The CRM-ization of Healthcare
We’ve been watching this for a while. A few years ago, Salesforce embarked on parallel paths; the obvious option was to build tools that enabled users to craft systems of engagement. The second started when the company also began reaching out to various industrial sectors with its technology and those of some partners. The result has been a vibrant vertical industry approach and a plethora of apps that do more than capture and store data, a.k.a. systems of record. Today, Salesforce and partners are deeply involved in delivering systems of engagement in specific industries.
Many of the industrial apps apply CRM techniques to unique situations and the CRM aspects of marketing ideas and serving customers are easily translatable. But along with that, Salesforce has also touted its platform as a general-purpose development tool capable of supporting systems of engagement in a variety of areas that are sometimes distant from the original CRM mission.
Healthcare is one of those areas. CRM works remarkably well with some aspects of healthcare, for example, using call center tools and techniques to proactively remind patients of a pending appointment or to take their meds. With this we’re witnessing CRM invade one of the most conservative areas of IT. Salesforce is catching healthcare at the moment it appears that people are awakening to the idea that they need to be wise consumers of healthcare just as much as they need to pay attention to the details of buying a car. It’s also a time of transition from a paradigm of “fixing” broken patients to one of keeping them well, and you need systems of engagement for that.
A recent research report (Connected Healthcare Consumer) from the company says as much. Customers or in this case patients, are demanding the same kinds of access to their healthcare vendors as they’ve demanded elsewhere. For instance, 94 percent want access to walk-in clinics, 76 percent want in-home visits–something doctors used to do routinely. Also, 68 percent want mobile apps for health coaching. That’s all CRM and we’ve seen this kind of thing playout in other industries as they adopted cloud-based CRM and demanded more purchase options and advice online.
The drivers for all this are also common. There’s a distinct need for the healthcare product or service to come to and fit into the busy lives of customers. We saw a wave of e-commerce and omni-channel service and support evolve while medicine remained static. Medicine needed smarter systems and they had to be cost effective and secure. Today AI is providing the smarts and platform is delivering the tools.
What do patients want?
Aside from paying for care, which CRM by itself isn’t in a position to affect though 64 percent rated paying as somewhat or very challenging, challenges reported included taking time off from work which 51 percent found somewhat or very challenging and 44 percent said finding health services nearby was somewhat or very challenging. The current crop of healthcare systems of engagement are designed to help with these and other challenges.
Today a lot of service or information that patients might need doesn’t need to come directly from their healthcare providers. So in addition to bringing systems of engagement to the bedside, Salesforce just announcedinnovations to bring pharmaceutical and medical device teams closer to their customers. For instance, the Connected Healthcare Consumer report noted above also says that “62% of healthcare consumers say it’s very important for pharmaceutical companies to educate them on how to get the most from their medication.” That’s certainly something that a doctor or nurse could do but over the years we’ve become expert at finding our own answers.
Sure there are situations where patients could go too far with the information they can access online but that was always a risk. Perhaps a greater risk, though, is for providers to not have information because data is spread out across silos. The Salesforce Health Cloud is designed to help by transforming the patient journey – giving organizations actionable information in one place for improved internal and external collaboration and smarter, data-driven decisions.
Finally, in the medical device arena, CRM is front and center with tools that help build customer relationships between device makers and their professional consumers. There are new solutions for sales agreements, which can be lengthy and detailed, and account-based forecasting for helping improve the accuracy of sales forecasts which can be long affairs.
My two bits
All of this by itself is a drop in the bucket of healthcare IT but it’s amazing how many drops have already reached the bucket and how many good ideas are out there. To be honest it’s also amazing how much low hanging fruit is available for the picking.
Healthcare is 1/6th of the US economy. One in every six dollars of GDP goes to clinics, doctors, pharmaceutical and device makers, and others. The US also has some of the most expensive healthcare costs among its peer industrialized nations. The US spends upwards of twice as much per capita as its peers. There’s intense interest in lowering costs to make the nation more competitive and believe it or not, IT is an important gatekeeper.
Inaccessible siloed information often has to be duplicated to provide effective treatment (translation: we’ll re-do that lab work). When the information can be accessed it often has to be transmitted by fax machine. So, yes, IT will be an important part of fixing US healthcare. Converting aging healthcare IT requires approaches that surround old technology with better and newer systems while enabling old systems to continue functioning. Cloud systems of engagement based on powerful and easy to use platform technology will be a big part of the solution.
DevOps for Salesforce Lightning
The tools you work with have a lot of impact on what you can accomplish and the more sophisticated the tools the better, especially in software. Beagle Research (my company) just completed a study into using a DevOps strategy with the Salesforce Lightning Platform. The work was sponsored by Copado a DevOps solutions provider. DevOps is a strategy for building, changing and deploying enterprise software that can also be used with a Scrum or Agile methodology as well as others. More than concentrating on code and coding, DevOps is more holistic looking at culture and infrastructure in its broadest manifestation.
Even if you’ve never built systems you can surmise that planning, developing, assessing, testing and deploying software are all critical milestones and they’re often spread across technical departments of IT like development and operations, hence the name.
It can be challenging to compare enterprise software strategies. For instance, using an on-premise hardware and software stack has been common for decades but with the development of cloud computing, users find they can eliminate having to care about a good deal of their development environments leaving it all to the cloud vendor. How do you compare overhead and costs between cloud and on-premise? What are the effects on speed to market, reliability, security? To control for some variables and enable us to make an apples-to-apples comparison, we chose to research only companies developing and maintaining systems using Salesforce Lightning and a DevOps strategy.
Companies ranged in size from fewer than 100 employees to more than 10,000. There were similar measures for number of salesforce users and number of developers as well as the number of production orgs. Two-thirds or 67 percent said they run between 2 and 7 production orgs. Most of the respondents were C-level executives (48 percent) or upper management (40 percent).
We found that DevOps is delivering value for most of its users though the larger organizations have greater challenges, more on that in a moment; 17 percent claim over $5 million in benefits from using a DevOps strategy. These people have a good understanding that software flexibility drives business agility and impressively, 54 percent say their lead time for making changes to their Salesforce orgs is between one day and one week. Compare that to a more traditional process that takes weeks or months.
But we also identified an elite group that operates even faster–21 percent say their lead time for making changes is less than a day, and 8 percent say it takes less than an hour. Taken together 83 percent can make changes in a week or less.
In other recent research I’ve been involved in, delivering running, tested and deployable code was much slower. Clearly, if a business depends on its ability to quickly change to meet changing market demands this is where you want to be.
On the other hand
As you might expect though, the benefits of a DevOps strategy were not evenly distributed across all users. Generally, smaller businesses with smaller development groups did better overall at establishing DevOps programs and at excelling within them.
The most successful businesses using DevOps are those that use a well-integrated set of tools to move through development and deployment. Many organizations, especially smaller ones, use a combination of in-house developed and opensource management tools. At best the great variety of tool choices suggested to me that some best practices are still being worked out.
Even with Salesforce Lightning and a DevOps approach you can still have issues and almost everyone had the experience of deploying a release to a production org and having a service degradation. A plurality of respondents, 43 percent, said a problem occurred up to 15 percent of the time and the vast majority or 86 percent said service degradations happen less than half of the time. This is an important snapshot of the state of the industry. Speed of delivery slightly exceeds stability of releases indicating a need to bring the two metrics more in alignment.
Some best practices considerations
- A strong majority (60 percent) say each developer in the business has a private development environment.
- Also, 77 percent say they use version control to store code and click-based Salesforce customizations.
- Most synchronize their development environments with the latest changes from other teams with 41 percent doing this on-demand or at most once per day and 42 percent saying they do this between once per day and once a week.
- 75 percent say changes made in version control trigger automation tests.
- 87 percent have confidence that when automated tests pass the software is ready for release. However, meta-analysis of the data strongly suggests that the greater a team’s confidence in their tests, the higher their change failure rate. Skeptics who were neutral on this question experienced a 40% lower change fail rate than those who expressed strong confidence in their tests.
It’s good to be skeptical.
Part of the allure of the digital disruption is having the capacity to change a business process to take advantage of changing market conditions and many businesses are already having that experience. Big data and analytics tell us what needs attention but then we still need to change our systems’ behaviors. Flexible software contributes to a business’ agility and that’s good. But that speed and flexibility need to be balanced by security and what I can only call the bulletproof-ness of the new or changed code.
The businesses most able to reap the rewards of DevOps tend to be smaller though large enterprises have their bragging points. While larger businesses already see benefits from a DevOps strategy, they are the ones with the greatest potential to do more. What’s holding them back?
In any organization size breeds complexity which causes business friction. We don’t have all the data to say so unequivocally, but it seems that bigger organizations have more walls to break down.
It looks to me like the development tools are pretty good. Not enough businesses have well integrated management suites to handle the complexity and it also seems like culture forms stovepipes which causes less stellar performance. If that’s so there’s still some cultural work to be done enhancing communications within and between developer groups and the business. DevOps tools can be a big part of that help but as with the psychiatrist trying to change a lightbulb, the bulb still has to want to change.
Coming back around
It’s occasionally useful to ask where customer service as a business process is going in addition to analyzing the latest technologies. That opportunity presented itself recently when Salesforce announced its acquisition of ClickSoftware, a field service and workforce management company that Salesforce has been partnering with since 2016.
I was intrigued by a photo accompanying a news item about the deal at one of the many industry sites tracking the news. It showed a field service technician talking on a cell phone, with an open laptop as he serviced an array of solar panels. What impressed me most about this was that the photo didn’t imply anything about robotics or manufacturing or any of the other tech sectors that have gotten field service attention over the last decade.
In a way those are all derivative of the IT impulse that’s been with us since the 1960s. Solar panels represent a different technological disruption that’s just taking shape and that will be with us untill mid-century, I think. They represent two distinct long economic cycles called K-waves.
What’s fascinating is that the newest technologies likely to need all sorts of service and support are increasingly in areas not considered traditional tech. This is why I think that an economic cycle is turning. Let’s face it, the tech revolution is getting long in the tooth and what once employed many people has been commoditized to the point that what was once a whole computer room now fits in our pockets and the jobs that once supported that infrastructure have evaporated.
The new tech disruption seems to be all about sustainability which I wrote about in a recent book and the people who will need service and support are increasingly on that sector, hence my interest.
In older sectors service and support is increasingly coming from automated systems as Steve Fioretti, vice president of product management at Oracle told me. We’ve known this for some time, nevertheless, the penetration by automated systems has been impressive.
In some government service systems associated with taxation for instance, Fioretti says up to 70 percent of questions get handled by automation. What started as a way to offload service calls and lower costs has become preferred. Millennials and Gen Z customers, especially, are happy to figure things out for themselves rather than waiting in line.
On balance though, Fioretti told me, “Everybody is saying the contact center is going away but it’s not.” I think he’s right. New uses are coming into view. As more routine issues are handled by automated systems, businesses find they can focus more on the difficult issues or at least those that don’t have binary answers. “It’s enabling our customers to hire different competencies,” Fioretti said. For example, he says that one Oracle customer specializing in home goods, hires agents that are more well versed in interior design because they’re getting into the nuts and bolts of a customer’s project instead of dealing with simpler questions about, say, returns. As a result, these agents have better engagement and customers have richer experiences during a call and customers are happier.
The numbers seem to back all this up. Earlier research commissioned by Oracle show that 60 percent of all consumers expect the ability to talk to a human when they call the contact center. Clearly they don’t always use that channel but it’s a confidence builder just knowing that if all else fails, there’s still the phone or text or social media.
But back to the solar panels. New markets, new disruptive innovations, are the places where customers have the greatest likelihood of struggling and that brings with it a need for customer service. It’s likely that these new industries will need a long runway before they can apply service automation to some processes. For them the call center in some evolved form will be very important.
The future looks like the past
But all of that automation doesn’t explain what’s happening in field service. There, machines are becoming more intelligent, at least to the point that they’re able to diagnose some problems and alert home base to generate a service request, for an impending problem. So, trucks can roll with a high certainty that they’re out to fix a specific problem and that they are not on some wild goose chase. We can thank IoT for that but also advances in field service automation, manpower management and navigation tools. This scenario’s importance grows exponentially when you consider what it takes to service, say, an off shore wind mill.
A disruptive innovation (or several) sparks a K-wave and significant economic activity that inspires additional invention and disruption. CRM itself is the outgrowth of a tech sector trying to deal with a hoard of new customers dealing with disruptive products that weren’t always designed or engineered perfectly. The rapid adoption of service automation technology is a good indicator that the tech sector has gotten its act together to the point that most customer issues can now be settled without human involvement.
I think Fioretti is right, the call center isn’t going away. The next wave of tech adoption in sustainability is going to require some of that old-style human to human interaction. I like to think that the aforementioned solar panels initiated their own service request through IoT protocols. But in that scenario, I also think there are call center agents assuring customers that the power outage is being actively worked on. The agents are necessary simply because customers’ experience with this new technology is still nascent and any vendor in its right mind, especially for a new category product, wants to keep customers happy. In that way the next generation of technology products and their service modalities stand on the shoulders of giants. What came around before is coming around again in a more powerful and automated approach.
Salesforce direction with ClickSoft
What’s the big deal, I thought? Last week Salesforce announced it was paying in the range of $1.35 billion for ClickSoft, a private field service automation and workforce management company. At first, I attributed it to a slow summer news cycle that was driving attention to the deal at a time when many people in the industry are off trout fishing near the Continental Divide or elsewhere. I was in the Hudson River Valley exploring history so that colored my thinking.
Face it, ClickSoft at $1.35 large is about ten percent of the Tableau data visualization buy a few months ago. I didn’t think it was that big a deal. Also, ClickSoft and Salesforce have been partnering in field service since 2016 so the acquisition signals something much more evolutionary than revolutionary. Then it dawned on me that that’s the point.
Ask this: When in the lifecycle of a disruptive innovation are customers likely to need services of all types including field service but also customer service and support? The need diminishes over time as a disruption is increasingly well understood and customers can figure things out for themselves. To crystallize this no one calls frustrated to not be able to locate the “any key” on their keyboards any more.
We’ve moved on and as we have, product prices and service modes have commoditized in tandem. You can’t lower prices along the commoditization curve if you can’t control costs and one of the biggest costs is labor. So today, products are increasingly well designed and made precisely to ward off every possible need for a service call and what isn’t obviated is automated with bots and intelligent systems.
Field service is just customer service for B2B-complex-systems and that has taken some refactoring as well, most exemplified by mobile systems that use VR to show technicians where to look and what to do on a service call. But Salesforce has had this kind of capability for some time now thanks to the aforementioned relationship with ClickSoft and other bought and built field service software. So why buy the company now?
Simply put, the buy was, I think, a defensive move that prevents any other company from buying ClickSoft and preventing Salesforce from fielding an increasingly important facility.
Go back to who uses services and when in the lifecycle of a disruptive innovation you’re likely to see service bloom and you might get an inkling that Salesforce is reading the graffiti and making the following determination.
We’re nearing the end of the 5th industrial revolution, what I call “The Age of Information and Telecommunications.” This is not to say that any of that technology is going away, just that it is commoditizing to the point that it becomes part of the economy and not the driving force. Previous eras, that I documented in a recent book, included textiles, steam power and steel-making, petrochemicals, radio, and cars.
The list is long, and in every case the prior disruptive innovations clustered (e.g. steam, steel, railroads, coal mining were reinforcing) and drove the economy for as much as 60 years. But eventually commoditization took hold and those things all became parts of the economy though no longer the driving force. So if you look at the ClickSoft acquisition you see not a tech company building out its portfolio (though it is) but a tech company getting ready to serve the next great disruptive innovation rather than being the disruptive innovation.
Perhaps the most perceptive photo accompanying a story on the acquisition was displayed on digitalcommerce360. It shows a technician with a mobile phone and a laptop servicing what look like solar panels. If ever there was an industry that’s taking off it’s the nexus around sustainable energy. Co-incidental proof: the top two fastest growing occupations according to the US Bureau of Labor Statistics are Solar photovoltaic installers and Wind turbine service technicians. Now, installers are not service technicians, but I think the analogy holds because part of installation is making the stuff work.
Importantly, those top jobs garner $42,680 and $54,370 per year respectively. The third fastest growing job category is Home health aids which only averages $24,200 per year. Disruptive innovations drive good paying job growth and neither of the jobs mentioned require a college degree. More proof.
My two bits
So what does the Salesforce acquisition of ClickSoft say about Salesforce? Well, Marc Benioff has been talking about a 4th Industrial Revolution for some time now, something I believe he picked up at Davos. Some people refer to Industrial Revolutions, I go with Ages because they’re more descriptive. The point to me is that so much of CRM was developed to help tech companies lift their customers over a big disruption caused by technology. Today the disruption is adjacent, and it is sparking another Age or Industrial Revolution. Salesforce saw this a while ago though I doubt they understood that sustainability would be the thing that received the torch in an unending relay race. So buying ClickSoft in such an environment makes all the sense in the world no matter who is on vacation.
Salesforce and Tableau in merger
Salesforce is buying analytics powerhouse Tableau in an all-stock deal in which it pays 1.103 of its shares for one Tableau share. The deal is expected to finalize by the end of October, about a month before Dreamforce.
A number of questions arise from this deal. For instance, why do this deal at all? Why keep the companies separate or what will the relationship be like between them? What’s Salesforce’s end game?
Why do it?
Salesforce has always had an appetite for expanding its footprint and often did its initial building in-house. At some point, though, the effort swells and it becomes clear that buying a company with built-out technology is the best way to a timely solution. I think that thinking went into this acquisition. Salesforce has been into the analytics game for several years now and perhaps progress was not as quick as it wished or maybe market conditions accelerated certain demands.
Salesforce Einstein was supposed to be its analytics answer but it appears now that the company’s appetite for insights goes deeper than what Einstein supports. Today’s press release seems to position Einstein as a sales and marketing solution and Tableau as a more general purpose one.
Also, Salesforce has begun using digital disruption terminology more seeming to indicate this arrow has a great deal of wood behind it. Digital disruption is about more than analytics in sales and marketing and even about more than coming up with a snappy answer to a customer inquiry.
Digital disruption is about managing by data rather than gut and it applies to all sorts of situations and conditions not associated with an in the moment interaction with a customer. So perhaps Salesforce is flashing a signal that it wants to be the trusted advisor to boardroom decision-making and that will require more horses than Einstein.
Why keep the companies separate?
The announcement noted that the two entities would retain their independent natures. In part this is because Tableau has 86,000 customers, some of whom are not Salesforce customers so it makes some sense to keep the entities at arms-length to signal to customers that while they may purchase Salesforce at any time, they won’t have to.
Another reason might be that despite the acquisition, this is still going to be a trial relationship. Keeping the entities more or less separate is a way to make a possible future split more feasible. Lastly, there’s good cultural overlap between the two parties but Seattle culture is different enough from San Francisco culture to maintain some respectable distance.
Salesforce’s end game
It’s hard to say what the end game is since that script is still being written. If the world continues its voracious appetite for information culled from existing data, it makes all the sense in the world to marshal as many resources as possible and Salesforce is doing this. But there’s also a sizeable backlash against data, analytics, and algorithms in the culture as well, driven by avaricious incompetence at Facebook and other social media players as well as international bad actors. Having best-in-class analytics may become a necessary tool for ferreting out and suppressing bad actors.
Salesforce has a big interest in being the vendor that can help its customers to imagine a different future driven by information. One of the areas it has been effective at is helping businesses see the difference between systems of record and systems of engagement. That’s the essence of digital disruption, upgrading systems of record to become systems of engagement and that takes a lot of information to pull off. So, acquiring Tableau may be nothing more than a way to sharpen the engagement discussion.
One final idea. Analytics is critical to identifying fraud and intrusion. Oracle has done a lot to add its own analytics to its Autonomous Database to foster better security. Salesforce is an Oracle customer and perhaps its largest customer. But Salesforce is not exclusively an Oracle shop and it might need the analytics to support an independent security regimen portable to other databases to ensure uniformity throughout its platform.
My two bits
All of this speculation is not exclusive, meaning there are likely multiple good reasons for the acquisition and we’ll see them evolve.
It’s always hard to see the value of an acquisition like this because we don’t have access to the imagination of the parties putting the deal together. Press releases don’t often help much because they’re full of platitudes aimed at investors who want to know how a deal will affect their stock in 90 days. It’s a terrible way of investing but it’s also what we have.
For the time being we have something that more or less makes sense and new tools for imagining a better future. Dreamforce will be full of deeper explanations for this and other recent announcements like Blockchain. It almost makes you wish summer was already over…nah.