Beginning in 2008, Maryland will become the first state to give consumers independent evaluations of Preferred Provider Organization health plans offered by four of the state's largest healthcare providers. The report card will help consumers make informed decisions, say representatives from the Maryland Center for Health Care Financing and Policy.
A national insurance expert testified at a consumer hearing that Blue Cross Blue Shield of Michigan used flawed, inappropriate methods to determine proposed rate hikes at issue in a consumer challenge.
American farmers and ranchers, for the most part, aren't having trouble finding health insurance, according to a recent study. But the same report also draws another more unsettling conclusion: Having insurance may not be good enough.
The report released by The Access Project found that 90 percent of farmers and ranchers surveyed had health insurance, but still incurred depleted savings, experienced debt, and delayed seeking care due to medical costs and steep insurance premiums.
With American farmers and ranchers struggling to cope with escalating healthcare costs, the problem has the potential to dramatically affect rural hospitals.
"Our small, rural hospitals are really the ones that are at the greatest risk," says Alana Knudson, associate director for research at the Center for Rural Health at the University of North Dakota School of Medicine, and co-author of the study. "Many of our small, rural hospitals have very, very small margins, so when the patients are unable to pay, it has a direct impact not only on the hospital but on the employees that work there--and also on the businesses that provide products as well as provide services to the hospital."
Carol Pryor, senior policy analyst with The Access Project, agrees, and adds that the insurance policies people across the country are forced to choose from play a big role in the problem.
"I think it absolutely has the possibility of affecting providers generally, which is especially important in the rural context where the healthcare infrastructure is more fragile," says Pryor. "It can affect providers both with people avoiding care then needing more costly care, but also to the extent where people's policies require them to afford large out-of-pocket costs. In some cases, people don't have the resources to pay for that."
As part of the report, more than 2,000 non-corporate farm and ranch operators were surveyed. Despite a high rate of insurance coverage among those surveyed, 26 percent of respondents reported high out-of-pocket expenses in 2006, with half of those families spending more $1,700 or more in out-of-pocket expenses.
Twenty percent of those surveyed incurred medical debt, or bills from hospitals, physicians, dentists and other providers that they were unable to pay, according to the findings.
"When you are looking at our farm and ranch families, you have to look at where they are getting their health insurance, and about a third of them are getting their health insurance through the individual market rather than the group market--that makes a big difference in the products that they are able to purchase, and the cost of those products," Knudson says.
The survey's findings are reflecting changes in the market that are affecting people across the country, Pryor says. She notes that health insurance premiums are rising much faster than either wages or general inflation, and in the face of increases in healthcare costs, insurers are trying to limit their risk by shifting more of the costs to consumers.
"As sole proprietors, farmers and ranchers are much more likely than the population at large to be purchasing health insurance in the individual group market," Pryor says. "There is lot of research that shows that both the premiums and the out-of-pocket costs are much higher in policies purchased in that market than in group coverage. Of course, they also don't have the advantage of having an employer share the costs of premiums."
With healthcare spending increasing, the problem is not going away any time soon, Knudson says.
"The challenge is that our healthcare spending continues to go up and the predictions are that it is going to be a steady increase--this is not something that is going to plateau or go down," Knudson says. "As healthcare costs go up, they have to be paid for somehow, and I think that is a real concern for our country because of the gross domestic product that it takes to be able to pay for our healthcare needs in our country."
Pryor says a combination of efforts would be necessary to help offset the challenges facing ranchers, farmers, and the rural healthcare providers they frequent. One might be preventing health insurers from "cherry picking" their customers, which can make coverage for people with existing health conditions more expensive, she says. Pryor also suggests possibly expanding public programs such as the State Children Health Insurance Program, or giving everyone the option of buying into a program such as Medicare based on a sliding scale based on income.
However, simply insuring more people may not be the answer either, Pryor cautions. "We need to be careful to say the issue is not just being insured. Almost all of these people are insured, they're just not getting the financial protection they need."
Those in the medical profession are often considered heroes. But Children's Memorial Hospital in Chicago expanded the scope of the word "hero" to include not only their own doctors and nurses, but also the donors who support the hospital and the children it treats. The hospital has launched a multi-integrated campaign to spread that message.
"Children's Memorial is an extraordinary place, filled with remarkable people and life-changing experiences," says the hospital's Web site. "It is a beacon of hope and healing, a home for heroes."
The campaign, which includes print, radio, tv and online, was designed to appeal to the target demographic--parents of potential patients. With touching stories and well-executed imagery, each campaign element focuses on a different service area or is aimed at a specific target audience, extending the campaign's reach.
One ad, for example, features a patient named Jake. Though the ad only shows children's hands holding a baseball, the creative message brings a sense of lighthearted humor to Jake's very serious story. The consistent mix between humor and the description of successful treatment make this campaign stand out. (Click to view full sized version.)
Pages on the hospital's Website, which encourage patients and their families to submit their own heroic stories, showcase the stories and images of the children featured in the campaign as well.
The most notable feature of this campaign, however, is that it maintains Children's Memorial Hospital's brand image while introducing a new concept. The campaign gives a warmth and personal appeal to the facility and shows that Children's Memorial is only as good as its patients, employees, and the community members who help to make it what it is.
Kandace Mclaughlin is an editor with HealthLeaders magazine. Send her Campaign Spotlight ideas at kmclaughlin@hcpro.com.
In last week's column I wrote about whether or not marketers are getting more involved in the strategic end of running a hospital. That got me thinking about all the things that hospital and health system marketers are--and are not--involved in. Now, I could be biased, but it seems to me a lot of functions aren't necessarily the marketer's job but, nevertheless, he or she has a stake in them.
Take billing and collections. Might not seem like marketing at first blush. But consider the recent story about a hospital that sent a collection agency to hound a homeless and uninsured man for his $42,000 bill. This was just an oversight on the part of the collections department. But imagine what the local readers thought when they read his story.
Now imagine what they think when they get their 13th "reminder" letter from your hospital because they didn't pay a $50 co-pay for an ER visit on time. At a certain point, you'd think the cost of paper, postage, and bad-will would add up to more than $50.
Patient safety and quality are always hot topics, especially when a surgeon operates on the wrong part of someone's brain not once or twice but three times. But aside from the obvious PR nightmare that is wrong-site surgery, is that a marketing issue?
You bet it is. Molly Rowe, a senior editor for HealthLeaders Media, wrote a recent column that will give you a glimpse into what kind of word-of-mouth that story's generating.
In fact, one of the most hotly-contested categories in the 2007 HealthLeaders Media Marketing Awards was the one for best quality campaign. Hospital marketers are indeed talking to their customers about these subjects. And they're finding ways to do it that aren't way over everyone's head, way too technical and boring, or just downright disgusting. I'm sorry, but no one wants to see a hospital ad with the word "pressure ulcer" in it.
Finally, it seems to me that internal communications is no longer an HR-only responsibility. More and more hospital marketing departments are partnering with HR to communicate with and serve employees. This was another crowded category in our annual awards. Many of the entries were for non-smoking campaigns. It's no longer OK to just send around a memo about a policy change. Hospitals that want to keep employee satisfaction high and turnover low launch sophisticated multimedia campaigns instead.
So tell me, what other functions fall under marketing's expanding canopy? Are these additional responsibilities a good thing? Or do they distract from your "real" work? Click that little talk button at the bottom of this page and let me know what you think.
Used to be, marketers had only a few basic questions to ask and answer. But the questions are radically changing these days: How effective are your marketing efforts? How can you measure that effectiveness? What's the ROI for direct mail and other elements within the marketing budget? Where can you trim costs to improve the bottom line without compromising your effectiveness?
After years of planning and months of public debate, Sacramento County has tapped Kaiser Permanente to open the region's next trauma center. Kaiser beat out Methodist Hospital of Sacramento, which had fought vigorously to win the trauma center nod. County officials have said that population growth requires the new trauma center by 2010, but Kaiser has announced it will open its center in 2008.
There are primarily two paths to growth in this or any industry. There's the organic variety whereby you grow your business through marketing, outreach and expansion into new regions. And then there's the fast-track approach of growing through acquisition.
The former entails a process of building relationships with business partners--be they providers, employers or individual enrollees--while the latter is based on acquiring a set of ready-made relationships. Success via the acquisition route, however, is dependent upon the successful integration of these relationships into your own operations. And there's the rub.
Officials with the Minnesota-based UnitedHealth Group issued a mea culpa of sorts recently, conceding that they mishandled the integration of some of their recent acquisitions. The result? A serious backlash from providers and enrollees alike--particularly in its PacifiCare operating unit--that is costing the company over a half million members.
"We pursued too much change, too fast, and the results were too disruptive," said David Wichmann, executive vice president at UnitedHealth, assuring analysts and investors that the most disruptive portions of the integration have already been completed. Wichmann says providers and consumers alike were alienated by the company's integration process, which included moves to shift call center operations overseas and to centralize provider relations rather than maintaining a network of regional representatives. Those moves are now being reversed, but much of the damage has already been done.
Ken Burdick, president and CEO of the company's UnitedHealthcare division, noted that the integration woes and other customer service problems would cause the United's membership rolls to shrink by over half-million members at the beginning of 2008--350,000 in risk-based membership and 200,000 in fee-based membership.
The member flight problem was most acute among those covered by its PacifiCare unit. In his presentation, Burdick noted that the unit is on target to lose 305,000 members this year and another 215,000 next year. The PacifiCare unit lost 135,000 members in the first year following the merger for a three-year total of 640,000 members.
Still, Wichmann and Burdick were optimistic that the company has turned the corner. Burdick said United is on track to boost its risk-based membership by 100,000 and its fee-based membership by 150,000 by the end of 2008. And Wichmann noted that the company has adopted a new attitude toward provider relations. "We understand relationships and we recognize that this is a health system that needs to work for everyone, not just for us," he said. "We're approaching negotiations in a much more inclusive and collaborative fashion and we're achieving comparable economic results."
Brad Cain is editor of California Healthfax and executive editor for managed care with HealthLeaders Media. He may be reached at bcain@healthleadersmedia.com.
The planned consolidation of Froedtert & Community Health with Columbia St. Mary's in Wisconsin would be the largest of its type since hospitals began forming healthcare systems more than two decades ago. The move will bring its share of challenges, but the two healthcare systems say religion will be a manageable one.
