16: A Person of Influence.... The KOL and the Chasm
Issue 16
Me-Too or Truly new?
Be honest - is your product innovative? Does it dramatically change the way that medicine is practiced? Or is it a nice improvement or add-on to what is currently being done?
If it is the latter, your customers will understand your product and market influence needs will be limited. But you will also be slugging it out with the other competitors that also can offer a similar solution.
If it is the former, then your product, its uses and benefits may not be intuitive. You will need to change behaviors (difficult!) and opinions (very difficult!). You will need to teach customers about the data that your team have developed. You would be wise to have a person of influence telling the story of your product. A Key Opinion Leader (KOL).
The KOL Profile
Think of a physician......
The origin of the term "Key Opinion leader" is somewhat obscure today, but it takes its origins from early studies in mass media and how customer audiences are influenced by it. Paul Lzarsfeld and his collaborators formed a model of how messaging is disseminated in a mass audience when the message or technology is new. In the model, rather than learning and making independent choices, people tended to seek opinions from others with influence and expertise who first assessed the new, and then guided others. Lzarsfeld's later, Pfizer-supported study of market adoption of a new drug led to a model that included the "Key Opinion Leader" in medicine - typically a physician that "interpreted" advertising and media messages for other physicians, then influenced them in their adoption of the new drug or technology. Networks (numbers of connections) are important, but so are the strength of the links.
In effect, KOLs mediate between pharmaceutical companies and important audiences: they are hired or wooed because of their potential to — as the term indicates — lead opinions. - Sergio Sismondo - CMAJ, 2015
This model is in full swing today. How do I know? In the most recent year for which data is available, 2023, $12.75 Billion worth of payments were made to physicians by pharmaceutical and medical device companies. We know this because the Sunshine Act of 2010, now requires such payments to be "open" -- reported on a publicly-available website. On this site, you can determine if your own physician has received payment from any healthcare company, and then make your own determination if such payments might have influenced his or her medical treatment choices.
While such payments are categorized by their purpose - General Payments, Research, Ownership & Investment - It is not unreasonable to believe that most of this money is directing the development of research to support differentiating messages for medical products, and then the dissemination of this information by influential healthcare speakers and writers. And of course, a true Key Opinion Leader will often have received payments well above average for others of his or her specialty - and often from more than one company.
Some will read the above paragraph and decide that something crooked is happening, and be thankful that it can be monitored from publicly available data. Others will be jotting down the CMS Open Payments website to begin shopping for their next KOL speaker, using payment magnitude as evidence of influence! Both can be right. The key is not the ethics of the process, but the quality of the message. A physician speaking about a technology that they know, and truthfully expressing its benefits and limitations, is helping the patients of their physician audience members and they should be compensated for their time. A physician speaking on behalf of a technology that they haven't vetted properly, or which has poor support and evidence for its claims is risking misleading his or her audience and may even be skating at the edge of legality. (But I'm not a lawyer....)
The Early Market and the Chasm
Geoffrey Moore, a well-known business writer and consultant with extensive experience in these areas, has written in detail about the process of adopting a new technology in an existing or new market. His framework applies to those products that are totally new - which require that users change their behavior, or in some other way do something completely different from the past. The new solution is very unlike the old - a disruptive innovation. For products like this, he breaks the market into 5 segments based upon, primarily, the willingness of customers to adopt your new solution at each stage of its development. But I will reference his simplified model - that of the "early market" and the "late market", with a chasm (space or disruption) between.
...[I]t is 1998, and for this time we have seen a commercial release of the electric car. General Motors makes one and Ford and Chrysler are sure to follow. Let's assume that the cars work like any other, except that they are quieter and better for the environment. Now the question is: When are you going to buy one? - Geoffrey Moore, Crossing the Chasm, chapter 1 (emphasis added).
The Early Market consists of those customers that have a vision for your product, are excited by it, and are willing to invest themselves into its development and adoption. The first surgical robots (proposed conceptually in the 1970's from NASA - Bogue, Indust Robot 2021, 48:3, 335-340) would fall into this category. Yes, they had limited use cases. Yes, they needed better accessories and software. Yes, they were expensive. But look at their potential! Pedicle screws are placed exactly by the robot, even if it is hard to do anything else with them. The innovators and early adopters - those surgeons and hospitals that had a vision for what these devices could do and were willing to work toward it - were quickly on board. They were the early market.
But then there was a gap - a chasm between those that had purchased and loved the early machines and the late market users. How many unused robots sit in the basement of your hospital?
Why the gap? Because the later customers required a different value proposition to get aboard the robotics train. They cared about efficiency, and repair history, and manufacturer reputation and cost and breadth of applications, and software updates and outcome improvements and a host of other things that none of the early users required. Without addressing these new needs, you will not sell another robot into this new market.
This leads directly to the strategy for crossing Moore's chasm. You must build an entirely new value proposition that meets the needs of your new (Late) customer segment, and which you know will take little from that of your prior (Early) customers. Most of the elements of your value proposition for the early market simply aren't relevant for the later market. Without changing your message, offering, and the ecosystem around your product, you are doomed to live in your small early market. You cannot skip the early market, because you need the enthusiasm of its visionaries. But you cannot stay there. And the difficult crossing is the only way to reach the vast Late Market customers.
Enter the (new) Key Opinion Leader.....
All of this requires references to messages and value that matter to your Later market. Initially surgeons used the robots in interesting and publishably novel ways. They spoke as visionaries of a new technology, and showed what was possible.
Eventually the visions gave way to research showing time savings, the development of adjacent software and accessories for greater utility (such as surgical planning, setup and workflow - Biomed Eng Lett 2023, 13:537-42). KOLS were now those who were leaders within hospital management, and could talk about efficiency and penetration in their healthcare market as a result of robots. The "product" now included the robot, but also software that makes it better fit within the usage case. The value proposition now included procedure time savings, the ability of hospitals to market their technical innovation to the communities that they served, and purchasing programs that let the hospital system "earn out" the cost of their robot through purchasing other products sold by the distributor. The product was "expanded" into a "whole product" to make it more desirable to a broad surgeon user population, and their hospitals that must buy in as well.
This transition is "Crossing the Chasm" according to Moore, and leads to a vastly different story from that of just a few years earlier. Meanwhile, the surgeons that were so influential in the early market have "swum back upstream" to take on the next innovation flowing into in their field. Some may stay to tell the new Late Market story -- but this role will mostly go to a new kind of KOL, who speaks the new language of the Late Market.
The transition includes clinical trial, efficiency and health economic results -- with KOL speakers telling the product story at conferences, luncheons, dinner meetings, medical education events, social media, podcasts, webinars and a host of other venues. It is the modern format for innovating, and then gaining broad adoption of your medical innovation.
It requires planning, care, timing, evidence, and yes -- influence.
Shaping Innovation for Medical Commerce
Engaged.....
(c) 2024 Todd M Boyce | Some images created using DALL-E3 or Adobe Firefly. Payments data taken from the CMS Open Payments website.