The Crossroads of Marketing & DGTL Health (ft. Sarah Sanders & Dr. Aaron Neinstein)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation, challenges, and opportunities across healthcare and life sciences. And now, your host, Ed Marx.

Welcome to Digital Voices. Today we're going to talk about digital health, but also marketing, because we all know that digital health in and of itself will be kind of limited if you don't have a good marketing partner. So today we have an awesome guest that'll share a little bit about how they work together from a digital health and marketing perspective to really make for awesome patient experiences. So before we go there, Megan, because you work in marketing, what are your thoughts about marketing and how you work with tech? Because you're in an advisory tech consulting firm, you obviously have this sort of relationship going on. How does it work for you?

Oh yeah, definitely.

SEO and analytics to Creating and maintaining those relationships.

The digital marketing experience is 100% driven by technology.

Cool. Yeah, you do a great job. Appreciate you being the producer of Digital Voices. So with that, I want to introduce my friends from UCSF, University of California San Francisco, one of the premier medical organizations in the world doing great things, not just in San Francisco, but beyond. And today with us, I've got Sarah Sanders. She's the Senior Healthcare Marketing Executive at UCSF, and Dr. Aaron Neinstein, who heads up digital health. He's Vice President of Digital Health. And so the great partnership that you're going to hear about and how we first met. So Aaron actually reached out to me because we're both pretty active on Twitter, and he realized that we were both at the same conference. It was a healthcare marketing type of conference, digital health. And so we connected and we're like, let's go running because we're both runners. So we actually met, went for a run. It was kind of fun, right, Aaron? And we went up to the capital of Utah. So this was in Salt Lake City, ran up that very steep hill. But the good news is we got to come down that same hill. We took a few pictures here and there of some of the sites within the city, but we just connected like on the whole digital and the whole patient experience and family experience. And we were talking about how important this relationship was. So welcome Aaron and welcome Sarah to our show.

Thanks for having us.

Thank you.

So Sarah, one of the standard questions we have in Digital Voices, 'cause everyone wants to know, is what's on your playlist? And after you answer, then Aaron, you let us know.

Like music?

Yeah. Yeah, if we were to like look at your iTunes right now, what would we see?

Well, I like Coldplay, so I have some Coldplay on there. And my son got me into Imagine Dragons, so that's kind of fun. They're coming to San Francisco and so is Lumineers, I think, are the other concert we have on our list of to-dos. So I've been listening up to some of those on my playlist for now.

I'm jealous. I would love to see Imagine Dragons in concert. And yeah, Coldplay is one of my favorite bands. What about you, Aaron?

The truth is, if you landed on my playlist, it's really overrun by my 9-year-old daughter's music because she's hijacked my Spotify account. So you would see a lot of JoJo Siwa and the Descendants on there. But my personal playlist, It's really anything at the intersection of blues and classic rock. So Led Zeppelin, Allman Brothers, Jimi Hendrix, Guns N' Roses, the Black Crowes. That's really my playlist.

Yeah, I like that too. That's some great music right here. So everyone tends to have sometimes written, memorized some sort of philosophy of life, their passion, life message, mantra. Aaron, are there words that you live by that are kind of your go-to that center you?

I don't have a mantra in the way you're describing it, but I think I'm not a deeply religious person, but my background is from Judaism, and there is a concept of tikkun olam, which means repair the world. And so it's really a concept that is core to who I am, and it means essentially leaving the world just a little bit better today than it was yesterday. And I would say that's very core to who I am.

I love that. Was that a Hebrew word phrase?

That is.

All right. Yeah, very cool. I like that. Sarah, what about yourself?

Well, I was thinking about when Aaron and I presented at the conference you guys met at. We had— I had a quote in there that's probably applicable to this conversation. And it was something to the effect of, to gain influence, you need to give up control.

Hmm.

And I think that's, for me, over the last maybe 5 years, that's been a really good thing to think about because, you know, there's long been a friction, I think, in some organizations between marketing and digital health and other parts of the organization in terms of operations and who owns the customer. And the truth of the matter is, We all do, and we can all contribute to that. So, it's really kind of been enlightening and a little freeing to me to live by those words and sort of say, nobody has to own anything, we just all have to collaborate with the same endpoint in mind.

I love that. And I think, Aaron, you did share that with me when we were together. That's a very key phrase. I love that. And I think we're gonna dig down a little bit more deeply into that, like you were saying, Sarah. Keep going with you. Tell us a little bit about your story. You can go as deep or light as you want on your personal side and professional side. But obviously, you have a journey to get to where you are today. Can you tell us a little bit about that? Yeah.

So most of my career has been in academic— adult academic medicine. I've been at 3 other adult academic medicines before I came to UCSF. And I think this is the 3rd organization in which I've lifted up CRM and all the data and technology infrastructure to support that. So I have a long history, I guess, of what worked and all the battle scars to show. It's, it's a hard, heavy lift to do, whether it's at a marketing level or an enterprise level, is it's just hard work. So I've done a lot of, I guess, in my career, a lot of work in the CRM space and the precision marketing space. So adults for the most part, but right before I came here, I also did pediatrics and applied some of the same principles in the pediatric space. I also have, you know, I'm the parent of a special needs kid. So I think I've also had just a lot of personal side interaction with health systems and how to manage a complex journey. And that's just given me some passion for making it easier for people and understanding the, you know, what they need and how they need to interact with an organization. such as ours. So I guess those are— that's a little bit of my background and why I find this work so fulfilling.

Yeah, no, that's great. And your other AMCs, is California newer for you, or did you start off sort of on the West Coast?

Yes, I— this is an adventure for me and my family, really from the East Coast, mostly Northeast. So my last academic was the University of Pennsylvania, and prior to that I was at the University of Maryland and the University of Rochester. So all sort of in that little Mid-Atlantic Triangle. So, this is my first West Coast organization, my first public institution, which is a bit of a different— I'd say there's a different mission related to a public institution like ours than there is maybe on the private side. So, and, you know, Northern California is stunning, which is one of the reasons why I decided to spend some time out here. It's just, it's gorgeous, and I have no complaints. I still feel like I'm on vacation. It's been like about almost— 8 or 9 months. I can't even— I've lost count.

But that's great. Yeah, when you can marry sort of your passions and then geography as well and be in a great place in a great organization, uh, there's a lot to be said about that. And yeah, there is definitely a special place for public health, and, and I wish all of our colleagues in healthcare would have some experience with it. I know when I was at New York City Health and Hospitals, it was tremendous being part of that kind of organization. Aaron, what about yourself? Tell us a little bit about your journey.

I borrow from Bob Wachter, who says that he's what happens when a sociologist major goes to medical school. I'm pretty much what happens when an American Studies major goes to medical school. So I've always had a passion for the humanities and the interrelationships between health policy and economics and sociology and psychology and science. I was a computer nerd kind of growing up in the '80s and '90s and found my way into endocrinology and diabetes because in particular diabetes care and I'm still a practicing endocrinologist, really sits at that intersection of the science, the biology, the human behavior, and then the use of technology and how psychology and human behavior interact. You know, as you use continuous glucose monitoring, for example, to provide biofeedback to patients. During my medical training, the HITECH Act was passed and I was fortunate enough to get hired out of residency to help lead our Epic, our EHR implementation. Coming out of residency. So I actually spent my last month of residency mostly in Verona, Wisconsin, getting certified at Epic. And so spent several years helping lead our Epic implementation. And then really over the last decade have been building the digital health program at UCSF as we came out of our Epic implementation and started to think about, well, what comes next in population health, in remote patient monitoring, in personalization of care? We've been trying to build those types of programs, building a design team, a product management team, a data science team, building capabilities with industry partnerships and developing our digital strategies. What's been really exciting for me is that I feel like my life as a clinician in diabetes care is really informative for the rest of digital health because I feel like diabetes care is always a little bit on the forefront in terms of a lot of these principles of using home device data, thinking about population health, thinking about personalization, the shift from sort of paternalistic medicine to more patient-driven care. It's been really great fun using the learnings from diabetes to drive our digital health programs more broadly.

Yeah, no, both of you have these fantastic journeys. Sarah, you really sort of opened the door to this. We're talking now about digital and marketing partnerships and what, you know, highlighting good ones like the ones that you have, but inherently in the past within other organizations, there's been a little bit of friction. How did you ensure that there was a frictionless experience between marketing and sort of digital health?

Somebody before me thought about that. I think that was one of the reasons that I came here, quite frankly, in terms of my recruitment process is like many healthcare organizations, CRM and data and precision marketing is all thought of really on the lead generation end of the patient journey. And so at the University of Pennsylvania, we did that very successfully for a very long time. And I just, I wanted to have more impact on the full patient journey. And so when I saw this job at UCSF and they were talking about enterprise CRM, and they were talking about a collaborative operating model. I was just— my eyeballs like lit up because I thought, oh my gosh, that's what I've been looking for. I want that ability to really influence from the end-to-end journey. To be honest, I mean, Aaron's really easy to get along with, and he's— he was on, on the phone the second day I got here, and, you know, we got to get together and do this work. So I think he himself is just a very collaborative partner and just wonderful to work with. But I think the organization Overall had this just a different approach and a more integrated approach than other places I've been. So it really set us up and is continuing to set us up, I think, for greater impact as an organization moving forward. And, you know, the potential for us to create something very unique in the healthcare environment, I think, is absolutely here at UCSF. So it's exciting to be a part of it as it Yeah, no, that's great.

And Aaron, clearly, because you're pioneering that department there with your colleagues, how did you view it? You know, because obviously you already had developed that sort of culture. How did you make that happen?

What struck me as we had the opportunity to bring Sarah here, and we're so lucky that we have her experience and expertise at UCSF now, if you, you know, people ask me, well, what is digital? Ultimately, at the end of the day, digital is capturing data that tells you more about your customers, who they are, what they want, what they need, and use that data to make your services better, make your product better. As Sarah was saying, typically, marketing has done all of that, but they've done it just at this one part of the top of the funnel or lead generation. As we were thinking about what do we need to do over the next decade to make healthcare better, we need to capture data to learn about our customers and improve our services and use those data to offer better products. Why should we keep marketing and their expertise in a box like that, both the technologies, the people, the expertise? If you think about healthcare, people aren't just making the purchase at the very beginning. Choosing. Yes, they're choosing who they want their doctor to be, who they want their healthcare organization to be. I was talking about diabetes care. Diabetes care is a series of thousands of sort of purchasing-like decisions along the way, and there's a lot of influence of human behavior and psychology. Those same principles and experience and expertise that marketing has, I think, are extremely applicable in the clinical environment. I think that's why Sarah and I get along so well and think about this very similarly is that we really share that same strategic vision about what we can accomplish together.

That's great. While you two are talking about this great partnership, we know that it takes other organizations a little while to get there. It just doesn't happen. What advice would you give for— let's start with you first, Aaron, and then I'm going to turn it to marketing. When it comes to digital trying to partner with marketing, so let's just say you're in a new organization and there's not this partnership taking place and you want it to, how would you approach marketing to try to make this happen? So I think you see where I'm going here is for those of our listeners who may not have this sort of relationship today, but yearn to have that, what's a practical step they might take from a digital health point of view?

I think Sarah's mantra is really important and I hadn't heard it expressed like that till she brought it, but it really rings true, which is to gain influence, you have to give up control. I think I've started to try to live by that mantra since Sarah brought it forward. I can't emphasize enough how true that is. I think another thing we've done is we've really tried to— and this is definitely more challenging— but we've tried to weave in what McKinsey calls the helix organization. There are other corporations that use different terms for it. Amazon talks about use of single-threaded leaders. If you read a book that some executives from Amazon published called Working Backwards, they talk about the single-threaded leader. There's an article from a few years ago in HBR about how Apple is organized, and they organized— they stopped organizing themselves with general managers managing individual P&L statements but moved towards functional organizations and having people come together and work on cross-functional teams. And so that's what Sarah was starting to describe that we have started building at UCSF is rather than managing our own projects through our own org charts or hierarchies where, you know, digital owns this project and marketing owns that project, we've actually started bringing together people from design, product management, digital marketing, IT, operations onto cross-functional teams that are Tasked with an outcome, with a particular institutional capability or a customer experience outcome together. I think that shift, while incredibly difficult, has been really impactful in getting people to think outside of their org chart and their sort of span of control towards more shared outcomes. Once you shift towards that structure, it becomes incredibly natural to work together because you have shared targets, you have shared outcomes. People start ideally drawing some of their identities from those cross-functional teams rather than just from the functional area that they come from. That's been a huge effort that we've been undertaking that I think has been really helping. I think that, you know, the last thing that's probably the quickest and easiest is just humility. And I think it ties to what Sarah was saying. Healthcare is incredibly complicated. You have to be comfortable knowing that there's so much you don't know and asking questions and reaching out and leaning on other leaders and other people's expertise. So I think above all else, humility.

Yeah. That's what— it's funny, you know, no one can see me writing my notes, but that's actually one of the things I wrote down as you were speaking. And then you said it is really critical. And, you know, a lot of the advice you just gave for digital trying to partner with marketing may be similar, Sarah, to what— how you would answer. But I wanted to ask you that question though, from a marketing point of view, anything else to add? So if you're a marketing person, Let's say you didn't have an Aaron and his team there that didn't feel this way, and it was a little bit more siloed. What's some advice, or what would you have done if it had been siloed and you were trying to bring sort of this new culture in working with digital?

The only thing I would probably add to that is like, just to start small. I don't think you have to create an entire new operating model like we've done here at UCSF to have wins. And the great part about this kind of technology and infrastructure is that you could just try things and learn. It's a real learning environment. So, if you embrace the learnings and embrace, you know, sort of an experimental quality in the work that you do, I think there's a way to pilot, learn, move forward, you know, apply it to a few more areas, and then scale. That's what I've done in the past. And I think, you just, you know, it begins to build upon itself and it kind of turns into, well, you know, self-fulfilling prophecy in a way, because you're just, you're building the plane while you're flying it. But in a way, it's, you're able to do that because of the nature of the results that you can obtain just by trying things. So, I guess that would be the other, you know, if you think too broadly, it might be overwhelming. I think some days it's a little overwhelming for us in terms of imagining what this whole thing could look like at an enterprise level. And so even then, we have to kind of break it down and say, okay, what's a quick win? What's something that will get us started? Let's just go there and move forward.

No, both of you, great insights. I know they're appreciated by our audience. So obviously, again, Erin, you've been at UCSF longer and doing this longer. You've come in within the last 8 or 9 months or so. When I asked you about outcomes, I know some of them may have happened before. Sarah, but can you share with us 2 or 3 outcomes of having a partnership like that that maybe would have been a lot harder and maybe never even achieved if you didn't have that partnership? So like 2 or 3 things that you've been able to achieve.

One of the first projects when I got here, we were trying to support— one of our big issues in a complex organization like ours has been access, just accessing care. So we have a lot of work that we're doing together as a team to try to break down barriers and make the organization itself more accessible. But one of the pilots we had was around our cancer center and providing an online appointment scheduling capability for consumers to sign up and talk to a nurse navigator and help them navigate the cancer journey. And so this really was coming out of an operational access challenge. But then we applied some marketing components to it. So we marketed the opportunity to be able to do this for, for a certain kind of cancer, a head and neck cancer. And what we saw over the last 6 months was, you know, it really worked. In fact, I think we invested $50,000 into the marketing plan for this particular program. And we saw even so far, even in this early days, not even really 6 months into it, we, we've seen almost a 20-to-1 return. So in terms of really being able to design an experience that's one that would help people get the care that they need in the way that they want to engage with us, and then applying, you know, some of our traditional lead gen capabilities to that experience, we've not only allowed some folks who really need to get in to get that care, but also, you know, sort of shown that it has a positive impact on the organization. So that's a quick impact one. We have others that aren't quite so financially driven, but that one I think is different because it was driven from a place of, of what do we need to do from an operations perspective? And we did some work with operations to make that possible.

Yeah, that's a great example. Aaron, what about yourself? What example can you share with us?

The other example that comes to mind is what Sarah brought up earlier around developing an enterprise CRM platform strategy, which we're in the process of doing now. It's something that we have sort of chipped away on the edges over the years at UCSF. And I think because we weren't approaching it holistically, we didn't have this strong partnership across different functional areas. What ends up happening is, you know, it's the blind man and the elephant, right? Where every person is sort of grabbing their piece of what CRM looks like. I think having Sarah here and together, we're, you know, building support around the organization to think about this really holistically. Because, if you're really going to use CRM well in the healthcare environment, I think you do have to think about it holistically and not piecemeal. We don't have an outcome yet from that, but I've seen the shift in, I think, the relationship that we have and driving it as a partnership between digital and marketing is enabling us, as an institution, to really think much more holistically, which I am really optimistic is going to help us long-term.

Those are great examples. The future. So to the extent that you can share, I know everyone's in a competitive environment, things like that. So we don't want to give away any great secrets or anything. But to the extent that you can share, where do you think we're headed with— I'll start with you, Aaron, in terms of digital health. Where do you think we're going with this? You already are leaders in this area, but I'd be curious, 1 to 3 year perspective.

We have a lot of challenges in healthcare, which are becoming all the more acute every day. I think Sarah touched on access to care is a huge problem in this country. Inequity being a big part of that and disparities. Costs of care are a challenge. The care experience for patients has not been good. So there are a lot of opportunities for digital health. As we saw in the last decade, we really, as an industry, we implemented electronic health records, which got us at least off of paper to a point where we have access to digital information, where we're starting to capture healthcare in a digital manner. The big opportunities here are shifting our care model and starting to leverage digital to shift the care model from in-person-only care as kind of the default where we're using our most expensive resources as the default option to— And even with telehealth, we haven't done this yet because telehealth today is really still a unit of time shared by a patient and a doctor on a video visit. We've changed geography, but we haven't really scaled the provider. I think the opportunity in the coming years is to use other care modalities to start scaling care better. I think a second one is automation. I think Eric Topol in Deep Medicine really highlighted this well where people often think of automation coming into healthcare as, let's build the AI doctor. Eric was really right on point, which is like, don't worry about the AI. AI doctor. Doctors love being doctors. Let's use automation to get rid of all, you know, prior ops and all of the paperwork that's dragging us down. We can automate that stuff out and help doctors and nurses practice to the top of their license. I saw an article yesterday or over the weekend that said that a primary care doctor, if they did everything they were supposed to do, would spend 26 hours a day doing primary care. So Clearly, we have a mismatch in the amount of work we expect the healthcare system to do and what people can do. And so, I think using automation to offload really simple, drudgerous tasks so that our highest-value resources can do what they do best. The last one is learning and a culture of learning. So, this is really, again, what digital is all about and why I think having marketing expertise at the table is really important, is gathering our data. So when we deploy self-scheduling, it's not just checking the box that we deployed self-scheduling and we implemented and on to the next project, but it's gathering data to understand what friction patients are experiencing, where they're dropping out in the process, have teams that are A/B testing improvement opportunities. So building the culture of learning that goes That's the biggest part of digital, isn't the visible technology that's in people's hands. It's actually the culture behind it that's enabling digital and making an organization digital. I think shifting the care model, automation, and then developing digital cultures of learning in healthcare organizations.

Those are all really good and profound. Sarah, do you have one that you'd like to add, like maybe from the marketing perspective?

Yeah, I think the one that sort of goes along with what Aaron was talking about, but is a little different is the ability to really personalize care.

Yeah.

Using what we know and what we learn and what we can anticipate about consumers to individualize what we need to do to help create an experience that's right for them. And so we have lots of consumers that they want a self-serve pathway. They want to be able to do what they want on their own time and get it done. And that's their journey. And we have others, you know, especially from this perspective of the underserved, that might need a higher level of support or a different level of intervention. And we want to be able to anticipate that as well and help create a journey for them. So it's even more apparent now that healthcare is not a one-size-fits-all. And some of these underlying technologies and data really allow us to create journeys that have equity at its core, not equality necessarily, but equity. And so that You know, this philosophy that we can create an experience solely designed for the needs of that individual, which might not be the same as the next individual that we interact with, I think is a really important application of this kind of technology. So that's exciting for me to think about.

This has been really good. I have pages full of notes here. And so if I, if I sum up, and then I want to give you both the last word, is, I mean, some of the golden nuggets for me was gain To gain influence, you have to give up control. Very profound. We talk a little bit about working in public health, which I encourage everyone to do. I think we all feel the same way there. I love what you said about teams. We asked, I asked a lot of questions around teams. And to me, based on what you said, how you know when you've achieved this integration of marketing and digital is when there's an identity as you're one team. You're not digital, you're not IT, you're not marketing. You're one team serving the customer. That was cool. The whole concept of humility, which keeps coming up, starting small, Sarah, like you were talking about, you know, cuz it's huge, especially if you're, if digital is new to marketing and just working to learn to work together with one another and sort of ending up on this whole personalized care. So I talked a lot of different things. So I wanna give each of you the last word. Sarah, we'll, we'll let you, if there's anything we missed or you wanna double down on, and then we'll end with Aaron.

The last word is that I don't think you cannot you can't put your head in the sand anymore. I mean, I think this is essential work. The pandemic changed everything in terms— from a healthcare perspective, how we deliver it, how consumer— what consumers expect to receive from us. You know, in a way, it was, you know, things that might have taken— great accelerator, I guess, is the point. It's really sped up our opportunity to innovate in this industry. And so, that's exciting. So, I guess my last word would just be like, Jump on board and start this work because I don't think you can remain competitive and, you know, essentially be able to really meet the needs of consumers if you're not thinking in this way in terms of digital health data technology, the end-to-end consumer experience.

Love it. Jump, jump in. That's what I'm taking from that, Sarah. Aaron, what about you?

I guess I'll come full circle. I would I would definitely double stamp what Sarah said in her summary. I'll come full circle to being sort of an interdisciplinary person, which is, I think there's a lot of value in curiosity and learning outside of your own area. And it's at the intersection of these different areas of expertise and skill sets where a lot of magic happens. And so take opportunities to learn from other disciplines and other functional areas. And find that synergy because, because great things can happen.

Well, Aaron, Sarah, this has been great, great information, I think, for anyone, even with those organizations that already have a good relationship with digital and, and marketing or those that are just starting out. So just full of good stuff. I, I really appreciate both of you and I appreciate your hearts. Like, I got a good sense of who you are as people and why you chose the paths that you have. So thank you for taking the time, sharing with our audience. And, uh, have a great day. Thank you so much. That wraps up another edition of Digital Voices.

Thank you for listening to Digital Voices podcast with Ed Marx. If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening.