The CX Files—NBA: The key to digital-first experiences in healthcare?
As the healthcare industry shifts to digital-first experiences, there is a growing opportunity to leverage prescriptive technologies to personalize engagement for healthcare practitioners and patients, and enable data-driven decisions that improve patient care.
Across the life sciences industry, there has been a groundswell of interest in Next Best Action, better known as “NBA.” In recent months, the term has come up in seemingly every other call I’ve been on with clients, ranging from global life sciences firms to biotech start-ups, from medical device manufacturers to diagnostics solutions companies. Much of this interest has come from commercial leaders, specifically those involved in commercial operations or field force management.
The rise of NBA
For those unfamiliar with the term, NBA refers to various solutions that use artificial intelligence (AI) and/or machine learning (ML) to make decisions or provide customized recommendations. While the concept is by no means new, recent advances in AI and ML have not only made these concepts more viable, but more importantly have widened the scope of applicability to new areas hitherto unimaginable. Some interesting NBA products that have hit the market in recent years include IQVIA’s Next Best recommendation platform, Pega’s Customer Decision Hub, and of course Salesforce’s Einstein Next Best Action solution, for example.
In this regard, NBA offers some interesting solutions that drive recommendations to reps while they are in the field. Which healthcare practitioners (HCPs) should be called on today? What messaging format does Dr. Jones prefer to receive, and on which day? Does Dr. Smith prefer content that focuses on safety/efficacy, or is she more interested in how this treatment can result in value-based outcomes? NBA offers the promise of equipping reps with a list of intelligent, actionable recommendations as they go about their job, improving performance while resulting in enhanced engagement with HCPs. When I’ve seen this done right, the winning solution usually involves something along the lines of providing reps a daily list of things they could potentially do, with a requirement to follow, say, four out of 10 of them per day. It can be extremely effective.
The concept of applying AI/ML to enhance field force performance is not a new one. An early entrant in this space was Aktana, a tech firm based in San Francisco that built a contextual intelligence solution that, among other things, acquires knowledge from HCP interactions to support reps with intuitive, actionable suggestions and insights. Aktana was founded in 2008.
Across the industry, similar to Aktana’s core features/use cases, most discussion on NBA has been related to field force enablement. This is not super surprising. Commercial organizations have long been searching for innovative solutions, tips, tricks, and technologies to improve field force effectiveness. With large teams of reps scurrying around doctors’ offices with tablets in hand and bags full of samples, the field force is at best a necessary evil and at worse an expensive and outdated institution in need of improvement or outright reform.
A challenge to the existing commercial model
To an outsider, the field force is in many ways an anachronism. Try explaining how the pharma commercial model works to anyone unfamiliar with the industry and you’ll invariably get a look of amusement or downright confusion. The field force is composed of hundreds — if not thousands, depending on the TA (therapeutic area)— of reps who call on HCPs to deliver pre-approved safety and efficacy information that can never go “off label.” It’s a wonder drugs are commercialized at all. But this is the industry’s commercial model, the same one we’ve had for decades.
In most commercial pharma organizations, the field force is the single most expensive line item on the commercial ledger, with marketing running a close second. Brand marketers and their agencies create content, and then work with the field force to ensure reps are properly trained to present it. The reps — AKA “the field” — go out into the wild to call on HCPs to inform them of the drug’s benefits. Then poof, like magic, scripts get written and market share for the treatment begins to grow.
To anyone who’s worked in the industry for a while, it’s not exactly a state secret that access to HCPs has been on a slow-burn decline for many years. The reasons for reduced access are manifest. For one, healthcare institutions are inexorably consolidating due to mergers and acquisitions, concentrating purchasing power — and formulary decisions — into the hands of a select few executives, not HCPs. At the same time, the industry has been under intense pressure to adjust to the shift to value-based care (and with it the emergence of alternate payment methods), taking some decision-making power away from HCPs, while — in theory anyway — shrinking the total amount of dollars dedicated to healthcare.
Another sometimes overlooked, but no less important, reason for pharma’s reduced access to HCPs has been the generational shift within the healthcare workforce itself. As years go by, a workforce of HCPs comprised mostly of boomers has given way largely to a group of Gen X and millennials who, because they tend to skew more towards digital natives than their predecessors, prefer interactions that take place across digital channels, as opposed to in-person. This trend was already well in place a decade before 2020…
Enter: COVID-19. Acting as an accelerant, the global pandemic poured gas on all these trends, greatly magnifying their impact across the industry. When most of the world went into lockdown in March 2020, the industry faced the frightening trifecta of no in-person access, fewer patients seeking treatment in certain indications, and reduced healthcare budgets. Pre-pandemic, “digital first” was a cute slogan. As the pandemic wore on, it became an imperative.
Thinking beyond the technology
To be frank, I find most current industry definitions of NBA to be limited both in scope and imagination. Taking a broad view, NBA has significant potential to impact far beyond the field force. The real opportunity centers on using these technologies to personalize customer — i.e., HCPs, patients, caregivers and other stakeholders — engagement and enable data-driven decisions that impact the customer journey in a true multichannel manner. Using this definition, NBA becomes multichannel Journey Orchestration, colloquially referred to as JO.
For those unfamiliar with the term, JO refers to the ability to deliver real-time, personalized experience across channels, through a combination of technology, data, and process. Using this broader definition, NBA is thus more than simply a tool for providing recommendations to the field; it’s a robust capability that delivers in-the-moment, personalized experiences to customers across multiple channels, both in-person and digital.
What are some use cases for this broader definition of NBA? An obvious place pharma brands can leverage NBA within is the contact center environment for patient support programs (PSPs) or HCP engagement. One thing to consider is during the pandemic, the humble contact center became the main customer interaction hub as call volumes went up considerably. Early in the pandemic, for example, contact centers saw increases of 300% in call volume. It safe to say many of these behaviors will ultimately stick, and both patients and HCPs will not only continue making more calls, but expect high-quality, personalized interactions when they use the engagement channel. Applying NBA to the contact center should thus be a strategic priority for any brand, boosting agent and customer experience.
Where we’re headed: NBA 2.0
But why stop there? Looking more broadly, NBA can mean using first-party data and AI/ML to personalize content and interactions across all channels: web, email, chat and so on. The possibilities are limitless, and I’m seeing some really cool stuff emerge. For example, I’ve been working with one large health system that is creating a customer engagement platform that merges clinical and marketing communications information in a data layer that can be leveraged in a HIPAA-compliant manner, via microservices, by various players in their ecosystem.
Sitting on top of this platform is an experience layer containing a headless CMS and a robust digital asset management tool to store and manage assets. Once this engagement platform is fully built, it will be easy to spin up and launch new digital touchpoints that leverage the rich data layer to meet patients where they are.
The end goal is the ability to integrate these previously disparate data sources and democratize the development of digital solutions across the patient journey, from awareness to treatment and beyond, with the goal of building a better, more holistic and patient-centric experience. This will of course require this organization to become much, much better at creating, launching and supporting digital products — in essence developing a product-centric operating model — but that’s a story for another post.
Another place I’m seeing discussion about NBA is within clinical decisioning support, or CDS, which basically refers to any technology that provides HCPs (clinicians, staff), patients, or caregivers with information and recommendations, intelligently filtered and presented appropriately, to enhance healthcare delivery and boost outcomes. While CDS has a steeper regulatory pathway than other digital health solutions — for example a glucose monitor or a smart pill solution — it’s compelling to imagine a future in which treatment is guided and enhanced with NBA, potentially delivered via smartphones and other consumer electronics devices, linking seamlessly to electronic health records and other clinical tools.
While many of these NBA initiatives are speculative and still in their infancy, there is no doubt this is where things are heading in the industry. Net-net, I expect significant investment in this space in coming months and years, and it’s an exciting space to be in.
With the rapid pace of change in marketing technology and ever-shifting consumer expectations, it can be hard to keep up with the latest trends. The CX Files was created to report out what the leader of Slalom’s Global Experience Team, Rio Longacre, is seeing from the field.
Rio Longacre is an executive with two decades of leadership and experience in the digital space across strategy consulting, technology services, data, and media planning. He’s a frequent thought leader and subject matter expert in customer experience management, digital business transformation and marketing/advertising technology. Reach him at riol@slalom.com.
Slalom Customer Insight is created by industry leaders and practitioners from Slalom, a modern consulting firm focused on strategy, technology, and business transformation.
