When marketers at Abington (PA) Memorial Hospital discovered that its community didn't fully understand the benefits of receiving cancer treatment at a full-service hospital rather than a dedicated cancer center, they knew it was time for an attention-grabbing campaign. So Abington enlisted Wilmington, DE ad agency Aloysius Butler & Clark to craft creative that would make patients and physicians take notice.
The resulting campaign was called "What If" and ran print, radio, and transit ads from June 2008–March 2009. Each ad emphasized all of the oncology and emergent services that Abington could provide.
"'What If' was born because we learned there was an opportunity in their market to distinguish Abington by asking the question 'What if?', as if we were the cancer patient—and that Abington provides the solution," says Lynda Rudolph, creative director at AB&C.
The creative team at AB&C wanted to create a compelling look and feel, says Marc Icasiano, creative director.
"We wanted to use some portrait shots which were in your face, and the large what if in combination with that would be hard to ignore in a newspaper," he says.
Due to the vast amount of physician feedback, Abington has since decided to extend "What If" to heart and vascular, neurology, bariatric, and HMI service lines.
"We knew the campaign had really taken off when it was brought to our attention that when a new physician from a competing specialty hospital called on primary care physicians, they asked him the same questions that were posed in the campaign," says Linda Millevoi, Abington's media relations director.
HHS announced Tuesday it is expanding its privacy enforcement team with two HIPAA "privacy specialists" who will help the public better understand their rights under HIPAA and enforce compliance among covered entities and business associates.
The jobs–called "senior health information privacy outreach specialists"–were opened Tuesday and will remain as such until August 31, according to usajobs.com.
The new hires will operate under the Office for Civil Rights (OCR), which enforces the HIPAA Privacy Rule and Security Rule and the confidentiality provisions of the Patient Safety and Quality Improvement Act through its Division of Health Information Privacy; HIPAA Security came under OCR’s umbrella on July 27.
The $120,000 to $150,000 positions will report to the deputy director for Health Information Privacy and the OCR director.
The news comes a little less than a month after HHS announced it would advertise a position for two "Health Information Privacy Specialists." Those positions, according to the job posting at the time, are "responsible for reviewing, analyzing, implementing, promoting, or improving proposed or existing programs or policies needed to implement OCR's authority for ensuring compliance with the privacy of health information."
The jobs posted a month ago seem to be in-house policy-makers, while the duties for the jobs opened this week are about public education and enforcement.
As for the positions advertised this week, they are to provide the "functional leadership, oversight, supervision, and coordination necessary to plan, coordinate, and execute activities necessary to provide outreach, public education, and technical assistance on the requirements of the Privacy Rule and Patient Safety to increase public awareness of rights and protections under these authorities and the responsibilities of entities to comply with these authorities."
Frank Ruelas, of HIPAA Boot Camp, says the recent moves by HHS–to move security under OCR and to add these new positions–may signal that "we are seeing a methodical evolution of enforcement from a reactive position to one of a proactive position."
"Previously, the enforcement process has been primarily complaint driven and also reflective of voluntary compliance on the part of covered entities," Ruelas adds. "With the recent HITECH Act, the pool of potential complainants will likely increase as will reporting by covered entities given the reporting requirements the HITECH Act."
The Office of the National Coordinator for Health Information Technology issued a report May 18 that highlights how it will carry out HIPAA privacy and security regulations in the HITECH Act.
According to HHS, the federal government will spend about $24.3 million on privacy and security efforts, including:
Audits
Reports to Congress
Training for state attorneys general
Carrying out regulatory and enforcement requirements of HITECH
"Clearly it would be easy to argue that the recent activity by the OCR to increase its enforcement capabilities, especially in these difficult economic times, is a signal that changes with respect to enforcement are likely looming on the horizon," Ruelas says. "Couple this with the recent delegation by CMS to OCR for enforcement of the HIPAA Security regulation, and one has to realize that the status quo has certainly been altered from an enforcement perspective."
In last week's column I wrote about anti-healthcare reform ad campaigns. And boy, did I get a lot of feedback. Many who commented on the column (Scare Tactics the Standard for Anti-Healthcare Reform Ads) and on the MarketShare blog agreed: Some anti-reform ads might be nasty and misleading, but they are effective.
This week, I watched a bevy of pro-healthcare reform ads. And if the anti-reform ads are rocky road, the pro-reform ads are vanilla.
Many (if not most) of the pro-reform ads use the testimonial style approach and hit upon the same themes using the same catch phrases with gloomy music playing in the background. The effect of this sameness is that there's no sense of wide-spread, bi-partisan support from a variety of different groups, organizations, and individuals.
Take, for example, a campaign from the pharmaceutical industry trade group, PhRMA, and the non-profit pro-reform group Families USA. It's a classic testimonial ad with seemingly unrehearsed stories from real people.
"When you lose your job, and you lose your healthcare, you feel hopeless."
"I'm not interested in a handout. I'm interested in healthcare coverage that I can afford for my family."
"My husband has a heart condition. And we can't afford for him to see a cardiologist."
The "It's Time" campaign from the Democratic National Committee is nearly indistinguishable, featuring the same tight head shots of ordinary folks telling their sad tales.
"When I lost my job, I lost my health insurance, too."
"My insurance company wouldn't fully cover me when I got sick."
"My father-in law walks with a limp, because he didn't have healthcare."
A third ad, "Illness," from the health insurance industry trade group AHIP, has the same flavor and delivers the same message but deviates slightly from the formula with voiceover narration. (Same depressing music playing in the background, though.)
"Illness doesn't care where you live. Or if you're already sick. Or if you lose your job. Your health insurance shouldn't, either," the narrator says, as photographs and videos of people who represent Americans at risk play on the screen. "So let's fix healthcare. If everyone's covered, we can make healthcare as affordable as possible. And the words pre-existing condition become a thing of the past."
OK, now I feel like I'm repeating myself.
So here's my question (it's the same as last week, in fact): Do the pro-reform ads work? More importantly, do they work as well as the anti-reform ads? Is a clear, consistent message better than attention-grabbing creative concepts and claims?
Head on over to the MarketShare blog to watch the videos of these and other ads let us know what you think.
Note: You can sign up to receive HealthLeaders Media Marketing, a free weekly e-newsletter that will guide you through the complex and constantly-changing field of healthcare marketing.
With all the week's ranting in town halls about what health reform will or won't do for Americans, I kept thinking about what the U.S. Census revealed last week about some parts of rural America.
The bureau's simple Excel chart showed for each county across the country just how many people under age 65 have no health insurance. No Medicare, no Medicaid, no Veteran's Administration benefits. And of course no private commercial coverage either.
So there they are. Of the 10 counties with the highest rates of no insurance, eight are in Texas, and the worst is Terrell County, just above the Mexican border. There, 46.9% of all adults not old enough for Medicare coverage have no health coverage of any kind. Terrell was followed by Edwards County, two counties to the east, where 45.9% had no insurance of any kind.
I wasn't able to reach anyone in Edwards or Terrell Counties but I had more luck with the third highest county, Hudspeth on the westernmost edge of Texas just east of El Paso. Hudspeth has 3,137 people. My call took me to the Hudspeth County Courthouse and to Alma Bustamante, assistant to County Judge Becky Dean-Walker in Sierra Blanca.
Turns out, Bustamante also serves as the county's indigent health coordinator and was the right person to find to learn about Hudspeth County healthcare.
"We had a (county-funded) clinic, but three months ago it was shut down," she says, apparently because there wasn't enough money to keep it going.
"Just as we speak," she continues, "county commissioners are convening to decide whether to keep it open. But it doesn't look very promising."
So that means that for those who qualify for the county's indigent program, she must help them get that care somewhere else, usually in El Paso or Culberson County, 30 miles away.
"Healthcare in the U.S. is more of a privilege than an essential thing in our country. That's my opinion," she says. "If you don't have the right job with insurance, you're not going to have insurance. It's a luxury."
In Hudspeth County, particularly Sierra Blanca, jobs with insurance are those like hers, with the county, or with the school system or prison. Getting a job with the U.S. Border Patrol will get you health covered too. But some programs won't cover spouses, and some require copayments or have high deductibles. It's not easy, she says.
Farmers and ranchers in the area, generally speaking, don't have coverage, she says.
Now, the pervasive problem in Hudspeth County, like many other counties in Texas and throughout the U.S., is diabetes. And there aren't many doctors who will treat patients with no health insurance these days, she says. There were one or two from El Paso, but, she says, "they come and go."
Most often, she says, patients "just end up in the emergency room" of a hospital in another county. "They're routed to a doctor that way. And I know that's not the best way to provide healthcare. It's more expensive."
Bustamante then tells me about her mom, who lived with Bustamante's older sister, who had an income and insurance.
One year, her mother needed surgery for a hernia that was causing her pain, and so she applied for Medicaid. "But my sister had a new van, and that disqualified my mom from getting Medicaid. If she would have sold the van, my mom would have qualified. Isn't that the craziest thing you ever heard?"
Her mother refused to go to the doctor because she didn't want to burden her sister.
She died in 2002 at age 65.
And her sister now has diabetes that has progressed to the point that she is on the liver transplant list. Soon, Bustamante says, her sister will move to El Paso to be close to the hospital when an organ becomes available.
By the end of August, however, she's being forced to retire from her job, and there's a question about whether she will still have health coverage, or whether she and Anna Bustamante will be able afford its copayments and premiums.
I asked Alma Bustamante what she thought about the progress made toward health reform in Congress and the President's speeches pushing for a public plan.
She said she really hadn't kept up with the details. "I really don't know much about it. I've heard something about it, but I can't really tell you much."
For Bustamante, I suppose, this is the way it is. Like she said, healthcare in the U.S. is more of a privilege than it is essential, at least for people in her part of west Texas. "Healthcare is a luxury," she tells me.
I wondered what the people railing against health reform in the town hall meetings might think if they just made a call to a little town like Sierra Blanca in Hudspeth County.
There are two stakeholders who hold enormous potential in reducing (or eliminating) racial and ethnic disparities in healthcare—and they're not physicians, nurses, or policymakers. Health insurers and employers have an opportunity to improve patient outcomes. This is more than a moral issue. By focusing on racial and ethnic disparities, there is also an opportunity to lower long-range health costs.
The way to do this is by working together to take the financial leap and invest in programs that focus on collecting and surveying vast amounts of patient ethnic and racial data, which would help insurers and employers know how to tailor programs to reach at-risk populations.
That's what they could do, but few employers and insurers are working together to tackle the issue.
There are three reasons from the employer side:
Many employers are ignorant of the problem.
Employers are concerned about the legality of collecting and sharing race and ethnicity data.
Businesses don't want to face the administrative burden and cost of collecting that information.
But the connection is clear. Minorities are experiencing worse health and those health costs are being transferred to payers. By examining where disparities exist, employers and health insurers can understand the problem and, in turn, create targeted programs that reach those members.
Instead, only 3% of employers say they are examining disparities in their workers' healthcare quality, according to Mathematica. The few health insurers and employers that have worked together on bridging the disparity gap have found they need to collect data through both direct and indirect methods. Direct methods include self-reporting of race and ethnicity during enrollment or clinical interactions, and via Medicare and Medicaid. Indirect methods include collecting information through geocoding and surname analysis.
The indirect methods have become more sophisticated, but nothing beats having direct data from the individual. The problem is that many health plan members don't want to give personal information to their insurers because they think the company will use it against them. In fact, Mathematica said only about 30% of health plan members provide that information.
This is where employers come in. Unlike health insurers, employers are required to collect race and ethnicity data from their employees under the Civil Rights Act of 1964. This means that employers already have the race and ethnicity information. It's just a matter of businesses and health insurers working together to share the information.
Though the vast majority of employers are not keyed into the problem, more employers are now asking how health plans are dealing with health disparities as part of requests for proposals. There are some employers and insurers that have already started work on the problem. The National Business Group on Health and Office of Minority Health have joined forces to promote the issue and Cigna is collaborating with a large employer to improve breast cancer screening.
Employers are also using evaluation tools, such as eValue 8, to assess how health plans are tackling health disparities. The survey tool allows employers to look at health plans' performance in such areas as health information technology adoption, communications, disease management, provider performance, and patient safety. eValue8 also includes questions about how health plans are dealing with disparity-related activities, according to Mathematica.
Although there have been advances, most employers are still not aware of the problem. Higgins suggests four ways to reverse the trend:
Health insurers must educate employers about the importance of the problem and the associated costs of the disparities.
Health insurers must educate employers about the legality of collecting data and sharing it with insurers.
Employers must understand the added up-front financial burden of surveying the data, but appreciate the long-term financial benefits associated with closing the health disparities gap.
National leaders must encourage more employer participation in programs that target racial and ethnic disparities.
Addressing these problems is not just a feel-good issue. This is a bottom line problem that the healthcare system will need to address as the face of this nation continues to change.
"Until employers recognize the business case for reducing disparities—lower healthcare costs and potentially a more productive workforce—employer interest is unlikely to gain serious traction," says Higgins.
Manufacturers of biologic drugs would get 12 years of exclusivity—not seven years as had been suggested by President Obama—under an amendment to the House healthcare reform bill (HR 3200), which has been approved by the Energy and Commerce Committee.
The amendment language and proposed exclusivity period (12 years) closely follow the provisions in the biologic amendment included in the Senate Health, Education, Labor, and Pensions (HELP) Committee reform bill approved in July.
However, while the amendment had received strong bipartisan support (a 41-11 voice vote) within the House committee, opposition to the amendment has emerged in the form of committee Chairman Henry Waxman (D-CA). Waxman and several others introduced a bill (HR 1470) this spring that they said would sharply narrow the exclusivity period to 7 years for most biologic drugs and 7.5 years for biologic drugs used to treat rare diseases or conditions.
The biologic amendment, offered by Rep. Anna Eshoo (D-CA), reflects language in her bill (HR 1548) that she had introduced earlier this year, she said. The amendment calls for "developing a pathway" for "biosimilar" drugs—or generic drugs that have similar properties to the biologic drugs.
Biologics—one of the fastest growing segments of the drug industry—are complex medicines derived from large molecules of living tissues or organisms. They include popular drugs, such as the breast cancer drug Herceptin and the anti anemia drug Epogen. Biologics account for the top six drugs sold last year, and account for sales of $40 billion annually—with much of those sales going to Medicare beneficiaries.
Supporters of the 12 year exclusivity period say it is needed to allow enough time to develop safe generic versions of the biosimilars. A "properly designed pathway" for biogeneric entry will over time, "lead to additional market entrants, lower prices, increased access to drugs and a few billion dollars a year in reduced spending," said Alex Brill, a research fellow with the American Enterprise Institute, at a hearing on biologics last month of the House Judiciary Committee Subcommittee on Courts and Competition.
However, Waxman said during the markup of HR 3200 last month that Eshoo's amendment not only enacted "a lengthy monopoly period" of 12 years, but it "allows those periods to be extended with so-called evergreening." This is a practice by pharmaceutical manufacturers of making small adjustments or changes to their drugs as a way to extend their control over the product, he said.
Overall, the Federal Trade Commission, in a report released this summer, noted that the entry of biosimilar drugs into the market "will be less dramatic than generic drug competition." The entry into the biosimilar market is likely in biologic drug markets larger than $250 million in annual sales.
Next week, Utah will become the second state—after Massachusetts—to operate a health insurance exchange, an idea which is being debated as part of federal healthcare reform. The Utah Health Exchange was signed into law in March by Gov. Jon Huntsman Jr., who resigned yesterday to assume his post as ambassador to China.
The exchange, which goes live Aug. 19, has a Web site where individuals and businesses can compare and buy health plans.
With the exchange, employers will have the option of depositing money into their employees' health savings accounts—rather than paying a portion of their premium—to allow them to buy any plan they want. On its launch day next week, the Utah Health Exchange is expected to begin enrolling daily up to 150 small employers those with between two and 50 workers—who will offer their workers this option.
In early November, the employees will be able to log on with a PIN number and select a plan. If no plan is selected, they'll be enrolled in a default plan chosen by their employer. Their coverage will start Jan. 1.
According to Cheryl Smith, strategic plan development manager for Utah's Office of Consumer Health Services, small employers that could not otherwise afford to offer their workers benefits will be able to put some money toward their health insurance. A recent survey of small businesses in the state showed only 40% were able to offer their employees health insurance, and of those, about 79% were struggling to pay for it.
Workers who purchase their coverage through the exchange will be able to keep their plan—even if they leave their jobs.
Individuals and families who don't get insurance through an employer, can use the exchange to buy a plan from a carrier or locate a broker near them to assist them. The exchange's site will provide side by side comparisons of information, such as deductibles, co-pays, and premium costs.
The exchange initially is expected to feature plans from four carriers: Regence BlueCross BlueShield of Utah, UnitedHealthcare, SelectHealth, and Humana. Each is required by state law to offer at least two plans, but it is anticipated that more will be offered.
A new study by the Medical Group Management Association finds that finances, and the adoption of electronic health records continued for the second consecutive year to be the top concerns of most medical practice professionals.
According to the Englewood, CO-based MGMA's 2009 Medical Practice Today: What Members Have to Say, the top three challenges of running a group practice remain the same as in 2008. They are:
Dealing with operating costs that are rising more rapidly than revenues
Maintaining physician compensation levels in an environment of declining reimbursement
Selecting and implementing a new electronic health record
Beyond that, however, the 2,077 respondents to the Web-based questionnaire say their No. 4 challenge is collecting from self-pay patients, particularly those with high-deductible plans and health savings accounts, has become a growing concern.
The No. 5 challenge concerns managing finances in the face of uncertain Medicare reimbursements. Recruiting physicians, which in 2008 was the fourth-ranked challenge, slipped to No. 6 this year.
MGMA also asked study participants how the recession is affecting their medical groups and how they are responding. Ranked by average score, the participants indicated the most probable effects of the recession on their practices are:
An increase in uninsured patients
Improved billing and collections and/or denial management processes
Decreased revenues
Postponed capital expenditures
Operating budget cuts
Staff hiring freezes
Many respondents said they were experiencing the effects of the recession on their practices. For instance:
36.6% say they have postponed capital expenditures
34.7% are seeing a rise in uninsured patients
34.5% have implemented a staff hiring freeze
33.9% have cut operating budgets
33.3% have improved billing and collections processes
33.1% have witnessed a decrease in revenue
On the positive side, nearly 82% of respondents say there was a zero probability that their group would file for bankruptcy protection. Nearly 80% also said there was a "zero probability" their practice would close because of the poor economy.
President Obama is trying to reclaim momentum for his healthcare initiative with a direct rebuttal of what he called "scare tactics," rumors, and misrepresentations. A town hall gathering was the start of what White House officials promise will be a more pointed response to the crescendo of what Obama called "misinformation" coming from critics of his healthcare reform efforts.
A New Jersey patient being charged $72,000 for a spinal fusion procedure that Medicare covers for $1,629 was one of the findings in a survey sponsored by America's Health Insurance Plans in which insurers were asked for some of the highest bills submitted to them in 2008. The group said it had no data on the frequency of such high fees, saying that to its knowledge no one had studied that. But it said it did the survey in part to defend against efforts by the Obama administration to portray certain industry practices as a major part of the nation's healthcare problems.
