Relentless Health Value

Mark Conklin can be reached by email at mconklin@pharmacyquality.com and through http://www.pharmacyquality.com/ or https://www.EQuIPPp.org/professional.aspx . He can also be reached on twitter @MHConklin

Jeneanne Rae is an internationally recognized thought leader and expert in innovation management, design strategy, and customer experience. She has served as a consultant and teacher to dozens of leading organizations during her twenty-year career, including Procter & Gamble, Under Armour, Microsoft, Kaiser Permanente, Johnson & Johnson, AARP, HP, and AIG. In addition to penning articles for top industry publications such as the Design Management Review, Innovation Management and Fast Company, Rae has written extensively for Bloomberg BusinessWeek and was named one of its "Magnificent Seven Gurus of Innovation" in its cover story on the creative corporation. She was later hailed one of BusinessWeek's "Leaders of the Year," for her groundbreaking work in the study of service innovation. Prior to forming Motiv, Rae spent seven years on the executive team design powerhouse IDEO and was President of management consulting firm, Peer Insight, for six years. She has serviced as an adjunct professor at Georgetown University's McDonough School of Business for 10 years and has taught executive education through a number of top-ranked programs. Jeneanne holds a B.S. in marketing and finance from the McIntire School of Commerce at the University of Virginia and an MBA from Harvard Business School. Check out http://motivstrategies.com/ or e-mail Jeneanne@MotivStrategies.com to set up a speaking engagement with Jeneanne. Follow Motiv Strategies on Twitter: @motivstrategies Follow Jeneanne Rae on Twitter: @JeneanneMRae

Stan Berkow is co-founder and CEO of Sense Health, a NYC-based healthcare startup focused on delivering superior health support to underserved patient groups. Prior to Sense Health, his passion for better understanding health and behavior brought him to the Columbia University Medical Center, where he coordinated clinical trials in the Department of Behavioral Medicine. His experience at Columbia highlighted the immense gaps in care patients receive and led him to pursue his interest in improving people's health using technology and design. A firm believer that technology will only improve healthcare when infused with empathy, humanity, and great design, he is focused on creating products that connect providers and patients while still taking into account the unique needs and constraints of both groups. Stan contributes on the Huffington Post and holds a BA in neuroscience from Bowdoin College. sensehealth.com stan@sensehealth.com Montefiore Behavioral health Center: http://www.montefiore.org/mbhc

LEO P FRANCIS, PHD – President, LPF Solutions Leo Francis is an award-winning communications professional with a unique mix of commercial and scientific expertise and a proven record of success. He is a skilled communicator and visionary who is also operationally robust in translating scientific ideas into organizational value. He began his healthcare career in international clinical development at Gensia Europe Limited with a focus on the development of novel cardiovascular agents in surgery and arrhythmia diagnosis. Leo was instrumental in the preparation of the NDA for this unique device-drug combination Over the next several years, Leo moved into medical communications leadership positions at Adelphi Group (US), OCC Europe, Ltd (UK) and Gardiner-Caldwell Communications (UK) deploying his expertise with most major pharmaceutical manufacturers on all aspects of the prelaunch/launch commercialization process from clinical study design, market shaping and preparation, positioning, thought-leader development engagement, healthcare organizational alliances, value proposition development and tactical deployment of medical communication strategies at both the domestic and global level. Since being US-based, Leo's recent roles were within Publicis Healthcare Communications Group (PHCG) as President, Publicis Medical Education Group (PMEG), leading an eclectic group of six medical education agencies, following which he progressed to the role of Global Group President responsible for a portfolio of Global Advertising and Medical agencies (market research, market access, healthcare consulting & managed markets) and cross discipline skill centers (strategic planning, patient & consumer insights, data analytics & strategic services, medical insights/analysis). In 2010 and 2012, Leo was honored in PharmaVoice 100 as one of the 100 most inspiring leaders in the life-sciences industry. Thereafter, Leo has been developing his Healthcare Consulting business, LPF Solutions LLC (www.lpfsolutionsllc.com; Twitter: #lpfsolutions) and has Pharmaceutical company and Healthcare agency clients across several business areas and therapeutic categories. Leo's holds a Ph.D. in Physiology and Pharmacology from the University of Central Lancashire, UK

3:11- Kent talks about how he got from top secret military work to healthcare, specifically remote monitoring of biometrics. 5:11 - Lessons from 9/11, monitoring vital signs and stress levels via biometric headsets. And how to transmit this information back to the cloud from a technology perspective. Hones in on cell phones. 6:00 - Working with McKesson to do a small pilot for diabetes patients and the Navaho indian reservation. Began to focus on the 15% of people consume 80% of healthcare cost. Found that the trick to ROI is to align the technology solution to these high-risk patients. But that’s hard because the people who most need the technology are probably the least likely to use the technology: elderly, indigent and either are intimidated or can’t afford the technology or will attempt to use the technology in a way that doesn’t contribute to their health, like downloading games or selling the device in a pawn shop. 8:40 - First hope was to monitor people in their disease to identify people who are likely to wind up in the hospital or in danger of their disease exasperating to the next level. 9:00 - Use of monitoring devices in heart failure, for example to avoid hospitalizations. 10:50 - Chasing efficacy, alignment of reimbursement of physician incentives and the latest technologies. Constant pursuit of the right solution to try to engage patients at the right cost and the right incentives to doctors. 12:30 Stakeholders most interested in technologies like this are those financially responsible for the patient, especially those interested in capititated cost. One of the most effective, and the most costly ways to improve outcomes is to have a skilled nurse work with patients. The least costly is if the patient can use their own device to monitor themselves, but this is also the least compliant. So need to find a solution in between. “one solution doesn’t fit all.” Need to figure out what fuels people to engage them and keep them as high compliant as possible and keep them out of the hospital or ER. 14:45 - How the MedApp solution walks the middle line between cost and effectiveness. This solution is designed for the 15% of the market that consumes 80% of the heath resources. It needs to be simple, transparent in the background, ubiquitous. It can’t require extra steps. Humans don’t work any other way. An example of how Kent’s scale is automatic and transparent this way. 19:05- with this 15% patient population … the plan is not going to know which phones or technology their patients are using. And also have to be careful that the devices are not “hockable.” The unit needs to be “dumb” but highly automated and easy for the business model to work, all within a regulated environment. 20:50 - McKesson pilot. “Let the nurses be clinicians, not technicians.” By using the MedApp solution was cheap to make and deploy to patients. 19:00 An example of a fail. Microsoft Healthvault and Cleveland Clinic try to use the patients own technology and connectivity to configure each patient for a congestive heart failure pilot. 23:30 - In this transformational period and experimental phase, the technologies are altering quickly. What we need to do is be less hardware dependent. People were concentrating on the health of the patient, but not the health of the device from a technology and connectivity standpoint. Need to be able to update firmware over the air, need to configure automatically if things change. Devices can’t be high maintenance otherwise the data-stream interrupts and the whole program goes down. What helped us most to become a key player here was our acquisition by Alere. Alere brought to us a full continuum of care to follow the patient longitudinally from a rapid diagnostic, care, education and data/analytic and informatic standpoint. 26:30 - The downside to a silo’ed industry which Alere overcomes with their “modular” approach. How Alere can identify dangerous trends in a patient’s health before they culminate in acute events. 28:00- transitioning from an analog company into a digital service organization 32:30- “CIA Effect.” You can’t replace all the operatives with technology and massive amounts of data. So much data that no one could act on it. It’s not cheaper to have nurses and just rely on data collection and technology. It’s not cheaper, because nothing was getting done. The best way to go is a hybrid approach. have powerful technology that collects data and synthesizes it down to key points. Then have the doctors and nurses be able to look at these points and determine who to act upon. One of the biggest problems have today, align incentives for doctors and nurses to make sure that they are paid to act on the information they get. 24:30 - Fitting seamlessly into the lives the healthcare providers. The technology or data we provide can’t require massive extra steps. Doctors want systems around looking at trending, do long haul work in the background. But the technology needs to be relevant and accurate, otherwise results in Alert fatigue.Fine tune system so the Alerts fire off appropriately. 37:10 - The priority of Alert Fatigue because it impacts workflow and efficiency. But this will take time to stratify patients so can classify patients for the alerts that matter. Otherwise, fire off alerts that are meaningless and that’s when systems fail. 38:05 - Alere’s customers are organizations concerned with controlling costs in health management. So sometimes subcontracted skilled nurses, direct payers, providers concerned about 30-day readmits, accountable care organizations (of course), large employer groups with chronic care programs trying to reduce costs like Toyota, GM, Ford or Steel mills. Those who are financially responsible for patients gravitate to us. 40:40 - Strategic approach — lots of conversations and experimentation. Trying to align technology with those where we can make the most difference, and therefore, we are most interesting to the payers and others who support those specific patients. 42:00 - The first thing that any investor is going to want to know. Advice to app makers. Listen, learn and figure out what things work. When create a solution, are you creating a solution looking for a problem or visa versa? Need to find a problem, then identify how big of slice of the market has this problem. Then make sure you know who will pay for it. 44:30 - “It could be cool, but is it needed?” 45:30 - The biggest timesuck for an entrepreneur? Chasing funding. 47:10: The best way to generate acceptance for an innovation is to generate energy: win awards, do press, get interviewed. Create buzz and educate the marketplace while you’re seeking approval for your development. Be sure to “show the shiny bits.” The human mind gravitates back to the sexy. Maybe it makes sense to keep the cool parts even though it might not be the best to support the business model. “If you build it, they might not come.” 50:10 - Kent’s prediction for the future … connectivity between the patient and healthcare stakeholders. Consolidation of the industry, engagement requires integration into a solution that all works together. Hardware commoditized. transformation of the newly available data into evolve into predictive solutions. Let's build “The Nest of Healthcare.”

Today I speak with Michael Kuderka, an experienced pharmaceutical marketer. I liked what he had to say about being authentic. Michael suggests that pharmaceutical brands these days need to lock down a patient population where the brand can legitimately add the most value, and then own that market by developing strong value propositions for each stakeholder along the patient journey. Michael says in the long run, this is a much better strategy than fighting for a tiny piece of a giant pie. Especially when the clinical differentiation across such broad sweeps of patients is rarely well-defined and even more rarely will motivate prescribers to switch up their current standard of care. Soon after my talk with Michael, I heard a guy named Ian Altman speak on another podcast. His message dovetailed perfectly with Michael's point of view. I immediately went out and bought his book, called "Same Side Selling." Ian advises that sellers and marketers aim to be “Some Things to the Right People." He says that when a buyer senses that the seller is more interested in selling than in delivering value, trust vanishes. I can easily see how this applies to pharmaceutical brands. 0:00 - How Michael went from the defense industry to Pharmaceutical Sales and Marketing. I like a term he uses for smaller pharma … “Micro-Pharma” 2:15 - How the role of the healthcare marketer has changed: Formerly silo’ed functional teams have begun to work together and follow patients throughout their disease management journey. 3:50 - An example of what a patient journey might look like for an h.pylori patient 5:17 - How Michael’s brand team tackled the challenge to help patients via providers and caregivers by keying in on the problem perpetuated by the current standard of care … an overuse of one kind of antibiotic. 6:45 - Giving the prescriber a solid answer to the question, “I need to prescribe this brand because…” The answer needs to be compelling enough for the physician to champion the brand with payers and also compelling enough for a prescriber to break what might be longstanding prescribing habits. 10:00 - Niche strategies - from a forecast perspective, many might find it alluring to battle it out for a small piece of a big pie … but Michael talks about the advantages of owning a segment where your brand has the most value. “In the niches you’ll find the riches” 10:45 - Focusing on the patients where a brand delivers the most impact might be the fastest path to market success. Because it hinges on the brand’s authentic value, physicians will see success. They become believers, and it is through these believers that marketshare multiplies. Being authentic also attenuates the problem where really good reps who see that a sweeping unfocused strategy isn’t working will come up their own splinter approaches. That’s bad news for a brand. 12:30 - Major lesson learned? No value proposition is one-sized fits all. Every stakeholder along the patient journey— doctors, nurses, pharmacists … each has their own unique lens and a different impact on the brand. 14:09 - Transforming those various value statements into marketing: Michael talks through an example where one value message worked for payers and providers, but pharmacists required a different message. 16:56 - How can pharma collaborate? Around patient outcomes, says Michael. Each stakeholder has a role in outcomes. 18:19 - I pose a tough question — do patient outcomes sometimes play second fiddle to other organizational goals, like profitability? Michael emphasizes authentic brand value and supporting the patient as a guiding star for healthcare business. 22:00 - Value is, in some cases, synonymous with reducing cost. If this is true, then creating value for certain stakeholders might in fact diminish patient outcomes where the improvement in outcome is deemed not worth the price. 24:39 How viable might it be for an app developer to sell data to pharma? Michael talks about the challenges an app developer might face. 26:17 - Considerations a pharma brand manager might weigh before deciding to fund or subsidize a mobile app. Main takeaway, partner early in the app development. Michael Kuderka An innovative marketing professional Michael Kuderka is a pharmaceutical Marketing Director with over 22 years of sales and marketing experience. Michael has a demonstrated talent for branding, positioning, messaging, and strategic and tactical planning for such products as Covera-HS, Boniva, Zenpep, and Pylera, and brand life-cycle experience ranging from early commercialization, to launch, to in-market branding, through generic competition. In his career Michael has gained experience in large and small specialty pharma settings, working at Pharmacia Corp., Roche Laboratories, Eurand, Inc, and Aptalis Pharma, resulting in hands-on experience in the Cardiovascular, Osteoporosis, Cystic Fibrosis, Pancreatic Insufficiency, H.pylori, and the Duodenal Ulcer disease markets. Michael Kuderka can be contacted via e-mail at mkuderka@comcast.net.

"What is this podcast?" It's a valid question that I've answered many times lately. This podcast is about the people of the healthcare industry— the entrepreneurs, employee-preneurs, business leaders. Those of us who struggle, every day, to do what we can to make healthcare better. We all know the health industry is a tough place to drive results. It's highly regulated, enormous, chaotic and rife with vested interests. Implementation of almost anything involves navigating a very messy middle. Relentless Health Value is about us. It's about our successes and lessons learned. My guests share their stories. They talk about how they manage to stay strategic and focused when their days are chock-full of too many distractions, too much data, too little data, and triple-booked meetings. They talk about what they're currently excited about, what's inspiring them, what's troubling them. They offer advice and share an insight or two. They talk about their role and what they hope to achieve. And this is important. It's important because in order to collaborate, we need to understand each other. There are a number of health industry podcasts already out there and I'd like to give them a shout out. They make it easier to keep up with what's going on with the industry by covering news, current trends and topics: First Word Pharma - Daily podcast to keep you up to date on who bought who, who sued who and the general goings-on. A robot reads the copy. Pharma Marketing Podcast - Hosted by The Pharma Guy. His guests talk about their latest projects. Healthcare Informatics - Health IT focused. HIN.com - Episodes are short, usually teasers for a longer webinar but cover trending topics. AJHP Voices - Pharmacy-centric. Pharma Talk Radio - Sometimes clinical, sometimes not. Guests share their recent projects. Medical Sales Guru - Mace Horoff gives advice on how to sell medical/pharma products. (In the podcast, I neglect to mention the HIMSS podcast called "HIE InPractice.") My name is Stacey Richter and I'm the founder and CEO of Franklyn Healthcom, a marketing agency specializing in communications to decision-makers at healthcare organizations. I'm your host. Take a listen and I thank you very much if you subscribe. Upcoming episodes feature Robert Herzog of eCaring, Kent Dicks of Alere, Leo Francis of LPF Solutions among other American entrepreneurs and business leaders you might want to get to know. Visit us online at RelentlessHealthValue.com

Today on the program, I speak with Robert Herzog, Founder and CEO of eCaring. eCaring is a system, with an iPad app as its centerpiece, which increases the efficiency and productivity of care managers responsible for patient homecare. His system is a great way to extend healthcare into the home, and collect actionable data from the home. Both are essential to control outcomes because it's where patients spend 95% of their time. A few things that Robert said which I found very interesting: eCaring customers are people who were "ripe for change?" Inertia is his biggest competitor. Robert credits some measure of his success to his relentless drive toward intuitive simplicity His plan to integrate eCaring data into a larger data pool is to work through HIEs (Health Information Exchanges) eCaring enables a great use of care extenders, who have the data to be able to talk to physicians if necessary. So it's a very efficient use of resources. Robert Herzog CEO, eCaring Robert has an extensive background in digital media and creative enterprises as an entrepreneur and executive. For several years he was deeply involved in the home and extended care of his mother Grace, which gave him an understanding of the problems eCaring is designed to solve. He has been a pioneer in applying new technologies to business ventures, working as a senior executive with startup companies such as Motionbox, Diva, ON2 Corp, Softcom, Granite Films and City Winery, major corporations including JPMorgan Chase, Cahners Communications and the Sarnoff Research Center, and not-for-profits including New Jersey Appleseed and Ecotrust. In public service, he was the creator and Director of New York City’s Energy Office, and also taught public school. Robert is also an author and filmmaker. He graduated from Williams College and has a Master’s from the New School. ecaring.comquestions@ecaring.com