Voice of Customer Turning Physician Insight Into Action with Marney Reid, Erika DeLeon, Dr. Ira Kirschenbaum, and Dr. A.J. Rush

Speaker A: M. Foreign.

Speaker B: Welcome to Connect to Develop where we bridge healthcare strategy and leadership insights.

Speaker C: Welcome back to Connect to Develop where healthcare strategy meets bold leadership. I'm your co host, Marnie Reed and today we're discussing physician advisory meetings, or as we'll call it for the rest of this podcast, Voice of the Customer. Something that most medtech or pharma companies run at some point in either their strategic planning or on an annual basis to just maintain that connectivity to their customers. We're not really talking about that checkbook version. We really want to go over today how to make these impactful. So in doing that, who better to help shape this discussion than to incredible thought leaders and surgeons who have participated in plenty of these sessions.

Speaker B: Thank you, Marnie. Yeah. This episode is really focused on companies, what companies get right and, and where they may need to adjust when it comes to planning or running Voice of Customer. So today we're joined by Dr. Ira Kirschma, chair of orthopedics at BronxCare New York. He's also the editor in chief of the Journal of Orthopedic Experience and Innovation and a nationally recognized leader in joint reconstruction, uh, sports injuries and innovation. We're also joined by Dr. A.J. rush, a fellowship trained board certified spine surgeon specializing in minimally invasive and technology driven spine care, including robotics, AR and emerging digital tools. And we're just so excited and pleased to have these two experts from different generations, different practice environments and different innovation lens and really allowing us to have this really deep conversation that's gonna be so rich for the next hopefully good half an hour to 45 minutes.

Speaker C: Uh oh, the clock is ticking. Let's make it good folks. Okay, let's first discuss what you do not want to do in Voice of the Customer sessions. And one of the things top of mind for me, Erica, keep me honest here is where you bring all of these incredible surgeons and where they think they're coming in is to add their input, their expertise, their thoughts. But then they get in the room and what they find is it seems like the company has already put something in mind that they want to achieve or they want to hear. And they're really just trying to set up the whole meeting so that the surgeons validate what they've already come up with. And really Voice of the customer is just that it's you intentionally and really open minded, listening to the voice of your customers so that you can do whatever the goals of that session are. So I would love to start with Dr. Ira Kirschenbaum when you're invited to A VOC session. What signals to you that a company is really genuinely looking to learn and shape their direction based on your and your colleagues input?

Speaker D: Well, thanks, and thanks for having me on this podcast. I feel first of all that it's so important that the company understands what the problem is they're trying to solve. For a Voice of a Customer session, what is the problem? Everyone thinks, let's find some solutions. And half the time people don't understand the problem they're trying to solve. So I think clarity as to what the nature of the problem is that you're being asked to go into this meeting to help solve. You know, sometimes there's a voice of a customer where they just want to learn about surgery behavior in general. And those are complete failure. You need to have a clear plan of what you as a company would define as a wild success. And I think understanding what problem you're trying to solve, that could be. Do these surgeons understand augmented reality? Do these surgeons understand how much it takes to put a price tag on an implant? I mean, what are you trying to solve by getting all these minds in the room? Because if you don't know that, then you don't even know. What is your first question you're going to ask.

Speaker B: That's a really good point. And just to kind of piggyback off your comments, Dr. K. I'm just going to kind of unpack that a little bit more. What are the signals that indicate a company's truly listening? First check in a box. Like, what are you looking for? Kind of early in those conversations.

Speaker D: Yeah, I think, you know, one of my colleagues used to always say this. One of the best words is because. So when I get contacted by a company, they say, we'd like to be part of a focus group, a voice of the customer group advisory council. Because, uh, you bring to the table this, others will bring to the table that. And we're trying to understand a very particular thing. And if they don't really signal that to me as to why they're asking me, it's such a sign that this is probably going to be a bit of a waste of time for them.

Speaker B: And for me, M. That's really interesting, A.J. you being in a high tech, high innovation specialty, what are the questions that you look for or look for companies to be asking you with your experience?

Speaker A: Yeah, I think this is a great question and you know, not necessarily to steal Irish statement, but I certainly think the because is important. But, you know, I think the further you go into sort of newer enabling technology or even if you're engaging with companies that maybe aren't even in that space yet, they sometimes don't know the because either in some of these more novel, more tech specific technologies and you know, future directions. But I think really you can extrapolate that because idea and same thing, maybe get back to the why, like if a company can express their goal or what they're trying to learn when they're engaging with the surgeon advisory group, especially on some sort of novel technology or something like that that kind of isn't really well explored or may not even be solid footing for them historically. You know, if they can certainly enunciate or kind of explain their goals, what they're hoping to, you know, find, or with the surgeon advisory board or something like that, then I think certainly you might be along the same lines. But I think it's certainly as you get further into the realm of kind novel techniques or novel technology, you know, it can be sometimes the blind leading the blind sort of scenario. And that's where I think really understanding what their final end game or what the goal is super important. Because then at least, you know, you have some sort of lighthouse effect in terms of where the conversations are going and where hopefully the advisory role would lead to in terms of utilization and obviously utility to both the surgeon group as well as the company themselves.

Speaker C: I love that term, lighthouse effect. And AJ literally, as you were talking, uh, I don't know exactly what I was using to describe it, but I remember sharing with some colleagues, you know, if we don't fine tune and share with the surgeons exactly what we're trying to figure out, it's like asking them to go run a race, but telling them we're not really sure where the finish line is. So have at it. Here's some water. Let me know how it goes. Let's shift to learning opportunities because honestly, a lot of great experiences come from running. Some that maybe weren't so great to start with, and there's just continued improvement. So back to you, Ira, uh, from your experience, what are some common mistakes? Obviously calling, not telling the surgeon why they're being picked, not explaining to them the role of not only yourself, but the colleagues that you're joining, and then not understanding the problem. But let's talk about the actual experience of the session being run. What should companies avoid doing to make it a great outcome for everyone involved and to make it worth you leaving your practice and your patients and for them to incur the time and expense to fly all of you in?

Speaker D: That's an amazing question and I have about three hours. Right. To discuss that. Is that.

Speaker C: Absolutely, yeah.

Speaker D: Good, good. You know, I think there are a number of things I'd like to touch on. One is the company needs to do their homework on the cohort. Because the cohesiveness of a cohort in the voice of a customer focus group actually takes what may be a not so great moderator, or maybe a not so great because into a superb voice of the customer session because the cohort gets it. You know, if myself, AJ five other surgeons who are high technology people know the space well, I can't emphasize enough that as a company, you need to do your homework on the cohort. And don't just choose people who use your stuff a lot. You have to actually pre screen them with questions and find out if they have the expertise to really help you because that cohort in action is going to make or break your whole session. And failure to get together the right cohort. If you're trying to figure out, for example, how to position your technology in an ASC and you find out that three of your people who do, who are in your cohort only do like 8% of their cases in the ASC, this is not going to be such a great discussion, you know, so doing your homework on who's there, not just because they're loyal to your product, but because they probably have content expertise on a topic you're doing. And I find getting together a poor group of people is the biggest failure of most voice of customer sessions. Worse than a bad moderator.

Speaker C: That is so great. I did work for an ASD company and they were very good about bringing in a mixture of their existing partners and utilizers and non partners and utilizers. So that there was a very diverse group. And so the conversation was truly all about solving for that problem at hand and not just let's reward some of our, you know, biggest money makers.

Speaker A: I mean.

Speaker D: That's right. I mean, I think it's so important to also understand that you're going to need different ranges of experience. You know, at some point in time you may have some with 30 years experience, but don't forget the person who has less than five years experience. They're your future customer, they're the early adopters, possibly they're maybe closer to new technology. So you're going to need a range of experience as well. I mean, I wouldn't be the editor of Joey if I wouldn't say that experience related to innovation is so important.

Speaker C: I love that. A.J. how about yourself? Is there Something that stands out where you said, you know, so much was going well, but it was this one little thing that if the company could have tweaked it, it would have been a phenomen voc and I would have been really excited about what comes next.

Speaker A: Yeah, you know, I mean it's, this is such a hard conversation. I think it's somewhat difficult to answer in broad strokes because we're talking about so many different kind of voice of customer opportunities, right? Whether that's an asc, novel technology, new product, optimizing an old product, how to uh, increase engagement, alpha launch, beta launch, all these different words that are, they're thrown around. And so I think it's somewhat difficult, but I think broad strokes answers. I think it absolutely, as Ira said, requires multiple viewpoints, multiple vantage points. Whether it's young meeting old, old meeting young. You need people with a couple more gray hairs. But I think you also need people that are young and innovative because as Ira alluded to, the customer base for pretty much anything we do is vast and surgeons careers are quite long and probably only getting longer with the ability to, you know, engage things like enabling technology that maybe take off the workload that we all have in terms of whether physical labor or even the mental capacity. So you know, I think it's uh, important to have different views because that's how you get a better global view. And I think companies that I've ever seen that do it, right? I mean there is the classic example, right? Maybe a Kol, maybe a high volume guy or girl, maybe young and old and then obviously someone that's super research heavy as well as maybe someone that's super clinically, clinically active. Right. I mean, I think that classic model still holds true to most things. You kind of, you get every single person under the sun if you kind of include those. But certainly I think things are left out if any one of those individuals may not be part of a team because that can be a problem. And then I think obviously as Iris said, doing your homework on those people is extremely important because just because those individuals, you know, match that kind of CV or resume, you know, how vocal is this person in a group setting? Are they a team player? Are they going to give you the run of the mill answer that the company wants to hear, Are they going to say something that maybe shakes the boat a little bit? And I think knowing that about each one of those individuals is super important because what you don't want to do is have maybe an older surgeon that doesn't say as much because they kind of fit the status quo, or certainly the opposite, I think, is more commonly true, which is the young person in the room is usually the last one to speak up and certainly doesn't want to shake the tree, especially when some of these opportunities may be their first engagement point with a company. And so they don't want to, like, be the thorn in somebody's side, because who knows, maybe that would affect future engagement opportunities. And so I think, you know, there's a fine line there, but certainly to create a great team and to have the best feedback and then obviously plan moving forward for any development or any type of initiative, I think relies on that.

Speaker C: Um, that is such a great point. I've been running medical education and professional development for surgeons for such long time. And I definitely noticed to your point, there is very much a hierarchy, especially with orthopedics and spine. And so you bring in, you know, that early career future Kol. And if you've got, you know, some of the people like the, uh, IRAs in the room, they may be more tentative to speak up. And so that's really on the moderator to create that safe space to constantly, either themselves, if they're comfortable pulling that young voice in, or sometimes what I like to do is in advance tee up, uh, my KOLs and say, hey, we have so and so and so and so in the room. If they're not speaking up, do you mind pulling them in? And then, you know, at some point they'll just get comfortable enough to start, you know, jumping in on their own. But such great ideas.

Speaker B: Yeah. Marnie, I love that you're pointing out kind of teeing up in advance. And if there are folks in the room that are able to kind of bridge that gap, kind of leaning on the audience or anyone in the room is always super helpful. I'm going to flip us for a moment and just kind of move us along. I would love to hear, especially because Marnie and I both have been in this field and in this industry, and I've seen a variety of voice of customer sessions. I would love to hear each of you kind of talk through what has been the best experience in your career for a voice of customer that you've been engaged in. And Ira, let's start with you.

Speaker D: Well, the best experience probably is one I was not involved with. No, I'm just kidding. I think in a lot of ways, the best experience is first when the moderator has a number of icebreakers, breaks the ice right from the beginning. And maybe I've seen Some techniques that work specifically well are polling. In the beginning, there are a lot of, you know, Internet based polling softwares and you can sort of get that audience gets to know each other. When you start asking like six to eight questions and they see the immediate, and everyone uses their iPhones and they put the answer in and it goes up on the screen and everyone begins to learn about, oh boy, I'm only in the 21% group that likes that answer. I'm starting to learn who I'm, um, with here. And then it begins to set the stage of some subgroups and some tribal behavior related to the topic. Like if you're talking about an arthroplasty group, that may be the patella resurfacing people and the non patellar resurfacing people and, you know, no one knows who everybody is. Well, in the beginning I found some of the really good experiences when all of a sudden when there's, let's say, three sides to story, you get to know who your compadres are on the other side of the road and other side of the table. And I feel that type of competitiveness essentially to get your voice out makes a very good voice to a customer. When people are competing in groups and going back and forth and you start seeing loyalties develop among people and they get to know each other. You know, the quiet people in the room are, uh, at times time, sometimes the loudest voice of the customer. When I've moderated sessions, I've actually called on people who didn't say things and then they would say the most profound things. So I think the best ones is when the moderator pulls out what people think early on. You got to know where people stand early on and then you start getting very granular on the topic when you start developing and knowing where people stand on the issue very early on, I've seen some very exciting arguments and some very profound advice coming from a lot of people once they really got to know who was in the group and what their philosophies were.

Speaker B: You just gave me the axis behind your thinking. Watching you moderate personally and doing, doing some polling. So that's actually really interesting and good to hear. No, uh, that's, that's great. A.J. what are your thoughts here? What has been your kind of best scenario that you've been a part of over your career?

Speaker A: Sure. You know, luckily, you know, you set up a great podcast here since it's like, I think I might be a little bit younger than Iris, so he's a bigger deal kind of goes back to the question we had previously. So because I probably haven't had nearly as many experiences and I think think they kind of vary as I alluded to before, you know, in like a bigger group setting. I absolutely agree with AIRA that in discussions of say like a novel allograft product or bone graft kind of supplement, something like that, at least in our space, I certainly like when and I've seen it be very successful when people ask broad based questions. I completely agree that, you know, whether it's cell phone based, interactive polling, etc. Etc. I think think you get kind of a feel of the room, people start to ease up. They feel like, especially if you're kind of the outlier, that maybe you are not an outlier. And so I think it's certainly helpful then to be able to speak at ease without feeling like you're alienating yourself or those around you. And so I think that is really the greatest icebreaker, especially in those kind of larger like committee style, you know, give us your feedback sort of sessions when you know, maybe companies are just in the broad strokes phase of, you know, some type of development or something like that. I think if you fast forward to some things I've been involved that I really liked a lot, you know, in like an alpha launch team or even like a preliminary design team discussion, certainly in those settings, small group meetings, whether it's via Zoom or something like this, I think is super helpful with you know, kind of the intros and you know, talk shop sort of scenarios is super helpful because again, I think it kind of levels the playing field in terms of, of expertise, career longevity, etc, and certainly starting with like, you know, when you do this surgery, what's the biggest choke point that you see? And having a guy who's been doing it for 30 years essentially tell you it's the same thing you see when you're only say five years out. Right. I think is probably humbling for them and certainly uplifting for the young surgeon to know that what's difficult for you is still difficult 30 years later. And so I think having that opportunity to have kind of of like minded discussion at a very casual basis is super helpful. But then again keeping it close knit to where, you know, you can start to kind of commiserate in difficult situations. I'm thinking very specifically of like a preliminary design team conversation where young or old, everyone kind of agreed on the same issues and the same status quo that we see in the market, certainly with the available implants, and then realizing that we're all fighting the same fight, whether you're in New York or Dallas, Texas, or anywhere across the globe even. I think being able to find that commonality and then work from there is super effective and super helpful. And I think it probably goes back to developing a good team, right? I mean, if it starts maybe as a kind of sounding board in terms of everyone's kind of complaining of the same things, but then once everyone has, like, a common bond, then you do have that quiet pursuit. The room is like, you know, I actually see this one particular thing, and maybe everyone doesn't agree, but then I think now you have the opportunity to be a little more expressive and a little less concerned of, you know, have someone like, you know, calling you out or disagreeing you. It's more of a communal conversation. And I think that is what ends up being super effective and super helpful. And I really think it goes back to, how did you pick those people? What were the goals of it? And it kind of goes back to all the questions you already talked about, right? Like, if you know the problem, if you understand the why, if you understand the because, you know, and now you have different people in different portions of their career and their expertise and, etc, you're going to have a really good discussion and certainly, I think, effective feedback for the company and obviously yourselves, depending on kind of, again, what the nature of the conversation is. And that's really where I've seen it be super successful. I could certainly get more granular in terms of very specific situations, but I think that's really what I see as being most effective and most helpful. And I think it really just starts with Finding Common Bond and Talking Shop.

Speaker C: Those are all such great examples from you both. Let's go into something where, as much as I love the actual experience and the voice of the customer, and seeing that debate that AJ And Ira, uh, alluded to in some of these, which I think you get the most effective, you know, solutions that come out of them. Let's talk about one of my favorite things with this, and I'm going to first start with a, uh, Benjamin Franklin quote that I love. If you fail to plan, you are planning to fail. And so I think to the point that you've all talked about where you've come in and you've had this extraordinary experience. It's because the people most likely started anywhere from six months to 10 months in advance, you know, really defining the why, the who, the because, the how. I think one of the best ways for surgeons to have a great experience is to run something that makes it feel like it's flawless and it's touchless and like you're winging it because there's so much off the cuff, candid discussion. But literally where, you know, the run of show, as we call it, which is a 15 page document that everyone knows, it's almost like a finely tuned orchestra or a perfect musical. So I think one of the first things, and Erica, you know, jump in with me at any point is you really, whoever's running that, voice of the customer, be it marketing, development, you know, any of the above, really get internal alignment and senior leadership buy in. You're about to spend a time of lot, lot of time, a lot of money. You're about to disrupt the lives of some of your most important current and future clients. You know, make sure that you've got a senior leader really buying in. And then you want to get very clear, as you've both already talked about, what are the goals at hand if we go in for this, what are we going to get out of it? And it's absolutely okay if what you get out of it is we need to understand what our problems are. Problems are oftentimes, you know, I'll see a client that doesn't really know what the problem is, so they go into solve, solve, solve mode. And they haven't really discovered what the problem is first. And so sometimes voice of the customer is best used to defining what is that problem. And then once you define that problem, do we have the right people that sat in that room to then create the solutions to it? Another thing that I think that maybe sounds a little bit weird is you really want to pick an agenda, you want to get time allocated, adding in some buffering for really good discussion into what especially Ira was alluding to, you know, calling on that quiet person that you can just see the wheels, you know, turning behind the eyes and you want to get something profound out of them, but, you know, padding in 30 to 45 extra minutes for that discussion, sticking to that agenda. You want to have a good mix in the room room. You want to have those cowboys, cowgirls. You want to have the people that are much more methodical. But if you go off on a tangent and you don't accomplish half the day, you'd have kind of wasted everyone's time. Erica, uh, do you want to get more into the operational aspects of what good looks like when you're planning for a VOC session?

Speaker B: Yeah, I'll share and I would love to kind of get both our and AJ's thoughts. But I would say that where I think a lot of companies miss the mark is, and even before the physician gets in the room, there really needs to be a level of internal clarity. And not only just clarity strategically, but I would say at the minimum, the company has to understand their data. We hear the term data is king, and I know it's so cliche, but as somebody who's like fueled by operations and scale, I really believe the data tells a story. It tells what we're seeing, what you're not seeing, where are the gaps. And it also, to be honest, it really kind of reveals some of those areas of weakness. What's not working, where are they getting stuck, Whether it's clinical, operational, whether it's an adoption, whether it's go to market strategy. And the biggest one that I would love again to get your thoughts on once I kind of unpack this, is, is the company really willing to change at the end of the day? Right. So we go through all of this effort, we're pulling the best experts to have voice of the customer, and we get this feedback. And is the company really willing to implement those recommendations or take those insights and put them into execution? Because if you're bringing in physicians, but you're not willing to shift that direction or adjust the product or rethink your entire approach, even if you feel like you're taking five steps back, then it truly stops being that voice of the customer session at the end of the day. And it's really more about just a validation exercise. And to Marnie's point, you're just wasting everybody's time. So to me, what good looks like really starts before the meeting itself. It's about coming prepared, being self aware, knowing your data, and being prepared to change after the fact based on the feedback that you receive. And would love to just hear your comments, aj, maybe start with you just kind of based on what Marty and I both just kind of went over.

Speaker A: Sure, yeah. I mean, I think you certainly hit it on the head and I feel like I keep saying the same thing over and over, but it definitely comes down to the planning and I think really the decision of who you're going to have involved in that discussion or validation or whatever it might be, because in reality, if you have super users of XYZ product or technique or whatever, uh, and you know, you're kind of just as you said, kind of putting it to a sounding board, it's like an echo room of, you know, continuing the status quo. I think data is king you should, you know, certainly have people that know the product or whatever you're looking into immensely. But at the same time, you know, you kind of want to look for the people that don't, the people like, why doesn't so and so surgeon use my product, use this thing, whatever. And you know, certainly you may not be able to get that person to talk to you, but I would to like least want that vantage point because I think if it's just an echo box of everyone patting themselves on the back, you're going to get nowhere. And it certainly was not just a waste of the company's time. It's probably the waste of the people that are theirs time. And it's not going to move, whether it's the product, the technique, the surgery, the anything forward. And you're not really innovating if you're not having that background noise of kind of the haters in the room. And so I think that's where the planning is super important. And whether that's using data to say like, you know, this surgeon always seems to have an issue with X, Y, Z, we need to get him in here and talk to him and similarly maybe have him in the same room, him or her in the same room with someone that's like, I love it, it's great. This is the way it should move forward. This is the Kol in this particular topic that we're going to talk about today. And but I think having multiple voices in multiple different, as I said before, kind of experience levels etc is super relevant because if you haven't, you're going to get nowhere. And it was, again, as you guys said, kind of just a waste of everyone's time. But more importantly, I just, I don't think it will be innovative. And at that point, if you're looking at it from like a global company level, you're not really moving forward. You're not really moving the meter. And so, you know, you're kind of going to end up falling behind, unfortunately. So I think it, you know, background research, understanding your customer, understanding the end user, and really just knowing as much as you can about every single person there is super relevant and important. And you know, as you said, data is king or queen and certainly the most important thing you can have to fight that battle. I'll turn it over to you, Ira. You certainly have probably some good notes on this one.

Speaker D: Well, you know, it's great. Everything you said, I completely agree with. I was thinking when Eric was talking about one word and that word was empowerment, that the Corporation has to empower the people that they choose to run and organize with some agency to make change and not just, you know, show up and bring some KOLs in. And you also need to empower the group, the voice of the customer group, and say, this group's going to make an impact. So empowerment of both your own employees as a corporation and empower the voice of customer group, the kols is critical. I think the success of any project, and this is known business jargon, is first you need a sponsor or someone high up on a company who believes in a project but is not going to do the daily work. Then you need to assign a leader within the company. And the sponsor's job is to make sure the leader can lead well. And if you have that sponsor leader relationship, then the people who are doing the work on the grassroots level are really knowing that the leader has been empowered by the sponsor, which may be the executive vice president or maybe the CEO themselves, to make change. And if a group doesn't have that empowerment, then I don't think this voice, a customer session is going to bring back valued information to move the needle for that company.

Speaker C: I feel like. And uh, this is obviously dependent upon if you know, product, service, technology. Sometimes you get into a voice of customer and maybe you're not leading it. And it is very clear that the person that was tasked to lead this does not understand the clinical workflow and how it fits in and how it impacts the physicians and the physician support team on a day to day basis. And that's one of the areas where I've seen things go left real quick because immediately out of the gates, you now lose credibility with everyone in that room. And then another thing that I see, I'll, uh, come up a lot and once again dependent on what you're there solving for for is understanding the reimbursement landscape. And depending on the goals and the attendees, you know, what does that look like? Because oftentimes this can shape some of the feedback. You know, there's great pie in the sky, visions of what we can accomplish, but then you've got to operate it. So, and you know, not saying that this needs to be the complete focus, but you also want to understand who your competitors are in the, the market. Irregardless of if you're on that design team that AJ alluded to, or if you're innovating something, you know, on a future technology that Ira was talking about, like VR, you know, what's in the market, what is your differentiator and how can we play well either in that space or make a big wave to create something new. Erica, what do you think?

Speaker B: I'm thinking, Marnie, about your comments on the reimbursement specifically and just given my background, just for context that I have in quality outcomes and it goes back to data. Like I just kind of go back to the data and how the data tells a story because the reimbursement landscape itself is continuing to just shift and change. And we know, you know, with CMS guidelines and everything changing and innovation moving as fast as it does, and, you know, AI and all of the aspects of our industry that seem to be moving very, very, very quickly are impacting how reimbursement is being addressed. And so I think that when we're thinking about voice of customer sessions, that has to be a critical part of the discussion. That has to be a critical part. And you would imagine that, you know, companies are. That's a given, but not necessarily. And Ira, uh, you actually have a really great example of the reimbursement component and your impacts and your way in there and, and without kind of naming the specifics, that might be actually a good example to share if you could. I know I'm catching you off guard.

Speaker D: Sure. No, no, no, no problem, no problem. I. I only have one of those in my life, so, you know, it's easy to remember. You're not just kidding. Before I tell the story of understanding reimbursement, having your kols understand that, you know, the old line, why do we rob banks? Well, because that's where the money is. You know, in a sense we do innovation. Innovation in a lot of ways saves the health system money, but sometimes has to be paid for or you can't have it. So if you don't understand where the money's coming to pay for that innovation, that innovation can't come to light. I had an interesting story where I called up to get priest authorization for a product. That was what I felt, a very, very solid innovation in the outpatient space in pain management. And they didn't approve it. So I asked for a peer to peer and I ended up getting a peer to peer. And the doctor said, I'm doing this peer to peer because I could feel your pain. I said, not as much as my patient. You could feel my pain, but you feel my pa. And she said, but the reality is we don't have this drug even on formulary, so even if I wanted to approve it, I can't. And I said, well, who do I contact to get on formula? Well, the medical director and a certain team that makes the decision. I actually wrote a nine page letter to this national insurer as to why this drug needs to be on formulary. And I do have to say I really thought that letter was going to rapidly go into the shredder and hopefully it would have jammed the shredder of this large insurer. But lo and behold, six weeks later, they put the drug on formulary. And it just shows the power of an individual who understands that if I don't get paid for that drug, that the community that I work in, which happens to be the poorest congressional district in the country, can't have access to, to that drug. So understanding the reimbursement landscape in innovation allows innovation to continue.

Speaker B: Yeah, it goes to show again, the power of the voice of the customer. You know, folks like you, like aj, you guys are in it every day. You're seeing what others don't see. So your voice, it's just, it matters. It makes incredible change. So as we were going through that, I just thought about that. So I know that we was kind of catching you off guard, but Barney, any thoughts on that?

Speaker C: That, you know, I love hearing that because, Ira, uh, I'm not calling you old because I know that's where this goes, but you are such a well respected and tenured physician and you know, I talk to surgeons these days and they're just so beat down and burned out by everything that they've got to go through. You know, the EMR system changes, you know, the prior authorizations, the clawbacks, you know, the split payer routes, and just trying to understand the business of it all and care for their patients, which is really what they just want to do day to day and to see you take time out of your day to write such an impactful letter that had an amazing impact. And not only that, but advocating for all of the patients in your area, for that payer as well as all of your peers. That's really cool to know that there's still physicians out there that are willing to fight back. So I love that. Aj, anything you want to leave us before we close out this podcast?

Speaker A: It's a most open ended question ever. I could just say whatever I want right now. No, you know, I think we've gone over everything. I mean, I think it really, you know, you could talk on this for hours because I think if you broke it down, there's so many different avenues. And obviously we kind of spoke offline. We were talking about this talk, uh, before, beforehand, in terms of what we even mean in terms of voice of the customer. So I think I would just lay it back to kind of what we've already said, which is to me the bottom line in any of these scenarios. And maybe we kind of ended on a really good note in terms of including kind of the elephant in the room, which certainly becomes whether it's the payer reimbursement structure. But as Iris said, kind of the cost of innovation, I think is quite important. And where do you put that cost? Is it on, on the end consumer insurance companies, the company in general that's developing something, whatever. At the end of the day, everything has a cost and you have to certainly be as judicious as you can in order to create value with the least investment. I think that's what we all kind of realize value based care ends up being. But you know, I think to do that most effectively is really what this conversation has been about. And that's you have to ask the right questions, understand the question, have an idea of where the answer might go, and therefore, you know, arm yourself appropriately with the right team of individuals that has the appropriate expertise, the foresight, you know, certainly the vision, as well as potentially, you know, at least for certain scenarios, the appropriate amount of wisdom and understanding of where it is and where we're going to be able to execute that effectively. And I think if you can hit all those pillars, if you can find a group, a team, if a company can empower someone to lead that charge, you're going to be set up for success and you're going to have, obviously, Ira and I speaking as kind of the end consumers or innovators, depending on where you are in that process. I think you're going to have, you know, an excellent conversation and certainly an excellent end product or end answer to whatever question might be answered. And I think the only time that fails is where any of those things are lost along the way, which is. Is quite vast. Right? I mean, but if it's built from the beginning, the right way, then you're going to find ultimate success. And I think, as Iris said, that that's going to end up being innovation, improvement and you know, ultimately success for our patients.

Speaker B: Such great bottom line comments, AJ there's so much that I'm taking in just, you know, personally having been in the seat of being involved in these voice of customer sessions. It's pretty impactful. Ira, uh, closing thoughts, remarks that you'd like to just share before we wrap up?

Speaker D: Oh, uh, you know, I think AJ said a lot there that I agree with 100%. I think some closing thoughts I would say is if you want the voice of a customer, then you need to give the customer a voice. I know that sounds a little circuitous, but a lot of companies don't give their customers a voice. They try to shove down a certain technique down their throats or, you know, only show them what they want them to buy. And you need to give your customers a voice. And um, you'd be amazed how many customers want, even for humanitarian reasons, not just, you know, the X amount per hour they get paid for consultants who people you want are people who want to be in a room because they feel as a customer they want a voice. They want that spinal cage to be improved, they want that knee replacement to have better kinematics or whatever it is. You want those people who want to have a voice. And if you can get those people and give your customers a voice, then you're going to get a great voice and a customer experience.

Speaker B: So good. So, so good. I really, you know, Marnie and I both really want to thank you for joining us today. You know, your insights are ah, really exactly what companies need to hear. And at the end of the day it's not the polished version, right. It's the behind the scenes, the real version and the insights you share. So thank you so much both, both, you know, aj, Ira, for joining us on um, this evening and just sharing your thoughts, your expertise. We can't wait to hear what questions comments folks have after listening you all share.

Speaker D: No, thank you.

Speaker C: You can find more interviews on our YouTube channel at, uh, Marnie Reed presents.