Episode Six: Impact-driven community digital health innovation with investor & innovation executive, D.D. Johnice
The Empowered Patient Podcast
Going beyond sick care requires informed and empowered patients. This is achievable through price transparency and unbiased quality care that meets both public and private health insurance regulations. This podcast aims to explore the intricacies of quality patient care through thought-provoking conversations with providers, healthcare executives, corporate CEOs, technologists and patients. We will also seek to provide you with simplified actionable paths to feeling good and living well.
CEO/Chief Strategy Officer, The Wonder Guild. Formerly Sr. Director, Community Health & Social Innovation, Kaiser Permanente. Founder of The Wonder Guild companies, a speculative design and innovation consultancy that helps enterprises discover, design and bring to market sustainable new products, services and business models. She and her Wonder Guides connect global startups and corporates, advise innovation leaders, develop unexpected partnerships to co-innovate the health, consumer packaged goods, financial services, energy and supply chain industries.
Previously, Ms Johnice led the Community Health Innovation Lab for Kaiser Permanente, an $80B US healthcare provider and insurer where she designed a model for accelerating affordable housing and accelerated emerging solutions to address socioeconomic determinants of health.
Harvard and Boston University-educated innovation executive, investor, startup advisor, and entrepreneur. D.D. is a uniquely capable and innovative business leader who happens to specialize in communications and technology platforms for the 21st century. As an accomplished, creative strategist, speculative designer and futurist skilled in solving business challenges using design, innovative applications of technology, non-traditional operating models and unexpected partnerships. She has helped clients design ecosystem-fit products, services, business models and solutions that sustainably achieve exceptional and measurable financial and organizational goals.
Through her work leading corporate innovation in the healthcare, technology, advertising and marketing, and financial, business and professional services industries, she had the privilege of designing new, self-sustaining, high-impact solutions that leverage what’s best in people, communities, nonprofits, business, government and technology to solve the greatest health, social and economic challenges we face as a society.
Episode Questions:
1. Our conversation today is with Harvard and Boston educated innovation executive, entrepreneur, investor and startup advisor, D.D. Johnice. Welcome to the show. D.D. how does digital and med-tech companies design product that gets buy-in and adoption from patients (consumers), health plans, employers, health systems, and government institutions?
2. How can we design solutions that go beyond identifying chronic disease and treat root-causes that nudge consumers towards demand-driven behavior change for wellness and thus generate super-hero results?
As American society strives to build healthier communities, it confronts nature’s cruel trick (human beings aren't built for modern life) and an unholy trinity of processed food, industrialized agriculture and a healthcare system that treats symptoms of chronic disease instead of its root causes. These realities are mutually reinforcing and diminish America’s overall health status. They’re making Americans sicker, more isolated and less productive. Lifestyle transformation is the only way to reverse these negative trends. Consumers influence market dynamics with every purchase they make, every meal they eat and every activity they pursue. Demand-driven reform generates super-hero results. The good news for Americans is that better lifestyle decisions (and purchases that support them) will make us happier, help us feel better, give us more energy and lead to more productivity. As more Americans embrace healthier lifestyle decisions, the market will respond with better and more available products and services for health-oriented buyers. Improving the health and wellness of America’s communities is this generation’s greatest challenge. Since chronic disease disproportionately afflicts low-income communities, failure to reverse negative lifestyle trends threatens America’s quality of life, prosperity and sense of fair play. Innovation and rising to big challenges are American hallmarks. Epigenetics, behavioral psychology, cool technology and social connection are powerful tools for improving individual and community wellness. We should use them all. It’s time to NUDGE America and Americans toward wellness. It will make our country better, our communities more prosperous and, most importantly, our people healthier.
3. In 2019, CVS invested $67 million in growing affordable housing options across the U.S. last year—and the healthcare giant said it’s hoping to significantly grow those investments in 2020. In 2019, the investments made nearly 300 new permanent supportive housing units available, which target people who are impacted by domestic violence, chronic illness, homelessness and addiction, officials said. CVS’ funding also backed the creation of 450 units for seniors, 59 for veterans and their families and 38 dedicated to Native Americans and their families. The efforts are a critical part of the company’s Destination: Health initiative, which targets social issues. Is the future of creating health for the population, social determinants of health (affordable housing, transportation, food equity, etc)?
“I think housing is the anchor, and the spokes are all of the other things that help address the social determinants of health,” Garth Graham, M.D., vice president of community health and impact at CVS and president of the Aetna Foundation, told Fierce Healthcare.
4. Community health is complex because it involves getting human beings to foster trust and create a partnership that moves consumers to better health outcomes. Where do you start with community health partnerships that move the needle of change and impact?
5. In creating healthier communities, individual zip code and availability of rich soil for agriculture and availability of healthy food determines better health outcomes, can you elaborate on this?
6. You spent almost seven years with Kaiser Permanente as Sr. Director of Community Health and Social Innovation. How has this work changed your leadership style in creating value for health consumers and their stakeholders?
7. What can digital and med-tech companies do to drive transformative change without large marketing budgets (is it a focus on content strategy, amazing product design, great customer feedback loop)?
8. What is the role of advertising, marketing, and product design to nudge consumers and their communities to adopt healthier lifestyles?
9. As an author of Everybody Else’s Guides, if you could have a billboard with anything on it, what would it be and why?
10. Which hurdles did you personally face during your career and how did you overcome them?
11. In their 2008 best-selling book, Nudge: Improving Decisions about Health, Wellness and Happiness, Richard Thaler and Cass Sustein applied behavioral science to “nudge” individuals into making beneficial healthcare choices. The authors describe this approach as “libertarian paternalism.” It incorporates three basic human traits: bounded rationality; bounded willpower; and bounded selflessness. To exploit bounded rationality, Thaler and Sustein recommend that cafeterias array food choices to encourage healthier choices. Most people engage in mindless eating. Paternalistic libertarians can tame this impulsive behavior by adjusting environmental factors such as plat size (smaller), glass shape (thinner) and food placement. Altering these factors encourages smaller portions and healthier food choices. Is it effective to tax unhealthy products than subsidize healthier alternatives?
12. D.D., what fundamentals have shaped your investment philosophy/criteria (time as a founder, time as a startup advisor, and investor)? What do you look for in founders and milestones they must be achieved for you to make an investment?
13. Make It Fun. Make It Easy. Americans know they need to eat smarter, smokeless and move more. Getting Americans to actually do these things require reorienting home, work and play environments. Emotional connection is essential. That’s why it’s easier to quit smoking with a friend. Convergence media is among a wave of disruptive, accessible technologies (kiosks, activity trackers, home monitors, decision aids) that gives consumers new tools to manage their health. Hip, user-friendly smartphones with powerful apps make behavioral changes fun while connecting participants to like-minded friends. Wellness-friendly work environments also encourage healthy living. How did you implement these with your work at The Wonder Guild and previously at Kaiser Permanente?
14. How do we design and use survey/questionnaires to gather information of employees that encourage healthy behaviors, recommend the appropriate type/level of care for each member of your workplace?
Psychologist B.J. Fogg runs the Persuasive Tech Lab at Stanford and is expert at designing strategies to alter behavior. Fogg believes the following three elements are essential for behavioral change: Motivation (high to low); Ability (easy to hard) and Triggers (natural and designed). When the desired behavior does not occur, one of these elements is missing. Fogg has assembled these elements in his Fogg Behavior Model (FBM) that incorporates three core motivators, six simplicity factors and three types of triggers. Behavior change requires Libertarian Paternalists to get specific (identify desired behaviors and outcomes), make it easy (simplicity changes behavior) and use the right triggers (no behavior change happens without a trigger). FBM provides a powerful framework for simulating behavior change.
Within that context, here are several proven tactics for promoting healthier behaviors: Make it Easy: Set achievable goals, take baby steps, make it cheap, make it fast and understandable; Measure: Track food consumption and activity. Make healthy choices top of mind. Find ways to transmit data automatically to personal health records; Celebrate Success: Applaud achievements in public and virtual ways. People have an unlimited capacity for positive feedback. People will walk several flights of stairs to win virtual merit badges; Eliminate Negative Cues: Get the cookies out of the house; take a walk to beat the afternoon blahs; Encourage Team Activities: Bind people in wellness activities, such as competitions, mutual commitments and coaching. Behavior change is always easier with a buddy, and Calibrate Incentives: Offer positive and negative rewards. Make it fun, edgy and entertaining to complete a health assessment. Make it painful and expensive not to.
15. How do you become wellness heroes and rebels with a cause for patients? (Medical science is amazing. Healthcare is complicated. Good health is a basic human right to which millions lack access)
Making Wellness Cool Thirty years ago, “tree hugger” was the derisive term applied to environmentalists. Today it’s cool to be green. Markets love cool. Companies respond with products and services for cool customers. Hybrid cars, LEED-certified hotels, reusable water bottles and all manner of environmentally friendly products and services populate American commerce. The environmental movement changed attitudes and behaviors. A similar wellness movement is now underway. Americans are waking up to our national lifestyle challenge and the market is following with healthier foods, activity trackers, lifestyle management tools, entertainment and media attention. Targeted and cool messaging works. Ask Texas. In 1985, the Texas Department of Transportation was spending $ 20 million a year to pick up beer bottles and other trash from the state’s highways. The biggest litterbugs were young men and traditional appeals weren’t reaching them. Admen Mike Blair and Tim McClure of GSD& M came up the slogan “Don’t Mess with Texas” to persuade “bubbas in pickup trucks” to stop littering. The slogan appeared on road signs along major highways, in television and radio commercials and in print advertisements. It worked. Between 1986 and 1990, litter on Texas highways decreased 72 per cent. Through similar messaging strategies, health advocates found that the yuck factor was more effective at encouraging handwashing among rural women in West Africa than education campaigns. Likewise, premature wrinkle warnings reduced tanning-bed usage among teenage girls substantially more than skin cancer education. Human connection, the cool factor, heuristics, triggers and technology are smart tools that Libertarian Paternalists can employ to make it easier for people to make better lifestyle choices. It’s best when people think that behavior change is their idea. In many ways, using these strategies levels the playing field and gives wellness a fighting chance against sophisticated messaging from commercial enterprises. It needs to be as cool to eat a veggie burger, as it is the Great American Thickburger. American health and wellness depend on it