Four questions What do we need to know? How could we predict ? How could we plan ? How could we work together?
Definition System designs that simultaneously improve three dimensions: – Improving the health of the populations; – Improving the patient experience of care (including quality and satisfaction); and – Reducing the per capita cost of health care.
Design of a Triple Aim Health System Enterprise
Purpose of segmentation Number of segments should be small enough Every one in the population should be included Individual segment should have similar set of needs for planning Segments should differ significantly enough from each other
Traditional Segmentation Approaches Medical conditions Utilization Predictive risk modeling Joanne Lynn’s Bridges to Health model
Definition of Personas personas are fictional characters created to represent the different user types within a targeted demographic, attitude, and/or behavior set that might use a site, brand, or product in a similar way.
Chronic Care Collaborative - C3N Project Inflammatory Bowel Disease population Parent and child personas Optimized model for all segments
Design Process Principles - Desirability - Feasibility - Viability Extensive input from patients and clinicians Aim to reduce transactional costs
Healthy Foundations Life stage segmentation 1) Unconfident Fatalists 2) Live for Todays 3) Hedonistic Immortals 4) Balanced Compensators 5) Health Conscious Realists http://www.thensmc.com/sites/default/files/301846_HFLS %20Report%20No1_ACC.pdf Healthy Foundations Life stage segmentation DoH, UK
Health Conscious Realists Highly motivated Feel in control of life and health Don’t take risks and have long-term view Health very important English population Balanced Compensators Positive outlook and behaviours Health is important Focused on looking and feeling good If take health risks, use compensatory mechanisms Unconfident Fatalists Negative health behaviours Don’t feel in control of their health No motivation to improve health Often fatalistic Recognise the need to change Hedonistic Immortals Want to get the most from life Taking risks is part of leading a full life Know that health is important to avoid getting ill in future, but do not really value it right now Live for Todays Short-term view of life – don’t think they will get ill soon Value health, but leading a healthy lifestyle does not appeal Unhealthy behaviours Don’t feel good about themselves Do NOT recognise a need to change HCR 18% BC 17% LFT 29% HI 14% UF 23%
Key findings - Liverpool Needs of each segment differ : – services, communications and support they need for effective self management The approach needed to motivate Unconfident Fatalist to self manage requires much greater resources (both financial and time) than other segments With the ageing population and the number of patients with long term conditions increasing, this is significant problem for the NHS Unconfident Fatalists Long Term Conditions Long Term Conditions & bad health
Clubcard has enabled Tesco to understand their customers to increase the amount they spend Customer data Customer insight Customer management Long term customer loyalty enables… to drive… to achieve… Customer segmentation Communication strategy Business strategy Increased customer lifetime value
Healthy Foundations could enable the NHS to understand their patients to increase the amount they engage / self manage Patient insight Patient management Long term patient satisfaction enables… to drive… to achieve… HF segmentationCommunication strategy Commissioning strategy Increased patient engagement with their health Collecting patient responses to HF questions
Case Study: How Healthy Foundations can help tailor and target campaigns, leading to behaviour change Increasing early presentation of breast, bowel and lung cancer
Where are they? (bowel) Smoking (heavy)* Alcohol (heavy) ObesityDiet (5-a-day) DeprivationScreening non-returns Non-elective admissions (per 1k population) Mortality (per 1k population) Top ranking wards (all factors) Score PictonWooltonClubmoorCentralEvertonPrinces ParkSpeke GarstonChurchNorris Green34.5 Norris GreenChurchNorris GreenKensington & Fairfield KirkdaleRiversideKirkdaleGreenbankCounty30.5 Everton, Kensington & Fairfield Mossley HillCounty, Speke Garston KirkdalePrinces ParkCentralCountyNorris GreenKirkdale30 Speke Garston Allerton & Hunts Cross Anfield, Belle Vale PictonSpeke Garston PictonCroxteth, AnfieldEverton 29 Clubmoor, Kirkdale ChildwallOld SwanCountyKensington & Fairfield CroxtethWooltonKnotty AshSpeke Garston28.5 Belle ValeCressingtonKensington & Fairfield EvertonNorris Green Allerton & Hunts Cross Belle ValeKensington28 AnfieldWest DerbyTuebrook & Stoneycroft AnfieldClubmoorKensingtonClubmoorCroxtethClubmoor24 County, Princes Park, Yew Tree CentralWarbreckOld Swan, Tuebrook & Stoneycroft CountyClubmoorNorris Green, Yew Tree CountyAnfield23 Knotty Ash Yew TreePrinces ParkPictonEvertonMossley HillWarbreckCentral22 Old SwanWarbreckFazakerleyRiversideAnfieldKirkdaleCentral, Clubmoor, Everton, Knotty Ash AnfieldPrinces Park21.5 Sue Cumming, Insight Manager, Liverpool Public Health
What do they look like? (bowel) Top ranking wards 1Norris Green 2County 3Kirkdale 4Everton 5Speke Garston 6Kensington & Fairfield 7Clubmoor 8Anfield 9Central 10Princes Park Most deprived in the city / dependant on the state Elderly reliant on state support / live in bungalows on social housing estates / resident wardens Lower income workers / urban terraces / often diverse areas Single people of older working age or even pensioners 067 M57I43 K49 N61 Low income older couples in former council estates O69 Sue Cumming, Insight Manager, Liverpool Public Health
Marketing strategy Objectives Raise awareness of the signs and symptoms of bowel, breast and lung cancer Increase early presentation to primary care Unconfident Fatalists Least likely to be aware of symptoms Least likely to report symptoms Recognise they have health problems Make ‘excuses’ not to report symptoms (e.g. wasting doctor’s time) Heaviest users of GPs Strategy Targeted campaign to raise awareness of symptoms and raise confidence in presenting to primary care Training for primary care so they know best way to prompt discussions with this segment 20-30% of eligible population
Health Conscious Realists Low maintenance – highly motivated Already engaged with services Most likely to become ‘ambassadors’ for the campaign Most likely to name symptoms Strategy Will be receptive to ‘noise’ around campaign and will need little more to raise awareness and prompt presentation Encourage them to ‘spread’ the word and be ambassadors for the campaign 23-25% of eligible population Marketing strategy Campaign live April – August 2011
Bowel = 19.1%Lung = 7.19%Breast = 0.58% INCREASE IN EARLY PRESENTATION Increase of GP presentations comparing April – Dec 2010 and April – Dec 2011
INCREASE IN 2 WEEK WAIT REFERRALS Bowel = 26.12%Breast = 23.52%Lung = 7.9% Increase in GP 2 week wait referrals between April – Dec 2010 and April – Dec 2011
CASE STUDY: Using insight & HF to inform commissioning, tailor service design and develop tailored communications Borderline Diabetes pathway Public Health Liverpool
Context Support Unconfident Fatalists Live for Todays 1:1 tailored support from known & trusted sources (prefer GP) Don’t like group activities Mentoring to motivate Be careful not to patronise – they know they need to change, they want to know how Like detailed information to take away 1:1 tailored support away from medical setting Prefer group activities with peers Mentoring to prevent them getting bored / distracted Need reminders and often Don’t like detailed information as they get bored easily Wont seek out information – you need to go to them