am hospital association, marketing health services, spring 2013

HealtH ServiceSAmericAn mArKeTinG ASSOciATiOn / Marketingpower.coM Spring 2013

biG dATAVanguard Health Systems creates a tech-savvy engagement strategy

criSiS reSPOnSeSix tips on how to implement a crisis preparedness drill

inSurAnce exchAnGeSExpert insights on how to handle the new insurance marketplace

Baystate Health finds its competitive edge by engaging customers to create the experience

CollaborationCommonwealthin the

collaboration in the commonwealthBaystate Health finds its competitive edge by engaging customers to create the experience

by Suzanne bharati hendery and wilson c. mertens

contents

28cover story

departments

04Marketing

Mix

features

20 a Sea Change FroM exChangeSHealth insurance exchanges could alter the flow of u.s. health care promotion and delivery

by Preston Gee

24 Making the ConneCtiona strategy for leveraging Big data, and new digital and mobile tools to effectively reach health care consumers

by Devin carty

american marketing association MarketingPower.com/magazines

HEALTH SERVICESAMERICAN MARKETING ASSOCIATION / MARKETINGPOWER.COM SPRING 2013

BIG DATAVanguard Health Systems creates a tech-savvy engagement strategy

CRISIS RESPONSESix tips on how to implement a crisis preparedness drill

INSURANCE EXCHANGESExpert insights on how to handle the new insurance marketplace



Spring 2013Volume 33number 2

Debra Landers, CMO of Community Health Systems, discussesenterprise-wide marketing

interview by rhoda weiss, Ph.D.

knowledgebase16

editorial board analysis online Insurance exchanges by rhoDa weiSS, Ph.D. 06

social strategy content enjoys a Glorious reign by SuSan Solomon 08

customer experience Lessons Learned by beth braDfielD wriGht 10

in the trenches practice makes perfect by Diane GaGe lofGren & John nelSon 12

strategic insights a remedy for readmissions by rhoDa weiSS, Ph.D. 14

executive perspective everyone Benefits by howarD lee 32

rhoda weiss, ph.d., [email protected]

2 marketing health servicesSpring 2013

Welcome to another issue of Marketing Health Services. One of the most transformative changes in health care will soon be open for business. Online marketplaces, better known as exchanges, could sig-nificantly alter how we do marketing. Trinity Health’s Preston Gee offers a comprehensive overview and editorial board members describe their strategies for the new marketplace.

Another transformation is occurring in digital and social media. St. Joseph Health’s Susan Solomon stresses the importance of content generation in building a digital reputation. And Devin Carty outlines

Vanguard Health Systems’ efforts in leveraging Big Data, new digital tools and traditional media to effectively reach consumers.

Imagine supporting the marketing needs of 135 hospitals. That’s a reality for Community Health Systems’ Debra Landers, who shares her mega-health system’s successful strategies to standardize market-ing in every CHS location.

Gaining the competitive edge is on everyone’s must-do list. Suzanne Hendery chronicles Baystate Health’s engagement of customers in their patient experience that’s helping achieve market share prominence.

Today’s complex, transparent organizations are ripe for crisis. Kaiser Permanente’s Diane Gage Lofgren and John Nelson delineate how crisis drills can spell communications success. And my column suggests new ways of reaching stakeholders.

Coverage alone does not guarantee a healthy population. CEO Howard Lee details how University Health Alliance’s groundbreaking initiatives are putting health back into health insurance.

Marketing executive Beth Wright has spent her career promoting the importance of medical screenings. Then she received a diagnosis of cancer. Beth’s unforgettable journey should impact the way that we all provide care to our communities.

Phone (800) AMA-1150 • Fax (312) 542-9001

AmericAn mArketing AssociAtion

david reibstein Chairperson of the AMA Board 2012-2013

dennis dunlap AMA Chief Executive Officer | [email protected]

editoriAl stAff

rhoda weiss, ph.d. Editor-in-chief | [email protected]

mary m. flory Managing Editor | [email protected]

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Art

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Marketing Health Services (ISSN: 1094-1304) is published quarterly by the

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Spring 2013 | VOL. 33 | nO. 2

1-800-ama-1150marketinGPower.comcopyright © 2013 american marketing association

LEONARD ACHAN, CCO/VP, Marketing & Communications, The Mount Sinai Medical Center / JUDy AKINS, SVP, Marketing & Communication, Mercy Health Ministry /

ELLEN BARRON, AVP, Marketing & Communications, University of Iowa Health Care / PETER BRUMLEVE, CMO, University Hospitals / DEVIN CARTy, CMO, Vanguard Health Systems / KATHLEEN DEAN,

System VP, Communications, Marketing & Public Affairs, PeaceHealth / KATHLEEN DEVRIES, VP, Marketing & Communications, University of Chicago Medicine & Biological Sciences / ERINNE DyER,

VP, Corporate Communications, Marketing & Outreach, Carolinas HealthCare System / PATRICK DySON, EVP, Strategy & Corporate Services, Borgess Health / DAVID FEINBERG, SVP/CMO, New york-

Presbyterian / DIANE GAGE LOFGREN, SVP/CCO, Brand Communications, Kaiser Permanente / PRESTON GEE, SVP, Planning & Marketing, Trinity Health / BILL GLEESON, VP, Communications, Sutter

Health / ROSE GLENN, SVP, Marketing & Public Relations, Henry Ford Health System / DEBORAH GORDON, CMO, Network Health / MATT GOVE, CMO/SVP, External Affairs, Piedmont Healthcare /

DALAL HALDEMAN, Ph.D., SVP, Marketing & Communications, Johns Hopkins Medicine / MISTy HATHAWAy, Chair, Marketing Enterprise, Mayo Clinic / SUZANNE HENDERy, VP, Marketing & Commun-

ications, Baystate Health / JEAN HITCHCOCK, Corporate VP, Public Affairs & Marketing, MedStar Health / OREST HOLUBEC, SVP, Marketing & Communication, Providence Health & Services / DEBORAH

ITALIANO, Executive Director, Marketing, Stanford Hospital & Clinic / SUE JABLONSKI, SVP, Corporate Marketing & Communications, Ohio Health / LINDA KALAHIKI, SVP/CMO, UHA Health Insurance /

MICHAEL KILLIAN, VP, Marketing & Public Affairs, Beaumont Health System / MARK KLEIN, SVP, Communications, Public Affairs & Marketing, Dignity Health / DEBRA LANDERS, VP/CMO, Community

Health Systems / CAROL LOVIN, President, CHS Management Company, Carolinas HealthCare System / MEGAN MANAHAN, VP, Marketing & Communications, Mercy / PAUL MATSEN, CMO/CCO,

Cleveland Clinic / JUNE MCALLISTER FOWLER, VP, Corporate & Public Communications, BJC HealthCare / TERESA MURPHy, VP, Marketing & Communications, Fletcher Allen Health Care / SARAH

NEWSON, AVP, Communications, University of Texas MD Anderson Cancer Center / MARK PARRINGTON, VP, Strategic Transactions, Catholic Health Initiatives / KEALA PETERS, VP, Marketing &

Communications, Hawaii Pacific Health / KIM REyNOLDS, VP, Marketing, LifePoint Hospitals / JOyCE ROSS, SVP, Communications, Catholic Health Initiatives / MARK ROTHWELL, VP, Marketing

& Communications, Dean Clinic / JULIE SHERMAN, Senior Director, Brand Services, Banner Health / STEVE SHIVINSKy, Corporate VP, Communications, Blue Shield of California / SUSAN SOLOMON,

VP, Marketing & Communications, St. Joseph Health / DON STANZIANO, Corporate VP, Marketing & Communications, Scripps Health / TOM VITELLI, AVP, Communications, Intermountain Healthcare /

HOLLy VONDERHEIT, VP, Marketing & Community Relations, Indiana University Health / BETH WRIGHT, VP, Corporate Communications & Strategic Marketing, Capella Healthcare

A note from our editor

editorial board

3marketing health servicesSpring 2013

South African families who participate in a program sponsored by the country’s

largest private insurance company receive rebates for buying healthier foods, such as produce and whole grains. A family is entitled to a maximum refund of $125 a month.

$125

by the numbers

bn

Two nonprofit health care groups analyzed states’ efforts to make medical care pricing information

widely available to consumers. Overall, 36 states received letter grades of D or F.

36

ALSO FIND US ON

YouTube

FIND OUT MORE AT

marketingpower .comRecent AMA podcAst Author Series: Converge: Digital marketing expert ray Velez explains how the merging of technology, media and creativity is revolutionizing marketing. Listen in: Marketingpower.com/podcasts

Recent AMA webcAst Keep Your Stories Straight: Learn how to align your social media and content marketing strategies, and how to measure the success of your efforts. Log on: Marketingpower.com/webcasts

now on AMA tV Loyalty program trends, analytics and the customer experience, interview tips and more. Tune in: Marketingpower.com/AMAtV

Get diGitAl! MHS subscribers, you can read your latest issue on your computer, smartphone or tablet. Check out our digital edition at Marketingpower.com/digitalpubs.

HEALTH SERVICESAMERICAN MARKETING ASSOCIATION / MARKETINGPOWER.COM SPRING 2013

BIG DATAVanguard Health Systems creates a tech-savvy engagement strategy

CRISIS RESPONSESix tips on how to implement a crisis preparedness drill

INSURANCE EXCHANGESExpert insights on how to handle the new insurance marketplace



The Alzheimer’s Association reported that health and long-term care services for people living with the disease will total $203 billion in 2013.

$203billion

The U.S. Department of Health and Human Services is testing three dozen care delivery models involving 50,000 health care provid-ers and more than 1 million beneficiaries.

The Obama administration said that it could take up to one year to see results.

03Dozen

According to market research company Lab42, 57% of consumers do not fully understand what their insurance covers.

The U.S. spends 20% of GDP—an estimated $2.8 trillion for 2013—on health care.

Industry Vitals EditEd by MarguEritE McNEal


marketing mix

mm

RECRUITING participants

for HIV prevention studies

and treatment can be a

challenge, so Dr. Raphael

Landovitz of the UCLA

Center for Clinical AIDS

Research & Education

used Grindr, an app

popular with young,

gay men for sexual

partnering, to find 375

participants for a survey,

according to a study

published in the Journal

of Urban Health.

Sourcing gets techy

real-time surveysHarnessing personal technologies to prevent, manage heart diseaseThe home health care

aide is the fastest-growing profession in the U.S., according to the U.S. Labor Department. As baby boomers age, the number of in-home care workers is expected to increase 70% between 2010 and 2020. However, despite the rising number of job opportu-nities, the average hourly wage is $9.70.

BooMing joB, SMall payCheCk

SMARTPHONES, APPS, SENSORS AND OTHER DEVICES will help researchers study cardiovascular health in real time. A new project called the Health eHeart Study aims to gather data from up to 1 million participants on a wide variety of measures associated with cardiovascular health, including blood pressure, physical activity, diet and sleep habits. The researchers, from the University of California, San Francisco, hope to find more precise strategies to predict the development and slow the progression of heart disease. Their strategy high-lights the growing potential of smartphones and other devices in medical research, Jeffrey Olgin, chief of cardiology at the University of California, told The Wall Street Journal.

$9.70

Some employers are using private exchanges to allow workers to shop for health plans in an online marketplace. Last fall, Sears Holdings Corp., Darden Restaurants Inc. and Aon Hewitt offered employees a set contribution to use toward health benefits. Workers could pay a larger monthly fee for richer plans or choose cheaper options that require higher out-of-pocket fees. Of the 100,000 employees who used the exchange, many more opted for lower-priced plans with bigger fees, ac-cording to consult-ing firm Aon Hewitt, which operates the online marketplace.

health exChange inC.

Timely topics in the health care space EditEd by MarguEritE McNEal


marketing mix

ALTHOUGH CALIFORNIA

voters struck down Proposition

37, a controversial ballot mea-

sure that

would

have re-

quired

the la-

beling

of certain

genetically

modified

products,

Whole

Foods

is not

letting the issue rest. The

health-conscious grocery chain

announced that by 2018, all

items sold in its American

and Canadian stores will note

the presence of genetically

modified organisms, or GMOs.

Industry experts predict that

other retailers will join the

movement.

Leading labels

SoCial powerDiabetic Connect, a social network site for people living with the dis-ease, drew more than 1.4 million monthly unique visitors in January, more than the American Diabetes Association’s website, according to comScore. One of more than 50 condition-specific socially powered sites owned by Alliance Health Networks, Diabetic Connect offers personalized content, tracking tools and discussion platforms for its members.

LAST yEAR, a New york doctor launched Sherpaa, a virtual doctor’s office with physicians and specialists who examine patients by e-mail and text. A real-time command center for health needs, Sherpaa works exclusively with companies and counts 500 customers from 30 businesses.

FROM NIKE’S FUELBAND to Weight Watchers’ points system, health-tracking tools abound in today’s marketplace, but they’re not for everyone. A survey from the Pew Research Center found that 69% of U.S. adults track some sort of health indica-tor for themselves or a loved one, such as their exercise routines, weight, diet, blood pressure, blood sugar, headaches or sleep patterns. Of the survey respondents, only 29% said that they use a gadget, app or website to monitor or record this information. The majority of participants just keep the data in their heads or jot it down on paper.

Old-school tracking

the doctor’s Iming

Dr. Susan Gonnella, chief physician

Courtesy of NikeInc.com

Co

urt

esy

of

Sh

erp

aa

.co

m

Timely topics in the health care space EditEd by MarguEritE McNEal


matt goveCMO and SVP of External Affairs

piedmont healthcare

Deborah gordonVP and CMO

network health (massachusetts health plan)

“With six years of experience in reform, we learned the criticality of, (1.) public awareness, as exchanges significantly change how consum-ers purchase health insurance, and marketers should promote their offerings, and educate and help people through the transition; (2.) delivering value, as consumers ‘vote with their wallets,’ and it’s critical that health plans design options based on market demands, representing the customer’s voice in that process; and, (3.) collabo-ration, because although we’re ac-customed to competing, we must now focus on common interests to ensure that the market succeeds for the benefit of end users.”

“Last year, we decided that the best strategy for population health is partnering with WellStar, another Atlanta system, to form a health plan. This adds scale, a physician network, expertise and ability to participate in the exchange, if we wish. Marketing a new insurance product is an enormous undertak-ing, but by leveraging the branding of our organizations, Piedmont WellStar Healthplans should hit the ground running when we introduce the brand to consumers. For open enrollment this fall, we’ll add direct mail, community events and digital campaigns to the mix.”

eDITorIal boarD aNalySIS

Interviews by RHODA WEISS / [email protected]

How is your organization getting ready for the exchange? What marketing strategies are you pursuing?

I t’s the centerpiece of U.S. health reform. Online insurance exchanges, or marketplaces, start offering insurance plans this fall to individuals

and small employers, and will go into full swing in January 2014 when coverage begins. Consumers will be able to compare health plans, purchase insurance and learn if they’re eligible for Medicaid or subsidies to help pay premiums. Exchanges are expected to enroll about 7 million people in 2013 and 24 million by 2016, according to the U.S. Congressional Budget Office, creating countless marketing opportunities. Eight editorial board members—representing health systems, hospitals, physician groups and insurers, and including one who is experienced in exchanges—share how they are getting ready for this new marketplace.

•MHS•

patrick DysonEVP of Strategy & Corporate Services

borgess health

“As Michigan continues to devel-op its exchange, Borgess is focus-ing on financial planning related to provider rates for health plans obtained through the exchange; the impact of an exchange on small, medium and large em-ployers’ potential migration to the exchange; and the impact of Medicaid expansion. Further, it appears that while some health plans may offer products on the exchange by Jan. 1, 2014, most plans are targeting Jan. 1, 2015.”


mark rothwellVP of Marketing & Communications

dean clinic

Tom VitelliAVP of Communications

intermountain healthcare

“We continue to promote and strengthen our brand as we have always done, since a strong brand will be more important than ever as more individual consumers make health plan purchasing decisions through the exchange. We are also planning to reach out to consum-ers and small businesses to help them understand the Affordable Care Act provisions that take effect in 2014, including the availability of premium subsidies.”

erinne DyerVP of Corporate Communications, Marketing & Outreach

carolinas healthcare system

“Our teams are aligning mas-ter brand communications and messages to create and build a stronger relationship with Carolinas HealthCare System. We are evaluating ads to ensure that they reach the right audi-ences with the right messages. We are staying abreast of fed-eral and state policy changes to ensure that we fully understand the implications on our business, specifically how we market and communicate to patients, and to ensure that we have a seat at the table as decisions that impact our world are made.”

Teresa murphyVP of Marketing & Communications

fletcher allen health care

“Fletcher Allen leads an account-able care organization, OneCare Vermont, under the CMS shared savings program for Medicare beneficiaries. Participants include Dartmouth Hitchcock Health, nearly all of the state’s communi-ty hospitals and many health pro-viders. OneCare Vermont could potentially include a multi-payer shared savings program for patients enrolled in the exchange next year. Through our subsidiary, Vermont Managed Care, we pro-vide care management services to populations covered by Vermont Health CO-OP, Vermont’s first cooperative insurance company, available on the exchange in 2014.”

Dalal HaldemanSVP of Marketing & Communications

Johns hopkins medicine

“We have been working closely with local government officials, insurance companies and con-sumer groups to prepare for the impact of exchanges and other reform provisions. We initiated additional education, training and outreach, including a symposium on primary care—all with the aim of increasing the understanding of impending changes on admin-istrative staff, physicians, local communities, and our network of physicians and other providers, and making stakeholders more aware of our managed care offer-ings and products.”

“Our integrated system (hospital, clinic, health plan) is strategizing on what the future looks like. We are continuing current marketing strategies, but given our market’s capitated nature and the pending launch of the exchange, we’re in-vesting more resources in segmen-tation beyond current audiences. We will focus on targeted vehicles (digital, CRM, community relations partnerships and public relations) that deliver the right message to the right audiences to ensure the right result, selecting Dean as their health care partner.” Mhs


C ontent has forever been king for marketing professionals, yet recently, discussions have

intensified about the importance of content generation in building a digital reputation. “Content marketing” and

“brand journalism” are widely talked about.

First, some definitions: Content marketing is the process of creating and distributing relevant and valuable content to attract, acquire and engage a

target audience. It can leverage a variety of channels (print, mobile, social, etc.), but unlike pure advertising, it relies on storytelling rather than bravado. Or, to put it simply, if you want to tell the world that you’re a rock star, advertise. If you want to show why you’re one, have great content.

Brand journalism follows the same philosophy but contains a dash of controversy, especially for journalists. It employs digital publishing and social media to spread content and speak directly to consumers. Marketing professionals disintermediate news professionals by writing and distributing their own stories.

Journalists’ concerns aside, why have content marketing and brand journalism become such hot topics?

One reason is that the platforms for content dissemination have exploded in recent years. Whereas there were formerly just Facebook and Twitter, there now are so many new options. It’s enough to make marketing professionals’ heads spin. (For example, are you familiar with Vine?)

Also, with Google’s Penguin product, the rules of search have changed and great content is key to winning the game. Traditional chest thumping and flaccid text that fails to engage readers are not going to get anyone anywhere because a bad user experience is synonymous with low Google rankings. And low rankings are death to marketing professionals. The Cleveland Clinic’s Health Hub is one of the leaders of the content marketing pack. The site is filled with content generated by experts within the organization. Users are encouraged to share as much of the stories on as many platforms as they choose. Mayo Clinic offers a similar site.

So how does one get started with content marketing? First, eschew any preconceptions that content is purely the

social strategy

Content Enjoys a Glorious ReignWhy stocking your website with exclusive content is worth the effort

SuSan Solomon [email protected]

content mArketing


written word. Social media platforms are driving a visual revolution. Think about the unique and, admittedly, addictive visual platform of Pinterest, and if seeking an example of how it’s done right, go to The Wall Street Journal’s Pinterest site, where the editors have created a fascinating blend of words and images. Also, don’t forget Instagram, the fun photo-sharing network. Not only can users post photos, but also they can edit them with sophisticated tools to make their visual postings truly intriguing.

Even the traditionally text-focused platforms have gone visual. Google+ offers lots of white space and larger photo options, and it’s no secret that Facebook content with attractive visuals gets noticed more in a news feed.

It’s not all about pretty pictures, though. There has to be a great story to tell, which usually doesn’t worry most marketing professionals. But if you’re one of those rare marketing professionals who isn’t writing the next great American novel in your after-hours, here are some ideas for search-engine-loving content:

• Interviews: With interviews, there’s an added bonus because the experts likely will link back to you. Also, your readers trust information from experts.

• Lists: Think “top 10.” There’s no need to be as clever as David Letterman, but keep the lists short and information-rich.

• Polls and surveys: Display results visually and publish them on your site. Then reach out to media outlets to discuss your findings.

• React to news: Journalists do it all the time: Find a local angle to a story that everyone is talking about. This technique helps the content provider to be viewed as relevant and as an expert.

• User-generated content: Ask readers to comment on or review a recent health seminar. Yes, there’s a risk, but positive comments from

unbiased readers are well worth it. Of course, have a social media policy clearly visible that protects you from any potential HIPAA issues.

Once the stories are lined up, establish a reliable editorial calendar. Track your material’s placement and production, and plot its repurposing and promotion. For example, content placed on Facebook one day can easily become Web copy, an Instagram upload and a Pinterest post the next.

Content is the new king? Not exactly. For marketing professionals leveraging the new platforms, it’s more like a diamond jubilee celebration. Now go join the party. Mhs

✒ SuSan Solomon is vice president of mar-

keting and communications for St. Joseph Health,

a 14-hospital health system in California, Texas and

New Mexico.

.com leArn more! Read about the Cleveland Clinic’s content marketing efforts in the Winter 2013 issue of Marketing Health Services at MarketingPower.com/mhs.

If you want to tell the world that you’re a rock star, advertise. If you want to show why you’re one, have great content.


H aving worked in health care since 1980, I have been promoting mammography for

more than three decades as the single best way to find cancer in its earliest, most curable stages. As a marketing professional, I know that one in every eight women is going to need additional diagnostic testing, most of which will rule out cancer.

It’s my job to know that these additional tests and procedures—then treatment for the small percentage who actually do have cancer—allow my hospital to generate enough income to cover the costs for our services plus make a profit, thus showing an ROI on our marketing efforts.

I was always that one woman in eight who needed more testing. The first time it happened, following my baseline mammogram in 1997, I was alarmed, but as the follow-up testing was requested year after year, it became routine. Imagine my shock, then, at being diagnosed with Stage II breast cancer in 2012, which I discovered myself just a month after my routine screening mammogram. According to most research, my three-centimeter tumor had

to have been growing for more than five years. After my surgery, three additional cancer sites were found in the same breast, none of which had been detected by the mammogram, ultrasound, breast MRI or physician exam.

At first I felt betrayed. Then I knew that I’d been blessed. Sixteen doctors, three hospitals and four outpatient centers later, here’s what I’ve learned thus far in a journey that’s making me a stronger person and a better health care marketing professional.

The BenefitsThe silver lining, from a professional standpoint, of facing breast cancer is that I’ve seen the customer experience firsthand and I’ve learned so much more about what can improve patients’ inter-actions with health care providers.

For starters, first impressions count. At my first meeting with my breast surgeon, he concluded our appointment by hand-ing me his cell phone number because he “didn’t want me to experience additional anxiety when a simple phone call to him, day or night, might provide an answer or reassurance.” I was so impressed that I told a lot of people about it, but I never

actually used his cell phone. For a min-imal investment in time, this physician likely is generating a huge ROI with this approach, which makes every patient feel very special.

I also felt special when I called his office, even though I got an answering machine, because it told me that I should press “one,” just like the doctors were instructed to do. I felt like a priority.

Second impressions count just as much. As special as I felt at first, I just felt like a number later. At my next visit, there weren’t enough chairs in the wait-ing room for all of the patients awaiting follow-up visits. And in future meetings with my surgeon, he always seemed to be in a hurry.

My medical oncologist, with whom I spent the most time, always spent as much time as needed answering ques-tions from my husband and me. And while I’m sure that she answered the same questions day after day from nu-merous patients, she made me feel good about asking, commending me for re-searching and inquiring.

My plastic surgeon’s office always had treats waiting, from coffee and pastries in the morning to an ice cream cart one afternoon. I didn’t mind waiting as much there. My interventional radiologist al-ways called me personally from his cell phone at the end of the day following a procedure and he was the only physician who made it a point to ask for my feed-back on one of those numerous physi-cian rating sites.

Health care marketer’s takeaway: Find ways to make a great first impression, but don’t limit that to the patient’s first visit. Encourage satisfied patients to take that extra step and evaluate your practice or organization on a specific rating site. (The negative feedback will find you all by itself.)

Lessons LearnedA patient’s perspective on the health care experience

customer experience

Beth Bradfield Wright [email protected]

user insights


An Engaged ConsumerWhile not a clinician, I was likely a more educated and engaged consumer than most. Because of that, and my lack of intimidation in asking questions, I prevented at least a couple of medical errors. Additionally, I liked being able to provide input into my care.

And while I was quite engaged and inquisitive throughout the process, it does concern me now that I signed many papers that I never read. Several waivers had to do with taking photos of my breasts—before and after—with full license to post on the Internet and showcase in binders for others to see. When I signed, I just wanted to facilitate treatment. Now I’m looking for those papers to read the fine print.

Health care marketer’s takeaway: Work harder to encourage patients to be involved in their care and ask questions if they don’t know what’s going on or what’s expected of them.

Moving AheadHow blessed we are to live during this time, when there are improved tests to detect cancer, better options for treat-ment and new medicines to minimize side effects.

All three of the chemotherapy medications that I was given listed nausea as a potential side effect, so I can’t say enough about the powerful, new medicines that I was given to prevent nausea. My nurse told me about a man she treated a decade prior who so dreaded the nausea that he would get sick in the parking lot, even prior to entering the building for his chemo. She had just run into him again, 10 years later, in a grocery store. He was doing very well, but upon seeing her face—a full decade later and possibly before he even consciously recognized her—the

man immediately threw up, right there in Kroger. The mind, along with our sensory memory, is more powerful than we know.

Health care marketer’s takeaway: We would do well to remember the power of the mind and engagement of all five senses. What can we do to make patients’ treatments go as smoothly as possible and to make their lives better afterward?

I finished my chemotherapy in December, have started medication to minimize the risk of a recurrence and am now re-growing hair. Reconstructive

surgery will be completed shortly. My diagnosis, treatment and recovery have been a strategic opportunity to experience the health care system as a consumer. My cancer has given me a new perspective—on life, on health care and on the patient experience. Mhs

✒ beTH braDfielD WrigHT is vice

president of corporate communications and

strategic marketing for Capella Healthcare, which

owns and/or operates 14 acute care and specialty

hospitals in six states.

Beth Bradfield Wright poses with figure skater and fellow cancer survivor Scott Hamilton.

b y its very definition, a crisis is no time to get on-the-job training. It’s a time of intense pressure

when systems are strained, weaknesses are amplified and crucial decisions must be made on the spot. A blown first impression can leave a lasting mark—and be difficult to correct. The best way to handle a crisis is to be prepared for one, and the best way to do that is to practice. In other words, drill.

Crisis drills are a critical part of health care communications success, especially in the age of social media. Crises are more frequent now because of the com-plexity and increasing transparency of today’s environment, and the ramifica-tions are instantly known in one contin-uous news cycle. The Internet and social media have created more moving parts and accelerated the making or breaking of reputations during a crisis.

During crisis drills, organizations con-duct training to practice ways to protect the brand while informing the public in the event of a crisis. Drills allow orga-nizations to practice making decisions and engaging stakeholders in response

to the unexpected. They help to critique individuals and responses before there’s real reputational skin in the game so that when the time comes, teams are prepared to respond in real time. Hosting crisis trainings is critically important, even for the most veteran issues manager.

A Drill That Produces ResultsTo run a good simulation, leaders must create a crisis scenario that includes meaningful, challenging and realistic ele-ments for the team to practice. In a recent crisis drill, Kaiser Permanente designed a scenario that was fictional but ground-ed fully in reality, and it evolved and escalated over time. Participants initially were faced with what appeared to be a medical error, but the crisis quickly grew to include elements of medication abuse, compliance failures, union concerns and political sensitivity. This scenario was played out over the course of 90 minutes and was very carefully planned to engage crisis communicators who share accountability but work in nine different states.

When the drill was over, a thorough debrief was conducted. All participants shared their learnings, which ranged from social media eye-openers to re-newed awareness around the speed that information and misinformation travel.

Here are some proven processes to help you and your organization plan an effec-tive crisis drill:

1. Know your focus. The planning phase is one of the most important parts of a simulation. Before coming up with a scenario, teams should decide on the set of skills, structures or other elements that they want to test. It’s not necessary to practice on all aspects of a crisis. Setting up a scenario that is overly broad, especially if the drill is only an hour or two, is guaranteed to make it too superficial. Conversely, a training that is too narrowly focused, requiring too deep a dive into one issue or process, could fail to engage all participants and could appear too artificial. Most drills planned at Kaiser Permanente last between 90 minutes and a full day, and typically last less than half a day.

2. Determine how to measure success. Once a focus is decided, the next step in designing a scenario is to decide how the results will be measured. What should participants walk away with? Is it experience, education, awareness or knowledge? While training for the sake of gaining experience is not a bad goal, consider maximizing the investment of time and effort by ensuring that specific activities are tested and measured. Is there a desire to practice and uncover gaps in a team’s timing or nimbleness, or to offer an experience that tests the quality of the organization’s messaging response? Should both timing and


in the trenches crisis resPonse

Practice Makes PerfectTo best prepare for a crisis, drill!

diane gage lofgren & John nelSon

[email protected]

[email protected]


quality be measured? This helps determine if the drill has met the goals that you set out to achieve.

3. Teams should accept that not all aspects of the drill will be realistic. Make it as realistic as possible, but remember that it’s just a drill, so it will not be perfect. Don’t get bogged down with logistics, but use the drill as a learning experience. If there are participants who are known to have difficulty “suspending disbelief,” coach them beforehand or involve them on the team doing the role-playing, rather than with those being trained.

4. The best drills are fun. Crises are stressful—especially when it comes to health care—so keep simulations positive. Find ways to break the tension by using humor. Comic relief may be added where appropriate. For example, those who are role-playing (pretending to be bloggers, reporters or politicians, say) may want to use humor to emphasize a point. Take opportunities to laugh while in the

middle of the drill. Also, allow people to step back if they are getting too stressed or upset.

5. Create a learning space where

participants know that it’s OK not to be perfect. No one should feel as if his or her career is on the line during an exercise. Participants need to know that it’s OK to fail. In fact, a little failure helps people remember not to make those same mistakes when the real thing happens. The goal should be visibly focused on, and supportive of, learning.

6. Determine how to use what is learned to improve. Evaluate the drill after it’s complete. Things tend to pop up that may not have occurred to the team previously. Make sure to take note of these items to discuss after the drill is over and then come up with what will be done differently next time. Mhs

✒ Diane gage lofgren is chief communica-

tion officer and senior vice president of brand com-

munication, and JoHn nelSon is vice president of

brand communication at Kaiser Permanente.


I t never made much sense, especially to those paying the bills. The more patients were readmitted to an

inpatient facility, the more the hospital gained additional revenues.

Many return admissions are beyond a hospital’s control and are due to factors such as chronic conditions, unexpected complications, unhealthy lifestyles or non-adherence to prescribed medications. But hospitals share responsibility, including a historic lack of coordination and communication among those involved in patient care.

The Accountable Care Act attempts to stem the problem. Last fall, Medicare—which annually spends $15 to $20 billion for unnecessary readmissions—began penalizing hospitals for readmissions within 30 days of discharge deemed excessive for specific diseases. To remedy this, marketing executives are facilitating conversations and crafting plans to reach stakeholders, build relationships and promote partnerships to ensure a seamless, uninterrupted continuum of care.

Activities include forming e-communities that encourage digital conversations among stakeholders, offer information and address similar challenges; distributing e-newsletters with tips on caring for chronically ill patients; and sharing resources and data that help community providers and patients thrive.

Efforts also target incentive-based initiatives: pay-for-performance, financial incentives ties to patient experience scores and bundled payment programs. To stem chronic disease costs, Accountable Care Organizations—where groups of providers receive payment for the entire health of a consumer—promote wellness, prevention and evidence-based medicine while avoiding duplicated services, medical errors and unneeded referrals. And in medical homes, physicians lead a team of providers who embrace evidence-based and preventive techniques to contain costs in every aspect of a patient’s care with payment based on data that identify trends and uniform care.

Here are some stakeholder strategies to consider in reducing readmission rates,

better coordinating care and impacting community health.

Hospitals are improving discharge planning, with education and counseling beginning even before planned hospitalizations, and continuing throughout and following the inpatient stay. Nutrition, resource and socioeconomic assessments are increasingly performed to ensure that proper medications are taken, healthy diets are followed and additional resources—like home health services and transportation—are tapped.

To help ensure that post-hospital instructions are understood and followed, interactions may be recorded and shared online with patients and their families. Within a day or two of leaving the hospital, a nurse may call to assess the patient’s condition, identify issues requiring attention, continue the education process and ensure that physician follow-up visits occur.

For those at higher risk of readmission, follow-up calls are intensified and home visits added as part of a disease management program. Hospitals are facilitating stronger seamless relationships with community physicians, post-acute care, pharmacists and others who impact care in the community.

Physicians and their office staff are receiving more timely and comprehensive communication about their hospitalized patients who may be admitted without their knowledge through the ER or whose hospital care often is assigned to a hospitalist. Hospitals are ensuring that information is relayed to physicians in real time when their patient is admitted with updates and discharge summaries; follow-up physician appointments are made and kept; and medications are coordinated with physicians and pharmacies.

A Remedy for ReadmissionsThe Accountable Care Act will increase health care collaboration on the patient’s behalf

strategic insights coordinAted cAre

rhoda WeiSS, Ph.d. [email protected]


Family members are becoming more engaged in patient decision-making and patient care. Someone close to the patient often serves as a “coach” to assist in the transition.

Home health care is beginning prior to discharge, often on the first day of hospitalization or even before the inpatient visit occurs, rather than seconds before the patient is ready to go home. It is not unusual for a home health nurse, aide, social worker or physical therapist to visit the home prior to hospitalization to assess nutritional habits and medications, and potential risks or hazards, thus readying the home environment for a safe and healthy recovery. Telehealth monitoring devices are used more frequently to transmit vital signs to medical personnel.

Nursing homes are often a source for readmissions, yet there has been little collaboration or communication between hospitals and post-acute facilities. That is changing as hospital physicians, nurses, rehabilitation staff, case managers and discharge planners go into post-acute facilities to offer education on keeping residents healthy and out of the hospital, identifying serious issues early on, successfully reducing falls, and improving the facility staff’s clinical and patient management skills.

Senior living facilities, senior centers and Meals on Wheels offer opportunities for improving seniors’ health and independence. Senior centers represent essential partners in improving community care. Meals on Wheels volunteers—armed with information and skills on identifying clients with unmet needs—also are crucial partners in the continuum of care.

Public health, pre-hospital teams and pharmacists are vital to community health. With the emphasis on incentives for improving population health, hospitals are looking to public health departments

and neighborhood clinics to collaborate and act upon the findings of community needs assessments, identify high-risk patients, and partner more fully in immunizations and the identification of community resources to assist patients. Pre-hospital teams—paramedics, EMTs, ambulance drivers and police officers on the front line of patient care—as well as pharmacists, present opportunities for further collaboration, communications and education.

Health plans are important to patient follow-through and sources of access to community resources, whether it’s transportation, home care or direct support. While in the past, there was a schism and an “us versus them” environment between health plans and providers, insurers now are seen as a source of collaboration, education and pilot projects to improve community health.

Businesses represent sites where clinicians can offer education, screenings,

immunizations and programs on prevention, healthy living and caring for an older adult.

Less likely stakeholders, like schools, places of worship, community centers and more, are additional groups that can influence the well-being of communities.

By bringing together stakeholders in virtual integrated delivery systems, health care providers are taking a giant step toward another hallmark of health reform: population health management that better manages the health of entire communities. Mhs

✒ rHoDa WeiSS, pH.D., speaker, consultant and

columnist, is past president of AHA Society for Healthcare

Strategy and Market Development, receiving its inaugural

award for Individual Professional Excellence, and chair

and CEO of the 32,000-member Public Relations Society of

America, receiving the Health Academy’s Lifetime Achieve-

ment Award. A Kellogg Foundation Fellow, she was named

UCLA Extension Distinguished Instructor and she is the

author of Managing Health Care Reform: Ideas for Leaders.

leArn more! For more on marketing's response to the Accountable Care Act, turn to page 20.


W hile health systems continue to address the challenges of

standardization, centralized man-agement and choosing the right marketing model that meets both corporate and local needs, at Community Health Systems (CHS), these are part of the culture. CHS has earned a national reputation for supporting networks of thriving hospitals, some in competitive

As vice president and chief mar-keting officer of Community Health Systems, DEBRA LANDERS leads hospital strategic planning development, culture and leader-ship development, patient experi-ence, affinity relationship programs and traditional marketing, including digital, CRM and advertising. She has more than 25 years of expe-rience in nonprofit and for-profit health care organizations. Headquartered in Franklin, Tenn., COMMUNITY HEALTH SYSTEMS INC. is one of the nation’s largest publicly traded hospital companies, and a leading operator of general acute care hospitals in non-urban and mid-size markets. Through its subsidiar-ies, the company currently owns, leases or operates 135 hospitals with about 20,000 licensed beds in 29 states. Its Community Health Systems Professional Services Corp. subsidiary provides man-agement services to affiliated hospitals.

markets and others that are sole health providers in their communities. By applying sustainable processes, the organization helps affiliated hospitals improve operations and marketing.

An executive at CHS since 2003 and now its vice president and chief marketing officer, Debra Landers leads a marketing team that serves 135 hospitals across the country. Marketing Health Services recently spoke with Landers to learn about how CHS standardizes its marketing efforts, engages team members, addresses the customer experience, curtails outmigration, on-boards new facilities and communicates across the enterprise.

knowledge base

10 minutes withDebra LanDersInterview by RHODA WEISS / [email protected]

QA

knoWLeDgebase


Q: How have you been able to standardize marketing throughout a very large health organization like CHS?

a: Community Health Systems Professional Service Corp. is a manage-ment subsidiary known for standardized and centralized processes that support hospital operations. Business functions like IT, materials management, finance, operations, home health and others pro-vide the tools and support necessary for our affiliated hospitals to focus on quality care delivery, not developing processes and selecting vendors to help offer pro-grams and services.

Marketing is no exception. Our marketing department is responsible for establishing marketing partners and resources. Since standardizing the marketing department 10 years ago, our affiliated hospitals have worked with just one advertising agency. That enables efficiencies through shared costs and materials across the organization. It also helps ensure that materials are reviewed for accuracy and quality. Economies of scale for this one marketing tactic have saved millions of dollars.

We also provide Web support for all of our affiliated hospitals and clinics in-house. By utilizing templates, we’re able to act fast and turn around quality materials. This standardized system allows us to test products and, when we know they are a best practice, share them with facilities that have a need for a certain product. That allows hospital teams to select and implement quickly the products that work best for their markets. With research for new products done here, hospitals can spend their time on implementation, plus developing and maintaining important relationships with their local stakeholders.

While many systems may struggle with standardization, it is part of our

organization’s culture, evolving over the last couple of decades. It is more afford-able to create tools and resources that work for multiple business units than for each to create their own. This enables our affiliated hospitals to move quickly and be confident in their strategy and direc-tion. It also is important in our recruiting that leaders value this culture. CEOs un-derstand the critical role that marketing plays and the resources available to them.

Q: In what ways are you engaging the marketing team? Can you give examples of joint programs that have worked across the system?

a: The marketing team meets every Monday to discuss strategy and best practices from across the organization. Every other month, we host a webinar to share best practices, new resources and tools with marketing teams across the country. Additionally, when a new idea needs to be vetted, affiliated hospitals are always willing to be pilot facilities. Our emergency room discharge callback program (DCA) we created in 2009 is a great example. DCA creates a call queue of ED discharges from the last 24 hours. In 2012, hospitals across the system com-pleted 1.5 million calls. That extra touch point with patients is important to each hospital’s culture and the quality of care that it strives to provide.

Based on DCA’s success, this year an inpatient callback program (ICA) was implemented whereby each facility calls discharged patients within 48 hours. Both systems were created internally, saving more than $5 million in product costs. From product development like DCA and ICA, to CRM, and traditional marketing tools like advertising and interactive, we focus on creating great products. Most tools would not be af-fordable for smaller, community-based

hospitals. This model gives every hospital access to the same resources at their fingertips.

Q: Many health systems brand their hospitals with the system name, while others maintain the hospital name only. Why did you decide on the latter?

a: Health care is delivered locally and we recognize that each hospital, practice or clinic is unique. Each creates its own brand based on the services it provides, the people it employs and the role it plays in the community. In 55% of the markets where we have an affiliated hospital, it’s the only hospital in town. Employees and physicians of that local hospital create the brand for their facility. The brand is created by the quality of care that patients receive, and the customer service and comfort provided for patients and families.

A key branding strategy for our affil-iated hospitals is to ensure that internal relationships with physicians and em-ployees are strong so they become the sales team in each community. With each new acquisition, we work hard to demonstrate the value of a standardized model and what we call our ‘Community Cares’ culture. Within the first week of a new hospital acquisition, there is a Community Cares kick-off meeting to explain the ‘why’ behind the strategy. Whether it is the only hospital in town or it’s in a very competitive market, leaders have the tools to differentiate themselves in their market and create a culture of quality that every member of that team is proud to represent.

Employee engagement is really im-portant. Across our organization, 85% of employees surveyed in 2012 were satis-fied with the hospital where they work. Since there are 96,000 employees across the organization, we think that’s a great accomplishment.

Q: Patient satisfaction is gaining importance as health care moves from a volume-based to a value-based business. How are you ensuring great experiences for customers?

a: Customer experience is important for all of our affiliated hospitals. This is not a new strategy because of value-based pur-chasing. Leadership development efforts over the past few years added processes and tools that have changed culture. This culture change started with customer service training and quickly morphed into a way of life for team members on how they introduce themselves, clinical hourly rounding standards, alignment and accountability for goals, and a totally transparent leadership style.

As I look back on the last few years, the Community Cares culture has helped us move confidently into the next level of a standardized business model. With align-ment of goals across the organization, there’s opportunity for more transparency. With standardized goals, performance across the organization is ranked in an objective manner and leaders can bench-mark their accomplishments against top performers. These results are then tied to evaluations and incentive compensation. This also helps ensure that quality efforts are aligned in each hospital.

Each quarter for the past four years, I have shared through a webinar for over 7,000 leaders the ‘Top 10’ and ‘Bottom 10’ HCAHPS results. [Editor’s note: HCAHPS, or Hospital Consumer Assessment of Healthcare Providers, is a nationally standardized, publicly reported survey of patients’ perspectives of hospi-tals.] This transparency lists the hospital name and their score for each HCAHPS category. The effort is twofold: recognition for superstars and motivation for lower performers. Hospital leaders can be very competitive; it’s a race to the top. It’s com-mon for calls and e-mails to start flying a few days before a leadership webinar from people trying to learn who made the ‘Top 10.’ This healthy competitiveness

helps create great places for employees to work, physicians to practice and patients to receive care.

Q: A big challenge for rural hos-pitals is stemming outmigration to urban and suburban areas. What strategies have you exe-cuted to keep patients in your communities?

a: Research for years has shown that people prefer to get their health care close to home. We know that patients go where their family, friends, physicians and in-surance coverage direct them to. Culture efforts—coupled with physician recruit-ment, technology investments and facility enhancements—are all factors to reduce outmigration. Our affiliated hospitals have access to capital and invest greatly in their facilities, medical technology and other resources so they can be competitive in the marketplace, whether across the street or 60 miles away. It all boils down to consumer preference, physician confi-dence and making sure you’re part of the providers’ plans.

In Northeastern Pennsylvania, for example, a network called Commonwealth Health includes eight affiliated hospitals with more than 1,200

hospital beds, 1,600 physicians and 6,500 employees. Even though each hospital is independently operated, they work together as a system to share resources, skills and experience on a geographic basis to better serve patients. Due to the Affordable Care Act, this type of regional integrated delivery system is more important than ever.

Not all markets have the infrastructure or number of hospitals and other providers necessary to become integrated delivery systems. Those hospitals have to work especially hard to offer the best-quality services possible to keep the care local. Through affiliation with our organization, they are able to invest in technology, equipment and physician recruitment as a core strategy to encourage residents to seek care in their communities. This effort, coupled with skilled staff and specialty accreditations, hopefully helps demonstrate that there is no reason to leave town to access the care they need for themselves and their families.

For example, many of our affiliated hospitals have certified chest pain and stroke centers. When they can offer high-quality care and exceptional service, the hospital sells itself. Some affiliated hospitals offer a pledge to see


knowledge base

Through its subsidiaries, Community Health Systems Inc. owns, operates or

leases 135 hospitals with about 20,000 licensed beds in 29 states.


ER patients within 30 minutes. Each ER demonstrates and maintains quality and service metrics to offer this pledge. The results have been an increase in ER visits. Our affiliated hospitals—focused on improving quality care versus outspending the competition on advertising—are challenged in every market with competitive systems trying to market themselves.

Health care is a top industry for advertising expenditures, but instead of spending more on advertising, our affiliated hospitals focus on quality care and service to make sure that their patients, employees and physicians are the advertising tools. That’s not to say that they don’t advertise. They do. But they won’t throw dollars at messages that don’t have a direct consumer call to action. It’s about being selective on what the message is and what the return should be. Each year, marketing ROI tracking gets more sophisticated. Across our organization, we use customer relationship management to track just about every marketing dollar. Then we know what works and can quickly share that information across the system.

Q: On-boarding of new hospi-tals into health systems is a hot topic in marketing. How does CHS help new hospitals adjust to your culture and processes?

a: Our management subsidiary has a comprehensive on-boarding process for the entire hospital. From the marketing perspective, we have a comprehensive plan that outlines all resources and tools available. We start this process during due diligence and transition most acqui-sitions to standardization within three to six months. The Community Cares culture kick-off happens within the first week and align-ment with goals starts then. I think it’s fair to say that newly acquired hos-pitals are apprecia-tive of the support and resources. This is one of many dif-ferentiators for our organization. We focus on support and respect for local teams and communities, and are dedicated to supporting each local hospital’s effort to play a critical role in its community.

Q: How do you keep track of all of those facilities? How do they communicate with you and each other?

a: The marketing team in our man-agement subsidiary is very lean, with 29 people. We work closely with each

hospital to help it develop both the stra-tegic plan and marketing plan, and then offer support as each is executed. We hold national calls and tons of individual calls to support their needs. Most tracking is done throughout standardized systems, which saves a great deal of time for the hospital team. The pace is always fast and e-mails

total hundreds on most days. What’s criti-cal is that our culture is one of service. The marketing team is always available to help, regardless of the need.

While our marketing resources cover traditional elements like strategy, adver-tising, digital and customer engagement, they also help drive the culture and how hospitals differentiate in the marketplace. Those of us who are part of marketing teams during times of great national tran-sitions must be focused on the strategy and how to align all of the moving parts that make up health care systems today. Mhs

“Instead of spending more on

advertising, our affiliated hospitals

focus on quality care and

service to make sure that their

patients, employees and physicians

are the advertising tools.”


otentially one of the most transformative market changes for the U.S. health care industry is months away, in the form of health insurance exchanges (HIX), or what the federal government now

is trying to re-label as health insurance marketplaces (HIM). Whatever name or acronym by which they are known, the upshot is the same: This initiative—the implementation cornerstone of the Affordable Care Act—has vast potential to alter the way that health care is promoted, selected and delivered in the United States.

Despite their potential to shift the way that the health care sector conducts business, the response to exchanges by a surprising number of organizations has been mild at best, if not outright dormant, this spring. This quiet response comes despite the reality that exchanges offer an avenue for millions of individuals to access the system with insurance, which many of the likely enrollees have not had on a consistent level.

A SeA ChAnge From exChAngeSHealth insurance exchanges could significantly alter the flow of U.S. health care promotion and delivery, and marketing professionals can help direct their organizations' next moves

By Preston [email protected]

A f f o r d ab l e C a r e A c t

P


f greatest surprise in this non-responsive-

ness by the provider sector is the lack of advo-

cacy and preparation exhibited from the marketing function. Exchanges provide a rich and robust opportunity for marketing professionals, and for those in the market-facing functions, to gain cachet and to exhibit the acu-men that they have gleaned over the years.

If anyone should be leading the charge in each organization to gal-vanize the leadership team and the entire organization to rally around this new reality, it should be those in the strategy and marketing areas, who not only stand to gain cachet, but also can provide expertise and insights into how to tap this large wave of HIX enrollees and potential new patients.

It could be argued that the imple-mentation of exchanges represents the climactic realization of the Affordable Care Act, enabling a wide swath of previously uninsured individuals to have access to the delivery system via

established infrastructure, economic support and, in some cases, govern-ment subsidies. Individuals can par-ticipate in one of four tiered levels or programs, from bronze to platinum, that are differentiated by character-istics such as price (per-month fees), level of service, breadth of provider networks and economic responsibility for services received. The exchanges are state-based and have one of three constructs: state-run, federally run or a partnership between the state and the federal government. The determi-nation has been made for most states as to which program they will offer.

The mechanics may not be as im-portant as the underlying dynamic that exchanges prompt—namely, a decades-old shift from group-based purchasing to individual selection and purchase of health care in this country. This is seismic on several levels, but from a marketing stand-point, it underscores the need for an organization to be well-positioned in the consumer’s mind, as well as transparent in its cost-versus-quality

equation. In essence, it represents the long-awaited moment when health care moves from basically a wholesale industry to more of a retail model, with consumer-driven characteristics and implications. It represents a turning point at which marketing and strategy professionals may finally have found their forum, and a time when market-facing functions may finally have arrived.

American IdleThis is, of course, a sea change for the health sector in this country. In the past, the American health care consumer/patient has not been as engaged—economically or selectively—as he or she is in virtually every other industry. Consequently, the notion that health care is consumer-driven is both fundamentally false and ide-alistically fanciful. However, much of that may be about to change.

Nothing engages the consumer more than financial accountability and responsibility, and insurance exchanges provide that basic market

O


dynamic. Enrollees in exchanges not only will be responsible for monthly premiums—which, as learned from the Massachusetts experience, will have a high level of price elasticity—but also will feel a much larger economic impact when services are deliv-ered. For example, those who enroll at the bronze level will be responsible for 40% of the cost of the services delivered, silver enrollees will cover 30%, gold will cover 20% and platinum will cover 10%. This heightened level of fiscal responsibility likely will drive enhanced engagement, heightened awareness and dramatically increased interest in the transparency of costs and overall quality.

In addition, health care marketing and strategy professionals should see in this actualization of insurance exchanges a broader dynamic at play, one that moves the nation from defined benefit (as currently available through employer-sponsored insurance) to defined contribution. To gauge the real-time effect of this change and its impact, just observe what has happened on the financial-support side in American industry, as employers have migrated from yesterday’s model of post-retired pensions to the defined contribution approach, such as with 401Ks and 403Bs. This approach arguably has been an economic boon to employers and likely is the precedent for employer-sponsored health benefits.

Consequently, many industry pundits believe that employers eventually will shift their employees away from the current model to one in which the employer makes a contribution and allows the employees to select and manage their health benefit op-tions. This will begin with small businesses and likely will migrate to larger organiza-tions over the next few years. Supporting that premise is the rapid rise of private exchanges that are emerging to allow large- and small-scale employers that very option. It basically comes down to this: The world as we know it—and have known it for decades—is changing. Mhs

✒ preSTon gee is senior vice president of strategic

planning and marketing at Trinity Health in Livonia, Mich.,

which recently merged with Catholic Health East. The new

organization has more than 87,000 employees, 82 hospitals

and 89 continuing care facilities, with facilities in 21 states.

Reform SchoolingIf the actualization of HIX/HIM does usher in a brave, new world and a brand-new day in the health industry—particularly for providers—what can marketing and strategy professionals do to prepare their functions and organizations for the imminent changes from exchanges?

UnderStAnd the timing, key elements and milestones related to the implementation of the HIX/HIM, and keep the initiative front and center with senior leadership and, perhaps, the board.

ASSeSS the impact on each market in terms of increased volume, capacity constraints and stresses (e.g., emergency room), and financial implications.

reSeArCh, highlight and underscore the organization’s current market position related to perceptual positioning.

Provide the game plan and glide path for the meaningful preparation and successful execu-tion of market-based strategies to implement HIX, and to realize the benefits of this critical element of reform.

develoP marketing tactics, educational and promotional materials, and consumer outreach programs to inform, educate and engage the HIX enrollee population.

Provide the ongoing tracking of marketing strategies to senior leaders to assess the achievement of desired goals, increased vol-ume and enhanced market position, as related to HIX.

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ConnectionMaking the

By Devin [email protected]

A strategy for leveraging Big Data, and new digital and mobile tools to effectively reach health care consumers

t happens every second of every day. A consumer needs a quick answer to a nagging health care issue. An aching knee. A sharp pain in the side. A sudden

tightness in the chest. So where do today’s consumers turn to find answers to their health care troubles? More than likely, the impatient patient starts on the Internet, often using a mobile device, letting the Web provide a quick diagnosis.

In this same universe sit a thousand eager health care marketing professionals in a thousand different offices, all searching for new ways to connect with patients and consumers along every point of the health and wellness continuum. But how? Today’s communication options are complex, with a multitude of marketing channels. What’s the best way to connect with patients? On the Web? Through traditional media? A mix of both? Where and how does consumer data fit in?

For Vanguard Health Systems, a solution was found in building hyper-personalized connectivity among patients, physicians and health care organizations.

Based in Nashville with 28 hospitals in five states, Vanguard saw that the days of basing health care marketing on pretty billboards had long passed. It recognized the need to profoundly evolve the way that health organizations communicate with patients—to leverage health, diagnosis and behavior data for the good of the patient, grow and acquire new customers, and expand communication with consumers in a hyper-personalized way that meets their needs and advances the experience.

The strategy was simple: Make use of tech-nology and tools readily available—including vast amounts of patient data (Big Data) and rich analytics—to reach the right consumer at the right time, using a blend of both traditional evidence-based marketing and new digital and mobile marketing methods and tools.

I


The Importance of ‘Brand’ and the Digital UniverseIn today’s health care landscape, brands and experiences are critical to building patient loyalty, and it is becoming increasingly evident that patients care deeply about what their health organiza-tions and providers say and how they say it.

Patients also increasingly are turning to the Web to do research and help make health care decisions. In fact, health care is the single most searched topic on the Web:• 83millionconsumersconductedonlinesearchesfor“finda

doctor” in a single month, according to recent Google AdWords search data.

• 77%ofpatientssearchedtheWebbeforemakingadoctor’sappointment, according to the 2012 Google/Compete Hospital Study.

• Accordingtothesamestudy,44%ofconsumerswho conducted Web research for hospitals via mobile devices scheduled an appointment, as did 34% of those who searched via computers.

Patients are taking the reins when it comes to finding the health information that they need, on their terms. Health organizations, therefore, need a way to provide easy access to information on the products and services that the community needs and wants, while encouraging repeat visits to keep them healthy, attracting new patients and growing the health organization itself.

Given the importance of digital tools and information in con-sumers’ health care experiences, Vanguard sought to create a solution that would accomplish several goals: Leverage analytics to provide precisely targeted, customized information to individu-als who might be at risk for certain conditions, as well as to house-hold decision-makers; communicate with them in the ways that they prefer, whether via text, e-mail, postal mail or social media; and think through an empathic lens to make it easy for those in-dividuals to engage with health products and services by offering same-day visits, online check-in services and the like.

The last requirement was intuitive—almost a Customer Service 101 element—since as with any service, consumers expect and demand hassle-free accessibility. Targeting the information would inspire consumers to engage, while providing a better consumer experience would encourage them to stay engaged long term and ultimately help improve patient care. The pathway to achieving these goals became clear: Connect patients with health care or-ganizations and providers by using a mix of data and marketing tools.

Blending Emerging and Traditional Evidence-Based MethodsToday’s database-driven digital marketing tools make it possi-ble for consumers to connect with their health care providers in ways that were nearly impossible not that many years ago. By combining data, tools and technologies widely used across other industries, Vanguard created what it calls Health IDology to leverage data and transform communication between health organizations and consumers. Specific goals for Health IDology

were to increase patient engagement via continuous and targeted communications between patients and their aligned physicians; pinpoint and connect the right consumer with the right provider at the right time with the right methodology by mining rich pa-tient and consumer data; stay connected throughout the continu-um of care via automated communication methods; improve the experience by making it easier for consumers to make appoint-ments, exchange information with their providers and conduct customized online searches; and make the process of engaging in wellness efforts easier for both the patient and the provider.

Through research, it became clear that Health IDology need-ed to include a blend of digital marketing and more traditional methods, since no single method would be effective for every consumer.

One component merges both a comprehensive patient data-base and a consumer buying behavior database, which enables targeted communications based on demographic profiles for everything from gender and age to elevated disease risk and grocery and magazine preferences. By mining and analyzing this rich data, health organizations and providers now are able to create more custom communications to foster long-term patient-physician interactions—another factor to improve patient care.

An advanced CRM platform enables patient tracking by touch points from initial marketing outreach to doctor appointments, screenings and the like so that patients don’t fall out of the loop of health and wellness. Staying in touch with patients throughout the care continuum also helps offer reassurance that their provid-ers are continuously working behind the scenes to manage their comprehensive health care needs. From a patient’s perspective, peace of mind is priceless. From a provider’s perspective, it is essential to building patient loyalty and keeping patients healthy.

Health IDology also incorporates Web tools including search functionality powered by Google, mobile-friendly websites, content-rich landing pages for patient education and engage-ment, and physician-finder engines that quickly connect patients with physicians with one-click online scheduling. This last fea-ture does more than deliver an important convenience to facili-tate patient loyalty; it frees staff to focus on actual patient care.

For those populations not inclined to access health informa-tion via the Web, direct communications via text, e-mail, mail or social media remain effective and important engagement tools. Health IDology generates simple postcards, texts or e-mails from the CRM database to remind patients about health care mile-stones including screenings and regular checkups. For example, a 40-year-old woman could be reminded to schedule a mammo-gram, or a mother managing the health of her household could be contacted when her children need vaccines before going to summer camp.

With so many consumers moving to mobile and e-mail, these are key components of the solution. E-mail is a preferred method for many patients, and physicians increasingly employ its use. A recent study by Manhattan Research shows that nearly 40% of physicians use e-mail or some other form of electronic


communication with patients. Sixty-nine percent of physicians in that segment are using e-mail to answer questions after patient visits.

Enhancing Patient-Physician Connectivity and Building LoyaltyBy harnessing the power of the Web, marketers across the country are opening new avenues of health care communication, making it easier for patients to find health information, physicians or both. The advantage is that most consumers already use the Web as a search tool. To maximize the effectiveness and value to con-sumers, Health IDology employs the latest search engine optimi-zation methods to glean the most current data on top searches for health care information. Based on those searches, Health IDology generates information-rich landing pages about symptoms, treatments, tests and more. Embedding physician finders, online scheduling functionality or both in landing pages helps patients find nearby physicians who can treat their conditions with step-by-step directions from their homes—and it helps patients sched-ule appointments with a single click.

Like most consumers, patients are fickle. Brand loyalty has given way to convenience and price. This is why Health IDology also incorporates affinity cards: to inspire patient loyalty first by simplifying the process of visiting a provider and later by offering attractive consumer incentives based on individual buying behav-iors (mined from the robust CRM database). Incentives include discounts with local partners such as gyms, health food shops and local restaurants.

The affinity cards, managed by a third-party partner, securely hold a range of patient data from basic demographic information to dates of visits. The cards are offered on the patient’s first visit to a participating physician partner and are swiped at check-in

at each subsequent visit. This helps speed access to vital patient data, which can support improved outcomes. Use of the cards also eliminates the need to complete forms at each visit, increas-ing convenience by condensing wait times and greatly reducing administrative demands on staff. The results: ease of use, ease of access, and potentially a richer, longer-term relationship between patient and provider.

Transforming Communication, Improving Patient CareTo reach consumers who span a vast range of demographics and needs, health organizations are increasingly focused on aligning the efforts among marketing, organic growth, operations, prod-ucts and services. Health IDology is just one example of how leveraging data and digital, mobile and traditional marketing tools can better connect patients with health organizations and providers—and ultimately change the way that health and health care are delivered.

Solutions that leverage the latest marketing technology and analytics can help health organizations target specific popula-tions and connect them with the appropriate providers, products or services. These solutions also place an increased emphasis on wellness and keeping people healthy as organiza-tions move toward a new care delivery model. As new marketing technology methods emerge, Health IDology will continue to evolve as part of Vanguard’s goal to transform the way that health care providers communicate with consumers to build life-long relationships. Mhs

✒ DeVin carTy is vice president of culture, chief marketing officer and chief

experience officer at Vanguard Health Systems.

Data Patient database includes geographic and behavioral data plus medical data.

crm Enables ongoing patient communications through direct mail, e-mail, text and social media.

Search Robust search engine optimization powered by Google helps consumers find physicians online.

web Content-rich landing pages for patient education and engagement.

finD you Physician Finder engines connect patients with physicians.

ScheDule Schedule Now one-click scheduling allows patients to make appointments online.

recorDS VIP cards provide patient information and keep patients engaged.

makeS it eaSier for PatientS to finD PhySicianS anD ScheDule aPPointmentS

imProveS the Patient exPerience

keePS PatientS enGaGeD

THE HEALTH IDOLOGy ROAD MAP


Baystate Health f inds its competitive edgeby engaging customers to create the experience

Suzanne Bharati Hendery [email protected]

and Wilson C. Mertens [email protected]



When the audience of clinicians sat silent and unengaged after receiving approval to build a new $37.5 million cancer center in 2001, senior leaders at Baystate Health

decided to change the conversation. They invited patients to design the center that they wanted to see.

Twelve years later, after experiencing sustainable results and exceeding every metric for success, senior leaders realize that it was the right decision. With a new vision to transform the delivery and financing of health care to provide a high-quality, affordable, integrated and patient-centered system of care, Baystate is replicating the customer engagement process across the organization.

Treating Cancer Patients but No Cancer Program Baystate Health, headquartered in Springfield, Mass., is one of New England’s largest not-for-profit health care systems. Like many hospitals, however, its cancer patient offerings were fragmented. Patients, many of whom already were compromised, had to walk long hospital corridors to receive the care that they needed. Communication between physi-cians was inconsistent. Patients were expected to coordinate their own care and appoint-ments among a myriad of physicians and specialists, laboratory and radiology services. Baystate’s CEO at the time noted that the institution “had many practices for cancer patients but did not have a cancer program.”

Facilities were tired, unattractive and unfriendly. Patients saw clutter. Business and technical functions were in full view. The result was a cold, unprofessional environment, uninviting to patients and their families, and unpleasant and inefficient for staff.

The volume of radiation oncology patients was stagnant. Surgical oncology patients elected private community surgeons over Baystate-affiliated surgical practices. Of the eight centers of excellence at Baystate Medical Center, the cancer program had the lowest recog-nition and awareness among health care consumers in the area, under 50%. Even Baystate Health’s primary care physicians preferred to use community oncologists over their own hematology/oncology faculty by a ratio of three to one.

The medical director for cancer services and the marketing and communications team banded together to define a patient-driven culture, create an integrated program and build a strong brand anchored by the new facility. The goal for the renovated strategy was to gain a competitive advantage by developing a relationship-based approach that would exceed customer expectations for service.


Initial Steps: istening and Engaging Customers Efforts began by identifying opportunities to improve efficiencies in patient care and costs. Interviews with the community’s refer-ring physicians focused on how they chose an oncologist for their patients, what they looked for in a cancer program and how they perceived Baystate’s program compared with others. Suggestions for improvement—changing the management of patients in the inpatient oncology unit, clarifying the oncologic specialties and interests of oncology physicians, improving supportive care and end-of-life management—were shared with Baystate’s medical staff and administration. Changes communicated back to referring physicians quickly resulted in more referrals to Baystate, and built visibility and credibility for the cancer program and its leadership.

Initial steps in listening and engaging customers included: •Conductingpatientfocusgroupsinkeyareas(radiation,adult

and pediatric hematology/oncology and breast services) to determine high-value services, share positive and negative ex-periences, and learn wishes for the future program and facility.

• Hostingaseriesofcancerprogram-customerexperienceretreats with physicians, nurses, administrative and clerical employees, current and former cancer patients, cancer patient advocates, community members, architects, interior designers and construction managers. The group explored the changing economy, how developing an engaging customer experience is fundamental to an effective growth strategy, the current state of the cancer program from both clinical and patient perspectives, the development of a cancer center theme, the clarification of staff roles, and the reorganization of the cancer program based on functions rather than physician-defined divisional and departmental lines.

• Identifyingstrategiestodesignthespacethroughtheeyesof patients and families rather than physician specialty silos. When the work of several subcommittees was complete, a pa-tient or patient advocate would review the plans with a senior cancer program physician or administrative leader, all signed off with approvals, and the subcommittee would “sunset.”

• Establishinga“coregroup”consistingofseniorhospitaladministrators, cancer program medical leaders and admin-istrators, hospital construction managers, clinical engineers, internal communicators and information technologists to manage the program and facility design from both timing and budgetary perspectives. This group would make all strategic decisions, review subcommittee results to ensure consistency with the theme and program goals, and communicate mile-stones to internal and external (referring physician) audiences.

Partners on Your Journey of Well-BeingSeveral groups began writing a theme for the cancer program that would describe how it should be perceived. There was similarity between the results of all of the groups and unanimity regarding the final articulated theme, “Partners on Your Journey of Well- Being.” The theme demonstrated that cancer is a life-long and life-altering challenge with an uncertain destination. While a cure

is not always the outcome, at Baystate Regional Cancer Program, the goal is to ensure that every patient receives the optimal achievable outcome.

The theme became the most critical step in both the program transformation and the facility design process. It served as an internal touchstone, not an advertising tagline. Every request was tested against the theme to ensure the consistency of mes-sage and strategy. It allowed the team to achieve consensus on program and facility needs, and to use resources more effec-tively. This resulted in a facility and patient conveniences that resonated with the theme.

The theme was embraced by community partners, including the American Cancer Society, which sponsored a patient resource center in the facility. Community-based advocacy and support groups spread the word about the center, serving as design a dvisors, a source for referrals, and a destination for patients desiring support, complementary therapy and fellowship. Philanthropy was rejuvenated. The D’Amour family, inspired by the theme and the promise of improved care for the community, donated a major gift that was honored in the new name, The D’Amour (French for “of love”) Center for Cancer Care. Regular updates on the construction progress to all donors helped to generate naming opportunities for loved ones whose lives and legacies were celebrated by their gifts.

Personalizing the ExperienceThe message from patients was clear: “I want you to listen to me, know me, partner with me and create an experience just for me.” As a result, personalization in the Baystate Regional Cancer Program takes many forms. Each patient receives a multidisci-plinary consult with the entire care team together to discuss op-tions on the most successful treatment plan. When patients with tumors that require concurrent chemo-radiotherapy are referred, consultations are booked with an oncologist (radiation, medical or surgical) who takes the lead on the patient’s care, with other relevant specialists seeing the patient at the same time, either as a formal booked consultation, or as a short, introductory meeting with a more formal consultation at a later date.

Patients completing their chemotherapy and radiation treat-ments engage in a personalized educational session to discuss potential side effects, and receive an individualized “side effect management manual” with information about their specific treatment regimen.

In focus groups, radiation therapy patients asked to replace the communal gowning and waiting areas with private spaces. These were provided, increasing patient privacy, satisfaction and efficiency, and reducing the possibility of error resulting from patient misidentification.

Based on customer feedback, unique architectural, design and process-of-care elements were incorporated into the facility to create a feeling of comfort and a connection to nature. Physical barriers like glass reception windows and desks were eliminated. Charts, paperwork, phones, office procedures and the noise asso-ciated with all of these elements were relegated to a non-patient

L


floor to promote quiet and healing. Patients suggested appealing color schemes and ecologically friendly materials. All oncology services were consolidated into one location. Complimentary valet parking is available so that patients do not have to struggle to walk from the parking lot to the front door.

Marketing the Experience, and Building on the SuccessThe marketing campaign and advertising creative that included television, radio and print was meant to speak directly to the issues that patients expressed in the focus groups.

Wanting to elevate the brand to national prominence, the group sought out Ed Begley Jr., an actor of stage, screen and television with ties to the area. Perhaps best-known for his role as Dr. Victor Ehrlich in the 1980s hit television drama St. Elsewhere, Begley narrated radio and TV messages that spotlight the Baystate Regional Cancer Program’s unique approach to cancer care for patients and families through the D’Amour Center for Cancer Care. Begley, who donated his time to do the messages, applaud-ed Baystate’s patient-centered approach to care and for “actively involving patients in the redesign of its care.”

The internal theme, “Partners on Your Journey of Well-Being,” evolved into the external message: “The Baystate Regional Cancer Program. Experts in Cancer, Every Step of the Way.” It became the advertising tagline to symbolize the partnership with patients, the expertise of the Baystate Health team and the cancer journey, itself. All messages, artwork and advertisements were tested with consumers.

Engaging the customer in the process proved successful. Patient satisfaction for the last decade has improved to the 95th to 100th percentile for patients rating their overall quality of care as “excel-lent” when compared with other cancer programs throughout the U.S. Programs established under the same model of care at other Baystate facilities—Baystate Mary Lane Hospital and Baystate Franklin Medical Center—also are in the 90th percentile for “ex-cellent” ratings. Patients referred from Baystate’s owned medical practice physicians to the cancer program jumped from 15% to 70%. Volumes for hematology/oncology services have grown by 43%. Area consumers rating the Baystate Regional Cancer Program as “best” went from 48% to 70%.

Based on the success of the cancer program, the goal is to ensure that the customer engagement process is in place for every new facility and major marketing program. Last year, Baystate Medical Center opened the Davis Family Heart & Vascular Center based on the same principles of engaging clinical and marketing leaders. This year, the process is in place for the Baystate Breast & Wellness Center, a new patient-centered medical home-ambulatory center in Northampton, Mass., and a children’s specialty center. Mhs

✒ Suzanne bHaraTi HenDery is vice president of marketing and com-

munications at Baystate Health. WilSon c. merTenS, m.D., is vice president

and medical director of Baystate Regional Cancer Program at Baystate Health and

professor of medicine at Tufts University School of Medicine.

above: The D’Amour Center for Cancer Care, part of the Baystate Regional Cancer Program in Springfield, Mass.

right: The D’Amour Center for Cancer Care’s linear accelerator unit features clean lines enhanced by closets that maintain unsightly clinical equipment “off-stage.”

W hile Hawaii may be the last state in the union, we leapt ahead of the rest of the

country when the Hawaii Prepaid Health Care Act became state law in 1974. We have 40 years of experience with an employer mandate that offers health coverage to employees working 20 hours or more per week. Prior to the 2009 recession, Hawaii enjoyed 98% coverage and now it’s 92%.

Coverage alone does not guarantee a healthy population. At University Health Alliance (UHA), we believe that health plans must do more for members and their communities. Health plans have received justified criticism for limiting benefits, denying coverage and being the nemesis of providers for not allowing them to practice medicine as they see fit. That’s why physicians who wanted to improve health care quality in our state formed UHA 16 years ago. It was a refreshing change, and physicians continue to guide the insurance company’s policies and practices to ensure optimal care.

Most UHA policies are counter-intuitive. Instead of cutting back on benefits or making eligibility requirements more stringent, we

provide more benefits to support long-term health and well-being. Instead of maintaining an adversarial relationship with providers and physicians, we collaborate. Instead of shunning at-risk individuals for high utilization of costly services and procedures, we give them special attention and tools to better manage their health.

Even before health reform mandated preventive benefits, UHA was at the forefront by offering these benefits at no cost. We continue this win-win approach with extensive wellness programs starting with our own employees.

We offer stipends to subsidize employee participation in fitness programs and paid time off for exercise. We recently made a bold statement when some UHA employees challenged the local NBC/CBS Hawaii News Now TV team in a weight-loss contest coinciding with NBC’s The Biggest Loser.

UHA also invests in those who are not healthy. Using predictive modeling software, we identify individuals at risk for diseases like diabetes. Our physicians and nurses then collaborate with members’ physicians, intervening early to ensure that they get the extra medical attention they need.

We make health plans work for our members, rather than having members figure out how to make their health plans work for them. We educate members about their benefits, rather than debating why they cannot have a particular service. We believe that this level of personalized support is key for health plans in the future.

Two years ago, UHA was among the nation’s first health plans to introduce concurrent care for life-limiting illnesses. This “open-access model” allows mem-bers to receive supportive care while undergoing curative treatment.

Previously, to be eligible for hospice, physicians had to certify a life expectancy of no more than six months and patients had to forgo active treatment. UHA’s concurrent care benefit frees physicians from making difficult judgments about a patient’s prognosis. Earlier referrals for supportive care enhance, and may even extend, lives.

UHA also takes seriously its respon-sibility to address issues negatively impacting society. We became among the nation’s first to tackle rising deaths from prescription narcotics abuse, implementing stringent quality and safety policies that restrict opiate prescriptions to one physician and pharmacy, ensuring tighter controls and educating health professionals on counteracting this epidemic.

Health plans must continue innovations to support, rather than impede, optimal health. This is the only way to ensure that we provide our members with better health and a better life. Mhs

✒ HoWarD lee is president and CEO of UHA

(University Health Alliance) Health Insurance,

which provides medical, drug and vision plans to

employers in Hawaii. For more information, visit

UHAhealth.com.

Everyone Benefits


UHA offers a counterintuitive approach to health care

executive perspective exPAnded coverAge

hoWard lee

am hospital association, marketing health services, spring 2013

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