Deborah Gordon, Senior Fellow at Mossavar-Rahmani Center for Business and Government at the Harvard Kennedy School

A Deep Dive into The Opportunity of Healthcare Consumerism with Deborah Gordon, Senior Fellow at Mossavar-Rahmani Center for Business and Government at the Harvard Kennedy School

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Outcomes Rocket listeners. Welcome back once again to the Outcomes Rocket where we chat with today’s most inspiring and successful health care leaders really want to thank you for tuning in. And if you enjoy today’s episode please go to outcomesrocket.health/reviews. That’s our Apple podcast site. You’ll be able to learn more and also give us a rating and review because that’s the feedback that we enjoy hearing so much from you and make it the best. To follow up with you on the way the show is performing for you. So without further ado, I want to welcome my out standing guest. Her name is Deborah Gordon. She’s the senior fellow at Mossavar-Rahmani Center for Business and Government at the Harvard Kennedy School. She’s had an enormous amount of experience in health care some population health. But she’s also been chief executive officer at Voxent as well as served as chief marketing officer for Network Health. She’s got a wide variety of experience. I’m so happy to welcome Deb to the podcast. Welcome. Deb.

Deborah Gordon: [00:01:29] Thank you so much. Thanks for having me.

Saul Marquez: [00:01:31] Absolutely. And so Deb you and I had a chance to connect before the show and you had some really compelling stories but I wanted to ask you why did you decide to get into health care to begin with.

Deborah Gordon: [00:01:43] That’s a good question. You know when I was in college I took a course called culture and health and it was like a sociology course or an anthropology course I’m not really sure it wasn’t even my favorite course without alongside them. But it was so captivating the idea that help is not sort of a pure science. You know I thought oh that’s biology actually it’s culture and it nuance that’s not hard and fast definitions in the way that we think of as scientific fact. And I was really taken with that that notion that we serve look at our own health our own bodies through a cultural lens. And at the same time I was really troubled by the idea that not everyone has access to healthcare. And so when I got out of college and learned you could actually work in the field of public health I thought that was the greatest thing ever. No I felt that and I haven’t really looked back.

Saul Marquez: [00:02:43] Wow that’s so neat and just you just never know when it’s going to hit you. You know and for you it was that class and it wasn’t even the funnest but it just struck me. It was amazing this idea that culture is health awesome and so cool that you ended up in this realm of public health because it is basically around culture right our behaviors our norms our customs.

Deborah Gordon: [00:03:03] And now politics so you know here I am at the Center for Business and government where we actually look at the intersection of policy and practice.

Saul Marquez: [00:03:12] Yeah that is so neat. And what are interesting journey that you’ve taken. So what would you say Deb is a hot topic that should be on every medical leaders agenda and how are you addressing it or thinking about it.

Deborah Gordon: [00:03:25] Yeah I think it has to be consumerism or the role of consumers and healthcare decision making it sort of falls into the category of one of those things that people who aren’t in the medical field actually can’t believe we have to talk about more and say out loud what do you mean the patient isn’t at the center of healthcare already. Cool it is. But if we’re honest those of us inside the industry it’s not always more often the patient or the consumer. We’ve designed our system around doctors. I’m married to one so that’s great personally. But actually as a patient there are a lot of challenges with that. We’ve designed a system around insurance payment and financing our employers are involved for so many of us. And I think that’s what’s getting lost. Something that’s gotten lost and in a way the system has evolved over time is the individual consumer.

Saul Marquez: [00:04:22] And I couldn’t agree with you more or you know this idea that the health consumer is at the top of the health care organizational chart right. If you have the organizational chart I just had a guest that said we drew one out and where the CEO usually is we put the patient.

Deborah Gordon: [00:04:38] Nice. That’s fantastic. And I think it will pay that organization back. You know I think functionally I’m a marketer and marketing people good marketing starts to the audience. What does the audience need. What do they care about. How did they receive the information or the message here trying to convey not how do we want to convey it. And I think that’s been missing in health care.

Saul Marquez: [00:05:02] And I think that’s such a great call out Deb and I’m just curious what are your thoughts for the listeners as far as how can you put the patient at the center. What do you do. How do you do.

Deborah Gordon: [00:05:13] Well I think it starts with actually believing that they should be there that they should be at the center of value judgment or value placing a value on putting the individual at the core. I also think some honest reflection on how has it been you know who are we really designing for. And I think some organizations have done a great job of that. But. It’s not a fault it’s just a function of historical artifacts. And so I think if folks could honestly look at where does I like your analogy. Where does the individual sit in the org chart of that entity or that service model or whatever it might be to get really honest about that. And I I think the best way to stay either get or stay on it is to actually talk to the individual. So what I’m doing is research about consumer behavior or consumer attitudes specifically and purchasing decisions in healthcare. So how do people think about spending their healthcare dollars. Well the very first thing I’ve been doing is talking to individual and asking them how do you think about this. How does it feel when you’re in that situation. What do you wish were different or better. And I think it really starts with being open to the message knowing you need to ask then going to ask and then authentically listening to what people have to tell you they’ll tell you you know they’ll tell you what they need and want what they like what they take away from what you tried to convey and what they haven’t.

Saul Marquez: [00:06:45] Deb I think that’s so interesting in your approach. You know you’ve got a very methodical approach and a very honest and also simple one which I think ultimately it needs to be simple for it to work. Today we have a system that pretty much functions in such a way that the health care providers are really providing services in such a way that payers pay the majority of it or the government pays the majority of it and then the consumer finds themselves in the center without any control. But now with increasing deductibles minimums this is starting to change. And so I really find it interesting that you’re sort of tackling this topic in a time when we are seeing this shift. The average deductible plan being about three to five thousand dollars.

Deborah Gordon: [00:07:30] Right. And 40 percent roughly 40 percent of Americans are in what’s considered a high deductible plan. So they’re deductible is at least 13 hundred dollars or more. And that’s not even the whole of it. You know people are paying more and more out-of-pocket for copayments coinsurance and so taken together. There is this increased consumer financial responsibility and I think about a third not quite a third 28 percent of healthcare spending in the United States is coming out of an individual pocket either through out-of-pocket costs or the consumer or share a family share of the health insurance that’s big now. And it is because we spend more than three trillion dollars on health care in the U.S.. So roughly a third of a little more than three trillion dollars. I think it’s time to pay attention to individual in the purchasing decision process.

Saul Marquez: [00:08:26] Totally agree with you. What would you say an example of how an organization that you’ve worked with or just how this idea has been applied successfully.

Saul Marquez: [00:08:36] Sure. I’ll go back in time to the way back machine.

Saul Marquez: [00:08:40] Do it.

Deborah Gordon: [00:08:41] I had an experience early on in my time that I had joined a Medicaid health plan in Massachusetts of the Director of Membership marketing. I grew up at roll over time but that’s how I started. And one of the early challenges I was handed was figure out how we can attract more members and keep more of the ones we have. And in a Medicaid managed care environment it’s not so simple. In fact the product is free so you can’t differentiate on price. The benefits are mandated. They can’t differentiate on her assortment or are the product to sell. You can tinker on the margins pretty much. And we were in a in a market where the provider payer relationships were pretty sick. That changed over time. But at that time there wasn’t much you can do about who was in the network and who was and would be another place where health plans typically would differentiate. So we had this idea to look at what we called Extra down ahead of those special services or benefit discount movie ticket subway passes model things that might induce people to children or to feel good about the plan. And whatever we do we are good marketers. We started with consumer research with a focus group and we did a quantitative survey and the results were so clear. The number one thing that would change someone’s behavior in terms of health I’m so action in this market was access to dental care and it was like dental was the number one by a mile. The using his vision and then you know this other stuff we were talking about they were like you could give a movie ticket. That’s great but it’s certainly not going to change our decision about our health. So I was pretty bummed out because you know I did not have the budget certainly not in the marketing budget. You know yeah we’ll just add Denzel that I’ve said for adults on our part. So I kind of dismissed that I thought well that’s too bad we can’t do anything about it. And one day we were in the middle of this process. And I had this thought and it was so simple. And I just thought this thought popped into my head. Well what if we could do something about it. Like what if we could. Yeah. And I just posed that question to my team and they went off and got really creative and we basically came up with a pretty innovative gentil reward system and we designed a reward program for people who were in our plan for a certain amount of time we would rescind them a health assessment or help screening so we could serve on top of what was going on for them and if they filled out this really lengthy survey which helps us understand our membership better they would get a report card like a gift card could only be used at a dental office because it was a gift card and you and your listeners might know that you know if you don’t spend the money on a gift card it goes back what right you the consumer lose it which not we the provider of that part did not have to pay.

Saul Marquez: [00:11:51] Got it.

Deborah Gordon: [00:11:51] So what we did was we were able to create this pretty innovative not a comprehensive dental benefit but some step in the right direction for what people had told us loud and clear. They really wanted. We had a huge response. We had 30 percent response rate and at the same time it’s pretty big people Ali. Yeah it was. I mean for a survey let’s call it a survey. You know that research mentally what we were pretty sure right huge. Right. And then people would take this gift card and go to the dentist and use half of the value we had loaded a card with or we had one I remember we had one member send us the card back with a letter that said I don’t need this like I have. Somehow he had access to dental coverage. I really appreciate that you’ve done that and I can do that with high degree of confidence. They became a very loyal member even though he didn’t even use a word and so I think that’s a case of you know with of course the case. But it’s like you hear you ask what people what do you care about. You have to listen and then you have to translate that and be really open and really creative. How can we trust you know how can we accommodate that need a recognize that need. We certainly couldn’t institute a full dental benefit out of the marketing budget but we did come up with something that generated or provided real value.

Saul Marquez: [00:13:18] That’s pretty interesting Deb and appreciate you share that and you sat there and you got the knee jerk reaction that we all get. You know what. This isn’t possible. And friends we’ve all sat there at least once or twice every single quarter or even the year. Let’s just be conservative for the year and said we can’t do this. Well two parts of oration from Deb. She basically dug deep and had an epiphany. She said you know what. How can we do this and figured out an innovative risk sharing way that put herself out there in a way that created loyalty from these people using the plan. What can we do within our organizations to number one to ask those questions get the feedback listen and not stop. This can’t be done.

Deborah Gordon: [00:14:03] And if I could add something to that I really think it’s important if you can engage in that process to consolidate a thick skin. I can’t tell you how many times in organizations people have looked at me like I’m crazy and just decided that maybe I maybe crazy I might be wrong. I mean that’s also part of risk taking as being willing to be out on a ledge. But if you’re interested go out on a ledge and you’re right you can become a hero and derive no real results. You might be wrong. You might be crazy or you might be onto something. But until that answer is clear people might look at you like a little funny and I would just encourage people to be brave about that and you know not worry about it. So what. But what if you’re wrong. What if you had a wild idea and it was wrong. What if you’re right.

Saul Marquez: [00:14:56] Well I mean you’re actually would if you’re right listeners and Deb on that topic you put yourself out there you’re you’re taking a risk. Can you share with the listeners a time when you actually had a setback and what you learned.

Deborah Gordon: [00:15:09] Sure yeah sure. I wish I could say that was a hard question. I’ve said what it is with that back to because of course if you’re going to take rest and put herself out there you’re going to stumble totally. So really a really tough one for me. Also at the health plan I had taken over responsibility for leading our business development effort. And you know when I started up the plan we had one product we were a Medicaid product. We went through health care reform in Massachusetts. We had two products and we had this opportunity to continue to try to grow. But we also had a lot of entrenched assumptions about who we were as a plan. We were the small Massachusetts health plan and I thought well we can be bigger we do a really good job we have very high quality rating. We had very low administrative costs we were really doing a good job and we had grown tremendously. So I led a charge to try to diversify into another state or just leave the name of the state. But I I led the charge and I said we can do this so we can do this guys. Let’s do it let’s go for it. And we I basically practically lived in this other state for a few months. We got to know all the players. I arranged so many meetings. We listen you know I took my own advice. We actively listened. We the Astros what did they care about what did the state need what was going on in the Medicaid program there and how could we make a difference to make an impact. And then we poured all that good research on to market knowledge into our proposal. And I don’t think I went home for dinner for like three weeks before the proposal was through. I mean I poured my heart and soul into this thing. And we didn’t get it. And that was a topflight Crawshay. It was terrible it was embarrassing. It was disappointing. It was surprising because I really thought we had done such a good job. And so I know you’re going to ask what I think you already did ask what did I learn from that or you know what did I take away. And a couple of things. First of all around the same time we had put in a much smaller proposal for a smaller piece of business in a smaller chain store business. And we got that one night and it ultimately contributed quite a great deal to our business. Our business success and that sort of juxtaposition remind me that you know you win some you lose some it’s kind of basic but the other thing it makes me think about was I had to actually in order to get people excited about the process of going for it. I had to use an analogy I had said guys the leadership team let’s say we have to think like venture capital venture capitalists don’t only place that they know are gonna yield. They place a lot of that and they know most of them are going to fail. But the ones that hit. That’s enough. It’s what they need in order to get the ones that hit. You have to place a lot of that. And so I found myself reminding myself of my own coaching and that mentality that was. You gotta try sort of like we cited that sometimes go on a limb and you won’t always if you’re not failing you’re not trying hard enough. I had to reteach myself that I took it pretty personally. You know I want it. I like to win. So I was not happy but it did remind me to place a lot of that in business. And they don’t all actually have to come from.

Saul Marquez: [00:18:47] It’s a great lesson Deb and really appreciate you sharing that you know and in health care especially you we’ve got to be willing to take some risks to make the changes that we need to make the health care system more accessible. So kudos to you for doing that. And let’s take those risks listeners and let’s make sure that are calculated risks but let’s not be afraid of those failures that come out of them because they’re lessons there’s lessons in them and there they allow us to be stronger. Deb tell us a little bit more about an exciting project or focus that you’re working on today.

Deborah Gordon: [00:19:18] Yes. So I could talk to you about the research that I’m doing right now which at the Kennedy School I had this idea that we talked a little bit earlier about how much money is coming out of consumers pockets into healthcare spending and how maybe nonresponsive are not designed around the consumer. Our industry has then and I have this hypothesis that while it feels like a fixable. So I’m doing research again starting with consumers who understand what are people’s experiences. How did they experience the health care system and specifically financial decisions in health care. And I’m hearing all kinds of interesting things that it’s still pretty early and what I’m hearing out there starting to sound like him but not concrete findings yet but I could share a few things that I’m hearing. Settle first of all when I ask if somebody is willing to meet with me to do an interview. You can be an interview subject to research subjects. A lot of people say oh I don’t know anything about health care but I’m happy to talk to you and that’s fine. I don’t care if you know or don’t know I just want your experience. And when I get into an interview everyone has an experience actually everyone has the ability to reflect on that experience and what I’m hearing is a lot of confusion a lot of frustration but also some really clear I think glimmers of opportunity. So there are different kinds of people. Some people do all their research and they go into the doctor’s office or their health plan you know enrollment time and they know exactly what they want. I talked to a guy who had a really clear articulated process for making healthcare purchases. He would say I think about the criteria what do I care most about. I research against those criteria I might ask around. I make my decision period and it sounded so simple like buying like buying a car or a refrigerator. And I asked them to make other purchases. And he said Yeah I make every purchase that way and then I’ve talked to people who are really almost sheepish but they say you know I spent more time picking out her teacher or some shopping for a car than I have for her surgery or a health plan or my doctor. And they say look oh sometimes I’ll ask you know did you inquire about that. You negotiate that price. Did you ask that question whatever it might be. And I’ll say again kind of sheepish like oh I didn’t know it’s negotiable or Oh you’re right I should have done that. So I’m not actually telling you what you should do what to do and it’s just amazing what I’m finding that people are able to negotiate and are able to price shop in lots of other markets. They literally don’t even think it’s a possibility in health care like they need permission almost or someone to tell them you could do this. My very question makes people think oh oh I’m supposed to do that. Oh I didn’t know. I didn’t even know I could. And I’m really just trying to get there and so I think if your question prompts that kind of response then certainly it could concerted effort on the part of industry participants or campaign to help people understand how to think without shopping for healthcare services. I think there’s a lot of potential opportunity there.

Saul Marquez: [00:22:45] That’s pretty cool Deb and exciting do I see a book coming here. I don’t know if you are online or even starting with a blog. I think that that kind of blog Deb would get a lot of followers.

Deborah Gordon: [00:23:01] All right well I’m going to count shows my first follower I’ve heard it.

Saul Marquez: [00:23:08] As soon as it comes out let me know. I’ll definitely be listening. And so you know I think one of the things that you’re so right about is patients feel like yeah you know they just have to accept whatever is out there. There’s an opportunity for an educational campaign. And who’s going to own it. You know who’s going to own that campaign.

Deborah Gordon: [00:23:28] Yeah I think that’s that’s the hardest question because it’s hurt on two level. One is whose interest is it to have more educated consumers. I’ve actually talked to a lot of consumers who say they’re pretty skeptical about the industry and they blame insiders they say. I feel like I mean consumers who remember they told me I know nothing about health care before they started that conversation. Well in the stories they tell me they I kind of feel like it’s this way on purpose so that we stay confused. We consumers get confused and that doctors hospitals health plans conserve keep doing things the way they’ve always done them. If I you know if they were to of Teach me how to do this or ask the right questions things may have to change. And it seems like and I’m cool I’m sort of paraphrasing what I’m hearing. It seems like the industry doesn’t really want to change. And so I think there is a huge opportunity for someone inside a health plan hospital. So a coalition of professional society to sort of break through that negative perception and actually own the campaign and say hey we hear you we’re going to be all about you as a consumer parent that you know barring some really brave and visionary leadership from inside it’s going to have most disruption does come from the outside. And you know maybe it will be a book that I write or maybe it will be this campaign charge that I I lead but someone’s got to do it and actually lots of parts of the industry need to do it. And I think there are really solid ways of engaging. But it takes effort it kicks commitments and takes a philosophical desire to actually empower and any local now.

Saul Marquez: [00:25:27] I think you’re right. And you’re so passionate about this that I think something is emanating it’s in the works. I just see it as you feel it. I know it’s coming. Let’s pretend you and I are building a medical leadership course on what it takes to be successful in medicine today. It’s the 101 course or the ABC. Deb Gordon so you don’t write out the syllables and I’m going to give you four questions lightning round style and then you will finish it up with a book that you recommend to the list. She ready. Sure. Yes. OK. What’s the best way to improve health care outcomes.

Deborah Gordon: [00:26:05] Yeah I think the best way is to actually think hard about and be honest about what outcome you’re trying to improve. So I know because I was inside this industry that we measured a lot of stuff that we called quality as an example that had very very little to do with outcome outcomes are hard to measure. So we pick process interim steps or process measures that we can at least quantify what they’re not really getting at the core issue. And I can now say that’s from the consumer’s perspective as well I’ve always had the feeling like we’re not measuring the right thing. Well consumers define quality very very differently from one another and from the industry. So we would measure how many folks got there well has it and has not come up in a consumer’s view of quality or are our positive outcomes. I think the first thing is you know what you’re trying to achieve and really go after is that it might be harder but you’ll get closer to it.

Saul Marquez: [00:27:13] What is the biggest mistake or pitfall to avoid.

Deborah Gordon: [00:27:16] Yeah I think I call it staying inside the jar. So once I was at a conference I heard a fellow presenter say it’s really hard to read the label from inside the jar and I co-opt that phrase and I wrote a whole piece for The Harvard Business Review blog about how you have to get outside the jar so to speak. You have to get out into the world you have to ask consumers what they care about how did they experience things. Because too often we stay inside. We talk amongst ourselves. We’ve developed a language and counselors are calling us on it. My research also a very consistent theme which won’t surprise anyone or shouldn’t is people who don’t understand what we’re talking about when we write in our own healthcare language. So really getting out of our own environment thinking about our business and our services from the perspective of the world we’re trying to engage. I have a quick example I know this is the lightning round to probably over the first day that I got one advantage over it.

Saul Marquez: [00:28:22] Ok.

Deborah Gordon: [00:28:23] So I you know my most recent role as an executive role is leading a company that customized electronic health record for community based providers. And one of the things I learned not about the company that I was working on specifically but in that industry is the technology. We asked clinicians and clinical staff to use looks nothing like the technology they’re using in their day to day lives at work. They’re using this relatively old very cumbersome technology. And at home you know every single person who works in a hospital or a health care clinic at home has a smartphone has the latest smartphone and it’s getting used to that much different more usable interface. And so I think it’s not just about getting outside of your own jar and looking back and from the outside it’s actually looking across what’s happening in the world that is influencing how people think and what people act. I think too often we disconnect those things.

Saul Marquez: [00:29:28] Great analogy there. I totally agree. And listeners what are you doing to get out of the jar of healthcare and start looking at it from the eyes of the patient. The person Deb how do you stay relevant as an organization. Despite constant change.

Deborah Gordon: [00:29:44] Yeah I think I’m just a broken record. I think it’s really getting out into the world and talking to folks and asking hard questions and being willing to take some real feedback about what you’re doing. Folks will tell us will tell us when they’re you know we’re missing the mark or we’re becoming irrelevant and that’s it’s for us to adapt without feedback.

Saul Marquez: [00:30:05] What is one area of focus that should drive all else in your organization or company.

Deborah Gordon: [00:30:10] So I think it’s really about getting to know your customer. It’s still basic and it still dumb when I like we say that everyone thinks and believes they’re focused on the cup. But if you’re really honest about it who really know what your customer is feeling experiencing needing at this point. And so I think always engaging in authentic inquiry asking and listening for that feedback.

Saul Marquez: [00:30:38] Love it and what book would you add to the syllabus here.

Deborah Gordon: [00:30:42] Yes. So one of my favorite my favorite health care book. It’s called The Healing of America by T.R. Reid The journalist. He writes in A Tale of journalistic style and the author has traveled the world and he describes for those who haven’t read it. He basically describes a lot of pretty good health policy content comparative done in a very great kind of storytelling manner. And he actually does have a lot of different countries and exposes their health care system through the lens of his own experiences with patients and it’s just a great way to get a glimpse of the world and to really put our healthcare system into perspective.

Saul Marquez: [00:31:26] That’s so awesome. He went out there and he put himself and other jars and then stepped outside. I think that’s great. So listeners please go to outcomesrocket.health/debgordon and find the show notes of today’s podcast as well as a link to the book that Deb just recommended. And all of the things that we discussed here in the 101 course of Deb Gordon so much I really appreciate you guys tuning in. And Deb let’s conclude with a closing thought from you. And the best place where the listeners can get ahold of you.

Deborah Gordon: [00:32:01] Sure. I really believe and again I may be wrong. I just don’t think I’m wrong but I really believe that health care organizations ignore or underestimate the consumer or consumers at their own risk that the world is changing and in a generation. And I don’t think it’s tomorrow but at least in a generation if not sooner or healthcare organizations will be answering to consumers can find me on Twitter @gordondeb.

Saul Marquez: [00:32:31] Awesome. Listen I really appreciate the time that you spent here chatting about some really important stuff with our listeners and so looking forward to staying in touch with you and maybe even seeing that book.

: [00:32:45] Sounds good. I really like your confidence. I’m going to carry that around with me for a while.

: [00:32:53] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web www.outcomesrocket.health for the show notes, resources, inspiration and so much more.