Despite a veto threat from President Bush, a House committee has unanimously approved legislation blocking seven new rules that the Bush administration sought for the Medicaid program. The Bush administration had made it clear that it would oppose a moratorium on seven new rules that could reduce Medicaid spending by about $13 billion over the next five years. The rules would affect a variety of healthcare providers, and supporters of the moratorium say the rules will shift more costs onto states and the poor at a time when they cannot afford it. Bush said the rules will prevent states from improperly shifting more health costs onto the federal government.

Simply sending physicians newsletters, clinical guidelines, and audiovisual materials is easy, but don’t expect it to improve medication use or reduce drug costs. It’s just not effective.

Physicians are already stretched for time and there is a good chance your communication won’t reach their desks. And even if it gets there, they probably won’t read it. That logic seems simple, but managed care companies commonly use educational material dissemination as a stand-alone intervention. A new study suggests managed care try something else.

"Interventions designed to improve the quality and efficiency of medication use in managed care: a critical review of the literature—2001-2007" reviewed papers published during those years to gauge the effectiveness of strategies geared toward cutting costs and improving quality of medication use.

The predominant strategies featured were education interventions, monitoring and feedback, formulary interventions, collaborative care involving pharmacists, and disease management with pharmacotherapy as a primary focus.

The review found that all of these interventions are valuable if part of a larger program. Otherwise, they are a waste. For instance, disseminating educational materials alone "had little or no impact, while the impact of group education was inconclusive," according to the study.

Instead, a system in which educational materials serve as a piece of the program that is buffered by lowering or tiering copays, group education, disease management, and computerized real-time alerts is most effective.

One of the study’s authors, Sallie-Anne Pearson, who is on the faculty of medicine at University of New South Wales and Clinical School’s Prince of Wales Hospital in Sydney, Australia, says a managed care company must understand and address the issues preventing practice change.

"It might seem like a very obvious statement, but a multi-faceted intervention will not necessarily work unless it is targeted to the specific issues within the environment—effectively I am saying one size does not fit all," Pearson says.

The study found that there is simply not enough analysis done on the interventions’ impact on quality, efficiency, and costs. Here are four future directions the researchers suggest for managed care:

• Review study interventions done in "more lightly managed settings," such as PPOs. There has been a mere handful of intervention studies conducted in PPOs, though they comprise the largest percentage of health plans (61%).
• The researchers suggest that cost-effectiveness data are needed so companies can have enough information to know which interventions to choose. Few studies have looked into reported "medication adherence or patient-relevant outcomes."
• Though formulary changes and financial incentives are most commonly used to influence medication use, there isn’t much "high quality evidence" analyzing the impacts of the interventions.
• Future studies must take a longer-range view of the interventions. Few studies extended beyond two years follow-up and many were even shorter.

"It was great to see a significant increase in the number of studies published in the area, but it is a shame that so many resources are spent on studies where you can’t really make any firm conclusions about the outcomes," says Pearson.

This study is the latest example of researchers questioning the amount of review done on managed care’s programs and services. In recent months, RAND questioned disease management’s effectiveness in containing costs and whether DM is a good investment. The DM industry did not refute RAND’s conclusion that DM has not received many third-party evaluations, but stands by its claims that DM is a valuable component that can improve outcomes and reduce costs in some chronic disease states.

As the RAND and medication use study show, the industry has plenty of work ahead to both find the most effective programs and to silence doubting Thomases.

For those working in the managed care trenches, there is one important take-away point from the medication use study. Don’t rely on the postal service or e-mail provider to improve medication compliance and lower costs. Sending newsletters is easy, but it’s not effective. Instead, create a multi-tiered program that reaches out to the physicians and members.

CEO’s count the number of patients beds filled, pharmacists calculate the correct dose of prescriptions, and nurses verify patient satisfaction and other vital statistics—but, as much as I hate to admit it, the marketing of medical services is the soft science of the healthcare business.

While most people fundamentally agree that marketing is a necessity when it comes to competing for dollars, the often unmeasurable aspects of marketing rarely fare well on the CFO’s balance sheet. I would like to blame the CFO or CEO for not seeing past the numbers, but I can’t because the marketing professionals have presented the information to them.

Don’t get me wrong, as a healthcare marketer myself, I am partly responsible for this dilemma. I have seen and presented many great marketing reports and numbers that validate how many people were exposed to a hospital brand, eyeballs that came to the website, increases in patient satisfaction or procedures, or how many media impressions were developed in a public relations campaign. But even with all those facts, no matter how you slice and dice it, the bottom line is always that a marketing program is intuitive. These are hard facts that actually make marketing soft. You just “know” if it's working or not. You just “know” if the money you spend on building your name is driving more patients and customers to you, or if your sales team is getting more leads—your success is completely dependent on others’ ability to close the sale or deliver the care and, as a result, impact the balance sheet.

However, most people--especially any good CEO, CFO, or venture capital group—know that a good, targeted marketing plan can make the difference between a good company and a great one; or as Mark Twain said, "The difference between lightning and the lightning bug."

When working with countless for-profit healthcare companies and non-profit organizations, my team nearly always finds a marketing department that has a plan full of great intentions, novel ideas, good brainstorming, and imaginative concepts. These are intelligent teams filled with enthusiastic, creative people.

Unfortunately, we almost always find that the marketing plan in place is either ineffectively targeting the key buying audience or outdated. In addition, the marketing staffs often sidetrack their priorities to complete more immediate tasks. The marketing department is also usually the most under-funded, and most likely managed by people who have other internal-oriented duties within the organization, such as planning employee events and managing activities that do nothing to bring in more patients or clients.

As someone who thinks there is no greater satisfaction than converting a CFO or CEO into a marketing evangelist, I firmly believe that the soft science of marketing doesn't necessarily equate to bad science. As a matter of fact, market positioning and market awareness is a key determining factor in the success or failure of a company. It isn't just about a product or service anymore; it's about market perceptions. Creative and effective marketing can make the difference.

Here are a few tips to keep in mind as you go forward with your marketing programs:

Target your audience. Make sure your marketing team has a plan to know and target your potential customers and make it your marketing team's goal to find out everything they can about them—where they get their purchasing decision information, what they read, how they think and why/when they buy. This is the most critical element to an effective marketing program.

Invest in marketing and use PR. When I got my MBA, I was taught that companies should plan to spend 8-12% of their revenues–not profits–on marketing. For most companies that percentage is way too high. For a company trying to gain market share in any highly competitive marketplace, it's probably too low. A good marketing team and program can get by on less, but they really have to think outside the box and be aggressive. Use public relations as much as possible. PR levels the playing field and has a higher credibility factor.

Mix your marketing outreach tactics. There are an unlimited number of tools in the marketing tool belt, so don't just rely on advertising, direct mail, or phone calls. Advertising, no doubt, casts the biggest net and that is why so many do it. It is the carpet-bomb approach to marketing. While target marketing can be more difficult, the reward is much higher. Mix it up. Introduce direct mail, public relations, online programs, search engine positioning, effective trade show networking, speaking engagements, and other marketing tactics into your campaign. But always keep it strategic, focused, on-message, and highly targeted.

Consider outsourcing key marketing programs. It's not as expensive as most think, or at least it doesn't have to be. There are a lot of strategic marketing firms out there that specialize in the healthcare industry that have public relations experts, direct mail strategists, or Internet marketing gurus on staff. Such companies thrive when they work on behalf of their clients and don't get distracted by internal company issues. To paraphrase Ronald Reagan, "Your success is our success."

Separate your “sales and marketing” approach. All too often you see a company sales executive struggle to build a sustainable marketing program or develop a company positioning strategy; usually under the title of vice president of sales and marketing. The two skill sets, however, couldn't be more different.

Marketing is a support function. It is about bringing leads, sustaining momentum and building a brand. The marketing team usually looks much further out in its search for leads, through trade show positioning and media relations, and is usually more concerned with customer satisfaction after the sale.

Sales is about being the best you can be at developing and closing leads, working the up-front relationship and keeping the pipeline full. When the two skill sets work together in a strategic way, they can be extremely effective--but don’t confuse the two.

Execute. Building your marketing program is a sustained goal, not a destination. It's easy to become too focused on developing the right plan that is going to spark the market and ultimately lose sight of whether you can actually implement the plan.

The difference between lightning bugs and lightning is the perfect analogy to marketing since the goal of marketing is to illuminate a company, services or an entity. Both shed light and both are fun to watch—but given the choice I will take the energy from the lightning any day!

Silas Deane is the president of Logic Media Group, a full-service healthcare marketing, advertising, PR, and online strategy firm based in Nashville, TN.