:: Reimagining Healthcare: Through a Gender Lens

by Carolyn Buck Luce, Managing Partner at Imaginal Labs

(This excerpt from the introduction of “Reimagining Healthcare: Through a Gender Lens” is now available on Amazon)


The healthcare industry has a solution, at its fingertips, to some of its most intractable problems — but it still hasn’t grasped that solution. Its most dominant market segment consists of customers and end users who share needs that cut across health condition, age, ethnicity, nationality, education, and income — but the industry isn’t focused on this segment.

The needs of this dominant segment are understood and shared by many employees inside healthcare companies, including at senior levels. But their insights into their own demographic are rarely solicited. insights into their own demographic are rarely solicited.

Who are these insightful employees? Who are these customers? And what is the solution for the industry’s future growth?


Women comprise 59 percent of patients and make 80 percent of all decisions affecting patients in the US. Women make up 88 percent of healthcare professionals and, as mothers and wives and daughters, 66 percent of caregivers. Women are also the super-consumers: they control $29 trillion in worldwide control $29 trillion in worldwide spending — expected to increase to $40 trillion by 20183 — and account for 80 percent of healthcare purchases in general and 93 percent of OTC pharmaceutical purchases. In fact, the “SHEconomy” is the dominant force driving the industry to abandon its current model — which centers on disease, specific product offers, and opaque pricing­ and adopt a “patient-centric” model that is responsive to individual patient preferences, needs, and values.

Reimagining Healthcare: Through a Gender Lens book launch March 14!

Healthcare executives do recognize the cost savings and health benefits of a patient-centric model. In 2011, a CapGemini report predicted patient centricity would help pharmaceutical companies increase adherence rates. In 2012, EY’s Progressions report, which I co-au­thored, said the movement would disrupt healthcare business models globally by prompting new approaches to product research and development, nudging patient behavior, and forging collaborations with other indus­ try players. McKinsey predicted that patient centricity would prompt hospitals to try to modify patient behav­ior, alter pharmaceutical companies’ relationships with doctors and other medical professionals and spur the electronic availability of data and personalized medical information. A.T. Kearney cited a few early-stage ef­forts by Pfizer and Johnson & Johnson and called for pharmaceutical companies to adopt a health-outcomes focus in their offerings.

Certainly the executives I’ve spoken to recognize that the disease — and product-centered model is broken. The evidence, after all, is incontrovertible:

Approximately 50 percent of prescribed medicines are not taken by the patient. Even after pharmaceutical companies have succeeded in proving a medicine’s worth to doctors, and even after doc­tors have communicated that value to patients and written them a prescription, the sale and the cure aren’t taking place.

Two-thirds of new pharmaceutical products fail to meet pre-launch sales expectations. Even after new treatments have passed lengthy and costly scientific and regulatory hurdles, they fail in meeting expectations far more often than they succeed. Much of the industry’s $135 billion in annual research and development spending isn’t optimized-even when the treatments are scientific successes.

Penalties under the Affordable Care Act for high hospital readmission rates in the US are rising, not falling. Despite some exemplary exceptions, hospitals as a whole aren’t moving fast enough to keep patients healthy and avoid the need for expensive, repetitive care.

But executives are nonetheless slow to adopt this model. With the exception of some insurers and pharmaceutical companies, the industry remains stolidly within its business-to-business (B2B) comfort zone. The sheer size of the global healthcare market-$8 trillion, and still growing faster than inflation — makes transformation a daunting project. Add to this scale an ever-tightening web of regulations and delivery constraints, and it’s easy to see why the pace of change is glacial.

Yet healthcare consumers, empowered by technolo­gy and unprecedented access to information, are grow­ ing impatient. Armed with app-rich smartphones, and accustomed to instant gratification of their every need through Google and Amazon, consumers expect and demand better healthcare options. They see no bene­fit to being loyal customers. As better choices become available, they’re inclined to switch to them.

Hence to survive, let alone prosper, the healthcare companies of today must not only adopt a patient­ centered model, but also understand and meet the needs of their most important customer segment.



To help companies get a clearer picture of this vital segment, I led a research study for the Center for Talent Innovation (CTI), where I am executive in residence. The study moved us from “anecdata” to globally relevant findings and affirmed that women’s importance to the industry goes far beyond their value as super-consumers.

To better understand women as consumers, the industry needed, we posited, a new kind of market analysis. Our path forward was informed by author Clay Christensen’s famous idea: people buy products or solutions because they need them for a specific job, not because they themselves belong to a traditional socioeconomic demographic. In healthcare, people’s “jobs” are: taking care of their own health; caring for others in illness; and making healthcare decisions for others.

In the resulting report, The Power of the Purse: Engaging Women Decision Makers for Healthy Outcomes, we demonstrated that women perform not just the first two jobs, as everyone knows, but the third, too: they make healthcare decisions, not just for themselves, but also for spouses and partners, children, parents and in­ laws, and other family members and loved ones.

These women are, in effect, Chief Medical Officers (CMOs). They choose which medicines to buy and which treatment regimens to follow. They also act as Chief Nutritionist, Chief Physical Trainer, Chief Pharmacist, and Chief Veterinary Officer. They are the ones who make sure that everybody, including the patients and caregivers, does their job. As CMOs, they have the power to fire those who underperform­ doctors, hospitals, pharmacists, and insurers.

I would know, because I’m one of them.

My late husband was diagnosed with esophageal cancer in 2006. The doctors gave him three months to live, but neither of us was willing to accept that. As generally happened with healthcare questions in our family (as in most families, all over the world), I became the decision-maker: the CMO. “I’m the battlefield, and you’re the general,” my husband told me.

As CMO, I researched clinical trials for experimen­tal treatments for my husband, and I got him into them. To choose the best hospital, I interviewed doctors and surgeons. When it became necessary, I made the call to switch doctors and hospitals. I engaged with the insur­ance companies in what felt like a contact sport, and when I couldn’t get what I wanted, I switched insurers mid-stream. I went to all of my husband’s appointments and made many of the decisions necessary both to pro­ long his life and retain the quality of his life during chemotherapy, which is so painful and difficult for both patient and caregiver. And I did this while working a full-time, demanding job and guiding our four children through this difficult passage for our family.

At the end, my husband let me make the decision about when to call a stop to treatment, so that I could deliver on my promise that he could die among his loved ones, at home. We’d managed to give him three good years of life and love.

I was lucky. At the time of his illness, I was a principal and global leader of the Life Sciences sector at EY, responsible for a $1 billion professional-services business serving pharmaceutical, biotech, and medical­ device companies around the world. My years in the healthcare industry gave me knowledge and contacts that few people have. Even so, during this ordeal, the last place where I could find help and guidance in making a good decision was a pharmaceutical or insurance company. They provided neither useful websites nor knowledgeable and caring employees I could talk to. I found that many of our doctors were unprepared, unable, or unwilling to guide me in my decisions. The best source of information turned out to be my informal network: the women healthcare leaders that I had met through the Healthcare Businesswomen’s Association (HBA) and my client work. They gave me their “unofficial” guidance, along with their empathy and support.

I share this story because, as the research I conducted at CTI makes abundantly clear, women aren’t asking the industry for new medicines, which are often costly to generate. Rather, as CMOs, they are asking for a new relationship. They want providers who are committed to and engaged in the shared mission of improving health outcomes — not just pushing more products. They want companies to understand the many roles they perform and arm them with what they need in order to do their CMO jobs well. And they want partners who can solve for the three famines from which nearly all of them are suffering: time, trust, and knowledge.

As you’ll see in forthcoming chapters, women do not have these things.

(This excerpt from the introduction of “Reimagining Healthcare: Through a Gender Lens” is now available on Amazon)