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Geekipedia

November 6, 2007 by George Van Antwerp 2 Comments

Sure…a little off topic, but understanding technology is one of the critical components (in my humble opinion) to driving innovation and change in healthcare. Healthcare is not an early adopter of solutions. There is too much fear about change (and litigation).

So, when Wired but out this magazine supplement called Geekipedia, I knew it was a must read. As it says on the cover “149 people, places, ideas and trends you need to know now”.

Here are a few that jumped out at me:

  • AJAX – a suite of web-development technologies which produce squeaky clean surfaces. This allows web designers to build web sites that act like applications and accept user input and computing results without fetching entirely new pages from a server. I have worked with developers to use this before. Very cool. You see it on a lot more sites now, but anytime you enter data and the site changes without refreshing it…they built the site using AJAX.
  • APIs – application programming interfaces are sets of rules that govern how apps exchange information. These have been around for years and typically only mattered to the programmers and your engineering staff…but today APIs allow you to create custom applications using desktop widgets and mashups to have personalized sites that do all types of cool things.
  • Collaborative Filtering – this is the recommendation algorithm you see on Amazon or Netflix or many other sites. I can see healthcare one day embracing this in patient centric forums – patients with your similar benefits and genes were most likely to respond to this form of treatment.
  • Distributed Computing – most of you should know about this as the use of our computers to solve problems has been part of the news (good and bad) for years, but the point is to leverage the memory of individual computers in a network design to create a virtual supercomputer to solve complex problems that look at lots of data over years – e.g., SETI@Home that looks for extraterrestrial intelligence or FightAids@Home which looks for new AIDS treatments.
  • Mashup – these are sites / applications that are combinations of existing offerings that are cut and pasted together. For example:
  • Meganiche – with the Internet’s utilization now, it is possible to have a niche within a niche. For rare diseases, this could have some value.
  • Neurologism – all of the new areas of research driven by the breakthroughs in understanding the brain.
    • Neurofitness
    • Neuroceuticals
    • Neuroinformatics
    • Neuromarketing
    • Neuroergonomics
    • Neurosemantics
  • RNAi or Ribonucleic Acid Interference – “the silent assassin of cell biology”. It protects against viruses by tearing up the viral RNA and preventing it from making copies of itself.
  • RSS or Really Simple Syndication – you see this everywhere – on my blog, on websites, even in the new Outlook. This allows you to stream information to your reader (e.g., Google Reader) to see new information without having to go to all the individual sites. I wonder how many managed care companies and PBMs offer this on their websites today. It would be nice to get this pushed right to my personal Google page.
  • SEO or Search Engine Optimization – this is the use of tags and other links to maximize how your website shows up in a search.
  • Ultrahigh-throughput gene sequencing – this is all about the speed at which genes are sequenced which is obviously a big driver of personalized medicine and genomics. I am not sure I buy the prediction of “it won’t be long before a stall at the local shopping center will work up your genome ‘while u wait'”.
  • Widgets – these are small applications which can typically be embedded in a website using reusable code (e.g., a BMI calculator or mortgage calculator)
  • Wikipedia – this is a site that provides the modern encyclopedia full of links and information that is created by the net community – are you out there? Is your company or product?

It makes you wonder. As healthcare moves to more consumer centric and sales to commercial patients mimics Medicare Part D, will you see a United Healthcare avatar in Second Life or a Medco Facebook page. And, when will be see YouTube and Flickr being used to paint positive pictures of our healthcare system for the many people that it does work for. If politicians can begin to use these sites and big corporations encourage personal advertising of their brands, healthcare should give it some consideration.

Business Tools, General Thoughts, Healthcare, Innovation, Marketing / Communications, Software, Technology

Zagat Rating System for Doctors

October 30, 2007 by George Van Antwerp 1 Comment

A few weeks ago, Wellpoint revealed that they were going to work with Zagat’s to rate physicians.  I think any information with some benchmark is great.  Since it is patient driven, it also has the chance of being very subjective which is the risk. 

The talk about using trust, communications, cost, and availability.  I am not sure those would be my choice.

  • Trust: A great concept, but how can I be objective here. 
  • Communications: This one is critical.  Did they communicate well?  Did they write down any recommendations?  Do they call to remind me of appointments?  Were they timely in getting me follow-up appointments?  Do they remember who I am from my last visit?  Do they look at me?  If I bring in information, are they receptive to discussing what I found?  Are they straight or do they beat around the bush?  This should also include the office staff – are they friendly?  Bad office staff can blow it for a good physician very easily.
  • Cost: This is another critical one as long as it is not simply about the cost of the physician.  Did they take into account my formulary when writing prescriptions?  Did they make sure that physicians they referred were in network?  Did they prescribe generics or offer me samples?  Did they suggest non-invasive treatment options (e.g., diet)? 
  • Availability: Conceptually yes, but I am not sure your going to learn much here.  The best doctors should be the busiest doctor.  I wouldn’t want them to get a low rating simply because everyone goes to them.  Now, ability to stay on time would be good.  Ability to fit in sick patients within 48 hours would be good.  I might even include accessibility here.  Can I access the building easily if I am handicapped?  Does it have easy parking?  Does it have a place for my kids while I wait?
  • Technology: Why not measure how and if they use technology?  Online appointment setting.  Handheld prescribing.  Kiosks for signing into the office.  EMR. 
  • Outcomes: I hope that we get to a point where Wellpoint is complementing the patient data with outcomes type data or actual claims data.

Just a few thoughts.  You can find lots of blog entries about this.  Here are a few:

Consumerism, Healthcare, Innovation, Managed Care, Marketing / Communications

Companies from Health 2.0

October 4, 2007 by George Van Antwerp 3 Comments

I thought it was interesting to catalog the companies that were at Matthew Holt’s Health 2.0 conference. Many of which I was not familiar with.

MedHelp.org (interesting site which offers Q&A by disease topic with MDs and nurses)

ThinkHealth (medical management software)

Health Evolution Partners (a private equity firm)

Medstory (intelligent search for health)

Healia (health search engine)

Healthline Networks (health search engine)

WeGoHealth (disease specific communities)

Patients Like Me (patients sharing information with other patients)

Daily Strength (support groups)

Organized Wisdom (MD handcrafted search results)

Inspire (health and wellnes support networks)

DiabetesMine (site all about diabetes)

Enhanced Medical Decisions (uses natural language to look at drug interactions)

HealthEquity (health savings account software)

DNADirect (source for genetic testing)

Within3 (social networking tool for physicians)

Vimo (comparison shopping for healthcare)

Careseek (sharing information about physicians)

Health Hero – home health monitoring device

Additionally, John Sharp mentions a few other companies in his blog including:

Consumerism, Healthcare, Innovation, Software, Technology, Weblogs
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Health 3.0 – Ubiquitous Transparency

October 1, 2007 by George Van Antwerp 0 Comments

I was thinking about dieting over the weekend and thought back to an idea I had many years ago.  The concept then was to create a data integration layer for the smart house that integrated the data from your multiple devices.  Imagine the following:

You set a diet plan.  Your virtual health coach (think artificial intelligence) looks at your daily calendar and the food you have at home.  It proactively recommends what you should eat at the restaurant you are going to for lunch; orders a few items from the grocery store to be ready for pick-up on the way home; prints out the cooking instructions; and pre-heats the oven when you are 5 minutes away from home. 

Over time, it plots your caloric intake and suggests workouts based on your calendar and biorhythms. 

If I expand this concept, I would see this as a Health 3.0 type application.  Total integration of data (home, work, health).  Total transparency of information (healthcare, lab, medical, cost, quality, consumer goods).  And, availability of information anywhere and anytime.

I am sure there are definitions, but I think about Health 1.0 and Health 2.0 as the following:

  1. Health 1.0 was several things – workflow oriented applications (e.g., practice management systems), e-prescribing, online content (e.g., WebMD), and transaction hubs.  I saw the focus here on efficiency, quality, and connectivity.
  2. Health 2.0 is still developing and includes transparency and web tools.  I see the focus here on pushing information from companies into the hands of consumers. 

Surprising (or maybe not), there are several people using the term Health 3.0.  Here were a few things I found:

  1. Money magazine article about home monitoring and companies like Health Hero, NxStage, iCare, and CareMatix.
  2. This link which talks about the semantic web but has little other information.
  3. An article about the Health 2.0 conference which mentions Health 3.0:
    • Things start to change when the institutions don’t control all the information. Even though the largest flow of money will still be centralized and often mis-directed, the new user tools will make all the tangles more visible.

      At that point, the Health 3.0 conference will have to include folks from the establishment – government, large software vendors and entrenched health-care institutions.

 Who knows when and where Health 3.0 will really appear, but I generally disagree with the opinion that Health 2.0 isn’t real because there aren’t business models.  In the early dotcom days, the business models were limited.  Those that figured them out – WebMD, Amazon, eBay – survived.  First you figure out the concept and the value add.  Then, you figure out who can pay for it. 

Healthcare, Innovation, Technology

Are Patients Ready for Kiosks?

September 17, 2007 by George Van Antwerp 1 Comment

Everyone is moving to self-service. Quicker. Cheaper. Privacy. Automated. Etc.

There are lots of benefits. Think about all the information which is needed in healthcare along with all the linked processes. If this can be simplified and some of the burden pushed to patients that is great.

Now, this will vary by age and demographic. Typically older people will be more hesitant to use automated technology. Just look at your self-service grocery lines. Additionally, you have to watch interpretation of questions. I will never forget the doctor asking my grandfather if he smoked and him saying yes. I asked for a point of clarification and found out he had smoked 35 years ago.

I couldn’t find all the examples, but I have talked with vendors using kiosks for checking in to an office or hospital, providing translation services, helping match basic needs with over-the-counter medications, simplifying basic services (e.g., picking up a refill prescription), or for pushing information to the patient.

Kiosks blend challenges with physical design (height, location, screen size) with application challenges (number of screens, simplicity, data entry) with business model challenges (costs, advertising (Y/N), patient utilization). But, done right, I clearly see this as key to the future of healthcare. It will help address staffing shortages, address data quality, and help patients take on more responsibility.

Imagine walking up to a kiosk and using biometrics (i.e., retinal scanner, fingerprints) to log-in. Once you log-in, your history (Rx, lab, medical) is all available via your personal health record. You register for your appointment and get pushed health and wellness information that you can print real-time. You can then chose to print information for discussion with your physician based on monitoring of your cholesterol, weight, and blood pressure for your home system. Finally, because you log-in, the system automatically queues up other events for the staff to initiate pending your visit with the doctor.

Here are a few examples of kiosks in healthcare:

And, if you’re really interested in kiosks, you could read Bill Gerba’s blog on kiosks.

Healthcare, Innovation, Technology

Customer Event

September 14, 2007 by George Van Antwerp 0 Comments

What a great week. I have been so busy that I haven’t had time to blog, but I will try to catch up over the next few days.

I always love to mingle with customers and talk to them about their experiences with a company. As a former client, a current consultant, and a future employee of Silverlink, I got to join their customer event this week where 40 customers talked about how they use the technology and services to lower costs, increase efficiency, and grow revenue. Talk about empowering.

Some of the key content / discussions revolved around the following:

  • JD Powers study on healthcare company satisfaction including a great non-healthcare example.
    • It showed how satisfaction with auto insurance actually went up and was higher when the company raised rates but pro-actively told the consumer versus when they lowered rates. Talk about the power of communications.
  • Lots of talk about how marketing and data analytics are going to drive healthcare and how non-healthcare companies are setting the expectations for patients very high compared to the current state.
  • How disjointed healthcare communications are – provider, pharmacy, PBM, MCO, DM companies. No consistency.
  • A great presentation by Liz Boehm from Forrester research which made a few key points:
    • She reinforced the loss avoidance point I blogged about the other day stating that savings is equal to one unit of happiness while loss is equal to two units of unhappiness. So, for many, losing money is a bigger factor than saving money.
    • She pointed out the fact that any healthcare site that quotes a price always has some disclaimer about the accuracy. Why can’t we simply guarantee a price (like any other industry)?
    • She showed that member services (IVR, web) are the 3 most important factor in chosing a carrier after price and network.
    • She showed research that consumers are generally dissatisfied with contacts across all channels from their health plan.
    • She talked about using a persona to design programs and prioritize efforts.
    • She compared channels across cost, reach, engagement, and immediacy.
    • It was obvious that we have a long way to go.
  • Heard from a few customers that talked about how they allow Customer Service Representatives (CSRs) to go “off the clock” to help patients so that they can still track average call time but allow for flexibility.
  • I talked about process innovation and how to apply that to your communication process. I also talked about business process outsourcing.
  • We heard about best practices in driving response rates. Everyone always seems so amazed when they hear about response rates of 50, 60, or 70%. Very difficult to get and/or measure that in other channels.
  • Talked about how MCOs are using the automated call technology – ANOC (Annual Notification of Change) for Medicare, Collections, Lead Management, COB, Missing Information, Wellness Program Recruitment, Reminders, Surveys, and many others.
  • We heard about calculating the ROI with a detailed methodology.
  • We talked a lot about models from other industries that could apply.
  • We talked about data mining and analytics.
  • We talked about member satisfaction, loyalty, and how to survey and capture that information.
  • An outside consultant talked about experience based branding and how sounds can be your brand – Harley‘s engine, Sprint‘s pin drop, Ford‘s door chime, AOL‘s “You’ve Got Mail”.
  • Had several clients talk about how they use Silverlink‘s technology to enhance their product suite

All of the conversations and presentations reinforced how critical successful communications are to healthcare and how big of a hill we have to climb. It was great to see how effective, timely, and personalized the Silverlink technology could make the process. It is worth looking into if you are a managed care company, a device supplier, a PBM, a pharmacy, or even a provider.

Business Tools, Consumerism, Events, Healthcare, Innovation, Marketing / Communications, Research, Technology

Future Possibility?

August 16, 2007 by George Van Antwerp 4 Comments

I always like to try to think out-of-the-box and have tried to see a future where tools like Second Life will affect healthcare. (I haven’t played Second Life which is a virtual reality world being used for all types of things. Look into some of the articles or blogs about what IBM is doing with it.)

I was reading a blog entry yesterday on DigitOwl about some future technologies called semacodes, MyVu, and d’fusion (see below) and then saw a new entry this morning in the eHealth blog when an idea started to form.

Put simply, Semacodes are machine-readable codes that contain URLs. Think “cooler barcode” and you’re on the right track. Almost all advertising will carry Semacodes, enabling consumers to photograph them to connect to information instantly via a mobile device.

The second piece of technology Tom highlights in his blog is MyVu; “funky Robocop-style sunnies” that are already available at apple.com. MyVu glasses plug into your video iPod to create a virtual big-screen within the “real space” in front of you.

The third piece of Tom’s technology pie is something called d’fusion (no, it’s not a fancy French hair product). D’fusion is a software that will allow you to create “augmented reality”. Put simply, a merging of real time, 3D objects/characters with live video.

In the future, could we simply pause when we felt sick, put on our MyVu glasses to create a virtual big-screen wherever we are, use d’fusion technology to enter a Second Life type of environment, and see a whole series of MDs, specialists and others in real-time. They could be anywhere in the world. They could give you an Information Prescription and/or a real prescription (digital of course) with a series of semacodes on it that could be used to take you to other virtual environments or content locations. You could then stop on your way home at a kiosk to pick up any physical drugs or products you needed.

Of course this only works with the advent of Smart Devices that could be used to take all the physical measurements that a clinic, nurse or MD would take, but that seems very feasible.  A device injected inside you which constantly monitors blood pressure, temperature, and tests your blood could address this and push your data to a PHR or other data source that the virtual physician could tap into.

Great. No waiting. Instant gratification. No travel. Access to the best care in the world. Links to lots of information. Seems logical to me.  Already, people are trying telemedicine and telepharmacy.

Consumerism, Healthcare, Innovation

Clothes for Wellness

August 6, 2007 by George Van Antwerp 0 Comments

So what does BodyMedia have in mind…If you read this article from a few years ago, I think they are on to something.  Can you put sensors in people’s clothes without changing the comfort of the clothes – probably?  Can you link those sensors to data driven models to help drive behavior – sure?  Will people wear the clothes, use the data, and change behavior – who knows?

The concept is right.  Embedding technology into everything we do and using that data to push information to us at the right time is critical to changing behavior and driving technology enabled wellness.  I love the picture below of their reporting.  I get this from my GPS watch.  I definitely intend to learn more about what they are doing.

Consumerism, Healthcare, Innovation

Wellness Incentives

August 6, 2007 by George Van Antwerp 0 Comments

Can incentives actually drive wellness? Why not? Why?

Incentives are powerful tools once you understand the healthcare consumer and how they react. Is the incentive a lower copay? Is it a free service? Lots of interesting models are going to come up. It has worked in other industries but can it work here.

I think a lot will depend on the segment of the market and what you are asking them to do. A old person (i.e., a MD worshipper) is unlikely to challenge their doctor and push for certain action. A younger person in good health (i.e., a Living for Today) is unlikely to respond to messaging about pre-screening and general check-ups.

Here are a couple of the things out there:

Another model which will be interesting is existing companies like Maritz which do loyalty programs and incentive programs for other industries.  As they apply their skills to the healthcare market, it should allow this to take off faster.

Consumerism, Healthcare, Innovation

Genomics and Personalized Shoes

August 1, 2007 by George Van Antwerp 0 Comments

A product of one is something that is starting to become a reality.  You have been able to get clothes tailored to your specific body shape for years, but only at the high end locations or overseas.  You are now starting to see mass customization of shoes, jeans, and other items.

At the same time, we have the whole field of genomics which could lead to personalized prescriptions that are customized to your specific condition, genes, and other parameters.

So, with all of this technology available, why can’t we get mass produced health benefits that are customized to the individual and based on their income, family history, personal medical situation, etc.  It would seem possible to say to someone that based on their medical history and family history they are likely to spend $X the following year.  In addition, people of their similar age and geography have a Y probability of getting injured.  Therefore, based on their family and economic status, this is the right plan to minimize their out-of-pocket dollars while managing their probability of a catastrophic health event.

I am sure there is a reason, but I would love to see someone try.  Just a thought.  I saw an advertisement this morning about personalized shoes and began to wonder why we can’t personalize people’s health benefits.   And, I don’t mean simply the ability to buy a pre-defined healthcare plan as an individual, but the ability to provide inputs which custom designs a plan for you using some predictive intelligence.

Consumerism, Healthcare, Innovation

HealthIQ

July 31, 2007 by George Van Antwerp 0 Comments

I came across a new blog with a great entry on a healthcare IQ. Apparently, the physician who blogs here has used it before. It is worth a look.

As the principle for this blog, I disagree with his hypothesis about engaging patients since I think that someone other than the primary care provider needs to play this role. You can see a few of my thoughts in the comment to his entry.

Consumerism, Healthcare, Innovation

Loyalty Programs in Healthcare

July 26, 2007 by George Van Antwerp 1 Comment

I know several people working on this, and I think it will be an interesting challenge.  As I have been pushing for a while, healthcare needs to embrace ideas from outside the industry.  Loyalty is an good one.  But, healthcare has an issue.  For example, how do you reward use of pharmacy without incenting inappropriate utilization.  Or, how do you give points for using an ER without encouring “emergencies”.

The right answer is to encourage wellness, but the question is who pays for this program…the employer is the best option.  Managed care could pay for this, but the question is what is the likelihood of that patient staying covered by the same insurer.  Here is an opportunity for some universal solution where wellness costs were allocated over time to the insurers which owned the patient (e.g., like a depreciating asset where you pay for the initial years even though it may continue to hold some value).

But wellness is not loyalty.  If I am a pharmacy, I want you to continue coming back.  If I am a hospital who keeps building specialty centers, I want to get all of your healthcare dollars.  Probably (if it was possible to get), a loyalty program tied to share of wallet would be right.  For example, if 80% of your pharmacy dollars are at my store, I will give you 1,000 points.  If 90%, then 1,500 points.  Etc.  You would probably need a grid system so that those with the most Rx had the base point system multiplied otherwise someone with one Rx gets the same points as someone with 10 which doesn’t make financial sense.

As mentioned in US Today (July 24, 2007 pg. B1), membership in reward programs is significant across several industries (see the snapshot of reward membership in the US based on data from Colloquy below).

  • 254.4M in airlines
  • 238.7 in financial services
  • 137.4 in specialty retail
  • 124.3 in grocery
  • 107.9 in department stores

A reward system is needed badly in healthcare.  We have plenty of sticks but very few carrots.  Both are necessary in any environment.

As companies like Maritz which have worked in the Loyalty space within other industries increase their focus on healthcare, I think we will see some evolving models.  Stay tuned.

Healthcare, Innovation

Automated Calling Technology

July 23, 2007 by George Van Antwerp 1 Comment

I have had the chance to work with one of my previous vendors on their PBM strategy.  I find it to be a fascinating space – automated call technology.  They are at the heart of the consumerism push and work for 45 healthcare companies today.

Since a call center is often too expensive and often the turnover a killer for quality, that can be a difficult strategy for communications.  Letters are great from the fact that they can be perfectly scripted.  But, letters aren’t dynamic and aren’t real-time.  E-mail is good, but with HIPAA restrictions and other privacy issues, it can be constrained.

Everyone has a phone.  Using push technology with personalization and a dynamic engine for changing messaging has great potential.  We used this technology to drive brand to generic switching when Zocor was losing patent.  We used this to help people who got rejected at the Point-of-Sale understand their plan design (call avoidance).  And, we used this as a complement to our letters trying to move people from retail pharmacy to mail order.  It works.

I am working on the numbers now, but I suspect there is a few billion dollars worth of opportunity sitting on the table if healthcare fully embraces this technology.  By reducing inbound calls and using intelligent messaging to predict events and push information to patients, you can drive changes in behavior and make a difference.

Much more to come here…

Consumerism, Healthcare, Innovation, Software

Myths of Innovation

July 2, 2007 by George Van Antwerp 1 Comment

Guy Kawasaki has another great interview on his blog.  This is an interview with Scott Berkun, author of “The Myths of Innovation”.  If you are fascinated with innovation, this is a good read.  I have tried innovation internally and externally.  These last few start-ups which I have worked on have been great.  This article addresses some of the things I have learned the hard way. 

“Innovators are born and made
Innovators face lots of challenges outside the creative process – support
Get out of the ivory tower and “tinker”

Problem definition (i.e., asking the right questions) is key  (At HOK, we used to use a book called Problem Seeking for architectural requirements which is a helpful framework here.)

There is a lot more here.  I think companies often miss the importance of “sponsoring” innovation through several actions:

  • Encouraging people to try things and having a culture that allows risk
  • Capturing ideas and having people who look across ideas for new combinations of things
  • Having funds allocated to try things…if VCs who get their pick of ideas only expect 2 of 10 to flush out, why do companies look for 10 of 10
  • Bringing in people with diversity (background, culture, education, industry)

Innovation is a critical process for companies.  Thinking about how you create it, capture ideas, and manage your portfolio is important.  In this blog, I have talked about P-TRIZ and Return on Time (ROT) which are both relevant here. 

Books / Articles, General Business, Innovation

Medical Devices and the 10 Faces of Innovation

June 26, 2007 by George Van Antwerp 0 Comments

Today, I unsuccessfully searched for a smart consumer device that would link process and medical monitoring.  I am sure it is out there, but I couldn’t find it.  The opportunities are numerous.

Imagine having a device that monitored your blood sugar levels and sent off messages based on your current levels.  The messages could be to home to make something different for dinner.  It could be a note to yourself to remember to snack earlier in the day.  It could be a note to your physician keeping them aware of your situation.  I think that the opportunities for consumer centric medical devices that have embedded intelligence and plug into some type of BPM or process centric model are great.

Art_of_innovation This made me think of one of my favorite companies – IDEO.  If you don’t know them, you should.  They have been involved in all types of innovation and product design.  The Art of Innovation by Tom Kelley is a great book about their process.  You should also read the article about the different types of innovators in Fast Company.

This article categorizes them into Learning, Organizing, and Building personas.  Which are you?  I am either a Cross-Pollinator or a Collaborator (in my mind anyways).

Continue reading →…

Books / Articles, BPM / Process, Healthcare, Innovation

BPI Example

June 16, 2007 by George Van Antwerp 0 Comments

I often get asked the question of what I mean by BPI or Business Process Innovation.  I often talk about how process can create a competitive differentiator for companies.  There is technical innovation, product innovation, cultural innovation, etc.

Here is a quick example.  I am a die-hard Quicken user.  Every time I get gas, I print my receipt, carry it around for a day, and then enter it in the computer.  To Amoco, Mobil, BP, I am someone what “invisible” as a customer.  They don’t have a relationship with me.

Why don’t they think about their role in the process.  It wouldn’t be too hard to get me to register my cards with them in return for them sending me an e-mail with a digital receipt.  They could even send me a file that I could launch which would place the transaction in Quicken for me.

This benefits me (simpler, no risk of losing the receipt).  And, it benefits the gas companies because they now have a relationship with me.  They could include a coupon for goods inside the store or a car wash with the receipt.  Next time I go in, they can now cross-sell me.

This is what I mean by BPI.  Thinking about the process differently and looking at how you can impact the process in a novel way to capture more value and add value to the constituents.

BPM / Process, Innovation
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