Paying to Learn

I was just in Vegas and had the chance to go to a casino and play Texas Hold’Em. Even those we have casinos in St. Louis, this was really the first time I had been in a casino for more than 30 minutes. I play poker monthly with a group of 20+ guys in my neighborhood, and I was really interested to see how that game compared to playing for cash with locals in Vegas.

The next day everyone was asking me the logical question of how much did you win. I found myself personally much more focused on how long I lasted. I put up $150 and lasted for 6 hours at the table with a rotating group of 9 other players. I felt really good about this. I learned a ton about how I play and how the game is played.

When I first sat down, there were several players with $1,000 in front of them, and I watched many people buy chips several times. (You had to buy at least $100 and couldn’t buy more than $300.)

So…why do you care? Well I think there are a lot of analogies here to communication programs. I know we all think we want to find the silver bullet that drives success. Well, in general, it will never exist. You can continue to improve, but like at the poker table, the players (your members) change and vary. Everyone is different. And, as in healthcare, based on the situation, their behavior will change. A recent diagnosis (or a large pot) will change the way they look at information.

Sometimes, it is important to focus on learning quickly in an initial program to be better long-term. As long as you learn, capture what you tried systematically, look at the results, and improve over time, I think the cost of that is worth it. The cost of failure is often much larger.

Let’s look at programs to encourage patients to use mail order over retail pharmacies. For the PBMs, this is essential to their lifeblood. Moving patients to mail order not only increases their bottom line, but it allows the clients and members to save money. But, almost as important, it allows them to actively manage the patient encouraging adherence and driving generic utilization. After working on programs for more than 10 PBMs, it’s clear that there are lots of factors to consider and that success varies.

Does that mean you shouldn’t do anything or be happy with your success? No. You should be trying new programs and constantly iterating to drive improvement. Learn from your audience and continue to improve.

But, for those you interested in the poker story, let me finish it here…What did I learn?

• I have a “tell” which allowed the players that had been playing at the table with me for a while to know when I had a good hand. But, I simply asked one of them what it was and learned something about myself.
• When the stakes are low, everyone will stay in on the hand. (The game was a $1-$2 game meaning that it cost only $2 to play a hand. For someone with hundreds in front of them this meant that it was always worth seeing the flop.)
• You have to make the price of staying in the game higher so as to control your fate and not have someone get lucky on the turn or river card.
• Don’t get too focused on your cards and miss out what the other player has. Several times, I felt like I had the lead and then got a card to make two pair or three of a king and didn’t see the flush opportunity on the board.
• People in Vegas play all the time and have learned. They knew the dealers, the waitresses, and had played with each other at different events.
• They didn’t bluff. When they paid $20 to see a hand, they typically had cards.
• It is all about coordination – getting the right cards, having the right chip stack, betting well, and acting so as to get players.
• There are rules that are important to understand – e.g., how to call a raise.

But, I had a lot of fun. I learned that I could play with a lot of these people, and it only cost me $150. If I were to play again, I would be much better prepared. Now, we will see if it helps me with my friends. It’s hard to compare since it’s a different game and different population.

In summary, I think there are a few more takeaways for healthcare communications:

• Like my “tell”, you have to know what your brand perception is in the marketplace and how to use that or change that to drive trust in the messaging you send out.
• Participation in programs is based on making it easy. You need to understand what the hurdles are to participation and do what you can to minimize those. (For example, getting a patient to move to a generic or to split a pill may involve faxing their physician for them. Do it!)
• You need to continually improve your programs to be better than your competition. Whether it’s improving HEDIS scores, improving retention of your members, or improving mail order penetration, communications is strategic and you need to treat it that way.
• Don’t be complacent and miss out on new approaches and solutions.
• Don’t be myopic and forget to see the big picture by focusing on the wrong metrics.
• Take action. You have to play to learn.
• Understand your core asset (operations, web site, clinical data) and make sure it’s solid so that you can leverage it with your membership.
• Communications requires lots of coordination such as:
  • Across channels (letter, calls, call center agents, web, e-mail, text messaging, faxes)
  • Messaging variation across segments
  • Timing relative to events
  • Sequencing – letter than call or call then letter (for example)
  • Data integration
• You need to know the rules and the “odds” to predict behavior.