With President Obama's plan to tax the rich to pay for healthcare facing deep skepticism on Capitol Hill, key lawmakers are considering taxing the health benefits workers receive from their employers. So far, administration officials have been careful not to endorse the idea, which Obama blasted as a major tax increase last year.
This NPR audio report explores the darker, narcissistic, addictive side of micro-blogging phenomenon Twitter. Brian Unger explains how the social networking site works with just a twinge of sarcasm.
If you weren't living in Kentucky in the last week of January, the ice storm that crippled the Bluegrass State wasn't much more than a lead item on CNN—something regrettable that happened to somebody else. You watched the coverage. You felt bad for them, but you probably forgot about it when CNN moves to the sports segment. After all, there is nothing more local than weather.
The news that wasn't reported, however, was the widespread closure of rural hospitals, and hospitals running out of supplies and food, and leaving desperate, freezing patients to fend for themselves. That wasn't reported because it didn't happen. And that didn't happen because of the remarkable efforts by some of those small, isolated community hospitals in the path of the storm.
Methodist Hospital, a 205-licensed-bed community hospital in Henderson, on the Ohio River about 15 miles south of Evansville, IN, not only kept the lights on when a lot of the region was in the dark, but served as a shelter for townspeople who'd lost power, needed a warm place to sleep and a hot meal, and had nowhere else to turn. The hospital lost land-line and most of its cellular telephone services and the icy roads cluttered with downed tree limbs limited access, but Methodist continued to provide care because of dedicated employees, a solid emergency management plan, and the help of suppliers.
Don Nauser, director of materials management at Methodist, says the hospital was ready when the storm hit due to disaster preparedness training that several dozen employees at the hospital had taken at the Emergency Management Institute in Anniston, AL. The hospital set up its command center that spelled out each operational task and the personnel assigned to that task.
"One of the things they teach you at Anniston is the first 72 hours you are on your own," Nauser says. "The National Guard didn't show up with MREs and cots until the Monday or Tuesday of the next week. They were affected as much as anybody."
In the initial hours after the storm hit, when electric power for much of the area was cut by falling tree limbs and temperatures plunged, "everybody knew the place go was the hospital because everybody assumed the hospital would have power," he says.
The biggest obstacles for Methodist were the ones they didn't foresee. For example, when the land line went down, the local cellular telephone service that almost everyone at Methodist used also experienced weather-related problems and was all but inoperable. Nauser says they had to rely heavily on his personal cell phone, which was based in southeastern Missouri.
"Don't assume that one vendor, in terms of cellular service, is going to be reliable," Nauser says. "I would recommend having a backup. Ours here was completely off line." He said his cellular service was one of the few links that Methodist had to a smaller, remote sister critical-access hospital in Morganfield, 30 miles away. Methodist also relied on sporadic Internet service, so employees could update the hospital on their availability, and the hospital could update employees about their staffing needs.
Methodist was also able to use the Internet, satellite phones ("they work a lot better when there isn't ice on the antenna," Nauser says), and cellular phones to communicate with vendors who kept the hospital well-stocked, despite the nearly impassible roads. The main supply point in Paducah, KY had been hit hard by the ice storm. So, Methodist's vendors, which include U.S. Foods, Cardinal Health, and Premier Inc., went north of the storm's wake and routed supplies through Indianapolis. "We did not miss a delivery," he says. "It may have meant bringing trucks in at 10 at night or later, but the basic supplies that you need was almost uninterrupted."
There was a huge—and unanticipated—demand for oxygen canisters for home-bound patients nearby. Methodist found itself cast into the role of chief oxygen supplier for the area after local durable medical equipment suppliers and retail pharmacies that normally sell oxygen told their patients they'd either run out of oxygen or couldn't get the product to patients.
"They were telling people 'go to the hospital because we can't take care of you,'" Nauser says. "Every other problem paled in comparison to the demand for home oxygen. Smaller hospitals, know where your DME is coming from." The ice storm and its fallout prompted Methodist to reconsider whether it will expand its role as oxygen supplier for the area in the future.
As they struggled during the week-long emergency to provide care and shelter, Methodist officials didn't have much time to reflect on their reaction to the weather disaster. "You get to the point where you're running on adrenaline," Nauser says. But during that frenetic week, no patients were denied care or shelter and services continued in an orderly way. "When it was over I wandered back to the apartment and started to reflect that this worked smoothly," Nauser says. "It wasn't perfect. We learned lessons for the next time. But our level of preparedness helped prevent a whole lot of problems. It was as close to business as usual as we could get under the circumstances."
John Commins is the human resources and community and rural hospitals editor withHealthLeaders Media. He can be reached atjcommins@healthleadersmedia.com.
Note: You can sign up to receive HealthLeaders Media Community and Rural Hospital Weekly, a free weekly e-newsletter that provides news and information tailored to the specific needs of community hospitals.
When it comes to a mammography, most women want their results as soon as possible, rather than spending time wondering, "what if?"
Unfortunately, Bay Area Medical Center (BAMC) in Marinette, WI, was without digital mammography technology, which prompted many patients to travel to a Green Bay facility that offered same-day results. Needing to avoid loss of business and continued outward migration, BAMC brought patients the digital capabilities they were looking for and a message of assurance that they needed.
"When it comes to women's breast health the advertising piece is important but when we went back in and looked at the product we were providing we realized that that fell short of what women expected in terms of a mammogram," says John Hofer, director of marketing and public relations for BAMC. "We were creating a period of time where there was a lot of uncertainty. You get an uncomfortable test and then you have to wait for the phone call. I'm not a woman but I had a chance to talk to any number of women about this and that really was the dissatisfier."
After establishing its weakness, BAMC brought in the technology and capabilities the facility needed and also went a step further by introducing a new supportive role and competitive differentiator: the navigator. "The navigator is someone that goes through the results with you," says Hofer. "If there's a need for additional imaging for example, the navigator is there to walk you through it. We in healthcare are a big, complicated, confusing business to deal with. So we don't just hand you a pamphlet. The navigators are really hand holders . . . they're there for you."
BAMC, along with its agency The Roberts Group in Waukesha, WI, created a campaign to inform the public about the new range of services.
The team developed a print, radio, outdoor, and direct mail campaign that incorporated a new service-line-specific branding style. It included a newly-designed logo and service-line specific color schemes.
"We had a planning committee that was instrumental in building the program," says Hofer. Each campaign element also spoke to the target audience's primary concerns while fulfilling the organization's goals. The tagline ‘Life with Assurance' was used throughout as a way to speak to the concerns women had about breast health. Each element also finished with a strong bit of copy, which helped to tie the purpose of the campaign and the overall message together.
Success was tracked by looking at the number of mammographies and the hospital revenue the hospital tracked since the campaign launched. According to Hofer and The Roberts Group, BAMC has seen continued growth in its mammography business. In fact, the Breast Health campaign was such a success for BAMC that the template and creative concept will be used to launch other Women's Services programs in the near future.
Kandace McLaughlin Doyle is an editor with HealthLeaders magazine. Send her Campaign Spotlight ideas at kdoyle@healthleadersmedia.com If you are a marketer submitting a campaign on behalf of your facility or client, please ensure you have permission before doing so.
Healthcare marketers are sometimes criticized for lagging behind other industries when it comes to measuring the financial return on investment of their marketing efforts. But it turns out they might not be so far behind, after all.
Yes, marketing is hard to measure. But many companies don't even seem to be trying, according to a recent McKinsey & Company survey.
Marketing ROI across industries
The global survey asked chief marketing officers and other senior executives from around the world to describe how their companies assess their marketing campaigns, make their budgets, and plan new campaigns, as well as how their plans have changed as a result of the economic crisis, according to McKinsey, a global management consulting firm.
Interestingly, companies that market directly to consumers are doing better at measuring ROI than those that market to businesses. In healthcare, that would translate to better measurement of marketing to physicians and increasing referrals as opposed to marketing directly to patients.
That would make sense in the healthcare industry, since it's a lot easier to measure an increase in referrals—broken down by referring physicians—than it is to try to figure out how many patients checked into the hospital as a result of an ad they saw. (Especially since patients are notoriously bad at reporting what drove them to the hospital.)
Consumer-focused companies are much likelier to use best practices such as clearly allocating or defining marketing spending across the whole company and regularly reviewing the results
Despite the economy, consumer-focused companies are more likely to be increasing their marketing spending
Performance improves when companies use detailed spending metrics to compare spending both historically and with that of competitors
That's the good news (for B2C marketers, anyway). The not-so-good news is that 32% of all companies surveyed say they do not compare their marketing spending with any benchmarks, and only 18% use any detailed benchmarks beyond marketing spending as a percent of revenue.
That surprised me—and suggests that the experts, consultants, and pundits are being a little too hard on healthcare marketers.
Marketing ROI in healthcare
The healthcare industry is a hybrid of B2B and B2C with significant barriers to measuring marketing efforts, such as the fact that people don't go to the hospital right after seeing an ad or hearing positive word-of-mouth, but months or years later, when they actually need the service.
Regardless of stereotypes about healthcare marketers and their acumen (or lack thereof) in measuring ROI, marketing leaders at hospitals and health systems do seem to be making an effort—or plan to in the near future.
In the 2009 HealthLeaders Media Industry Survey, we asked marketing leaders at hospitals and health systems what emphasis their organization will place on measuring the ROI of marketing efforts the next three years.
The largest number of respondents (85%) said they'll use a mix or anecdotal and financial evidence to measure return, although only 6.74% say they'll employ hard, financial ROI measurement exclusively.
Further, two figures that indicate organizational strength in the areas of fiscal management and strategic marketing, according to the HealthLeaders survey:
About 48% of marketers rate the fiscal management of their organization as "very strong," while 31% say it is "slightly strong."
Almost 42% of marketers say they have "high involvement" in developing the overall strategic plans and decisions for the organization; the same number say they have "moderate involvement"
Of course, those figures are from the marketer's point of view. The cross-survey results, which include responses from all leaders, including CEOs, were slightly less rosy. They described marketing at their organizations as "slightly strong" (30%), "neutral" (29%) or "slightly weak (20%).
As with any survey, you have to take some of the data with a grain of salt.
The next marketing ROI step
What can healthcare organizations learn from business across all sectors, especially B2C companies?
The McKinsey survey suggests those organizations that look at what consumer-oriented companies are doing, implement the best practices of companies that take a vigorous approach to measurement, and better understand spending across the organization are more likely to allocate budgets more effectively.
"As companies weather the economic downturn, those that better understand their spending across the company are likelier than others to make targeted spending cuts—which are more effective than across-the-board cuts—and to plan to increase spending on both high-priority campaigns and experimental ones," the survey report concludes.
President Barack Obama sent a belated Valentine's Day bouquet to the population health industry when he released his $3.1 trillion 2010 budget plan.
Times have been tough in population health (disease management and wellness companies) over the past year. Experts have increasingly questioned disease management's effectiveness and CMS ended the DM-inspired Medicare Health Support demonstration, claiming that it was not successful.
Recently, another study, this one focused on the Medicare Coordinated Care Demonstration (MCCD), showed that care coordination programs with "substantial in-person contact that target moderate to severe patients can be cost-neutral and improve some aspects of care."
On the flip side, Randall Brown, PhD, director of health research at Mathematica Policy Research, Inc., in Princeton, NJ, and co-author of the MCCD study, questioned whether the typical DM program with a nurse call center and little or no face-to-face interaction would actually improve patient outcomes and reduce costs.
The MCCD study that was published in JAMA is just the latest to question whether call center-based nursing programs are cost-effective or spark patient behavior change.
Brown questions the DM model and said the population health industry has not provided strong evidence about its programs' successes.
"They are just not the right model if what you are trying to do is improve care for people who have chronic illness," says Brown.
But don't count population health out just yet. In his budget 2010 proposal, Obama included two provisions that could reinvigorate the population health industry:
A focus on prevention. In his budget document, Obama wrote "The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking—as well as guarantee access to proven preventive treatments."
Changing the way Medicare pays for hospital stays. Obama proposes paying hospitals under a bundled system that combines payment for the hospital stay as well as care for the patient for 30 days after release.
Population health companies could play a vital role in helping hospitals oversee patient care after discharge through its health coaching and remote patient monitoring programs. Though Obama hasn't put a dollar amount on preventive efforts and the administration is vague on specifics, the population health industry is not waiting to find out.
Tracey Moorhead, president and CEO of DMAA: The Care Continuum Alliance, released a statement saying the president's budget is a "welcome step toward a national commitment to chronic disease prevention and care." The population health industry believes they are well positioned to help effect change. "Population health improvement providers—prevention and wellness companies, disease management organizations and others serving people with and at risk of chronic disease—are uniquely qualified to assist policymakers with designing and evaluating prevention, care coordination and care management programs," said Moorhead.
This is all good news for population health except, in his budget, Obama said the country needs to invest in prevention that has been "proven to reduce cost drivers." There is still the lingering question that many in healthcare believe population health has not answered: Do disease management programs actually save money?
I wrote at that time, "In order for DM to have a seat at the healthcare reform table, the industry will need to fund research and look critically at its programs. Otherwise, 2009 could become the year in which DM was lowered into the ground alongside other healthcare acronyms that did not prove their value."
Now, here we are two months later, and population health could soon enjoy a renaissance, but there is still the same barrier—questions about program savings. Obama's stimulus and budget could be just the spark the industry needs, but population health needs to fund objective research and answer the nagging questions now.
Otherwise, the industry could miss its opportunity for rebirth.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.Note: You can sign up to receiveHealth Plan Insider, a free weekly e-newsletter designed to bring breaking news and analysis of important developments at health plans and other managed care organizations to your inbox.
The first dollars are now trickling in for construction of St. Bernard Parish's first post-Katrina hospital. Out of a $58 million cost estimate for the planned 40-bed hospital, St. Bernard's hospital service district now has an initial $2 million to move forward with preliminary designs on a 10-acre plot of land. Groundbreaking on the project is still months away, as local officials await an environmental assessment of the site. An archaeological survey may also be required because of the project's proximity to a historic site.
Wal-Mart Stores is striding into the market for electronic health records, seeking to bring the technology into the mainstream for physicians in small offices. The company plans to team its Sam's Club division with Dell for computers and eClinicalWorks for software. Wal-Mart says its package deal of hardware, software, installation, maintenance, and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half.
Wayne State University is considering a plan to transfer 10 faculty physician groups to the Detroit Medical Center as part of a larger restructuring that would set up a nonprofit organization under the DMC. The proposal seeks to overhaul the long-term partnership between the two institutions, giving the DMC full responsibility for the clinical programs and leaving the medical school to oversee research and training.
Hospitals would relieve the state burden for expanding healthcare to low-income residents under a proposal by Missouri Gov. Jay Nixon. The plan would extend Medicaid to an additional 34,800 parents at an annual cost of about $143 million. Of that, the federal government would pick up $93 million and hospitals would pay the rest, using funds now set aside for uncompensated care.
