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By James R. Williams and Tracy Thirion


Imagine shopping for a new car. You approach the largest dealership in town. The lot is packed with new cars. However, as you draw closer, you notice they are the same brand, same model, equipped with the same options and even share the same color. Before becoming the prey of the approaching salesperson, you speed off – confused. Down the street is another dealership. With a quick glance you notice the same thing – all identical cars, and even the salesperson looks the same.

How do you make a choice? Do you even have a choice? There must be something that differentiates one car from another or at least one dealer from the next, right? Maybe. Maybe not.

Obviously, an exaggerated example, but can you see the treatment of chronic venous insufficiency (CVI) falling victim to this scenario and being tagged a commodity like grain, precious metals, electricity, oil or natural gas? I’d argue it’s not only possible, but it’s already begun to take place.

Vein treatment offerings are sounding more and more alike. Words like “no surgery, no hospitalization, virtually pain-free and back on your feet the same day” are peppered into every vein specialist’s website. These words are true, and they are important, but their importance is diminished when every practice promotes this same message. What may seem like a differentiator to the provider has become an assumed requirement of the patient. “Covered by most insurance and specializing in varicose veins as well as cosmetic spider veins” are also a given and not a mark of distinction.

With good outcomes becoming almost ubiquitous, some attempt to differentiate based on the patient experience they create. However, these attempts to promise a better patient experience often fail to put space between competitors, due to a lack of credible data points that are meaningful to prospective patients.

To further complicate things, we are all targeting the same patient segment. Estimates suggest there are more than 30M people in the United States with CVI – yet only about 1.9M people at any given time are seeking treatment. Arguably, most, if not all vein specialists are targeting this 1.9M segment because it’s comprised of people who mostly understand they have CVI, recognize the effect it has on their quality of life and as such, are most prepared to receive treatments.

In short, it’s easier going after this segment than the less motivated 28.1M. So, not only are we promoting the same message, we are all targeting the same prospective patient and as an industry we look more like the fictitious car dealer above than not.




As vein specialists, how do we step out of the commodity trap? How do we create a sustainable point of differentiation in a “Sea of Sameness”? How do we reach beyond the small segment who are looking for treatment? How do we create messaging that resonates with them? How do we elevate awareness amidst the noise and complication of healthcare? How do we get past the fear or ambivalence of treatment? How do we balance the importance of vein disease treatment with the allure of cosmetic benefits? What is the right business model? How do we innovate on the medical experience? How do we elevate the patient experience?

These are questions many don’t ask themselves if they’re comfortable with their business and not feeling the pain (yet). You might not have a sense of urgency to break your own business apart and shake things up. These are easier questions for those feeling the inertia of a cluttered category, where it’s hard to stand out and there is no desire to be part of the Sea of Sameness. There are no easy answers. It’s not about working harder, longer or smarter. That just won’t do. Not enough. What is required is innovation, specifically disruptive innovation.

The Department of Commerce Advisory Committee on Measuring Innovation in the 21st Century Economy defines innovation as “the design, invention, development, and/or implementation of new or altered products, services, processes, systems, organizational structures, or business models for creating new value for customers and financial returns for the firm.” Innovation can extend beyond improved products, services or processes. It can also include new organizational models, methods of service delivery, ways of relating to customers and approaches to marketing.

Not too long ago we saw the single greatest disruptive innovation to hit the treatment of CVI ever. In 1999, the FDA approved RFA, VNUS Closure for the treatment of varicose veins. Not only did it replace surgical stripping as the gold standard, but its quality outcomes helped bring needed credibility to the disease state as well as the industry. Insurance companies began to cover the treatment that over time created a groundswell of demand. The number of vein specialists proliferated to meet this demand and within 10 years there were multiple companies with more than 30 centers each throughout the country.

U.S. healthcare in general has a long-standing record of innovation focused on diagnostic procedures, therapies, drugs and devices. However, we’ve done little to innovate the way we package, deliver and talk about our care. As we look forward, especially in the treatment of CVI, innovation will likely come from:

  • Strategically integrated organizational platforms
  • Further advancement of operating models that can maximize economic scale
  • Sophisticated research to better understand what triggers a patient to receive treatment
  • Increased use of technology to enhance patient communication
  • Streamlined care plans with an emphasis on patient experience
  • Greater use of big data and analytics to manage our business.




The concept of innovation is relatively easy to understand: New ideas that change a product or service so much so that it changes a consumer perception, behavior and expectation. But how does one actually innovate?

You can innovate by looking at your problem statements head-on, or you can meander sideways for inspiration. This might sound daunting, but consider the small steps that can lead to big ideas. Southwest Airlines (SWA) went into a competitive industry, and instead of playing in the red ocean of big city hubs, they went to B and C markets and tapped into a much bigger, underserved population. They considered their competition not to be other airlines, but cars, trains and buses. They were selling “freedom” and they built their experience, pricing and messaging accordingly.

They innovated by eliminating industry “must haves” to support their brand promise of freedom. No seat assignments, no change fees, no bag fees, no first class. They innovated by adding simple elements that cost the same or less than other airlines, adding FUN, with casual uniforms and peanuts as well as entertaining and happy flight attendant announcements.

They did NOT break the most important industry rules, like having seatbelts, or maintaining high safety standards. They were renowned for their employee happy hours and gregarious CEO, and they were proud that while they didn’t pay the best in the industry, they had more than 20 years without layoffs of their employee family.

That cultish mindset of being “different” was contagious to customers, who wear the SWA brand badge with pride. Now, SWA is an airline that flies from A to B using planes with no major differences in technology. However, their hub and spoke approach helps them reach an underserved population, and their unique brand voice gives them a competitive edge. The SWA brand stands out amidst every stuffy airline charging thousands for business class seats, building trust with a loyal customer base who chooses SWA because of its unique brand experience, policies and culture.






The way to disrupt our own business is to look outside of it, take our blinders off and break our own rules.

  • What are all the rules of how a vein treatment business is built?
  • What are the rules about treatment? About cost? About payment?
  • What assumptions do we make about what patients know, understand and care about? What if we’re wrong — how would we speak to them differently?
  • What rules are we following just because that’s how we’ve always done it, or because that’s what the industry does or that’s what patients expect?
  • What could we add to the experience that would surprise and delight them?
  • What labels, descriptions or attributes do we use simply because it makes sense to us as providers but not to the patients?
  • What could we get rid of that is not providing added value, or is a nuisance?
  • What could we easily add or modify that could surprise or delight patients or employees?
  • What industry outside of healthcare had the same challenges, were similarly commoditized, but managed to break free from the Sea of Sameness? How can we lift and shift that thinking to our own industry?
  • What other industry could we learn from? For instance, and staying with our automobile theme, what could we learn from a Formula 1 pit crew about how we intake, treat and follow up with patients to make the best use of their time?

In a category that has been commoditized, where players are chasing the same segment of customers, with near-parity experiences and playing by the rules of the status quo, we are ripe for disruption.

So, what can you do?  Of course, you can do nothing, sitting comfortably in the business you’re in, with the hopes that some new medical technology will come along that can be your “new news” that will give you your next bump. Or, you can plan for your own disruption. Because the question around disruption is not IF it will happen, but WHEN.

Would you rather be like Southwest, who found blue ocean1 where the other airlines weren’t looking? Or would you rather be like the taxi companies who had captive consumers, but ignored consistent customer pain points, then got disrupted by Uber? Or like Kodak who got blindsided by digital? Or how similar hotel brands were disrupted by Airbnb? They all took their customers for granted, myopically focused on the rules and the norms of their businesses, and limited themselves from imagining how they would put themselves out of business.

Like our fictitious car dealer, the opportunity for us to create something fresh and resonant is right in front of us. By going outside of our industry to collect inspiration, by challenging the industry norms that we follow, by looking through a lateral lens, we can elevate the patient experience and change our businesses for the ultimate win-win and leave this Sea of Sameness behind. VTN



1A phrase coined by W. Chan and Renee Mauborgne in their best-selling book of the same name, which depicts new, uncontested market space, that makes competitors irrelevant, as opposed to “red ocean,” which is derived from the image of bloody waters because of an abundance of aggressive competition.


James R. Williams has more than 30 years of experience building regional/national healthcare companies and executing successful exit strategies. His primary focus is disruptive outpatient spaces including LASIK, Varicose Vein Disease, Proton Therapy and other Cancer Treatment modalities. As president of Miller Vein, he is leading the development of a rapid growth strategy combined with a strong, supporting operational infrastructure. Additionally, he is an advisor to numerous healthcare companies and private equity investors.


Tracy Thirion has 20 years of experience in brand strategy and innovation. She helps clients take a new perspective to problem solving by bringing in outside inspiration and tools. As CEO of innovation agency Bamboo Worldwide, Thirion leads a team of experts in “white space” innovation, who help brands such as Yellow Tail wine, Starbucks, YUM!, Wrigley, Perrigo Pharmaceuticals and Miller Vein identify new territories to expand their offerings. As a mentor to startup incubators, she also loves to help visionaries’ big ideas take root.


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