Putting the ‘mind’ or the ‘me’ into personalized medicine

1. Putting the ‘mind’ or the ‘me’ into personalized medicine Howard R Moskowitz** Kenneth Rotondo Bert Krieger Mary Becker Mind Genomics Advisors, LLC White Plains, New York **Presenter

2. Topics • People differ – what does that mean • People want pleasing experiences – even in illness • What better things can do you say and do when you knew what people want to experience • Examples of such knowledge • Does it really work • Outcome metrics – congestive heart failure • Scaling up for the future

3. People differ in how they respond emotionally in a medical experience

4. Person to person differences • You don’t have to be a scientist or any type of expert to know that there are differences • Just look around at the stores .. Not at the products .. At the stores • People want different experiences • Some want simple in and out • Others want entertainment • Others don’t even want to be there … use web • The same thing happens with the medical experience

5. People differ in what they want • How do you get inside a person’s head? • And even if you could, what would you do? • Can science help?

6. People want ‘pleasant, positive’ experiences – even in medical situations

7. Today it’s all about the customer experience • Fred Reicheld developed the NPS .. Net promoter score .. Would you recommend…. • The NPS value is a placeholder for customer-empowerment • Technology gives the customer the vote • Look at all the instant polls of experience • And in the medical world … the Press Gainey value … just one • So when we talk personalized medicine…we ought to remember the person, his/her MIND

8. A poor experience is a bad thing financially

9. How do you create a pleasing experience

10. Typical approach - questionnaire • Ask the respondent (e.g., patient) to describe the experience • And then use that as a report card • Objective …. Improve the experience for the patient using feedback • This isn’t personalization … it’s merely general quality control

11. HCAHPS – Hospital Survey(32 questions) Hospital level results are publicly reported on the Hospital Compare website 4 times a year. HCAHPS results are based on 4 quarters of data on a rolling basis. Composite topics Nurse communication (questions 1, 2, 3) Doctor communication (questions 5, 6, 7) Responsiveness of hospital staff (questions 4, 11) Pain management (questions 13, 14) Communication about medicines (questions 16, 17) Discharge information (questions 19, 20) Care transition (questions 23, 24, 25) Individual topics Cleanliness of hospital environment (question 8) Quietness of hospital environment (question 9) Global topics Overall rating of hospital (question 21) Willingness to recommend hospital (question 22)

12. Examples from the Questionnaire 5. During this hospital stay, how often did doctors treat you with courtesy and respect? 1 Never 2 Sometimes 3 Usually 4 Always 12. During this hospital stay, did you need medicine for pain? 1 Yes 2 No  If No, Go to Question 15 13. During this hospital stay, how often was your pain well controlled? 1 Never 2 Sometimes 3 Usually 4 Always 14. During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? 1 Never 2 Sometimes 3 Usually 4 Always

13. Point of view • The questionnaire is an evaluation of the experience (bad to good) • There are NO SPECIFICS listed as being desirable • There is NO WAY TO USE for an individual to drive change..other than by guessing • There is NO TEACHING HERE, just a report card

14. Mind Genomics ----- Understanding the patient’s ‘mind’ without years of analysis on the couch

15. The reality of today pushes for measurable experiences • The strive to measure makes ‘measurement’ the end all and be all • ITRS (it’s the rating, stupid) • We behave according to the laws of reinforcement • Reinforcement scores..and whatever gets a high score is important • And thinking…think about what will raise the score • Reminds us … of school…study for the exams, like the SAT … rather than learning

16. An alternative idea • Let’s understand what the patient feels about different touch points, experiences in a hospital • But without massive expenditures • Without masses of fairly expensive in-depth interviews ..which are valuable but can’t cover the full range • So I’ll talk about our approach • In the formative stages, with data

17. How we do it: S-R (stimulus response) • Present vignettes of the experience .. Different aspects • Get responses • Adherence – can you comply • Experience – do you find this pleasant • Use statistics to deconstruct vignettes into what components ‘drive’ the response • Result – understanding the experience

18. We illustrate with data • Understanding: Teens facing the hospital • Understanding: Talking to adolescents about weight • Understanding: What Afro Americans want for health care • Convincing: Woman to select hospital in which to give birth • Convincing: Communicating to the poorer Afro American, for colo-rectal screening • Convincing: Congestive heart failure patients to adhere to a healthier life style (and 70% DROP in within-30-day-readmit)

19. The Process Flow Target Clients Distribute Online Survey Strongest Messages Identified Develop 6x6 Survey/Statistics Matrix Identify Target Population Conduct Online Survey Mind Genomics Viewpoint Groups Segmented Analyzes Survey Results Viewpoint Identifier Assigns Consumers To Identified Groups

20. Case history #1– UnderstandingThe teen facing the hospital

21. Teens and doctors in hospital • Personal Attention 27% • Permanent Bond/Mentorship 38% • Honest/Open communication 35% Messagingone group doesn’t appeal to the other…

22. The test stimulus: A vignetteCannot be ‘gamed’ . No PC here

23. How to Read the Data – A regression model is used to calculate the individual impact of each message to motivate an individual “to take a screening test to prevent colon cancer”. A separate model is run for each analytical group/column. Scores shaded in green have positive impact within a given column “take a screening test to prevent colon cancer”), those shaded in pink decrease motivation, unshaded scores have no impact for that group. Structure of data – What you will seeWhat each messages delivers (estimated by regression)Is it a relevant message, and to whom “Propensity” score is the unexplained variance in the regression model. Represents motivation which cannot be attributed to any single message but must be taken into account when assessing overall motivation of an analytical group. Messages may not have similar impact across analytical groups Even scores which appear neutral for Total Sample may mask strong differing opinions among other groups Some messages hold no appeal regardless of target

24. What these numbers mean • Constant represents people’s initial propensity to say yes (rating 7-9) on the 9-point scale • A baseline.. In the absence of elements • Each element generates an estimated driving power • We are looking for standout messages which break through the clutter • These stand out messages are the ones to use

25. Mind Genomics revealed three mind-set segments for teens facing hospital

26. Case history #2: UnderstandingTeen girls with eating problems

27. Three Unique Segments Emerged The ‘Aware, But Don’t Care’ The Control Seekers The Low Self-esteem Team 27

28. The Survey begins with an orientation screen

29. Each respondent evaluates unique combinations of elements

30. The Control Seekers- These are girls who are not necessarily overweight, but feel as though they have little control over their lives, and therefore seem to seek this control by limiting how much they eat.

31. The 'Aware, But Don't Care’-These girls are average in body weight and self-esteem. They are aware of how much they eat, and know that it might not be the healthiest way, but aren't motivated to change their habits out of stubbornness and/or laziness.

32. The Low Self-esteem Team- These girls have very low self-esteem, criticize themselves frequently, and feel inferior to their peers due to their weight. Additionally, many have some sort of family history of health related problems due to poor eating habits.

33. Case history #3: UnderstandingWhat Afro Americans want for health care from the US government (election year platform)

34. The approach • Identify elements from key websites and government information • Put them into the Mind Genomics format • Afro-American respondents • 20 elements, combined into 25 different combinations … standard Mind Genomics ‘torture test’ • Look at total panel, and identify interpretable segments • Four segments emerge …different desires

35. Total – all Afro Americans – No clear pattern of elements

36. Afro-Americans on Health PolicyMind set segments 1 and 2

37. Afro-Americans on Health PolicyMind set segments 3 and 4

38. Case history #4: Convincing“Selling” a hospital for birthing

39. I’m expecting a baby…What hospital do I choose for delivery?

40. What appeals to the majority of surveyed women? What turns them off?

41. Different women – different preferences Seg 3: Realistically Prepared (18%) Seg 1: Professional Staff (33%) Seg 2: Family Utopia (33%) Seg 4: Pamper Me! (16%)

42. Let’s look at the 4 different segments or mind sets

43. Segment 1 (33% of population) – interested primarily in professionalism of staff. Not concerned with atmosphere.

44. Segment 2 (33% of population) – looking for family-friendly atmosphere. Not concerned with private rooms or emergency care.

45. Segment 3 (18% of population) – wants to be prepared for any outcome. Not too concerned with luxury care for moms.

46. Segment 4 (16% of population) – wants to be pampered. Looking for Mommy-centered experience.

47. Case History #5: ConvincingCommunicating to poor Afro Americans need for colo-rectal screening

48. Short background • Goal – how to motivate poor Afro-Americans to get regular colo-rectal screening • Early detections saves hundreds of thousands of dollars • Results – Four mind-sets • Create viewpoint identifier – four questions to identifier which mind-set, to give correct messages

49. Colo-rectal screeningThe four mind-sets or viewpoints (segments) Viewpoint 1 I Am Convinced 57% of sample This viewpoint is motivated to get a screening test to prevent colon cancer. There is no discrimination across the test messages because all of the messages are motivating. Viewpoint 2 Screening and Prevention 15% of sample Talk about the benefits of screening…early detection prevents death from colorectal cancer and why without screening symptoms appear to late to cure. Also encourage the client with concerns about the procedure to speak to someone they trust. Viewpoint 3 Personal Appeal and Early Detection For A Cure 14% of sample This viewpoint is motivated when the messages relate to a personal perspective and early detection to stop cancer. Viewpoint 4 I Am Convinced…Don’t Talk About Risks and Consequences 14% of sample This group is highly motivated to get a screening test. Avoid discussing risk factors, death and concerns related to colon screening because these messages are behavioral barriers.

50. The 30 second Viewpoint Identifier identifies segment affiliation when administered to a client Click to See Live Demo of Typing Test. Click Here