’t.

We all know reshaping human behavior is no easy feat, but it’s virtually impossible without a greater understanding of what’s going on in someone’s mind. Whatever windows into that world are available must be considered, especially if science is on its side. Although creating effective training programs will likely be expensive and difficult to personalize, it’s a step in the right direction and one of the few solutions that might help both patient engagement and patient-physician communication. That’s truly some heavy lifting.

I love peanut butter and jelly sandwiches.  Well, actually jam, but you get the picture. Even now that I am old enough to be making them for my own child, I still eat a PB&J at least once a week.

So when I saw the Candwich I thought it was a joke.  Really, what could be easier to make than a PB&J?

And do you really want a sandwich that’s shelf stable for a year?

It got me thinking,  how much is the popularity of processed foods related to our burgeoning obesity epidemic?

Convenient and cheap, processed foods are a godsend to the time starved and budget conscious, but a dirty little secret lies within.

Turns out, all calories are not created equal. Take a cheddar cheese sandwich on whole grain bread and compare it to Velveeta on Wonder bread.  Same number of calories, but the processed option has about a 10% additional caloric burden because it doesn’t require as much energy to digest.  So processed foods actually help you put on more weight than whole foods with the same calories.

It’s easy to recommend eating whole foods over processed ones, but the fact remains that eating whole foods is much easier when you aren’t trying to make ends meet.  To change that behavior, you’ve got some serious cultural, behavioral and economic hurdles to overcome.

As Elaine Livas, who runs the Project SHARE food pantry, explains, “A gallon of milk is $3-something. A bottle of orange soda is 89 cents,” she says. “Do the math.”

The Body Mass Index (BMI) has long been the standard for assessing obesity as its simple, convenient and cheap.  But it has also been dogged by complaints that it’s inaccurate and limited.  A study in the journal Pediatrics suggests there might a more accurate measurement to assess obesity in children – neck circumference (NC).

Neck circumference could give a more accurate measurement of someone’s body fat composition than BMI, particularly in the all important spare tire area.  NC has a strong correlation with central adiposity (fat around the middle), which studies have shown is a good indicator of obesity-related complications.

In the battle against obesity, more accurately measuring body fat composition is a big step in the right direction.  But obesity management, and the management of metabolic diseases commonly associated with obesity such as type 2 diabetes, high cholesterol and hypertension are things we need to focus on now. 

Through the use of behavioral science, we’ve learned that while the conditions varied, the motivations and barriers to change of patients diagnosed with those conditions are very similar.  We’ve called this a “metabolic mindset”, and believe that if approached correctly, is susceptible to change.

One of the core things our behavioral science approach delivers are the true insights into what makes people do the things they do. What makes them tick?

At what point in time do we consciously decide to change our behavior and actually follow through with it? What really causes that synapse to fire?

I think it’s a powerful visual experience vs. long exposure to information. I believe you can talk to people and expose them to endless words and warnings and facts but when someone sees a concept only then can it has an immediate and profound effect.

Here’s a personal experience.

Started working out over a year ago at the YMCA. Not to “bulk up” or for any reasons driven by vanity. Just to stay in shape and keep healthy since I’m now in my mid-40s. So I start this and for a couple of months I’m diligent. I feel better, sleep better—all of it.

Then the inevitable happens. I start getting tired of it.

Stop finishing the routines. Skipping the tough stations. Finding more and more excuses to not drag my lanky frame out of bed at 6:00 am three times a week.

But I stick to it. And then one morning I see it.

A noticeable difference in my chest and shoulders. (Okay I say noticeable but keep in mind that when you’re 6’ 5” and 165 lbs. even a tiny Slim Jim of a muscle is reason for champagne.)

It.

Was.

Working.

Instantly my mojo changed. Getting up was no longer a struggle. I pushed the routines instead of drifting through them.

I knew that exercise was good for me. I knew it was good for the heart and lungs. I knew that at my age I needed to be doing this to live longer.

I knew all of that but was rapidly ignoring it. It was only when I had the experience of visually witnessing something personal that my mindset and attitude did a 180˚

I’m sure you’ve had similar experiences in your lives.

Now my point is not to enamor you with tales of my Adonis-like physique (um, not) but to illustrate how impelling and powerful it is to see change instead of knowing it.

This is especially true of patients. When they can see their actions making a difference focus and perseverance leap.

Our challenge as health care marketers will be to discover fresh and succinct ways to show very complex subjects using little, if any, language. With personal health care rapidly moving online and on to smart devices the need to clearly communicate in a purely visual language only grows.

As pharma marketers I think right now we sometimes fall back on using language as a substitute for a solid idea. It can become an out if we’re not careful.

Now before all the copywriters out there provide feedback let me be clear: words are just as important as images.

Please read that again.

A superbly crafted copy advertisement can be just as elegant and powerful as a visual one.

But the truth is in a short email or banner ad we won’t have the luxury of being able to Cover That In The Body Copy.

It won’t be easy.

Especially in the realm of pharmaceutical marketing. It’ll be tough, frustrating and difficult work but our clients need it. They deserve it and certainly the physicians and patients deserve it. And personally I love the emerging challenge of it.

Just don’t ask me to do it at 6:00 in the morning.