Transparency: It's About the Customers

Maureen Larkin, for Healthcare Strategic Management, September 26, 2007

Few days go by without another news report about one of the 50 states requiring its hospitals to post quality, cost, or patient satisfaction data online. Web sites now contain data about infection rates, mortality rates, and which doctors perform best when working on heart patients in California. Hospital executives are busily working to figure out a way to provide patients with the data they're demanding to make healthcare decisions.

Fueled by the rise in consumer-directed health plans, the transparency movement is one that's here to stay, says Carolyn Kent, a consultant with Cleverley and Associates, a consulting firm based in Columbus, OH, and author of the white paper Marketing in Times of Price Transparency.

Consumers have been forced to pay more attention to their healthcare, and now they're gaining interest in, not only the cost and quality of your facility, but the total experience as well.

"Transparency speaks to the package of values that a consumer is looking for," Kent says. "Marketers have to constantly come back to understanding what consumers value and position themselves to deliver."

Responding to the transparency movement doesn't just mean posting pages of data on your site. It's about posting information that your patients want, in a way that they can understand.

What do they want?
Some hospitals are loading their Web sites with data about quality metrics, costs for various procedures, and patient satisfaction ratings from various organizations. Next spring, the federal government will release the first results of its own patient satisfaction data, the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS), and hospital executives across the country are meeting to discuss their strategy for reporting these survey results.

But do cost, quality, and patient satisfaction data really affect how patients choose where to seek care? Healthcare marketing expert Anthony Cirillo of Huntersville, NC-based Fast Forward Consulting says no.

"Even with all the emphasis on transparency, I think it still comes down to where the physician recommends people go," Cirillo says. Most consumers don't care about--and don't understand--the cost and quality statistics offered by government and advocacy groups' Web sites, he says.

It's the total hospital experience that most interests consumers, Cirillo says. When considered individually, most people aren't interested in the data that tell them how often Hospital A's patients receive their medication on time or the average length of time it takes nurses to answer patient calls. Instead, consumers are interested in the total hospital experience--a collection of things that happen during their hospital stay and how they'll feel when their stay is complete.

Kent agrees. "A lot of Web sites I've seen simply repost information that is on the CMS Hospital Compare site, but try to put yourself in the shoes of Joe Consumer. If I have a heart attack and I get taken to your hospital, I know you'll give me aspirin, but what's the significance of that? For hospital marketers, it's a key question to answer. Help them understand what it means and make them understand that they will receive the highest quality care," she says.

The trick, Cirillo says, is determining what information is most attractive to the consumers in your region. For a marketer, this should be easy to do, he adds.

"Create a culture of data collection so that people are telling you what to be transparent about," Cirillo says. If you live in an affluent community, cost may not be something your audience is looking for. If you're in a city with several well-known hospitals, patients may expect quality care from their hospitals and worry less about which hospital will provide them with the best care, Cirillo says.

Share patient experiences
High Point (NC) Regional Health System is one of those hospitals that has several high-quality competitors close by. "We have found in our region, from our own research, that quality is very much assumed," says Eric Fletcher, chief marketing officer for the 384-bed hospital. "The consumer has the advantage of having very high-quality providers, and the consumers assume that if they are going to a hospital here, that they are getting quality care."

Because of that consumer expectation, Fletcher says simply posting quality metrics on the hospital's Web site wouldn't do. That's why High Point Regional is using a different approach to responding to transparency: patient blogs. Since 2005, High Point has hosted patient blogs, encouraging those undergoing cancer treatment, giving birth, or having bariatric surgery to share their hospital experience.

"One of the things that we as marketers can do is help to improve the experience for our patients, and then, after you improve the experience, help communicate why that experience is superior to that of a competitor," Fletcher says. Allowing patients to give firsthand accounts of their hospital experiences is one way of doing so, Fletcher says. The increasing distrust of traditional marketing methods and the constant demand for information make blogs a great way to reach the public, he says.

"When we looked at those two things--transparency and distrust--it led us to think, let's focus more on the experience, and enlist the help of citizen marketers," Fletcher says.

Perry, a 45-year-old man diagnosed with lymphoma, was the first patient to blog on High Point's site. Perry wrote about the tests and treatments he underwent in his effort to beat the cancer, and eventually used the blog to share the good news in November 2005--he was given the all clear by his doctors. Since Perry's blogging experience, others have joined in, telling their stories of childbirth and bariatric surgery.

Offering patients a virtually unedited forum is risky, Fletcher says, but the hospital has only a couple of restrictions about what can be written on the site. High Point has some rules that prevent the violation of HIPAA laws, and writers are asked to avoid profanity, but otherwise, they are allowed to write whatever they wish.

"We've had situations where someone was blogging and had an experience that wasn't so great, and they said so," Fletcher says. "The patient had a long wait for a visit when they shouldn't have, and it gave us the opportunity to come onto that blog and explain the problem, apologize, and post a response."

The key is how you respond to situations such as these, Fletcher says. By interacting with the patient's blog, executives were able to show the public, not only that they care about what patients are experiencing at their hospital, but that they are committed to changing what's wrong with the experience.

"And it humanizes us a bit," Fletcher says.

Showing that you can admit your hospital's weaknesses can indicate your hospital's commitment to giving patients the information they're looking for. "Openness reiterates the idea of transparency," says Kent. "It really adds a nice touch of humanity to the type of services that a hospital delivers."

Calculating patient cost
Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, NH, is one of those hospitals that has loaded its Web site with pages of quality, cost, and patient satisfaction data. But DHMC's site has been designed in a way that gives patients the tools to determine what the data mean for them. One of these tools is an out-of-pocket cost estimator. Through a series of questions, the estimator helps patients figure out how much different procedures will cost them, factoring in their health insurance or lack thereof.

"It gives individuals some grasp of the cost of healthcare and a picture of the whole expenditure of resources around delivering a service that they very much need," says Melanie Mastanduno, director of quality measurement. She says DHMC wants patients to be able to factor cost into their healthcare decision process instead of making it their last priority.

"When there's an elective procedure in which they actually may make a plan for timing, this is very helpful information," says Mastanduno.

DHMC also provides information about the hospital's financial assistance program and allows the consumer to determine whether they qualify right on the Web site.

"We want individuals to not think of price as a barrier, but [as] one additional component to the decision," she says.

DHMC has been offering this information to its patients for the past 15 years through its call center but went online with costs in February 2005. Before showing costs, DHMC started with quality information, including procedures such as bone marrow transplants: survival rates, satisfaction data, how many patients experienced complications, and the typical length of stay, Mastanduno says. It immediately got a positive response.

"It's what they really wanted to know," she says. Seeing the data answered questions patients had and provided them with information that allowed them to plan for their procedure. "And our providers say it's helpful because patients come to them and already have questions in mind."

Since then, DHMC has consistently added new information to its site and is getting approximately 10,000 hits per month, says Mastanduno.

"There's no question that this trend is all over the national media," she says. "So consumers are much more aware."

So how did DHMC determine that the out-of-pocket cost estimator was a service worth providing for patients? It asked them. Before any data are included on the Web site, DHMC gathers employee and patient-focus groups to discuss new content.

"Quickly, there was an excitement factor about how they could interact with the tool," she says. For those with high-deductible health plans, the calculator allowed them to more quickly understand the costs they would be responsible for.

And the Web traffic data that DHMC receives show that the cost estimator is being used heavily by consumers, Mastanduno says.

"We are finding about 25 percent of the hits for some of the different Web pages--mainly the cancer pages--are happening between 11 p.m. and 7 a.m.," she says. "Those are not our competitors surfing the Web in the middle of the night. Those are real patients looking for information on the conditions that affect them."

Like High Point Regional, Mastanduno says DHMC is committed to showing quality results regardless of what the scores say. For example, only 62 percent of patients receiving surgery for a herniated disc report that the treatment has given the pain relief they expected. This statistic is posted on DHMC's site, and Mastanduno says she often gets e-mails from consumers asking about the numbers. Having that result online is a perfect example of how committed DHMC is to transparency, she says.

"When people see numbers that aren't in the 90s or at 100, they actually trust us more," she says. "If we're going to be transparent, we're hoping to show a fair, balanced set of indicators. If we need improvement, we're going to say we are working on it."

Where do you begin?
Despite data that show patients aren't clamoring for cost, quality, and patient satisfaction numbers just yet, marketers say the time to develop your hospital's strategy is now.

"It's coming, so if we don't jump in front of it and lead it, it will be dictated to us . . . by the government or coalitions or whatever it may be," says Fletcher. "That's a situation none of us wants." Taking the lead in this process will only help your hospital in the long run, he says.

If your hospital hasn't yet developed a strategy to deal with the transparency trend, Mastanduno says the first step is to get support from the hospital's leadership.

"[Its] patients and [its] prospective patients have the right to know this information as part of their healthcare decision-making process," she says. "Our executive leadership said that from the beginning. If the opportunity is out there to have this kind of dialogue with your patients and your public, your leadership needs to stand up and say, 'We're going to take part in that dialogue.' "

The second step, of course, is knowing what data to provide for patients. Beyond advertising, this is the type of marketing that requires real, important communications with customers, she says.

"It's about having communications with our patients and our prospective patients," Mastanduno says. "It's a partnership."

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Maureen Larkin is the editor of Healthcare Strategic Management. She may be reached at mlarkin@hcpro.com. This story first appeared in the September edition of Healthcare Strategic Management, a monthly newsletter by HCPro Inc. For information on all of HCPro's products, visit www.hcmarketplace.com.