Customer Experience at the American Medical Association

This transcript was lightly edited for length and clarity.

Michael Krigsman: Tell us about the American Medical Association and your role.

The American Medical Association, the AMA, which I will call it from now on, is a mission-based organization to promote medicine and public health. We do that by being a very powerful ally to physicians. We speak with them with a unified voice. We remove the obstacles that get between them and their patients. We're taking a leading role in addressing chronic care epidemics that are affecting this country, and we're driving the future of medicine.

My role, when I first started here a couple of years ago, was primarily focused on accelerating our membership growth and retention and increasing engagement with our audience. Subsequently, brand strategy and marketing has folded into that. I think of experience as being a pretty broad platform, but it does encompass pretty much how we are engaging with physicians, residents, and students on the topics that mean the most to them.

Why is customer experience so important?

I think it's a broader conceptualization of marketing. In fact, there's a big HBR article that I just saw this week that said CX is the new marketing. Really, experience is the thing I think that encompasses product, technology, and marketing because they really have, in this environment, come all together. You've really got to be looking at all three of those things as the total experience that your consumers, or your members in our case, have with you.

Yeah, I came from the not very closely related world of horseracing in my past life, but I've been in digital media and marketing before that for a long time. The explicit desire here was to have somebody come in and really help the organization get up to speed on the digital front because it is so closely connected these days with engaging with our audience and accelerating membership.

How does digital transformation relate to customer experience at the AMA?

I don't start anything that I do with, I'll call them, digital blinders on. The first thing is to figure out what the job that you're trying to get done is. Inevitably, of course, these days, if you're trying to meet people where they are, that does involve digital platforms. We are, in essence, like any other subscription business in that we have something that we're trying to get people to belong to. If you're going to communicate with people and build a subscription business, you do need to have that platform in place.

I think, basically, today, most organizations or businesses, they have to act in three ways. They've got to have the consumer product focus of a company like Proctor & Gamble. They need to have the publishing experience and content management experience of a New York Times or Washington Post, and they need to have the data and analytics platform and skillset of like an Amazon. That's a tough organization to build these days. But if you're going to succeed in creating a member experience and really interacting with people, you've got to be able to do all three things.

What is digital transformation?

All of the above, yes. I think digital transformation is a bizarre and scary term. I don't walk in the door saying, "We need to have a digital transformation," because that is really kind of meaningless to people. A lot of times I would say it's better to think about that in retrospect after you've gotten something done, but the digital platform is essential in helping you achieve your business objectives, and that's really what it boils down to.

We have a question from Twitter. Sal Rasa asks, "How do you see long-term care in the realm of transformation and integrating change from the customer's experience?" which I guess is the patient experience in this case.

Even though my purview here is mostly communicating between us and physicians, ultimately, I'm there to help them in what they care the most about, which is patient care. There is no aspect of healthcare right now that is not being transformed digitally. One of the most exciting places, and I think it probably has more relevance on the long-term care side, is remote patient monitoring because you'll look around at most systems and they're equipping themselves to have people not come to the hospital, not come into the office, but to provide people with the technology to be able to do what they need to do from home and to be able to communicate with them from a remote place and have their progress monitored.

How did you double the membership growth rate at the AMA?

It was an exciting couple of years. It was one of those things where it's not just one thing; it's a lot of things. For anyone that's in marketing, product development, or anything in the digital world understands is there are a lot of levers, but there is a framework that I've seen repeat, I'd say, over the course of my career at any of the businesses that I've worked on. Even though the context might be different that the work is essentially still the same.

It really all starts with really understanding who your target audience is. That's first and foremost I think a thing that, especially in the digital world and era of digital transformation and the digital heroes, it's always been a very product-first era, which I harken back to my days at Proctor & Gamble or Leo Burnett in advertising. I know, first, always start in understanding your target audience and everything kind of flows from that, including what your value proposition is.

The understanding that, even among physicians, they're not a uniform group. They care about different things. They're interested in different topics. That kind of segmentation and really understand who we're trying to talk to and what value we can bring to the table is the first thing. That precedes technology, digital investment, all of that kind of stuff.

Once that's in place and you find a way to actually express that value proposition in language well suited to the digital world that we're in right now, then you start to build out the infrastructure. We had a lot to do to kind of bring our, I'd say, kind of subscription digital infrastructure up to speed. We hadn't really done a lot of digital marketing in the past before I arrived. There was, of course, email marketing, but that kind of experience flow when you begin to do digital advertising and understanding how it's set up and how the metrics come out of it is something we had to build.

Once that was in place, we could really start to focus at a higher level in the funnel and put the emphasis on building an audience. For us, we're not trying to be the New York Times or Washington Post in terms of attracting tens of millions of people. We have a very specific audience out there and so, for us, it's, how do we engage with more of them more frequently?

What did you do differently than the AMA had done previously?

Well, there were some strategic, I'll say, starting with the target audience. When we looked at physicians, I would say the initial paradigm was more around career stage or life stage. Sometimes that works. If you're a student or a resident, you're in a very specific place in your medical training, specific institution, and that makes sense. But out in the world where you're talking to physicians is where that segmentation started to break down.

For us, we can look at our audiences and know the types of content that we're interacting around and then begin to kind of personalize an experience around that. For instance, there is a large segment of our audience that's interested in advocacy. We need to treat them like that's a topic they really can't get enough of and to figure out what is the offering to folks in that target audience and how should we talk to and correspond with them. That requires a very different way of approaching our communications, which I would say, if you looked at our website a couple of years ago, it would have been more in line with a traditional association site. Even though we had news and it was updating, it was not put together in what I would call a unified approach that can be powered through content and content marketing and then also be well tuned toward engagement and conversion on the other end.

That rebuilding process started about a year ago. We finished and launched the new site back in November, along with a mobile application with the same underlying content. We have approached 80% growth in terms of a unique audience at the site level. That is translating into more members through digital channels.

Your first task was then to really go out, I'm assuming, and speak with your members to find out what they care about, what matters to them.

It was. Believe me; they're not shy about telling me that. I actually had people reach out to me before I even started. I actually learned a lot through one of those episodes where somebody did reach out and say, "Hey, I'm not a member of the AMA and I don't feel like you represent us."

I actually went and spoke with him. What I learned was the thing that then kept repeating over and over in every interaction that I would have subsequently, which is, there are a lot of folks out there that don't have any idea of the great work that this organization is doing on behalf of patients and physicians. That clearly became job number one for me is to make sure that they do understand that because there is incredible work going on here on so many different fronts that have so much impact on people in this country.

How did you build brand awareness at the AMA?

Yeah. People are very busy and they're all binge-watching on Netflix, and so how do you get attention? I have learned in prior roles that if you have something, especially something that's even remotely complicated or there is a lot under it, it takes time to build that. You're not always going to get to spend 20 minutes with somebody at a time to do that. In fact, that's not very scalable, and you have to kind of look at how do I, over the course of time, accumulate that 20 minutes or whatever it's going to take to be able to explain what my value proposition is and support it in a way that will kind of turn people around if they've been negative before or move them from someone that's open to it into kind of a positive zone?

That requires operating across any number of different platforms but recognizing that just because you do the work or just because you write an article or put together a piece of content doesn't mean that people are going to see it, whether it's posting on our site, then amplifying that through social channels, through media, through our members, through our ambassadors. There are so many different ways that we've expanded how our audience can actually interact with those messages.

Yeah, it really does come down to marketing. We have found for ourselves that content is an incredibly effective way of expanding the reach and impact of our mission objectives. If we're doing work in physician burnout, work that we believe has led to the first decrease in physician burnout that we've seen in several years, it's imperative that we reach more people with a message that, "It's not your fault. You don't need to go do yoga." Even though taking care of yourself is fundamentally important, it's system level problems that are causing issues with physician burnout and we've got a set of tools and resources to help physicians figure out how to fix those system-level problems.

For us, my job is to get all of this content, information that our subject matter experts here produce, into the hands of the people that need them in whatever practice environment they're working in. That's good old fashioned marketing of which digital marketing is just a subset.

Yeah, it's really important because you may have the assumption, for instance, that all physicians care about a topic like physician burnout or practice innovation or that they all care about advocacy and certain issues within that, but it's not necessarily true. When we create content, we keep these target segments in mind. When we put marketing power behind them, we're going to talk to people, whether it's on a social platform or through email, that care about those topics.

What are the cultural aspects of digital transformation?

It's 170 years old and just getting started. I love the excitement at this organization about embracing change and having an impact. That's what it's all about here. Frankly, I'm thrilled with how much we've been able to achieve in a two-year period. That comes from the top here and from our board who made it an imperative that we embrace the modern set of marketing tools and engagement tools to further the initiatives of this organization.

A lot of what I've done over the past couple of years is introducing new language, the language of digital marketing. That terminology is not necessarily familiar to folks and the metrics that are associated with that: How many people are coming to the site? How often? What are they doing? What does a marketing funnel look like?

How do we leverage social platforms, which may be a couple of years ago people didn't believe that we would be able to interact effectively with physicians, students, residents through those platforms? It turns out that's not true. It's been an incredible place for us to tell our story and interact with our members and prospects.

That, I would say, has all been supported by data-driven experimentation. The thing that's most thrilling to me is, you work in an organization with a lot of physicians. They're driven by data and evidence, and so I'm well suited toward an evidence-based situation like this where we can do an experiment and I can show that 30% more people will do this if we try it this way.

I've been so humbled by digital marketing over the past 15 years that I love ideas. I love testing ideas, putting things side-by-side, and showing people you really can make a difference when you try things. This organization, I'd say, culturally, has been changed by that because they can see the evidence base that happens when you test. Then you just put those best practices into place and you just keep improving, so it's been pretty exciting.

Although there is this impression, I think, that people have of physicians as being resistant to change, and so how did you get physicians to interact with you and embrace and accept these new ways of doing things?

The way to do that is to meet them where they are and to really understand them as an audience and what they're really interested in. Instead of kind of operating from our own set of initiatives and what we think, it's really understanding what they think and want to know more from us.

I also had the benefit of part of the American Medical Association is the Journal of the American Medical Association. They are a medical publishing powerhouse, a first-rate publishing organization that's inherently about speeding research into practice. When I look for role models or have role models for this organization, there is a very clear set of folks and an operation to show the way.

We have a question from Twitter. Again, it relates to physicians, who are your audience and your constituency. What is the value that physicians gain from the AMA, how does that manifest, and what are the implications of that for the digital expression?

That's interesting because I was having a conversation with somebody about, what do you get for your membership? I think that's a very typical way that people approach it. A fundamental thing is, you can offer tangible benefits, which we do.

For us, you do get a subscription to the Journal of the American Medical Association. You do get access to some very good pricing on insurance, life and disability, things that really matter. You do get to participate in changing the direction of healthcare if you want to participate in our policymaking activities. Then there is a wide array of other types of savings and tangible benefits that you get.

Fundamentally, people are going to join an organization like the AMA because they believe that we are a powerful ally to physicians in the thing that they care the most about, which is patient care. Really getting to the core of what that message is and then how that gets communicated and supported, depending on what you're interested in specifically as a physician, that's the foundation of why people join an organization like this.

Where does customer experience fit at the AMA?

Well, there are a lot of different realms that that applies to. I think one of the most interesting things, as we think about experience with this organization, there is, let's say, a core group of folks who are deeply involved, for instance, in our policymaking activities and are the people that'll travel here to Chicago in June or to another location in the fall for our annual and interim meetings. They're deeply involved and they have a set of experiences that extend throughout the rest of the year.

Now, for a lot of other people, their experience doesn't have that personal touch. I would say, for many of them, they would get their initial invoice in the fall and then please renew in the following year. That in-between time, maybe they came in contact with something we've written. Maybe they saw a press release that we put out. Maybe they would have seen an article that would have run in a newspaper that talked about what we're up to.

We really needed to take back that control of the experience, determine what that was, and then market it to them. For me, we're in the process of using digital platforms to create that experience for physicians so that we're engaging with them on the topics that they care the most about, where we can deliver the most value to them, and all of the mission work that we're doing to get it in the right hands of people centrally and not leave that to a passive experience.

Then there's the infrastructure that underlies that. I would say our digital experience, which is where we're meeting people, whether it's on our site, through social platforms, that's something we've supercharged and that facilitates that experience.

We have another follow-up question from Twitter. If the value is helping improve patient care, then how do you do that and again link it to this notion of digital transformation and the customer experience that your providing to your members?

If I go back to kind of where we started, there are different ways that we are a powerful ally in patient care. One of that is through our advocacy initiatives. It's speaking for physicians with a unified voice to all the players that matter in healthcare. That could be the government. That could be pharmaceutical companies, technology companies, you name it. There are a lot of players in healthcare and doctors' voices need to be represented so that we don't end up in situations where physicians are working for the technology and not vice versa in service of patient care. That's one area.

The second area is, there are very clear things that get in the way of physicians delivering care to their patients. Right now, a study that we did basically determined that, for every hour of patient care, face-to-face, physicians are spending two hours behind a computer screen entering in notes and other stuff into the electronic health records, including a couple of hours at night. That's not what we want to be doing right now.

Physicians are spending time getting authorization from the insurance company for the treatment that they want their patients to have. Then maybe they go to get a prescription and they can't afford it because the price of prescription drugs is so high. We're working on those problems to make sure they go away so that we can facilitate the patient care that needs to be put in place.

The third thing is, you're well aware of the many public health crises we have. We focus on particularly three of those right now. One is on dealing with hypertension. A second is with prediabetes where there is just incredible problems, as you know, right now with the number of population, about 80 million, that are prediabetic and don't even know about that. Then the third is the opioid epidemic, which is obviously consuming vast amounts of our healthcare resources in treating. We're facilitating ways to make that situation better and hopefully put an end to the opioid epidemic.

I'd say the final way that we do that is through something I don't think a lot of people know about, which is driving the future of medicine. We are facilitating the changes that are happening in medicine right now. I talked about remote patient monitoring before, but telemedicine is something that's increasing in usage and all of the infrastructure that underlies that needs to get put into place to make sure that doctors have what they need to be able to do that and, from a technology payment standpoint, all of that kind of stuff.

The other thing, and this is affecting, of course, every aspect of business out there is data. One of the key things about data right now in healthcare is, it's not necessarily hooked up in a way that can connect the input when a patient comes in the door and the outcomes. There are different systems that underly that data input and the portability of that. We are putting in place an infrastructure and what we would call an innovation ecosystem to facilitate the flow of that data so that it can actually deliver better patient care in the end.

As you develop better member experience and you're bringing members in, how does that help in terms of your advocacy function and in terms of building a cohesive group or a cohesive block of physicians that adds weight and influence to your advocacy function?

Yeah, I think part of how we view ourselves on my team and I think it's a little bit of a different paradigm before is, we're essentially lead generators for the folks that are on our advocacy and our mission parts of the organization. I see my role as getting someone to kind of raise their hand and say, "I'm really interested in advocacy initiatives and of this kind of variety." That may be a person that just wants to read the newsletter, and so I can give them our advocacy update newsletter. It may be a person that wants to write their congressperson and say, "This is what I care about." It may be a person that wants to get trained and go to Capitol Hill and visit lawmakers.

We have created kind of a pipeline, for lack of a better word, a spectrum of ways that you can engage on the advocacy front. We have a quarter of a million members right now, but we represent all physicians, whether they're members or not. I think people understand that.

What is your playbook for engaging your membership?

It kind of goes back to the old marketing, which is, start with your target audience. I think once we had a better understanding of what our audience segments were and that you could communicate with different segments in a more personalized fashion, that we didn't need to treat our audience of physicians, students, residents as a one-size-fits-all group. That you could have conversations that people care intensely about and build the relationship that way as opposed to being more generic.

For me, it's good old fashioned listening and consumer focus. It's reorienting around audience instead of initiative and product and really following that audience where they are and what they want to talk about.

We did the ground level work here of, once we determined what those audience segments were, then going in and taking a look at what are the key search terms in the area, how do we stack up on that, what kind of content are we building in those arenas, and why has it or not worked? For us, it became an issue of testing that hypothesis. I'd say one of the breakthroughs we had was translating all of the work that we do, for instance in an area like physician burnout, into more topical content that can reach people and bring folks in.

Let's say that an article we might have written about physician burnout a few years ago would bring in a few thousand people at a time. We found a way, basically, by optimizing what we were writing through the headline, through the kind of content and, of course, rebuilding the site infrastructure to be SEO friendly that we could multiply that audience to the tune of 300x. [Laughter] It's a lot more people that get exposure to that and that's through a combination of organic traffic and then observing when something is getting traction that you can then begin to invest in supporting that through your content marketing efforts. Again, it's back to ground level, consumer marketing, digital marketing, foundational elements that meet consumer needs and then employing best practices to reach people.

How much of that draws on SEO techniques versus changing the type of content that you developed in response to learning about your members?

It's heavily in both arenas. We definitely had an obstacle at an infrastructure level with the site because it wasn't built to be optimized for SEO. We hadn't done the proper things that I think a lot of publishing organizations have done in terms of building in that infrastructure, but that's not enough to do it. We could have a perfect infrastructure situation and just not reach people. That is just plain and simple going and matching up the categories that we build content with what people are looking for.

It's pretty straightforward to go out and look. How many people are looking at articles around physician burnout? How many people are looking for articles around prediabetes? What are the specific topics in those areas that they're looking for?

Half your traffic should at least come from organic search and so, for us, it became, how do we match the kind of demonstrated consumer interest out there with content that was worthy of being clicked on? A lot of our articles that you would read right now, I'd say, would be unrecognizable, maybe, to what we had written a few years ago and, certainly, in the league of any leading digital publisher.

Can you give us just an example of, say, a piece of content that you've done now that does well versus the kind of content you did in the past?

Yeah, the burnout article that I mentioned before. We did an article called Physician Burnout: It's Not You; It's Your Specialty. It had a listicle at the center of it where you could take a look at what the top burnout rates were by specialty. It had a great headline, really well written, every keyword hit possible, and that article immediately took off.

Now, we did the same article two years ago in a very different way, of course. What we saw was, even though that had been, up to the point, one of the leading articles we ever had done, that the traffic to the new way of doing things was 100 times more. That shows you a direct comparison of when you apply first-rate digital publishing techniques around the topics that people really care about and you can see the needle move.

As somebody who develops lots of content, of course, this topic is of real interest to me. Can you tell us what was the old article like compared to the description you just described of the new one?

Most of the stuff that we had written before, I'll call it, more promoting objectives of our different kind of divisions and mission organizations without thinking through, how can I make this article really interesting, stand out, and be something that someone would click on? As you know from being a content creator, there's the art and science of that.

There's the science that underlies it around keywords and tagging. There's the art of good writing, which brings an idea to life in a way that, in this world where it is so hard to pry someone away from Netflix, what is going to make you click on that? Then once you have that in place, how am I going to reach people with that?

In the past, that article would have just been posted. It might have gone out in our newsletter. Right now, what we see is, when we have something like that that begins to get traction is that we can then, basically, employ content marketing to actually invest in reaching more people with that content primarily through social platforms.

We have another question from Twitter. What are the kind of operational changes that you made at the AMA to deliver better member experience? I think we were talking about one specific type but, in general, what kind of operational changes have you made?

I think one of the most interesting and key changes that we made here was establishing a digital publishing team. I know that that might seem like a strange kind of concept but, for an association, it's not first nature to have that.

The resources were there, so there was a content team that was part of marketing. There was a UX small group of folks in another place. The analytics person was in IT. Then there was a direct marketing function that was separate from that.

I came from a publishing background. If can ask the question, "How many people are coming to our site?" and we're not quite sure what that answer is, you can see we're not going to get traction until we act like a digital publishing team with a set of metrics and that kind of operation that powers a digital publishing team.

One of the things I thought was so amazing was, once that was recognized and a proposal got put in place, different folks around this organization said, "That makes sense. Let's put that together." We created that initial publishing team and then we have invested in building that out, so it now looks, acts, runs like any first-rate digital publishing group that you'd name.

How did you get the buy-in to make that investment?

Thankfully, I have a great deal of support here and people who understand that we need to make changes to communicate with people in the ways that the times demand. I think once I could kind of build a case here for, "Hey, this is how it's operating right now. There isn't the connection that we need between somebody that comes in on a certain topic and membership or engagement with our mission-related content. We're leaving a lot on the table from an engagement standpoint."

I could prove that through analytics and show, through continued testing, just how much better it could be. Again, back to working in healthcare and with the set of folks here at the AMA who are very motivated by progress and evidence. That is what led the way.

Do you start transformation bottom-up or top-down?

I hope it's not unfair to say both. I'd say one of the most influential things was that focus on small wins and about removing obstacles here that were really frustrating people in terms of the member experience. I'll give you a great example.

Before I came, there had been kind of an analysis of what it took to get a marketing email out. It was taking a really, really long time, and I'm used to, in my past, to be able to have something. If it needs to go out, it can go out in two hours.

I took a look at why that was happening and you could just see, organizationally, that those kinds of traditional digital publishing and digital marketing roles hadn't been well established and there were just too many people involved and not necessarily people with the right expertise at writing emails and sending them out, targeting, and doing all that stuff. Part of that was organizational. I had the ability and the authority to come in and say, "You know what? We're not going to do it that way anymore," and that cut the time to get something out by about two-thirds. Now we're down to a few hours if we need it.

Then looking at the templates. How was the writing done? I love rolling up my sleeves, working with someone, showing them how we can do better, and putting that in a test. All of a sudden, we start to accumulate all of this evidence around small wins, about open rates and click-through rates, and member conversion through that one little thing. That creates a great deal of momentum and sets people off on an innovation path.

On the other end, in the big picture part of this, I look for stories out there that are maybe even unrelated to tell people the story of how things can get done. I used a very funny example, which I won't go in drastic detail, from my own personal experience to show how an individual out there has built a YouTube channel, a social following, video, instructional materials, downloads, all of this kind of stuff. This is an individual person. I use that as a case study to show here is how digital marketing works today.

Here's what it means to say SEO. Here's what content marketing looks like. Here's what a premium piece of content is and why that's gaited and why you need to collect an email address and then what you do with that after. I think those real-world examples, whether or not they're from healthcare or not, have been really effective in bringing that story to life.

Final words of advice?

My experience here, I think there's a common approach that I've seen time and time again that always starts with your audience and really understanding and making sure that you have what I would consider a very actionable segmentation in place that is fundamentally tied to your growth metrics. If you don't have that, I wouldn't do anything until I had that in place. Then and only then, you're really looking at, how do I develop and communicate a value proposition that matters to people in this day and age? Then comes the digital marketing and the digital transformation pieces of that.

Again, I don't call them digital transformation pieces. I just say, "We need to get this job done. I'm trying to move this particular metric from here to here. Here's the way that I think I can do it. Here's the evidence I built along the way to try to show people how it can work without making a billion dollar investment." On that note, I guess I would close and just say, one of the things that I've really grown to appreciate here and something that has always been part of my career is being super scrappy and making a lot of moves that are very low risk that enable the data and show people how it can be done without being scary and transformational leap.