The Human Centered Design Podcast with Gerry Scullion

Amy Bucher 'Applying behavioural science within the healthcare realm'

John Carter
December 8, 2022
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Amy Bucher 'Applying behavioural science within the healthcare realm'

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Episode shownotes

I caught up with great friend of the podcast, Amy Bucher. Amy is author of Engaged on Rosenfeld Media and we chat about her role of CBO (chief behavioural officer) at Lirio.

On Lirio's website, they state 'Our purpose is to combine the power of behavioural science with artificial intelligence to drive positive behavior change for the betterment of all people'.

We chat about how this works within the delicate realms of healthcare - and makes for a fantastic conversation.

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Episode Transcript

This transcript was created using the awesome, Descript. It may contain minor errors.
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[00:00:00] Amy Bucher: One of the things we're really looking at in our platform, both in the technology and the design side, is how do we help people really understand all of these different behaviors as part of a connected ecosystem and start to coordinate the things that they're doing so they don't feel like they're just going one by one by one.

[00:00:14] Amy Bucher: On the AI side, that means cultivating the algorithm to be able to make decisions about more things than just the content of the messages. So also things like what channel do we message somebody? Is it better to message Amy on her cell phone about her flu shot, and then in email about her mammogram?

[00:00:34] Gerry Scullion: Hello and welcome to This Is Hate cd. My name is Jerry Scullin and I'm a designer educator, and I'm the host of This Is Hate cd. Based on the wonderful city of Dublin Ireland, our goal here is to have conversations that inspire and help move the dial. Organizations have become more human centered in their approach to solving complex business and societal problems.

[00:00:54] Gerry Scullion: Now, I caught up recently with great friend of the podcast, Amy Butcher, Amy's author, have [00:01:00] engaged on Rosenfeld Media, a book definitely worth checking out, and we chat about her role as cbo, um, which is the chief behavioral Officer. At L now on L'S website, they state our purpose is to combine the power of behavioral science with artificial intelligence to drive positive behavior change for the betterment of all people.

[00:01:20] Gerry Scullion: Now we chat about just how this works within the delicate realms of healthcare. And it makes for a fantastic conversation with Amy. Amy's super cool. But before we jump in, if you like what we're doing here and please help us out with doing one or two things, you can do both if you want. It makes me super happy if you do both.

[00:01:35] Gerry Scullion: Number one is leave a review wherever you're listening to this podcast. That only takes a couple of minutes and it really, really helps with the findability of the podcast. Those algorithms really love your words and your five star ranking as well. And second thing is go on better and become a patron.

[00:01:52] Gerry Scullion: It really helps the podcast stay alive. You get an ad-free stream of the podcast for as little as one Euro 66 per month. That's like [00:02:00] half a cup of coffee in Dublin, and you also get a shout out as thanks as well on future podcasts. There are other plans there. We can get exclusive items too, such as an embroidered hoodie and also a t-shirt and notebook and so forth, and literally all the money.

[00:02:14] Gerry Scullion: Directly to editing, hosting, and maintaining our website, which is now a repository for human-centered design. Goodness, we we're probably hitting nearly 230 episodes up there at the moment, and all proceeds go towards making sure that we can keep the lights on at this estate cd. Anyway, let's jump straight into this episode.

[00:02:34] Gerry Scullion: Amy Butcher, how are you? How are you doing?

[00:02:38] Amy Bucher: I'm good. How are.

[00:02:40] Gerry Scullion: I'm not so bad. We've just had a bit of a, a catch up. Can't believe it's been, has it been three, two and a half years? Pretty much, yeah. A few years. Couple of years. Couple years. Just we were talking, you know, it was just before the pandemic happened, before it all went a bit weird.

[00:02:56] Gerry Scullion: Um, that's the pandemic, not me or you, but, [00:03:00] um, . You've been super busy. We've been messaging each other, sort of like ships in the night on different platforms over the last couple of years. Um, you moved on, you were in a new role. Um, but maybe you tell us a little bit more about, um, where you're at now and what

[00:03:17] Amy Bucher: you're doing.

[00:03:18] Amy Bucher: Yeah, happy to. So last time we talked, I was at Nadow, where I was the vice president of Behavior change design. Mm-hmm. . Um, about a year and a half ago I moved to a startup called L, which, um, we have an artificial intelligence platform that we use to send behavioral science based messaging to people about their healthcare.

[00:03:35] Amy Bucher: So if they're, um, you know, due for an immunization or a cancer screening or a wellness visit, we're able to message them about that, but in a way that really connects with whatever might be stopping them from taking. And the AI helps to personalize that outreach over time. So I'm, I'm the Chief Behavioral officer there.

[00:03:51] Amy Bucher: I lead our behavioral science team, which includes behavioral design, you know, kinda my, my bread and butter, my background. Yeah. And also behavioral research, which is really [00:04:00] focused on proving out the effectiveness of our products and kinda feeding that research back into the design process. And, um, one of the very cool things, I mean, you probably know I'm not an expert in AI by any means, so there is an artificial intelligence team as well.

[00:04:13] Amy Bucher: We have a chief AI scientist, and that, that for me was a huge reason to join l to be able to work alongside a, another science team and really learn from them and kinda absorb as much knowledge as I could. Although, I'll say the main thing I've learned is that I know nothing ,

[00:04:30] Gerry Scullion: I can imagine it, it's, it's probably safer to say that in a business like l.

[00:04:35] Gerry Scullion: I don't know that it is in a traditional design business where you almost feel like you have to have the answers to everything. Um, but maybe take a little bit of a back step, but we're not gonna go into the road, down the road, should I say, of what behavioral design is. We kind of covered that off in the last episode.

[00:04:51] Gerry Scullion: For anyone's listening to this, we wanna know a bit more about Amy. Go back and check it out. It's in March, 2020 on the podcast, or just scroll through iTunes. [00:05:00] It'll be. Amy, you also wrote, engaged the book, um, on Rosenfeld Media and that was the last time we caught up. How did the book do over the last, uh, two and a half years?

[00:05:11] Gerry Scullion: I know you've been busy speaking about it.

[00:05:13] Amy Bucher: Yeah. Uh, I mean, very non-traditional kind of book promotion process because it came out in March 3rd, 2020, and as we know, the world shut down about a week later. So I, I didn't have what I think of as the typical experience where you might go visit, you know, companies and teams and do workshops and really talk in that sort of in person format.

[00:05:31] Amy Bucher: But I did do a lot of, um, podcast and reviews and virtual presentations. One of the things that actually. Um, an advantage of having to do everything remote is I feel like I was able to speak much more to people outside of the US because honestly, traveling to another country is, is time consuming, but it's not really a big deal to, um, you know, hop on a zoom even if it's at a strange hour of the day.

[00:05:54] Amy Bucher: So, um, I feel like internationally speaking, I probably was able to talk to more people and, and kinda [00:06:00] spread the word about the book more than I would've other. I don't know, like what to benchmark it against to say like how it did. But I will say one of the things that I really loved about it is like, even this week I got a message on LinkedIn from somebody who I don't know personally, who had come across a copy of the book and was looking through it and you know, had some very nice feedback to share.

[00:06:19] Amy Bucher: And so that to me is, is sort of like the wow moment. Like, oh my gosh, there's real people out there who are reading this and thinking about it.

[00:06:25] Gerry Scullion: Yeah, absolutely. Well, I. There's a lot of good points in that. Um, the fact that you, you probably didn't have to travel, but it was a different experience and how you did, I mean like that podcast alone generated an awful lot of inquiries in my end.

[00:06:41] Gerry Scullion: Um, a lot of stimulus for great conversations around what behavioral design was, and it really educated me as well. Cause I think at the start of that conversation I was like, Hey, a limit, I'm a little bit suspicious of behavioral design and design coming together. Cause I was coming from the perspective of nudge.

[00:06:59] Gerry Scullion: You [00:07:00] remember the whole kinda of nudge craze, like we're just gonna behavioral nudge them into our channel and then manipulate them. But I guess I'm, I'm interested to learn Moreo. Um, and it sounds like it's, it's obviously, it's a, um, technology focused business leaning on ai. How are they using behavioral design and design generally to inform the creation of the algorithms?

[00:07:29] Amy Bucher: Yeah, and let me start by saying, our product is called Precision Nudging . Um, but we do use. A much broader toolkit than just nudges. I, you and I, I think, share some skepticism towards, um, you know, nudges as the, the whole package. And even, um, when I was interviewing at Larry, I was like, tell me there's more than just nudges.

[00:07:49] Amy Bucher: And I, I was satisfied that yes, it's a, it's a more sophisticated, um, Tool kit. You know, not just have their place, but it's not every place. So, um, my behavioral [00:08:00] design team, I think of them as a tip of the spear. Once we close a contract with a client, the behavioral design team is the first team internally who's activated.

[00:08:06] Amy Bucher: And so we do a little bit of consulting. We call it our behavioral discovery and design process. If we're building a new product, like if, if we have a client who comes in and says, Hey, I wanna do precision nudging for, um, lung cancer screening, that's something we don't do. , we would wanna do some work within their organization to really understand the patient experience of lung cancer screening.

[00:08:25] Amy Bucher: You know, what are the behaviors that somebody needs to engage in to get to that, you know, other side where the screening is done. And it's usually gonna be something like scheduling and attending that appointment, but, , sometimes there's more to it. Like we have a program for colonoscopy and so we really mapped out all of the different behaviors around preparing for that colonoscopy.

[00:08:43] Amy Bucher: Um, in states, in the United States, if you're gonna anesthesia you to another, drive you to and from the appointment, they don't let you get behind car. So you making sure those sorts of supportive behaviors also covered. Um, and then we're, that team is also actually building the intervention. So I have people who are, I [00:09:00]call behavioral designers, that's their job title, and they have behavior science training.

[00:09:03] Amy Bucher: So they're doing all. Action path mapping, you know, documenting what behaviors we're trying to change and what are the, uh, determinants of that behavior, the things that make it harder or easier. So that gets into all the stuff we talked about before, but then they're actually working closely with what we call our behavioral creatives, who are writers and visual designers, to translate everything that comes out in that research into content and.

[00:09:27] Amy Bucher: So we're basically taking one behavior change technique per message, um, and writing content and creating a, a new image of the spoke image to bring that to life. And then that becomes the message that we'll send to people through, um, either email or text message or whatever other channel our customer organizations want to use.

[00:09:45] Amy Bucher: And it's kind of an interesting nuance to the work. I hadn't previously worked so closely with creative teams to translate the behavior science into content, but um Right,

[00:09:54] Gerry Scullion: right. It's really. I was gonna ask more around the patient journey. Say for arguments sake, the [00:10:00] colonoscopy journey, I'm gonna take the, the, the least popular one that most people wanna talk about.

[00:10:05] Gerry Scullion: Um, but is it an omnichannel experience? Are you able to track the behavioral side omnichannel, or is it primarily just digital? So anything that happens on a smartphone or.

[00:10:16] Amy Bucher: Yeah, so right L'S precision nudging right now is digital only. However, we, one of the reasons we do that discovery process is to support the, um, sort of live analog experience because mm-hmm.

[00:10:29] Amy Bucher: one of the ways that we think about it is we can use the messaging to get people to decide to take action, you know, get them started on that behavior, but then they're gonna go out and interface with the health system, you know, they're gonna call and try to schedule the appointment and have to go through, you know, buying their laxatives and taking them and all.

[00:10:45] Amy Bucher: And we recognize that although a lot of that experience is outside of our control, we can advise our clients on how to improve it using behavioral science. So a lot of the work that we do in our discovery is things like, Ll review the patient education materials and make suggestions for ways to make [00:11:00] them easier to understand or align them better with the way people behave.

[00:11:04] Amy Bucher: Mm-hmm. , we do a lot of like, call scripts, call center script reviews. So if they have a phone representative who's doing reach out, sometimes there's tweaks you can make to those scripts that make it more likely that someone will respond and understand what you're asking. Of'em Hm. . And so that, that's how we're trying to influence the kinda offline part, but our, our product itself.

[00:11:21] Amy Bucher: Digitally focused.

[00:11:23] Gerry Scullion: Okay. And is li the provider of the service or do they sell to, um, third parties, so to speak? Like a health provider, like an insurance company? What is your, how are they

[00:11:36] Amy Bucher: making money? Yeah, so we, we primarily sell to health systems right now, although we are talking to insurance providers and, um, other types of healthcare organizations.

[00:11:46] Amy Bucher: So we white label our communications, they appear to come from the health system and for some of our clients, they, they actually are sent out through whatever mechanism they're already using. So, like for example, we've integrated with Salesforce Marketing Cloud for some of our. We can also send messages directly, [00:12:00] but we do do that white labeling.

[00:12:01] Amy Bucher: So it appears to come from the health system, the place where the patient receives care and the way that we make money. Um, most often we're actually doing value based contracts or risk based contracts where we're being paid for the outcomes that we produce. So we work with our clients to figure out, you know, what is the value of this appointment or behavior.

[00:12:18] Amy Bucher: Like what do you recognize in terms of revenue from a mammo. And then we take a percentage of that for the people that we're able to get to take action. And the nice thing about it, or the cool thing about it is that we're usually working with populations who are really disengaged, like with our, um, kind of marque implementation of our mammogram program.

[00:12:37] Amy Bucher: These are women who are at least two years past their last mammogram, and you're supposed to have that once a year. So these are women at least one year over. And you would expect them to be a little bit less responsive to outreach than someone who stays on top of their healthcare all the time. So, um, for us to kinda say, we'll, we'll take a piece of the revenue from, from these folks, these are probably patients the health system wouldn't have seen otherwise.

[00:12:59] Gerry Scullion: Right. Okay. [00:13:00] So there's a huge opportunity there for kind of bringing those people back into the system. And the, the bit I'm kind of like a bit confused about is how can you, how can you. Monetize that. How? How can you quantify that in order to take a, take a cut? Like is that.

[00:13:17] Amy Bucher: Well, Jerry, I have just published a paper that, I don't know if you were trying to toss me a No, no, no.

[00:13:22] Amy Bucher: Actually

[00:13:24] Gerry Scullion: you

[00:13:24] Amy Bucher: written paper there? Yeah. Um, it's in j Formative research, so, um, you know, peer review journal. Um, I wrote it with my colleague, Brenton Powers, who, um, actually. Created this economic model in partnership with our health Sy one of our health system clients. So it's around our diabetes program, which, um, really focuses on getting people with either type one or type two diabetes to see their primary care provider on a regular basis.

[00:13:47] Amy Bucher: Right? And so, um, the paper lays out the formula. It relies a lot on publicly available data. So, um, our hope was that it's something that other companies can replicate for the, for their own use for pricing interventions, but, [00:14:00] We basically looked at what will the insurance companies reimburse the health system for these visits.

[00:14:05] Amy Bucher: And that reimbursement rate is dependent on a few things. So with diabetes, there's very often comorbid conditions or other behavioral issues. We essentially used a percentage from national data to calculate. So like if you get a patient with diabetes come in the door, there's a 60% chance you get to talk to 'em about tobacco cessation, and that's something you get to bill.

[00:14:25] Amy Bucher: So essentially creating that, um, you know, that, that table of what would you be able to bill for for one of these appointments? And then also looking at the insurance mix that is in that health system. So just as a rule of thumb, your commercial health insurance plans are going to pay you the most and then your government health insurance plans are gonna pay you the least.

[00:14:44] Amy Bucher: So if you know what percentage of your patients belong to which buckets, you can kinda estimate. 5,000 people to take action. Like what, what kinda money would we make? So, ok, we actually ran the economics on what we thought the health system would be able to recoup from these visits. And then for each one that they book, [00:15:00] we get a percentage of that.

[00:15:01] Gerry Scullion: Right. What does the future of this, um, not just the business, but this type of work, what does it look like? And the second part of the question is, what are the risks associated?

[00:15:13] Amy Bucher: Yeah. So in terms of this type of work, and I'm, I'm interpreting this as sort of like the, the blended behavior science, AI approach to influencing patient behavior.

[00:15:24] Amy Bucher: Um, we are trying to look, I guess omnichannels maybe not the right word, but really orchestrating more of a patient journey. So in our early days, we very much focused on, um, kind of isolated healthcare behaviors. You know, let's, let's get your mammogram, let's get your colonoscopy. But in reality, we know that most people are going to the doctor multiple times a year for all of these things.

[00:15:45] Amy Bucher: Um, you know, even things like flu shot, which in the US most people will just pop by a pharmacy, not necessarily going to see their doctor For that, it's another health behavior to keep track of. And so, One of the things we're really looking at in our platform, both in the technology and kind of the, the design side, is how do [00:16:00] we help people really understand all of these different behaviors as part of a connected ecosystem and start to coordinate the things that they're doing so they don't feel like they're just, um, you know, going one by one by one.

[00:16:11] Amy Bucher: On the AI side, that means allowing, you know, not even allowing, cultivating the algorithm to be able to make decisions about more things than just the content of the messages. So also things like, what channel do we message somebody through? Is it better to message Amy on her cell phone about her flu shot, and then in email about her mammogram?

[00:16:30] Amy Bucher: Um, and the agent is able, and when I say agent, I mean like the, the model, the algorithm, it's able to figure out as it has more interactions with somebody, if they may be responsive on a certain channel for certain types of messages than others. Um, even things like time of day, day of week,

[00:16:44] Gerry Scullion: I would say time of day would be a really huge driver.

[00:16:47] Amy Bucher: Yeah. Yeah. I will say one of the really interesting things in collaborating with an AI team, I'm like, oh yeah, time of day, right? We send it day, not at night, but it's actually a very detailed transformation of the data because to an artificial [00:17:00] intelligence, like 2:00 AM and three, Are very different times, but to a human being who's gonna be asleep, that's basically the same time.

[00:17:06] Amy Bucher: And so there's sort of some decisions that you have to make about how that data gets consumed by the algorithm. Yeah, that I'm not really interesting to work through.

[00:17:14] Gerry Scullion: It's also different time zones. Well, presumably, cause in US you've got multiple different zones. Do. Happening congruently. So if they're like yourself, probably, you know, passing between time zones in the states, it's location specific.

[00:17:29] Gerry Scullion: Is that right?

[00:17:30] Amy Bucher: You know, it's funny that you ask that. I actually am not sure. I think so to date, our health, and actually in general when we work with the health system, they tend to be regionally based. So they might only have a, have a presence within one state or one region. And. For the most part, they're not crossing time zones.

[00:17:46] Amy Bucher: There's a couple states in the US where you have different time zones in the same state. So Tennessee, where we're based as one of them, and in that case, you're gonna have that one hour difference. I'm not sure how we deal with with time zones, because I don't know that we've ever [00:18:00] really had to do it in a dramatic way where we have like a client with East Coast and West Coast people where there's a three hour difference.

[00:18:06] Gerry Scullion: So how does it work in terms of. Being able to determine location and the time of day is that, I guess I'm, I'm coming from the, the service design side of things where there's tension snoop. Um, in terms of GDPR and based in Ireland, um, GDPR is a huge thing in Ireland and Europe. Um, how do they get that information?

[00:18:27] Gerry Scullion: Is it from the smartphone?

[00:18:29] Amy Bucher: No, actually it's not. And I will say too, um, we pay a lot of attention to GDPR and data privacy globally. Our expectation is that the US will start becoming more like the EU in terms of, um, data privacy laws. And so we're really as much as possible trying to, um, you know, generate our own data as opposed to purchasing other data.

[00:18:49] Amy Bucher: Cause our expectation is that will not long term be available. Um, Yeah, but so we, we receive data from our health system clients about their patient population. They, they basically send [00:19:00] a file to start, um, of the people they believe are eligible for whatever health behaviors we're messaging around. We verify that.

[00:19:06] Amy Bucher: So we work with our clients to really establish eligibility criteria. I mentioned diabetes. You know, we would look at whether someone has an existing diagnosis of type one or type two. We have exclusions. We would wanna know their last A1C value because that changes, um, the clinical guidelines around how often they should see their.

[00:19:23] Amy Bucher: But that file also contains, um, contact information which they have explicitly permitted the health system to communicate with them on. So, you know, we're, we're, if we email you, it's because you've given the health system permission to email you about healthcare behaviors, and then it typically will also include some of that location information you mentioned.

[00:19:40] Amy Bucher: And then we have a, um, one of our AI scientists specializes in geospatial transformation. I don't understand in detail what he does, but he's really able to take basic address data and start to understand things like social determinants of health. Is this someone who's living in an area that's really underserved by healthcare organizations and you know, potentially has access [00:20:00] issues, that kind of thing.

[00:20:01] Amy Bucher: So, um, we're for the most part getting that data from our clients and then we're able mm-hmm. to, um, you know, work, work with what we get there.

[00:20:10] Gerry Scullion: I remember when I was based in Australia, The, one of the services that I was working on looked at the parentification of children and the information being shared out, critical information about health services being shared out, uh, to non-English speaking families.

[00:20:31] Gerry Scullion: So computer stack language and Australia and Sydney in particular is very diverse. There's hundreds of languages, maybe even even a thousand. I think it's nine something in. The, the area of Sydney, what's li's take on how they can actually handle that and the sort of the multi-language, facet of delivery.

[00:20:51] Gerry Scullion: Cause in America it's pretty much the same. Um, how and what work are you doing in that space?

[00:20:59] Amy Bucher: Another [00:21:00] timely question, and I know you didn't know this, so we're,

[00:21:04] Gerry Scullion: this was actually pinned in as a, as a personal catch up. And I said to Amy, come on, let's do a

[00:21:08] Amy Bucher: podcast. Yeah. So, um, no, we, and the other thing too, you know, as part of my role is sort of establishing what are the pillars that we want to live into with our research and our proof points, and one of the ones that, um, we have on there is health equity.

[00:21:24] Amy Bucher: Kind of similar to, to Maow actually, L has attracted employees who are really mission driven. You know, they wanna work in healthcare, they wanna help people be healthier and kinda like, take control of their, their own, um, lives in this particular way. And so, um, we are very interested in making sure that we're offering our programs in the languages that the patient populations speak.

[00:21:44] Amy Bucher: We are only live in English today. We have in the past done some work in other languages, but the pandemic, we, I mean, we're designing people to take part in, in person care. So like you can imagine what the pandemic did too. But we had this [00:22:00] lovely opportunity to sort of pause and revisit our programs and, and get everything into, um, good shape before we relaunched in person care resumed.

[00:22:07] Amy Bucher: I am right now in the process of working on, not translating, but trans creating our content into, um, Spanish and working through getting all that on our platforms. We have a customer who's going to be launching in Spanish next year, early next year, that we're excited about. Um, the Transcreation process is what we're pursuing.

[00:22:26] Amy Bucher: They don't do like a word for word little translation. You know, this is fluent speakers who read the English content and then create, um, Spanish content that is, means the same thing, but may not word for word be the same. And that's really important because our content is all built with behavioral science.

[00:22:42] Amy Bucher: And so there's a lot of nuance around how we bring something to life. Like if we're writing a message that's supposed to demonstrate social proof, we would wanna ensure that whatever um, comes out in the other language is also doing the same thing. So, um, yeah, we're, we're, we're actively working on that.

[00:22:57] Amy Bucher: We, we are also talking to clients like in places like [00:23:00] Florida, California, Texas, where they have populations that speak Spanish, but they're coming from many different parts of Latin America. And so there's different dialects to consider as well. And that's another reason we chose to do transcreation.

[00:23:11] Amy Bucher: Cause we can work with people who can, um, deal with those, those grad. What

[00:23:16] Gerry Scullion: about, and again, I feel like I'm putting you on the hotspot here, like an interview, um, for a job almost. And talk to me about your experience with this, but in terms of, um, the literacy levels that the, the messaging gets delivered at.

[00:23:30] Gerry Scullion: Um, sure. Uh, America is similar to the rest of the world in terms of, um, my experience anyway as a practitioner. Literacy levels vary, you know, dramatically between people. Is there, is there an algorithmic kind of understanding? Based on the responses and the language that are coming back to them that they can drive, maybe they need to alter their message.

[00:23:51] Amy Bucher: We don't think about it that way. We just write all of our messages at a relatively low grade level. So we aim purpose grade five. [00:24:00] Yeah, like between four and eight. Um, to lower the better. We, as we write our program content, we pay for readability assessment tool that we run it all through. Um, and you know, we do the things like the words like colonoscopy, right?

[00:24:11] Amy Bucher: Obviously that's a, a long word. We're going raise the grade level. So, you know, we can replace that with a one syllable word for purposes of seeing that everything else, um, is at the right grade level. But we just sort of take this global approach here where if we write it at an easy to understand level, the folks who are more sophisticated will understand it, and so will the people who have, um, more literacy struggles.

[00:24:32] Amy Bucher: So, um, we, we don't use the algorithm for.

[00:24:35] Gerry Scullion: Okay, so imagine I'm gonna put you, you've got the good hat on. Okay. So you're, you're using this for purpose. How, how can this be used for, um, for against, should we say, against

[00:24:48] Amy Bucher: purpose? Yeah. Um, this is something we talk about a lot and I would say one of the bright lines that we so far, um, feel pretty strongly about is we would never wanna use the system [00:25:00] to determine who is eligible for care.

[00:25:02] Amy Bucher: So we are not making a diagnosis or a recommendation. Yeah, yeah. We're relying on clinical guidelines. We're relying on the, um, Science, science and medical folks at our client organizations to say, you know, these are the criteria that makes somebody available. We would not want the AI to make those decisions.

[00:25:18] Amy Bucher: There's just too many stories about. Going awry. You know, the AI is not a doctor . Mm-hmm. . Um, the other place where I personally feel a little squeamish, and I, I don't know if l would ever get into this just because of our business model and where we're positioned that you could certainly use the technology this way is for more like consumer type purposes.

[00:25:36] Amy Bucher: Like if you wanted to sell a product, Yeah, you could absolutely use this type of system to, um, you know, make sure that everybody's getting the most compelling possible message about that product. But that's not really something, I mean, and I, I don't think that that would be an ethical disaster by any means, but I don't think it's something that particularly interests us either.

[00:25:54] Amy Bucher: It doesn't feel, um, aligned with our mission. Yeah, it's

[00:25:57] Gerry Scullion: kinda. [00:26:00] Businesses like Cri Dunno if you know cri, they're an ad-serving platform. They alternate the messaging on display ads on websites across the internet, and they follow you. So if you search for a dehumidifier for argument's sake and one night, and then you go onto another website, two days later, they're like, Hey, this dehumidifier is still here.

[00:26:21] Gerry Scullion: And they're like, kinda like flashing at you. That's kinda what happens anyway, online, it's just kinda a, a step forward.

[00:26:28] Amy Bucher: I'm being followed right now, by the way, for an ad, for a really fabulous pair of boots that I bought. And I'm kinda of like, oh, I bought 'em. I

[00:26:36] Gerry Scullion: did it . I remember that. That was one of my friends used to work for.

[00:26:41] Gerry Scullion: And I remember saying that, I said, I've actually already bought 'em, but I bought 'em Inni, they're serving me the ad. And he's like, yeah, about that. You can't figure that one out yet. You know, we read your inbox . So, uh, it's kinda hard to close the loop.

[00:26:56] Amy Bucher: Where I think the type of AI we use might improve over that is [00:27:00] we do personalize based on behavioral responses.

[00:27:02] Amy Bucher: So of course, especially if we send the message, we know if people well with email, at least we know if people are opening it, if there's a clickable call to action, we know if they're doing that. And there isn't always, because for making appointments, a lot of want you to, so there may not be a clickable call to action in our message.

[00:27:18] Amy Bucher: But then we're also getting data back. Like did they make the appointment? Did they show up for the appointment? And based on that binary, yes or no. The AI is like, okay, let me, let me try harder or, you know, this sort of thing worked and I, I can send this sort of thing again. Perhaps if you think about something like ads, um, I'm sure that you could use this type of algorithm to be like, alright, you didn't click on it this time.

[00:27:39] Amy Bucher: Let's try something else. And, you know mm-hmm. get, get to the point where I'm much more reliably clicking.

[00:27:43] Gerry Scullion: I. On the thing where they weren't able to close the loop off. You've kind of answered the question there. Like another set of data arrives into the conversation and tells the algorithm, okay, they've, they've made their appointment.

[00:27:57] Gerry Scullion: Um, if you don't get that data in a [00:28:00] timely enough manner, what happens? Do the, does the messaging still continue? Is there a way?

[00:28:06] Amy Bucher: Yep. That's the problem. If we don't get the data back. Cause the way that it works basically is we will stop messaging you if you take action or if you uns. Okay. Um, and we do, we don't message you relentlessly.

[00:28:17] Amy Bucher: We actually build very long pauses into our message. We call it our pulse communication pattern, where we'll message you regularly for four or five weeks and we'll take a break of eight or nine weeks in resume. And we don't wanna re, people have reasons for not we hear about, uh, but that is absolutely a drawback and we don't have real time data integration.

[00:28:39] Amy Bucher: So far it. Really been necessary. There's, but there's a handful of people who are, they do make the appointment and then they get that next message. And, um, it's a problem that we definitely like to

[00:28:48] Gerry Scullion: solve. Okay. One of the questions is the sincerity and the system like, um, Do they disclose the fact that it's an algorithm talking to them [00:29:00] or do they have a picture of Amy up there, little circle of Amy, kinda go on.

[00:29:05] Gerry Scullion: Chief Behavioral scientist or designer. How does that

[00:29:09] Amy Bucher: work? Yes. We don't disclose where, so like I said, we white label the messages. So they will have our, our client, you know, logos and. Send her informations and such, l is invisible to the patient. Um, we also work with the health system, like for example, a lot of health systems in the US will have multiple locations that have different branding.

[00:29:29] Amy Bucher: So we work with them to make sure that every patient is seeing the branding that corresponds to where they personally go for care. So we're trying to leverage that, um, you know, familiar brand. And again, we're doing it all, like we're sending it on behalf of the health system. So I, I don't feel like it's any more.

[00:29:45] Amy Bucher: I don't know, devious than like if the health system used Twilio or Salesforce and didn't disclose what that platform was in place. Okay. And then the content of the message, you might not realize that it's not a typical marketing message if you're just reading one of those messages in isolation. Like we, we [00:30:00] work with our clients to make sure that we are echoing their brand voice in the tone of the communications that patients are seeing elsewhere in that organization.

[00:30:08] Amy Bucher: We really do want it to feel like it's coming from, from the person who's providing your care

[00:30:14] Gerry Scullion: because. The brand language if you want for, I can't think of another phrase of saying it. That changes between brands obviously. So I, is that something that you can, can take into consideration?

[00:30:27] Amy Bucher: Yeah. Yeah. And I, I will say, and

[00:30:29] Gerry Scullion: you versus, you know, Obama, there's different tones, voice.

[00:30:35] Amy Bucher: Yeah. I mean, one nice thing is health systems. I mean, they'll hate me saying this. There isn't that much variation. I mean, there's certain things that any sort of healthcare organization is gonna wanna communicate, you know, caring and respect and Yeah. Sure. Um, a really, a thing we see really frequently with organizations is that their, um, voice and tone has been developed to convey like we're part of the same community, like that sort of, uh, social aspect because a lot of.

[00:30:59] Amy Bucher: You [00:31:00] know, it's like they're, they're locally located and they want you to know, like we're part of the same community as you. So, um, we, we do pay attention to those things. But I will say, um, for the most part, there's a lot of commonality too. So it's not like we're creating completely different looking messages for health systems most of the time.

[00:31:15] Gerry Scullion: Yeah. Fair enough. Amy, I know we're, we're coming towards the end of, of our episode. They always fly when I speak to you before, before we jump off, what did you study in university? Cause I know there's people there in the background that are like, this sounds like an incredible job. Okay. Like where you're working in a really fast paced space where it's probably changing on a day to day basis.

[00:31:38] Gerry Scullion: But what's your background in terms of what did you study to get

[00:31:40] Amy Bucher: to where you're. Yeah, I, I feel like my background's really boring. . I studied psychology. I studied psychology in undergrad and then went on and got a PhD in psychology as well. Um, and. I love talking about my job path, cuz I feel like I really stumbled into my current position.

[00:31:57] Amy Bucher: Um, I, I finished my PhD in 2006 [00:32:00] and behavioral design wasn't in a formal thing yet. Yeah. It wasn't a thing. Like there were no jobs called that. So kind of bumbed into different, um, jobs. Like my first job was in a healthcare research or it was a healthcare agency, like a marketing agency that I was on a research team.

[00:32:14] Amy Bucher: And I, I didn't like that space, but I'm like, Ooh, healthcare. Like, there's a lot to do here for someone who knows behavior. And then my next job was with a startup, um, doing digital health coaching. So actually very similar to what L'S doing. Only L is, you know, 15 years more sophisticated with the world class AI team.

[00:32:32] Amy Bucher: So, uh, I do feel like I got a second bite at the apple there, but, Getting into that, that first tech organization for me was like, oh, not only should I work in healthcare, I should work in technology. Cause there's really this role where I can unite my psychology background with some of these, you know, UX roles, uh, product roles.

[00:32:52] Amy Bucher: And so that, that for me was kind of where my career path really began. All right. That's

[00:32:56] Gerry Scullion: awesome. Amy. What I'm gonna do is I'm gonna throw a link [00:33:00] to, uh, engaged the book in the show notes as well. But if people wanna reach out to you, what's the best way for them to do that? Well,

[00:33:07] Amy Bucher: you know, I normally say Twitter.

[00:33:09] Amy Bucher: We will see. Around. I, I'm not,

[00:33:13] Gerry Scullion: before we say, are you on Masteron

[00:33:14] Amy Bucher: yet? I did move over to Mastone, but I haven't figured out quite how to use it. So

[00:33:18] Gerry Scullion: I put did the fourth person in a week to say, I'm on it. I dunno how to use it yet. So I'm like,

[00:33:24] Amy Bucher: Hmm. Every time someone I like on Twitter post their ma on username, I like click on it and make sure I'm following them there too.

[00:33:30] Amy Bucher: Yes. So that's, that's the extent to which I've, I've really used it so far. I am on Twitter. I'm not planning to shut down my account, but who knows if the platform will exist. I'm Amy B and I have, um, a link to my master in there. I think it's also Amy b I just don't remember what server I'm on

[00:33:48] Amy Bucher: LinkedIn and.

[00:33:50] Gerry Scullion: Okay. Very good. I'll, I'll put a link to as many of those as I can possibly find, and who knows, time goes out, maybe they've all collapsed and been bought over by a mega Manc . [00:34:00] Amy, it's as always, it's brilliant to have you back on the podcast and you know, hopefully it doesn't take us two and a half years the next time.

[00:34:07] Gerry Scullion: Thanks so much. Yeah, we'll make sure it doesn't.

[00:34:12] Gerry Scullion: And there you go folks. I hope you enjoyed that episode, and if you enjoyed it and want to listen to more, why not visit? This is hate where you can learn more about what we are up to and also explore our courses while you're there, thanks again for listening.

John Carter
Tech Vlogger & YouTuber

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