Moving Digital Health

In this second episode of Moving Digital Health, the new podcast from MindSea, CEO Reuben Hall talks with Chris Cullmann of RevHealth. Chris is the Executive Vice President and General Manager at RevHealth, where he leverages his more than 20 years of experience as a digital strategist to help clients reach and educate physicians and patients exploring therapy options.

Chris shares the elements of RevHealth’s current projects that have him most excited—in particular, the data perspective. He delves into the progress and recent breakthroughs he’s seen in the healthcare market and points out the role COVID has played in accelerating usage of data and nonpersonal communication. He also illuminates the unique nature of healthcare marketing: that end users, or patients, are generally not the decision-makers when it comes to selecting therapies, as that responsibility typically lies with the physician.

Through the lens of his marketing expertise, Chris enumerates the mediums and techniques he sees working best explains the critical role of storytelling in patient communications. He highlights the importance of creating a narrative that can meet each user in their journey, and he how privacy restrictions have impacted marketers’ ability to reach patient populations.

The rapidly evolving landscape of data and privacy regulations is, of course, fundamental to any discussion of digital marketing. Chris discusses challenges around patient perceptions of data sharing. He highlights the critical difference between individual data and data regarding an individual’s membership in a particular group, and makes the case that a lack of context may be a primary barrier to data sharing for many consumers.

Chris and Reuben consider the future of data usage, anticipating several thorny questions that will need to be answered as progress marches on. In addition to the difficult decisions that will need to be made, Chris also offers a picture of vast potential payoff. He makes the case for data philanthropy and for physicians’ ability to encourage it and illustrates several ways in which data, leveraged effectively, could advance medicine. He also puts forth a few viable value propositions which, aside from pure generosity, might motivate consumers to trade their data.

Chris’s passion for the subject is clear, and his ability to articulate complex problems and solutions in engaging terms is not to be missed. We thank Chris for joining us to share his experience and his insight, and we hope you’ll enjoy his episode of Moving Digital Health.

Listen to Moving Digital Health on Spotify and Apple Podcasts!

Please subscribe to the MindSea newsletter so you will be notified about future episodes!

Read Transcript:

Reuben (00:00.04)
So welcome to the MindSea podcast series Moving Digital Health. Our guest today is Chris Cullmann, Executive vice President and general manager at Rev Health. Welcome, Chris.

Chris Cullmann (00:00.15)
It’s a pleasure to be here. Thank you.

Reuben (00:00.17)
Yeah, Thanks for joining us. Maybe you can briefly describe your role at Rev Health.

Chris Cullmann (00:00.24)
Absolutely. My role at Rev Health is to help our clients identify how to make best use of digital and emerging media and channels, how to use data and quite frankly, what’s become the more traditional, boring story of of digital marketing search email, display advertisements in order to have a more effective marketing. And in particular in the age of COVID, how to overcome where access through reps and health care, professional marketing and patients who may or may not be seeing physicians in the same cadence, how to have the same kind of continuity and communication and an effective communication in deciding exactly what kind of therapies would be appropriate for them.

Reuben (00:01.11)
Interesting. So I know Rev Health has like different service groups, I guess. And which is there one of those that is your focus or.

Chris Cullmann (00:01.21)
No as it was most of my career. Rev health has a essentially a center of excellence that is there to support all the different operating units. We have strategists and user experience teams that are deployed against specific accounts. But we have our our, our core offering, which would be rev health, the umbrella brand, which largely just promotional marketing to health care professionals, payer audiences, as well as medical education.

We have First Amendment, which is very much focused on our patient communications and being able to access those audiences which are typically aligned with advocacy for each of us, which is very much aligned against science and communication. I actually have a little bit less contact with there because sort of pre commercial. Obviously this has been created in order to respond to market changes and market demands as the organization has grown.

It’s it’s refreshing. It’s an independently owned organization. It’s been around 16 years. And I think our service offering is one that’s really oriented around the dexterity of being able to come to our clients with solutions that are not only the right size but effective for the kind of results that they’re looking for when they begin the engagement with the organization.

Reuben (00:02.45)
Nice. It sounds like you guys are covering a lot of ground there. Is there anything you like, particularly the exciting projects you’re working on right now?

Chris Cullmann (00:02.55)
There are quite a few. I think I am fairly limited in what we can talk about. We work on a lot of on launch brands that are pre FDA. I think what’s most exciting and I think reflective of what’s going on inside of the space is where we’re heading from a data standpoint. And I’ve been fortunate enough to work inside of health care for almost all of my career.

A little bit older than I probably care to admit at the moment. But one of the things that’s interesting is we went from a market that was five, six years behind the consumer market and both professional and consumer marketing. And we’ve just come such a distance in particularly post-COVID. We were already accelerating really quickly. But what’s happened since Covid’s come to COVID has really affected, I think, us globally.

But specifically in the US market is data and non-personal communication has really taken center piece relative to our being able to reach these audiences and deciding where we’re going to put specific marketing dollars at any given point. What’s I think really interesting about the health care market is we have an audience, the prescriber who’s not our end user.

The patient is the one we’re addressing with therapies, but the decision maker and one that in some cases rate limits what our actual and user of the patient is seeing because they’re making the recommendations against their their professional experience in the crafts and training, but one that every decision is leaving evidence. Prescription products are normally aligned against them, a physician writing a prescription or making an order in a hospital, setting for them to say that they’re making a choice in a preference.

And in particular, when we talk about the use of ICD ten codes to make a choice and selection against a specific diagnosis. So there’s a lot of data that’s available inside of the market just with that. And there’s a lot of other data fields associated with the practice. So when when I talk about what I’m most excited about and I think what organizationally we’re very much excited about is how do we intelligently use this data and not just data for data sake, but how do we really make smart decisions with data?

How are we able to not look at this massive corpus of data and all the individual feeds? But how do we really cherry pick those very specific salient points of data that are going to make a difference for marketing? And I think we do in a lot of different ways. You know, we’ve launched our own DSP this year.

We’ve really moved ahead in search. We’ve really looked ahead at using both dynamic analytics on the websites in order to dynamically change content, but also make decisions about where we’re driving these audiences based on their propensity of behavior or how we’ve identified it and targeted them using an endemic media partner or perhaps a channel or even the reps involved in that decision making process based on the conversations are having with the physicians.

And when we look at selecting the next piece of narrative that we’re going to serve to a to a physician and albeit even even a patient in a lot of these instances, even with HIPA in place to protect the patient’s privacy, there’s still a lot of opportunity for us to intelligently listen in a respectful way for privacy, to help lend a narrative that’s going to have a more meaningful user experience and one that’s going to really help participate in putting the right materials in front of someone who’s in a position to make a decision about their own therapy or a therapy for their patients.

Reuben (00:06.27)
Yeah, there’s definitely a lot of stakeholders involved there. And you mentioned the prescriber and obviously, you know, traditionally it’s medication or prescribing. Have you seen a breakthrough of any of the digital therapeutics or at in that field?

Chris Cullmann (00:06.49)
Yeah. I mean, I’ve seen I’ve seen a couple of different instances. Um, you know, one, if we look at space like the multiple sclerosis space, we’ve participated in programs that have both connected injection mechanisms that help the patients understand how proper adherence to to a therapeutic regimen is going to be more beneficial. And in particular, how to get better feedback intuitively from their bodies in order to help moderate that.

And I think some of the other things that have happened, very exciting inside of the spaces, beginning to experiment with categories that traditionally have been a little far off ahead from digital therapies and one that is a specific node is looking at, um, treatments inside of the schizophrenia area where a couple of manufacturers are experimenting in the space in using sensors and, and data capture components inside of pills in order to get a better understanding as to how to make sure adherence is first and foremost, but also to be able to take in body signals and see whether or not there’s any physiological responses associated with cycle up and down of being able to do

moderation using CNS drugs. I, I think one of the things that’s become especially evident in this past year is that I think there’s a renewed sensitivity around privacy and what we’ll call like ownership of data that was not part of the original enthusiastic rush into mobile health two or three years ago when we’re starting to see the release of a lot of wearables, a lot of data trackers, I think the tenor, the cultural zeitgeist is shift a little bit.

And I think there’s a lot more sensitivity around data. But what I also think is important is that patients are considering that there is a tremendous benefit to data philanthropy, and it’s not necessarily pertinent to say like a manufacturers therapy. But when we look at moving into categories that have like just large suites of data, something inside of the oncology space, like a breast cancer or a lung cancer, you know, there’s a there’s a population, a patient populace of patients there that, you know, statistically we can get a lot of value in looking at things like co-morbidities, height, weight, gender, whether or not we’re going to look at family medical history or genetics and for

there to be sharing of that data. I think, you know, you’re at a tipping point with the volume of data that you can make some really safe assumptions about what specific therapies are going to work and how that’s going to be applied. At the other end of the spectrum, you have rare diseases where every little bit of data that could be shared in sort of the clinical space, anonymized can give a lot of different insights into other patients that are trying to find their way.

So rather than have these pockets of small population where you’re trying very hard to activate the insights and varied quality as to the data that you’re able to capture, being able to pull that data and have the patients volunteer, that data can be a tremendous help to another patient or a caregiver who’s going to just start their journey.

And I think those are some of the tenets that we need to discuss culturally and to figure out how comfortable we are and what are going to be the guidelines. I don’t mean necessarily federal guidelines, although that is important, but really, like, what are the the cultural agreements that we’re going to have about anonymized data and in particular being able to help other people who exist inside of the same pop, same patient population that we do, and being able to provide something that is really giving back to the community in the true sense of the word.

Reuben (00:01.29)
And in your experience, how willing are people to to share their data once it’s explained to them in how it will be used in an ethical or anonymized way?

Chris Cullmann (00:10.41)
I’m if my exposure to it and I work a lot with the manufacturers. So I think that probably tempers a lot of the responses that I’m hearing. I think that there’s a little bit of reluctance. I think if the physician is going to be the one who’s going to advocate for that, and it’s done in the context of something like a clinical trial data or an H.R., that there’s going to be a lot more openness to it.

So I think a lot of it is what is the positioning of that experience for the end user? I think in a lot of patient populations. So there’s there’s a lot of apprehension and reluctance and rightfully so, to volunteer and work collaboratively. When we talk about data sharing. And this is where I, you know, the the component of that being the kind of the cultural zeitgeist, I think get us in particular, we’re fairly polarized country right now in our views around a lot of things.

And I think that there are a lot of pockets of mistrust. So I think the working with advocacy groups and working with clinical organizations that really have developed an academic rigor and a profile that’s available to the public perceptually can be a huge help to us finding soft ground in order to land those things, and in particular to be the advocates for being able to capture that data and showing back to the community the value of that data.

I think one of the challenges we have and it’s evident in, you know, we do work both in Alzheimer’s and several other neurological diseases where, you know, I think there’s a pushback from the community about this, the expediency of accelerated FDA review. And I think that there’s a lack of understanding as to how the the FDA approval process works and how manufacturers interface with the FDA.

And I’m not trying to act as the farm apologist here. I just think there is a lack of understanding about the role of the FDA relative to protecting patient populations and secondarily, how that process works when it’s when it’s an unmet need. And I think the most polarizing example was if you look at Biogen coming in to market and they’re being a probably a pretty vocal portion of the patient advocacy population that’s pushing back against the accelerated FDA review.

And then you look at how how much anxiety there is about the FDA, not approving COVID solutions in the same voice in the same year. I think it speaks a lot to an argument of convenience and not one that’s completely, you know, informed against looking at how policy works inside of instead of a federally organized group like that.

I also think it’s true when we look at digital health, like only, what, three years ago did CMI really approved physicians getting reimbursed for looking at digital data and the governance laws over, you know, what we talk about digital health or even protecting patient privacy is relatively immature relative to how quickly the platforms are advancing.

Reuben (00:13.48)
Yeah, for sure. I think there’s a lot of information there. Obviously, you know, things are changing at a rapid pace, but also sometimes the regulations are lagging behind. I’m wondering if you want to talk about the patient education side of things. You know, what mediums or techniques are really working in communicating with patients social.

Chris Cullmann (00:14.19)
That’s an easy answer. You I think even two years ago we were talking and it’s still relevant, but Facebook was really the space where we wanted to go in order to both identify patients in their journey awareness, education, their being a value proposition, or, you know, from a marketer standpoint, a conversion point still very much relevant into how targeting works and being able to find a a very large population of what’s traditionally the aging well.

You know, you get your nice sweet spot of, you know, everywhere from 45 to to 70 on Facebook in a pretty healthy population. What I think is interesting is the speed at which tick tock is moving into a lot of these patient populations and it’s distribute you know, it’s this distributed in that you see pockets of certain disease states that have like just massive amounts of dialog, both some influencers who are making really strong, high quality content that’s relevant to audiences and even physicians, you know, whether or not you have one.

An extreme like dermatology, which, you know, seems like low hanging fruit, but you have a lot of, you know, dentists are even starting to see oncologists and psychiatrists that are starting to talk about issues inside of their practice to other peers inside of Tik-tok. So I think you put that together and it’s people are still spending a lot of time.

And in particular, if you’re a patient suffering from a disease that’s content that is really not only valuable but that you find personally compelling and you can be drawn to those people like you who are going through that same kind of experiences. And even physicians are starting to see their downtime exchange inside some of these platforms for some.

Reuben (00:16.11)
Yeah, I guess has the the privacy restrictions enforced by Apple on Facebook, on on mobile and that sort of thing has that made it harder to to reach those people?

Chris Cullmann (00:16.23)
Um, I would say Facebook’s restrictions have probably been the most evident. You know, it’s still not completely clear what those ramifications are going to be. We have seen some deprecation in performance inside of the channels, but the actual conversion mechanics, when we look at the platforms as a whole, are negligible. I think that there is very much evidence of the tenor of the conversation.

QUESTION you had a couple of minutes ago. There is a sensitivity inside of the a lot of people’s homes now relative to privacy, and I think a lot of people truly understand what they what they’re pursuing when they talk about privacy. At the end of the day, all of these devices, whether or not it’s Apple, Android or any other platform, your compromise, your privacy for free content when you go to sites that are advertised, advertise driven, even if they don’t have trackable advertisements on them, it’s still around exchanging your time in exchange for data and the value of content typically in exchange for access to a more for marker standpoint.

I think they’re it’s very appetizing to to listen to what Apple’s value proposition is. But they are also still providing a a cohort to a marketer in order to provide access. And I think that’s very palatable for someone who works in health care. You know, we’re very we’re not very interested in reaching Jane Doe or John Doe one.

We’re much more interested in reaching somebody who’s in a portion of their journey that we can provide value to, you know, transactional. The marketer and health care is not very interested in the individual there. You know, that’s really the role of CRM. And you’ve already opted into an engagement in the relationship. And I think that’s a lot of the false argument in being able to create that construct of targeting inside of these ecosystems.

I don’t think there are many marketers who are trying to reach John or Jane Doe. That’s just an easier way to be able to provide and provide an identifiable handle for somebody who’s at the point of a transaction where they’re likely to make a choice. You know, like how close are you to a commitment of making a decision for for any one of the likes of this journey?

And I think that’s the most interesting thing. And I think a lot of marketers look at it that way as well. So, you know, being able to have identifiable cookies and even email is a targeting mechanism is much more about circumstance and urgency than it is about really being able to get to, you know, who that person’s identity is.

Reuben (00:18.56)
Yeah. Do you think patients and users understand that, that, you know, really when it comes to their data, a lot of times that like you said, people are interested necessarily in them as a specific individual, but more as their membership in a group or cohort or cohort, like you say.

Chris Cullmann (00:19.16)
Yeah, I don’t think I mean, even now, you know, when when I talk with, you know, people I know friends, family and even some colleagues when we talk about them, like how targeting on on a platform like Facebook works, they’re usually shocked at the level of accuracy that you can get. And they see it as you describe it as like a personal violation.

But the fact is, like you’re leaving evidence of your behavior everywhere you go. And this isn’t new. It’s just incredibly convenient and in real time. Supermarkets have been doing this for like 40 years. Direct mail houses have been doing a longer newsfeed, you know, like the mechanics of being able to get a Clubcard and any one of these things you were trading for coupons, your consumer behavior.

And, you know, quite frankly, access to your name and address and your spending habits in a very personal way. In particular, if you’re buying any kind of, you know, health care is at the at the supermarket right. But I do think that this idea of privacy is an important one as we’re trading our behavior at a very granular level.

I mean, when we started this call, I told you I had to shut off two computers to make sure and have any alerts like I’ve got, you know, like I’m giving up a lot of a lot of my behavioral insights when I bring my phone with me anywhere along the way. And I think those are some of the things that we want to make sure that we there’s some awareness of.

And I think it’s especially evident inside of health care. And as an organization that builds a lot of apps. You know, I think one of the value propositions that the app platforms are putting forth are the mechanics of things like, you know, Apple’s health a health solution, where you’re able to preserve the data on a device level and have a real construct of of both integrity and security that’s built around that exchange when it’s labeled health data.

The same is true inside of Google’s platforms as well, although not nearly as popular or as well marketed. And when we look at the the proliferation of something like the Apple Watch and Fitbit to some degree, I think that there’s a a big opportunity to reinforce to this patient population that well, that data is personal. It actually is a big value to, you know, if you’re going to talk to your physician about your overall health, you know, these signals are critical.

And in particular that that data, if not visualized, is of little use to the physician. Like, I can walk into my physician’s office with a year’s worth of data in a spreadsheet without it being visualized. The physician is neither in a position to review that data in any granularity nor are they provided a way to be properly reimbursed for that outside of like reviewing the digital health data, but being able to show them my health dashboard inside of my iOS device, it plots out averages.

A couple of spots were of concern like I haven’t worn and I’ve watched for a long time, like, you know, my pulse dropped below. You know, I got like a warning for four bpm in the middle of the night and was like, Well, okay, well, it’s not, you know, like a clearly calculate calculate all calculate viable health care issue.

But what’s interesting is this should be like, okay, well, that happened twice. We’ll consider that not a concern with you when we look at your overall health, because it’s been visualized here. Right. And I think, you know, there is an opportunity for these platforms to act. As you know, conversation points that have clinical rigor behind them, because you’re you’re looking at a corpus of data that a physician can say, well, this was a year’s worth of data, looks like you’re relatively flat, which is the way you should be.

You know, you’re at rest. Our heart health is here. You know, if we look at anti cardiac events, that’s here. It looks like you’re doing a regular regimen of exercise where you’re working 10,000 steps a day. Like you’re presenting to me a profile of somebody who is, you know, fits in moderate health. And, you know, I have your blood pressure and your weight and everything else right here, too.

You know, that’s really around picture.

Reuben (00:23.29)
Do you find that like physicians are more open to looking at that data or when someone comes in with their data from the Apple Watch and they say, oh, yeah, that’s you know, that’s fine, but, you know, that’s not real medical data or we can’t rely on that. Or they actually look at it and say, Oh yeah, this is actually a really useful data point that, you know, not to be taken on its own, but, you know, a starting point to to maybe look at something a little closer.

Chris Cullmann (00:23.59)
I think physicians, the physicians I’ve spoken to and I’m in a fortunate space to talk to a lot of physicians through exposure to my work. But even my own physician, which is anecdotal at best. But, you know, I’ll talk about the volume of physicians. I typically talk to are refreshed when the patient comes in with that, not because it’s some treasure trove of data, because they have someone who’s actively engaged in participating in their wellness.

Yeah, they have a they have a corpus of data that’s like, Oh, okay, well, if you’ve been wearing your Apple Watch for a year, like I’ve got a year of data where if I want to like deep dive into it, it’s here. But like I’m looking at someone who is lowering their, their, you know, their overall blood pressure for for a new Apple Watch or they’re at rest.

Health has been like moved from 70 to 65 due to exercise. But I’m looking at someone who has a regular exercise regimen that includes motion, some anaerobic exploration right there, even if they’re bringing their heart level up to a high level for 15 minutes a day. I can see that. And now I can talk to the person, not in the context of, you know, every physician tells a patient like we need to exercise more.

Well, what does that mean? Well, now I have a construct of if you tell me that you’re exercising a lot and you’re doing a half hour of physical activity a day, well, I’m I can tell you what I need you to do is 50 more minutes a day right now. It becomes actionable and it’s measurable. And I can put it in a chart and now a nurse can have that conversation and I can move to a telemedicine exchange where I’m talking about, well, I’ve not seen you face to face.

You know, the last time we were together, you doing a half hour a day, like, are you up to 40 minutes a day? It really does change a lot of the parameters because now the physician and the patient are having a shared dialog where they’re both looking at the same core data set. And it’s one that the patient is using as a metric for their own success.

Reuben (00:25.46)
So yeah, right.

Chris Cullmann (00:25.47)
And it changes a little bit of the parameters. Like I think Peloton’s a really good example of, you know, in participating in a, in a peloton like it’s logging your activity, right? So it’s a different kind of health metric. And I would, I would argue that, you know, physician, you know, you’re only looking at a snapshot, but you’re looking at someone who’s at their most performance when they’re exercising, Right?

Well, okay, Well, let’s look at your peak and let’s look at your, you know, your starting your cooldown and warm up. And now I’m getting a profile of like, okay, well, if you do this a half hour every other day and you’re not bringing your your heart rate up or now I’m starting to see an increase of your optimal heart rate.

Well, that’s good cardiac health. If as long as that’s good to high. But you’re talking about someone who’s, like, really working on a different level of calibration, I think, you know, a Fitbit or even those people who bring their phones on a walk acting as a pedometer, it gives the dialog to the physician, a rheumatologist, or any specialist who’s working inside of like motion, a completely different way to look at engaging with their patients.

Right, Because it’s a shared language and it’s now it’s a little bit beyond just having like, oh, here’s the point. Let’s talk about your health. You’re talking about the parameters are something that you’re wearing on your wrist or have come to your belt every day of the week. And I think the same is true of something like Alexa.

You know, I know there really still isn’t a construct for Alexa to be healthy and then just announce the products that are going to allow them to interface with the elderly patients in their home. Aging patients, the aging well. Right. It’s a really interesting construct. Are you familiar with this new product?

Reuben (00:27.28)
No different from the with the like the halo device, but that’s different from what you’re talking about, right?

Chris Cullmann (00:27.35)
Yeah. What they’ve done is they’re offering a product that was is just now it’s I haven’t actually seen one yet is a is a product that is basically Alexa designed for those who are aging in their home, in their own homes. But it allows her to be a caregiver permission model where both the patient and the caregiver can summon emergency services.

So there to be a behavioral insight into what’s going on in the home. So you won’t see that the person’s doing X or Y, but the person’s mobile. The person made a call today, right? So it allows you to have a glimpse into the person’s home and some insight into the behavior that’s going on there, but without being overly invasive into the person’s privacy.

And it also allows the person, the person who’s aging inside of their home, the ability to have a lot of other services that are an enhancement that really look to, you know, what are the tools that you would need if you were going to be aging with inside of your home that fit into the Amazon ecosystem? I think it’s a good example of Amazon.

Still a good job is to make themselves accessible to a really wide demographic of people, and they also have a brand that’s very much aligned with being able to offer a data oriented program to the marketplace because they AWG backs many of the pharmaceutical websites from a database perspective in a serving segment. So it really is a nice overlay of two different components inside of the brands.

And I think a good example of gently wading into the waters of how technology is going to be helping and expanding population of the aging.

Reuben (00:29.05)
Yeah. And a voice UI, you know via Alexa is certainly a great way to a great way to interact with, you know, elderly patients that have trouble with, you know, more more graphical user interfaces like, you know, apps and that sort of thing.

Chris Cullmann (00:29.26)
Yeah, and I also think, you know, it’s another example of Amazon’s very good about creating APIs. So, you know, looking at an ecosystem where you can add on to a service like that, for instance, you know, those who are, you know, there’s, there’s an aging population which struggles with arthritis, right? And it’s one of those generators These is that if you’re not a physically challenging the disease in several different ways, it’s the likelihood of progression is high but to it’s a very easy way to calibrate on you know, if you have arthritis in your hands for you, the amount of pressure you can apply at any given point is a signal as to how much

your pain is that combined with your reporting, your pain. So this is something that you can create a an extension to the Alexa program that allows you to apply pressure to a device. It reports it into this, you know, essentially like what’s likely going to be the Alexa hub for the aging. And for now you to have another data point that you can go back to the rheumatologist.

So you know, anybody who goes to the physician unless they’re happened to be in a lot of pain that day. What’s the biggest problem with someone who’s suffering from from arthritis? Right. Well, it’s it’s it’s all right, Doctor. Right. Well, the fact is you’re actually in pain, which is why you’re seeing a rheumatologist. And the fact is it could be getting progressively worse.

But unless you’re an incredible being that day, it’s not worse than it was the day before.

Reuben (00:30.48)
And yeah, people are terrible at self-reporting, you know, and yeah. And being accurate about it.

Chris Cullmann (00:30.58)
Yeah. So it’s like it’s being able to intervene in those times that allow you to have data points that are going to help with the actual caramel. Well, and same is true. You look at any chronic disease diabetes as another example where you know, to being able to chart that progress day over day, you know taking it taking my insulin spikes like you get a much better picture to all your overall wellness and in particular you start to overlay those behavioral things that you may not even be aware you’re doing, but could be contributing to the degradation of the disease.

And those are a lot of the narratives that I think are important to look where we as an industry are going like and again, to kind of pulling it back to the narrative we were having around privacy is, you know, look at look at the Amazon products and I’m sure there’s going to be a lot of sensitivity to it to an aging population.

Right. But what are you getting in exchange where your caregiver is getting some peace of mind and knowing that, you know, my loved one is is mobile enough right inside of their home? Right. So some assurance there without me having to call constantly to the person who’s there. What other services can we provide to make it more appealing to know that you’re being observed and any given point.

Right. And it’s it’s you know, you put those two things together, it’s like we’re providing a big peace of mind, a good opportunity. But, you know, if the other if if the person who has the Amazon product installed in their home and knowing that they’re suffering from arthritis or that they just had know hip surgery, well, what content can we introduce into that home in order to make that a better experience or more educated experience.

Right. Which us into another one of your categories.

Reuben (00:32.39)
Yeah. And it’s back to the trade you talked about, right? Yeah. Yes you are. You know, sharing and your data and leaving all these footsteps. But that data is also the, the insights into the, you know, the services or, you know, tools that can help you where you are in with your particular condition or in day to day needs.

But I think there’s still that trust bridge to be forged. And I think especially with Amazon, you know, a lot of people will just think, well, Amazon is, you know, it’s all about selling things. So they’re just trying to find different ways to sell anything, which may be true, But if it’s the right thing that’s going to help you, you know, live your life and be healthy, you know, is that worth the you know, the trade off for your for your data?

So, yeah, it’s definitely a very interesting and kind of nuanced space for moving into with this for kind of, you know, 24 seven monitoring type situation.

Chris Cullmann (00:33.51)
Yeah. I mean, let me ask you a question, right? So when you talk about the construct of being able to create, say, an app for Alexa, which I think is fairly fits into the, the parameters of, of your agency right. At what point are we as a manufacturer or an insurer. Right. I’m looking from the business side of it going to pay for that Amazon Alexa to be inside of your home in exchange for data.

If you’re if you’re a commercial insurance company and you’re talking about someone who fits into their coverage model of falling into a commercial, well, that’s a really interesting value proposition, right? If I know that you’re exercising on the regular and I know you fit a profile, do I reduce your insurance premiums? You know, it’s those automated there’s auto insurers that offer that, look, we can put a chip in your ODB port on your car.

And that way I have a profile as to what your actual driving looks like relative to, you know, not just mileage and you know, how many accidents you’re going into. But I can look at how fast you accelerate and how hard you break, and I can fit you into a cohort for pricing. I don’t have to actually have to look at your individual behavior.

I just need to know, you know, you fit into a specific profile and that profile is assigned, you know, a risk discount or a risk increase based on those driving behaviors. And then now becomes comes positive feedback, right? Which is, hey, you’re cohort six. We can lower your premiums by $200 this year if you move into cohort five, here’s what you need to do.

Reuben (00:35.25)
Because and well and then it benefits the safe driver because they’re actually paying a more appropriate premium for their behavior, you know, someone that might have the same demographic information, but a much different driving profile and would be the same thing for health. Right. Like, you know, those reduced insurance premiums for a healthier individual that is staying on top of their exercise and diet or medication, it benefits the people that are doing the right things essentially for their for their health or safety.

Chris Cullmann (00:36.09)

And, you know, what’s interesting is is and I’m curious to hear your perspective on this. You know, when we talk about people’s perception of data and privacy, I think one of the stumbling blocks is people don’t have context to their data. Right. Like, that’s one of the barriers to this, which is, well, I’m just giving up my data.

Right. But if you were to talk about like a well, if I was going to give up my health data in exchange for a discount or, you know, my exercise behavior collected on a wearable to the to to the my insurance company in exchange for a lower rate. What would be really beneficial to me is like, where do I fit?

You know, am I in the top ten median? Am I am I in the bottom 10th decile? Like, you know, you’re you’re you’re ranking me, but I don’t understand where I fit in. You know, if I knew I fit into a comfortable modern. You like a medium. Well, maybe I would be a lot more comfortable. But it was like, Yeah, sure.

You know, my data, I’m just like, you know. Joe Average versus. Yeah, well. Oh, well, I’m an outlier. Well, now, now I’m respectable, right? And I think that’s part of the apprehension is that people, they don’t know what they’re exchanging because they don’t know where they fit. And then that’s where this idea of kind of data philanthropy I think comes from.

It’s why I it resonates really well with me because being able to give it force without the personally identifiable information, I think reduces a lot of the risk. It’s just I don’t think people believe that it could be completely de-identified and in some instances I think it really can’t be and be meaningful. But I think there’s an opportunity to start to have that conversation around, you know, how much can I give up, where is it going, what’s the value going to be, and what do I get out of it?

You know, and I think.

Reuben (00:38.02)
For people like you or me who work in this space and kind of understand that tradeoff, you might be more willing to, you know, to share data because of that, that understanding. Right. But I think there’s been a poor job done of communicating to people know what some of the benefits may be of of sharing their data. And also, like you said, the you know, the instances where, you know, that data is collected and then it’s, you know, it’s breached and it gets stolen and it just all goes to breaking that trust and creating the fear of people that like like, no, I got to I got to hold all my data tightly and keep

it under lock and key because any any data breach is going to be a bad thing for me where it’s, you know, it’s much more complex than that.

Chris Cullmann (00:39.01)
Yeah. And I think, you know, you and I, I think are looking at it through one perspective, which is categorically like where we practice is one level, but, you know, being, you know, in a in a non at risk population is another. And then our age is another right where there’s a younger, you know, like kids coming up today, they they’ve only lived in a world like I’ve worked in a world pre-Internet.

It’s not very pre-internet but it was pre-Internet you know. But you know, it’s anyone like ten years my junior only knows referencing via a screen. And now you move back to like, like I have a I have a ten year old son. Like he’s growing up in a world where his data his data follow him around for the rest of his life.

You know, both in social media, school records, email, he already has an email account, you know, So it’s like, I think there’s going to be an adjustment several good and bad. Like I think there’s going to end up being a little bit of indifference relative to data privacy because it’s too much like it’s it’s just too much to manage.

Like some people are good with their finances and other people aren’t like, you think it’s going to be like that kind of conversation. But I also think that there’s going to be a lot of value adjustment against that data model, right? People are going to start to realize they’re giving up a lot in exchange for a little, and there’s either going to be a rise of privacy and paying for services or there’s going to be a lot more protection mechanics that are going to be put in place in order to allow people to have a clearer delineation into what they’re putting forth versus what they’re getting in exchange for their their data specifically like personally identifiable data.

Reuben (00:40.54)
And with the younger generation, you know, do you find that that greater awareness of growing up online makes people more free with their data or more cautious about sharing it?

Chris Cullmann (00:41.10)
Um, I would say the context that I’ve had any kind of like conversations with with, you know, emerging adults, like young adults, I think there is some apprehension around it. Like I do think that there’s a sensitivity to, you know, I’m positioning myself, you know, into into the world and into a market that I need to be cognizant of what I’m putting forward and where I’m putting my data.

I think that there’s I think that’s part of it’s going to end up being part of maturing. And I think there’s going to be a little bit of a resurgence into kind of anonymous profiles online, like there was when the Internet started, right where there was. There’s a lot of apprehension about even doing like financial transactions, like I’m not going to get my credit card in there, right?

Like, I’m not going to shop online. And yeah, you know, that has come full circle. And I think there’s, you know, not from a shopping standpoint, but I think that there is going to be kind of a rise of people having pseudo personalities and pseudo profiles for online communities.

Reuben (00:42.17)
Yeah, Well, and all of us in the way that, you know, people, you know, would perfect their image for social, right, you know, only sharing the, you know, the images and photos and moments that, you know, put them in a good light. You know, you could look at the same thing happening with data where people are kind of like filtering and being like, okay, I’m only going to let out this data that like, Will makes me look healthy and or, you know, maybe even actually, you know, editing and people getting like to that level or now I’m gaming the system with the insurance companies because you know, I’ve gone in and forged data that makes

me look healthy and active when really that’s not the case.

Chris Cullmann (00:43.06)
No, I think it’s a good point. I think it’s like the Wild West. I mean, I also think it’s interesting as we talk about profiles online on both Apple and Google have mechanisms in order to obscure your identity to third parties. But because we’re carrying the devices around with us, there’s kind of this single point of truth.

You know, Apple offers a service that allows you to obscure your email address and protect your privacy there. But there’s no fooling apple. Apple knows where those accounts reside. Google’s very much the same. You have a canonical, you know, identity and whether you’ve secured or not, you know, there’s there’s a lot of behavioral indicators that allow you to to eventually like come to that person.

So you know you have this. Yes those statements are true. But these large tech giants which are under scrutiny for regulation, at least the not globally, you know, that’s a little bit of what’s like, you know, well, there’s there’s a new regime and it’s actually, you know, more omnipotent than than, you know, country and geographic policy. Right. These things actually transcend geopolitical ties.

And they are becoming, you know, kind of nation states in their own right, although they haven’t, I think, really like flex that policy. But when you look at the amount of data they have, access to in their ability in order to to tilts things experientially like it is, it is, you know, something that we need to be cognizant of as individuals in the choices make.

And also, you know, on a country and political level.

Reuben (00:44.46)
Yeah. Because it does get more a compliment or a sorry complex. Can you have an organized organization like Google that has all this data and provides services across the world, but then specific countries will take issue with their privacy policy or the way they’re targeting users so that, you know, Google now has to customize its providing its services like for that specific region.

And then it gets fragmented across all these different, you know, exceptions as well. So yeah, as you add on those layers of technology giants and government restrictions and, you know, different types of data from different sources, it just like layers of complexity. Just keep building that make it such a so challenging to Yeah to regulate and and find ways to organize and make data more manageable for an individual user.

Chris Cullmann (00:46.00)
Right now it’s the truth. And you know overly that h.r. Systems which, you know, as sophisticated as they are surprisingly disparate in their connection to one another. I think that’s data interoperability actually that at a health care system level, I think will be the next kind of major subject matter for at least for us market to deal with in countries with socialized medicine.

I think it’ll end up being governed a little bit differently. But in the US market, it’s just so fragmented. And even with inside of the same hospital organization, there’s really a lack of operability to be able to provide data from like an imaging center to a cardiologist who’s on the different floor of the same hospital and vice versa.

And I think those are the things that are going to have the most immediate effective impact on things like cost of health care outcomes, data and reduce the cost of health care in quite frankly, in those privatized systems. You know, I think that that’s a much more boring story, quite frankly, but it’s one that’s actually going to be a lot more important nearer term.

Reuben (00:47.11)
Yeah, And I think it is something that almost like is just glossed over because it’s been in such a big issue for such a long time. And it’s hard to tell whether we’re actually moving forward on interoperability or not. Right. It seems like it’s kind of stagnant and there’s been so much talk about, you know, the standards and like all suffering and fire, but like, how do we know we’re moving towards and getting closer to that goal of having interoperability between different systems?

Chris Cullmann (00:47.52)
Yeah, Well, I think, you know, to tease that out is like, well, what are the success metrics? Is it, you know, being able to have, you know, like a markup specific for data variables? Is it about speed of transaction? Because those are two very different metrics. One of them being like prolonged residents of data and accessibility, like kind of like an open standard versus, well, let’s let’s reduce the barriers like with inside of a network and see whether or not like you can keep the data operability construct like with inside of an imaging database, but how quickly can we make it interoperable to like middleware to the larger network?

You know, like what’s the right argument to have when like, you know, Siemens or Philips owns the imaging tool and then, you know, Cerner owns the h.R. System and you know, nobody’s bothered to write the middleware, quite frankly. You know, no one has the licensing to write the middle, right. I think those are like which ones are going to be the most expedient and in particular, where’s the most monetary value to any of the individual stakeholders.

They’re at a hospital included, because they want the better outcomes data. And so I think these like these are not conversations we’ve been we were having like even 6 to 7 years ago and, you know, where is that talent pool coming from, Right? Like, where is the computer science expert who has a degree in like health economics, like, you know, finally that unicorn unicorn and like, you could solve that problem, right?

And in particular, if they’re if they’re motivated and I’m sure those people are out there, the question is like, well, how do we activate them in this modern space where we’re still having conversation about like, you know, you know, like, how do we change admittance and just general outcomes? And some of this is technology based, some of it’s policy based.

Reuben (00:49.46)
Yeah, I agree with that unique skill set. You know, someone who really deeply understands medical field and also has the technology side is certainly a very valuable skill sets. And I know here locally actually our university Dalhousie has a health informatics program that kind of combines those two things. Specifically, you, you know, the the intersection between kind of health and technology, which I think is, yeah, that’s a huge potential to make an impact in the future.

But it takes a long time for all that to happen.

Chris Cullmann (00:50.30)
That’s nice. What are some of the challenges that you’re seeing inside of the marketplace? I mean, I think you’re you’re dealing with both health care clients and dealing with like the on device security, on device networking and user experience. What are those challenges that you’re seeing and how are you tackling them?

Reuben (00:50.52)
So it’s interesting, you know, working on mobile devices with, you know, Apple and Google, you know, they have pretty good ecosystems in Apple, especially if you’re generally like following the, you know, the guidelines for how to build secure apps, then you’re you’re in a good position, whether it’s, you know, personal health information or financial information or whatever. Android is a bit more challenging.

There’s you know, there’s more ways that people can kind of reverse engineer the app and and get in there. But it’s really more at the API layer and the backend. So it’s more of the challenges are because it’s the data in transport and obviously that’s encrypted but the you know, where the data is stored in the database and the vulnerability is there are the bigger issue and you know, sometimes we are building the server as well.

And so that’s something we have to handle. But a lot of the partners we work with, you know, have their internal team that are mentioned outside. So we just have to work with them, you know, really closely to to ensure that, you know, the data is kind of kept secure from any. And there’s also partners we work with where, you know, we have built the system and essentially locked ourselves out for, you know, to maintain like the strictest level of privacy so that we can even kind of hand over the keys to the client so that the minimum amount of people possible now have access to that data.

Chris Cullmann (00:52.51)
And is a good policy to have. You know, because I think part and part of the conversation we had is as agencies is you know, what is the liability of an agency like, you know, five or six years ago was like if their website was up and running and you didn’t have any security breaches, that was good. Now it’s a question of how do you maintain persistent APIs?

What happens when your policy changes in the platform level? Who’s responsible for data integrity? You know, do you really have any like principles elasticity in regards to how long data will remain solvent inside of a database? You know, there are like a lot of like pseudo ethical questions, like when we’re talking about a health care data and preserving healthcare data, you know, iOS is a great example like that.

Health data gets stored in iCloud and can move from device to device. You know, at what point are you not expiring that, you know, like, you know, well, eight years ago, you know, well, I’d like, you know, pound jelly donuts and have beer all day like well, that was part of the health record that I would want expunged.

Right. And will. Well, you know, like, well, how do I do that? You know, how do I do that if I’m going to like, then apply for a health discount for looking at my health data, you know, like some really interesting, you know, concepts on ownership and integrity of data that I think are unanswered. And I think a lot of people are going to be uncomfortable with, and rightfully so.

Reuben (00:54.14)
Yeah. And it was it’s really interesting even, you know, the idea of kind of, you know, declaring data bankruptcy and saying like, okay, I’m I want to separate myself from this past data, so I’m going to, like, close my old accounts and, you know, have a new iCloud account and a new Google account and all of a sudden try and like start afresh.

I don’t think a lot of people are thinking about that right now, but it’s something that might become more common in the future.

Chris Cullmann (00:54.46)
Would like is is that obscuring like if you know, can I you know, can I sue to get access to that data as the insurer, if, you know, four weeks later you have a heart attack, right. You’ve obscured my view into the data, right. Like you’ve lied to me. Right. You know, it’s no different than like, you know, like, you know, just because you are, you know, you’re terrible prison record doesn’t mean you have prison records.

You know, like, it’s still like some of these like, like I said, it gets into like, these like interesting conversations about, like, like ethics and no one’s because, you know, those are records that exist and. Well, is Apple is are they in a position where they they will expunge that account completely? It’s not, you know, no longer discoverable.

You know, like there’ve been a lot of questions about people who are raising their Facebook profiles and then they’re not really a race.

Reuben (00:55.36)
Yeah, exactly the same thing. Right. But yeah, and the question is whether, you know, whether that’s your right to watch your race. Although I data or, you know legally if you’ve signed the prior agreement to share that data and then you get rid of it, then you’re in breach of that contract with whoever that may be from. Right.

So, yeah, definitely, definitely An interesting topic to explore. Let’s switch gears a little bit. I love to hear your take on storytelling and how you use that to communicate with patients.

Chris Cullmann (00:56.17)
Yeah, I mean, I think storytelling is an important part of allowing the health care narrative to land with patients. The fact is, I don’t think that there’s any huge epiphany for a lot of patients relative to the disease state. You know, Doctor, Google typically answer a lot of really high level questions. What becomes pertinent is how does this become meaningful and actionable?

Me as an individual, and this is part of why social has become, you know, a big part of any kind of, you know, health care marketing program and quite, quite frankly, culture, health care culture is we go to look for other people’s stories. How are they coping with the disease? What is their narrative? How does this one deal with a loved one who’s suffering?

I want to find someone like me, right? So it’s important that we’re able to find these individual elements and find things that are going to resonate with us. It’s a big part of making sure that we have people who look and sound like our patients in campaigns and that there are narratives that are accessible to different patient populations.

When we put them into market, we want to see even physicians want to see other physicians responding to products. Why? Because we want to have that true component of empathy. We want to know that someone else is going through that experience and in particular, we want to hear what those experiences are like. You know, I think there’s a lot of inherent mistrust in advertising in general, which, you know, from a culture that’s relatively cynical, like I get, but it’s those peer to peer experiences when they’re authentic that I think allows especially well for those are more of a construct like I think the it still needs to be able to, you know I need to

be able to have that that resonance right. I need to be able to see my own story in what’s being told and identify with it. It’s part of the reason why, you know, being able to pull in, you know, celebrities and influencers means so much, right? These are people who already have like a like an equity with a lot of, you know, of the audience.

And we’re borrowing that equity in order to provide, you know, get access to their ears and minds. So storytelling is a big part of what we do. I also think storytelling is a really important part of a user experience, right? You know, like I think a lot of a lot of our clients have this vision that a patient is going to health care professionals going to come to a website to come to the home page, and we’re going to read your story and we’re going to find that call to action that’s most pertinent to you.

And we’re going to you know, we’re going to spend several minutes reading through your site. You know, I think when you talk about storytelling, like everyone’s going through a journey and if you’re interacting with content in the middle of the day, you may be at a desk trying to interface with a patient and you actually don’t want to engage in the story.

You want access to that information. That’s part of the story, right? And being able to fit in and provide a value to that physician by making it accessible easily. That’s the story. Right to the patient who’s who’s looking to really understand, well, what’s it like to suffer from the disease? What’s it what am I what should expect to go through?

I was just diagnosed with the disease. What’s going to happen? They’re looking for stories. They’re looking for narratives that like, well, it may not be my specific story, but like, okay, what are what are ten stories look like? What’s what can I expect? That’s a that’s a big part of how storytelling fits into. And I think it’s it’s got to be specific to the product and it’s got to be specific to where the product is in the marketplace.

So, you know, not every brand’s a hero sometimes, you know, being able to have that information in front of the patient, that’s really matter of fact is everything that that patient needs.

Reuben (00:59.58)
Yeah, yeah. It’s providing value at at that moment a cool one. Just realizing that we’re actually running a little bit over on time here. There’s definitely more we could talk about, but I feel like we’ve had some great conversations and certainly some, some some great material here. I know for me I’m just like I try to keep up.

I’m like, Wow, it’s just like a wealth of information here. And yeah, it’s really been cool to chat with you.

Chris Cullmann (01:00.36)
You know I’m very passionate about the subject, passionate about the industry. You know, I’m fortunate and fortunate enough to have found something that I love participating in. And, you know, it’s right at the intersection of, you know, kind of creative communication and technology. And it’s the right time to and it’s an exciting space to be in, as I’m sure you’ve found as well.

Reuben (01:01.01)
Yeah, I think it’s certainly a very interesting time to be working in the digital health space. And I think for me, the most exciting part is the, you know, there just seems to be opportunities abound for improvement and value to be created in this space. And that’s what excited me to see that. Like there is so, so much farther we can go.

And you know, seeing where we can take it and in the next several years.

Chris Cullmann (01:01.33)
Yeah agree. And listen, it’s going to be rewritten several times in the next decade. It’s a really fast.

Reuben (01:01.41)
Yes. Yeah, 100%. All right. So, Chris, I just want to say thank you for your time. It’s been really interesting to chat with you and to hear your perspective on these issues. Hopefully we can get connected again another time.

Chris Cullmann (01:01.55)
Yeah, really exciting to have the conversation. I appreciate that. Appreciate the dialog. Thank you for inviting me. Cool.

Reuben (01:02.02)
And thank you for everyone that’s listening and hopefully got something out of this. If you like this episode, please subscribe to the monthly newsletter and we’ll notify you about future episodes.

New call-to-action