A new law requires the Oregon Health Authority to establish an electronic database for credentialing organizations, including hospitals, insurance companies, and other facilities.
Provider credentialing in Oregon is on its way to becoming more streamlined under a bill that mandates healthcare providers use a single credentialing system by 2016.
The initiative, known as SB 604, requires the Oregon Health Authority to establish an electronic database for credentialing organizations, including hospitals, insurance companies, and other facilities. It's the first state to mandate the use of a single credentialing system; the bill was overwhelmingly supported in the state legislature.
The bill was signed by Oregon governor John Kitzhaber (D) on July 1 and goes into effect Jan. 1 2014.
Jean Steinberg, CPCS, CPMSM, director of medical staff services for Bend, OR -based St. Charles Health System, says the idea to have a statewide database for credentialing and recredentialing providers has been in the works "for years."
"Oregon already has a mandated credentialing application, so this is the next logical step," says Steinberg. "We, in this day and age, should be way down the road with credentialing."
One reason for the setback, at least in recent years, was the focus on implementing the Patient Protection and Affordable Care Act, says Tom Holt, director of government affairs for Regence BlueCross BlueShield in Oregon. Holt says Regence BCBS supports the pending mandate.
"The problem has been on the radar for several years," says Holt. "It was stuck because most of the key players were, over the last two years, very much involved in Oregon's Medicaid reforms and now the [health insurance] exchange. So, projects like this got set aside."
State Senator Alan Bates, MD, a practicing physician, resurrected the initiative, which passed unanimously in both the state house and senate.
Steinberg is optimistic because Oregon's lawmakers took the significant step of making its system mandatory instead of voluntary, which is the case in the neighboring state of Washington.
"When you don't require something, and it doesn't get used, you're not really making a difference," she says.
Steinberg says her counterparts who participate in Washington's electronic credentialing system complain about the software program used to run it. That detail is one Steinberg hopes Oregon will get right.
"That's where the key lies here with us in Oregon… to get the best electronic system," says Steinberg.
The state has nearly 18 months to decide on the vendor, user fees, and how much vetting the system will do. It's unclear if the information entered about a physician will go through an initial, cursory validation check, or if it will be taken at face value, which would then require the healthcare facility to continue to check out a physician's background.
Steinberg says St. Charles will continue to scrutinize its prospective physicians regardless.
"I don't see an impact on staffing, because we will still verify the information. It will still be incumbent on each organization to verify that what [physicians] fill out is true."
There is some fear that Oregon's system will drive out credentialing services that are NCQA-certified as Credentials Verification Organizations (CVOs) and also affect some Independent Practice Associations (IPAs), which offer provider credentialing a sideline revenue stream.
Central Oregon IPA (COIPA), also based in Bend, does credential providers, but is not worried about the new system's effect.
"It's not a moneymaker for us," says John Ryan, executive director for COIPA, which represents more than 650 physicians and practitioners. "It's mainly to serve the community, since we have the infrastructure and staff."
Ryan also says Oregon's electronic system shouldn't replace outside provider credentialing organizations because outside verification makes good sense.
"I don't think it will completely remove the need… if they're doing it right," says Ryan, who also works with the Oregon Association of Medical Staff Services (OAMSS) to help steer the state toward how the mandatory system will operate.
The Oregon Health Authority (OHA), which oversees the state's public health plan as well as its children's health insurance program and employee benefits, is tasked with working out the technical details of the system.
Tom Holt, director of government affairs for Regence BlueCross BlueShield in Oregon, says there are two legislative sessions between now and the due date for Oregon's system, and while the operational minutiae are getting worked out, he expects the end result to benefit all parties who touch the credentialing process, including insurance companies like Regence.
"From our point of view, the win is simply taking the friction out of the administration of healthcare," says Holt. "Every health plan, [and every] hospital, has something that they're using. In an ideal world, there'd be one central place. For here it makes sense. We have a uniquely collaborative culture."
The White House is trying to creatively target young, healthy adults to persuade them to participate in health insurance exchanges. The NFL, NBA, and Oprah Winfrey were contacted, but none have signed a deal yet. Minnesota hopes it has better luck with Paul Bunyan.
Advertising for the new federally mandated health insurance exchanges is ramping up across the country. Open enrollment for a HIX, from Alaska to Alabama, is less than six weeks away, October 1, and pressure is on the White House to sign up millions of uninsured Americans.
Department of Health and Human Services (HHS) Secretary Kathleen Sebelius has set a goal of enrolling 7 million people into the exchanges by the end of March 2014, when open enrollment closes. However, the figure Sebelius and President Barack Obama's administration are likely watching more closely is 2.7 million. That's the number of people aged 18–34 that need to enroll to make the exchanges affordable, according to the Congressional Budget Office.
To court the young and healthy, HHS has announced it is holding a video contest to engage young adults to enter videos that illustrate the need for health insurance in three different categories. Budding directors, singers, and animators will compete for cash, and the winning entries will be determined by online votes from the public.
A more sophisticated approach, which has yet to materialize, will use high profile celebrities to promote the benefits of enrolling for insurance on the exchanges. Overtures by the administration to partner with the NFL, which would have reached the younger male demographic, got no help from a couple of GOP lawmakers and were eventually rebuffed.
Congressional Republican leaders, Senator Mitch McConnell (R-KY) and John Cornyn (R-TX), told NFL Commissioner Roger Goodell in a June 27 letter that partnering with HHS on "Obamacare" could trigger a fan backlash: "Given the divisiveness and persistent unpopularity of this bill, it is difficult to understand why an organization like yours would risk damaging its inclusive and apolitical brand by lending its name to its promotion."
Talks with other sports organizations, such as the NBA, have also reportedly cooled. The President has since turned to actors and comedians, such as Amy Poehler, Jennifer Hudson, Oprah Winfrey, and others to help convince younger people to enroll in the exchanges, but again, nothing has yet been produced to promote them.
HHS is not the only entity that knows a younger, healthier mix is needed to help balance the premium pool so that the exchanges are actually affordable. Insurers and states, particularly the 16 states that are running a state-based HIX, are also aiming at the younger crowd.
Minnesota is using its iconic mascots Paul Bunyan and Babe, the blue ox, to show why signing up for health insurance through its HIX, MNsure, is a good idea. TV ads show Bunyan getting hurt doing various activities, such as water skiing, snow skiing, and playing soccer, while Babe looks on.
Minneapolis-based BBDO Proximity developed MNsure's multi-media campaign, titled, "Land of 10,000 Reasons to Get Health Insurance." The ads are funny and will start blanketing the state early next week on TV, radio, online, and at the Minnesota State Fair.
In Oregon, officials are getting the word out with a one-minute TV spot featuring folk singer Laura Gibson, who strums a guitar singing, "Long Live the Oregon Spirit." The commercial strikes a hipster chord with the words, "Every baker, and banker, and indie rock band… will live long in Oregon."
The state is also relying on a hip hop group native to Oregon, Lifesavas, who is featured in another minute-long spot called, "Live Your Life". While capitalizing on Oregon's local music roots to promote the state's HIX is definitely an aim at the younger generation, Howard Rocky King, executive director for Cover Oregon, said in a release that they are also using grassroots partners to get the word out.
Community partners will likely play a big role in reaching consumers in states that opted out of running their own HIX, which is what most states (27) did. In South Carolina, community groups and health centers received $3.6 million to publicize the exchange.
That's a pittance compared to the more than $100 million California is estimated to spend. The gap exists because states that decided to either run their own exchange or partner with the federal government on one received more grant money to ensure success, which includes promotion and education.
But, another key piece of HIX enrollment is just that—enrolling people to participate. Developing and producing a catchy ad campaign will not suffice. This may be one case where audience reach will be a metric in the rear view because it's the number of people enrolled that matters most.
To that end, the Obama administration is using navigators to help inform and actually enroll consumers, which may work against enrolling the targeted demographic of 18–34. A survey from HealthPocket, a nonprofit insurance compare website, reveals that only 3 percent of that target audience plans on using navigators or nonprofit community groups as a source of help and/or advice for enrolling in a HIX.
Gabrielle DeTora, a hospital marketing consultant, says there are examples of successful healthcare campaigns aimed at a younger generation. She points to orthopedic service line campaigns that target high school athletes and their parents, as well as primary care campaigns directed toward educating younger people about diabetes prevention.
But, she also says that unless younger individuals are having children, they just are not buying health insurance.
"Reaching them probably won't be a problem, but selling them will be because there are so many other things that are competing for their dollar, like pizza and beer."
Other problems are also on the horizon that could pose a setback to HIX enrollment. Opponents of the Patient Protection and Affordable Care Act continue to fight the law. At the Minnesota State Fairgrounds, there is a billboard featuring a woman with her arms crossed with the question, "Why Can't I Choose My Own Doctor?" and a website refusemnsure.com.
As more components of PPACA get rolled out, it seems, so do opponents' advertising dollars. A USA Today report examined ad spending by detractors from 2010 to 2013, which showed they've spent $385 million tearing down the sweeping health reform.
With private health insurers who are participating in the exchanges, and federal money flooding the coffers of ad agencies to produce multi-media campaigns, HIX enrollment may be able to reach the Administration's overall goals, but the magic number of 2.7 million young people enrolling may prove too elusive.
Here's what can happen when internal departments of a hospital or health system start working together: Marketers get better data and gain insight into new opportunities for growth.
At the foundation of the buzz-phrase, 'continuum of care,' is the aim to make healthcare seamless and easy for patients, as they pass from one entity to another, whether it be from a family physician to specialist, or from a hospital to a rehab facility or home.
There is much debate over how to achieve transitional nirvana as there are a lot of moving parts, but, in general, it is at least easy to visualize how healthcare organizations should work together, eventually.
Likewise, the internal departments of a hospital or health system should also be working together (stop snickering), but work is more often done in silos, an approach that the healthcare industry seems to have perfected.
One health system is bucking that trend, at least with its marketing and physician liaison teams. Chattanooga-based Memorial Health Care System with 150 employed physicians, part of the third largest faith-based health system in the U.S., Catholic Health Initiatives, is breaking new ground.
Lisa McCluskey, vice president of marketing communications for Memorial, which serves southeastern Tennessee and northern Georgia, established a physician sales team in 2008. That's when she started working at Memorial and says she quickly surmised that the sale team and marketing needed to work closely together. Her vision five years ago has resulted in two major accomplishments: meaningful metrics, and a bigger seat at the table with the C-suite.
"Looking back at how far we've come since 2008, now we're seen as such key strategic partners," she says. "One battle that we [marketing execs] fight all the time is 'It's fluff' or, it's the first to get cut out of the budget, now we're seen as being a strategic partner."
McCluskey's journey to establishing a more fine-tuned physician relations and referral strategy team for Memorial started where many marketing departments remain today: Some consumer-based physician marketing with no real way to measure whether the marketing efforts were bringing in new patients.
"It was an evolution," says McCluskey. "Early on, we did not have a dashboard. That's the first place I started, trying to measure what we're doing. And then finding out what was valuable. From there, we developed metrics that they didn't even know they needed."
The metric McCluskey is referencing is new patient wait times, the amount of time it takes for a new patient to make get an appointment to see a physician. It's key to informing McCluskey if the targeted physician visits along with marketing are working to increase patient volume, which is another number they also measure, but it is markedly different from new patient wait times, explains McCluskey.
"Emphasis on measuring new patient wait times came up two years ago, as we more heavily marketed physicians. Then, it was more consumer-focused, but as we ramped up the number of referrals, it rose on our radar that having access was vital."
Patients don't want to wait a long time to see a physician, and McCluskey says if there is an emergency, the physician will work in a patient, but if there is an increase in how long it takes to make an appointment with a physician Memorial is heavily marketing, either through a traditional marketing campaign, or with physician liaison visits, or both, McCluskey knows two things: the demand exists for a particular service line and that the campaign is paying off.
It's a strategy she's used time and again since Memorial began tracking patient wait times. McCluskey gives a recent example of a campaign targeted for a specialist.
"At the start [of the campaign], the average new patient appointment wait time was four days," she says. "We conducted a series of targeted physician visits and combined that with consumer marketing. We then measured her new patient appointment wait time one month after the campaign concluded and it had increased to 4 weeks."
McCluskey says this data is more meaningful than simply reporting an increase in patient volume because it also informs customer service, highlights throughput issues, and reveals when it's time to recruit.
New patient wait times also tell the C-suite where growth opportunities exist. She says when she presented leadership with the information tied to strategic goals, a light bulb "most definitely" went off.
"It became more of a strategy conversation … such as, 'What are the barriers to growth?' " she says.
"It's that door-to-doc time; it prompts so many more conversations than just around, 'Well we're doing a marketing campaign'. That could be seen as soft, but instead you're tying [it to] metrics."
Healthcare organizations that go through a rebranding process learn a number of things quickly. Perhaps the most valuable lesson is that rebranding clearly identifies the organization's vision and mission.
Before rebranding
Putting a fine point on the term "marketing" can help a hospital define its strategy and vision. Too often, and for too long, the term has been a catch-all for branding, public relations, communication, advertising, and outreach. Those individual activities are part of the functions of marketing, but the terms are not interchangeable, and organizations that go through a rebranding effort quickly find out the definitions of each.
For example, Greenville Health System (GHS), a nonprofit, integrated network of hospitals and physicians in South Carolina, launched its new brand and logo this past March after months of working on defining its marketing goals.
Before taking the step to formalizing a marketing strategy, GHS had to find out who it was, according to its employees, patients, and community.
GHS was once known as Greenville Hospital System University Medical Center, which according to Sally Foister, director of marketing services, was confusing because the system isn't part of any university. As GHS continued to grow and acquire physician practices, so did the system's inventory of logos (at least 30 different logos at one count!).
But having multiple logos for one hospital or health system isn't unusual, especially if an organization is growing rapidly, like GHS did, or if corporate communications are left unchecked. That was the case at Children's Hospital Los Angeles. It rebranded in 2012, and in the process found 50 different logos in use. The reasons for having various logos are different, but the effect was the same at both Children's and GHS: a watered-down brand identity.
After rebranding
Foister says research in GHS's service area showed its market share was decreasing. The data also echoed what Foister was hearing internally and from the community.
"National Research Corp data showed that consumers didn't know who was part of us and who wasn't," she says. "Our brand was so fragmented."
An organization does not have to go through a rebranding process to understand the differences between marketing, advertising, and public relations, but being able to step back and take a broad view of where an organization wants to go helps put those terms in their correct context.
"When we deep dive into the differences, it really is an "ah ha" from most people because even marketing folks don't always get the concept of branding as an all encompassing strategy, and tend to think of it tactically in the form of an identity, tagline, name, etc.," says Rob Rosenberg, president of Springboard Brand and Strategy.
Using a firm that focuses specifically on branding can help an organization narrow its goals more quickly. GHS used BrandEquity for its rebranding process, but Children's Hospital Los Angeles did its branding work in-house.
The main idea, no matter which path is taken, is to be able to identify the system's vision and mission, or "promise," as Rosenberg puts it.
"Advertising and branding are strategies that companies employ to help achieve marketing goals," he says. "Branding, or the act of branding, includes not just the basic elements/tactics such as naming, identity, look, [and] feel … but also the fulfillment of a brand promise."
For GHS, Foister says its goals are three-fold, "to be seen as a leader, innovator, and model of change" based on individual interviews done with business leaders, academic partners, and leaders in the community GHS serves.
The qualitative research found that GHS is best situated to position itself as helping patients navigate a complicated healthcare system, Foister says. Those efforts would surely be hampered with a complicated and confusing brand identity.
And, she says the new brand and logo is simple and fresh, and long overdue. Anecdotally, she's heard positive feedback from her community on the new image. Another survey on awareness, which will likely be conducted within the next year, will show quantitatively if the new brand is catching on, too.
The low-cost and low-risk strategy of developing and maintaining a blog for your small healthcare organization might be the best investment you haven't made yet.
If your health system or hospital is still wading in the shallowest waters of social media, i.e. only periodically posting to Facebook, Twitter, and YouTube, a blog may be a gentle transition to the vast ocean of opportunities social media presents.
Blogging provides many benefits for hospitals and health systems. Think of it as the mouthpiece of an organization's megaphone. The message originates at the organization's, not on a billboard, not on a television commercial. Not to discount out of home media, but as Lee Aase, director of the Mayo Clinic for Social Media, pointedly said last week, a hospital or health system blog should be thought of as an organization's "home base."
All internet roads ultimately lead back to the blog, and a blog provides ultimate control over how a message is delivered and who can react to it. That's not the case on Facebook, Twitter, or YouTube, the three most popular social media platforms.
The Mayo Clinic's blog is a standard to which blogs from large healthcare systems are held, and rightly so, they do a great job of integrating its entire social media. I picked three other hospital blogs that are also getting it right. There are many more, but the following hit my qualifications of being easy to find, updated regularly, and nurturing a true community.
1. Cancerwise TheUniversity of Texas MD Anderson Cancer Center's blog is about all aspects of cancer, from diagnosis to survival and all the research in between. The blog features stories from a mix of physicians, patients, and caregivers, and the content ranges from first-person accounts of surviving cancer to tips on what to pack for an appointment at MD Anderson. Patient stories are the most engaging, and it's a place where the hospital shines, too.
Most hospitals and health systems know this, and have made patient stories a cornerstone of their marketing strategies to showcase patient experience and clinical expertise. Using the blog as another platform allows a separate space where you can embed videos, clinical advice, or other parts of the website that are easily overlooked or are difficult to find.
For example, a physician finder is a pretty standard tool that exists on an organization's website, if the system has employed physicians. If an organization has hundreds of physicians, it's easy for them to get lost in the shuffle. On the Cancerwise blog, when the topic turns to research or education, a physician is usually featured in the blog post with a link that opens in a separate window (pay attention bloggers!) to that physician's page, which includes current and past research projects as well as their history with MD Anderson.
Another important part of this blog is that it is updated at least four times a week. Even if you can't blog every single day, establish a pattern that users will come to know (and appreciate). There's nothing worse than finding a blog you enjoy reading and following only to come back to the same entry three days in a row. Patients and users are savvy and time-restricted. If you don't have what they're looking for, they will find someone else who does.
2. Scrubbing In Theysay everything is bigger in Texas, and to be clear, it's usually the Texans who are saying that, (I can say that because I'm a native Texan, but don't hold that against me). But at Baylor Health Care, based in Dallas, it's really true.
The health system has deployed an aggressive marketing blitz on social media channels and maintains not one, but two blogs. Its newest, Scrubbing In, made my list because it looks like other consumer blogs, which attracts a wider audience than Baylor Health patients, but is clearly all about healthcare, as the catchy title implies.
Baylor Health's other blog, Sammons Says, is also well-maintained blog about its cancer care services. Scrubbing In also made my list of top three because it is easy to find and the blog posts are topical. As I write this, from a desktop in Dallas, the city is abuzz and reeling from the news of the death of nationally known, but homegrown radio personality, Kidd Kraddick. At the young age of 53, he died suddenly in New Orleans, and preliminary reports point to cardiac disease, perhaps due in part to his smoking habit.
While other healthcare organizations are using the event as an educational platform for heart health, Baylor Health's Scrubbing In blog post acknowledges the loss of someone who was wildly popular in their own backyard first. Why is this important? It shows humanity and it fits with the personality of what a blog should be: a community of readers that find interesting topics at a place they trust. The blog treats Kraddick's death with a series of questions and answers about cardiac health with a link to Baylor Health's heart health online tools that a reader may be ready to use.
3. Signature Moms.This blog, maintained by Signature Healthcare, a hospital and multi-specialty medical group based in Brockton, MA, looks different from the other blogs on this list (and other lists of top hospital blogs) because it is written by and for a singular audience – moms. Developed in 2011 as a way to create a sense of community for moms who delivered and/or received care at Signature Healthcare, the blog reaches one of the most sought after demographics, particularly in healthcare where women are the primary decision makers.
I also include this blog on my list because Signature Healthcare is a relatively small hospital and medical group compared to the previous Texas giants, showing that organizations willing to be creative can achieve what bigger budgets do. To help make sure the content on the Signature Moms blog is fresh, the hospital holds a yearly contest online for local blog contributors. There are currently eight bloggers, and their only prize, besides achieving fame as a published mommy blogger, is $200. The alternating voices from Signature Healthcare's service area achieve the same community feel that other popular mommy blogs do.
It doesn't feel like a cheap advertisement for their labor and delivery services because the posts that the bloggers write are about them, and their personal experiences with their children. Sometimes the posts are about healthcare, but more often they are about the daily lives of moms and their kids. Lest you think the blog is great, but too small to care about, it recently surpassed 100,000 views and 2,500 subscribers.
The low-cost and low-risk of developing and maintaining a blog could be the best investment you haven't made yet.
The notion that it's too hard to determine the value of a marketing strategy is common. And it could be negatively affecting the way that marketing departments are viewed within the C-suite.
Spending money without knowing what you're getting in return is something most of us recognize as a bad idea, yet hospitals and health systems continue to approach their marketing this way.
For some organizations, tracking the value of a marketing dollar is qualitative and therefore generating ROI isn't easy. For example, the owner of a family practice in the Midwest told me last week, that it was "impossible" to determine the ROI of its marketing, which consists of its physicians being "very involved" in the community by way of attending chamber of commerce meetings, local community events, and the town's high school sports games.
As the owner of that practice put it, "How do you put a value on a physician being present at chamber of commerce meetings?"
As a writer and observer of healthcare marketing, I had no advice to give, but the implication that it's too hard to determine the value of a marketing strategy is something I hear a lot. And, it could be affecting the way that marketing departments are viewed.
With shrinking margins and price pressure mounting, C-suite executives are eager to see meaningful numbers from every department. Not measuring the ROI, even qualitatively, of an organization's marketing efforts, is one of the barriers to a marketing department's desire to be seen as strategic partner that supports the vision and mission of a hospital system.
One place organizations can start, is simply looking online using Google Analytics to get a baseline read of their website visitors. Yes, this is basic information, but (believe it or not) there are organizations that are either not doing this simple step or do not give much weight to the online statistics because they don't believe the information is meaningful.
Jim Connolly, CEO of Ellis Medicine
Jim Connolly, CEO of Ellis Medicine in upstate New York, calls online stats "invaluable."
"It's easier to track marketing if your objective is to drive people to your website, because then I can track how many people have visited the website and how much time they're spending on it," he says. "That gives us a real indication of who was attracted to us and what they were looking for."
Connolly, however, also recognizes that there are obstacles to moving marketing closer to the boardroom. He says the expense can be a roadblock, as well as the time it may take. For example, getting approval for a $15,000 marketing campaign will always be easier than one costing more. If a marketing campaign requires a lot of engagement from leadership, however, it may be a hard sell.
The big hurdle to overcome may be just getting the C-suite to agree that the organization needs to be communicating with the service area.
"You've got to feel that there's something important about getting your message out," says Connolly, otherwise any campaign, even a small one, will be a hard sell.
If you are able to sell leadership on a marketing campaign and they come looking for metrics that assign value, be prepared, says Beth Wright, vice president of corporate communications and strategic marketing for Franklin, TN-based Capella Healthcare. Capella operates in six states, but isn't a giant system with access to all the bells and whistles of an academic medical center.
"Capella is a system, but healthcare and hospitals are local, so measurement is different," says Wright, who works to measure what she can.
Wright says sometimes her resourcefulness means getting creative with who is part of a marketing effort. For example, to increase a particular insurance-covered procedure, such as bone-density scans, the registrar can ask three questions at the point of screening. That is a simple step worked into an already established process netting information about prospective patients.
Perhaps the biggest roadblock to bumping up marketing's reputation in healthcare is educating leadership about the nuances of everything a marketing department does, or can do.
"One of the obstacles is not really understanding what is marketing, versus advertising, versus branding," says Connolly. "I was fortunate to have people to educate me really well, and I thought I knew a little bit about this, but people raised my consciousness about the difference between those and how they need to reinforce each other. "
There's a crisis in your healthcare organization's future. It might be a natural disaster or a data breach, and it's closer than you think. Are you prepared to communicate effectively with the media, patients, and hospital staff?
Managing a crisis is something communication professionals dread, but they know it is something they are likely to face at some point in their careers.
But in healthcare, a looming crisis is not a likelihood. It is a certainty.
Just glancing at the news over the last few days, I've read about various hospitals across the U.S. that grabbed headlines for possibly exposing patients to hepatitis, seriously botching a blood transfusion, and treating a patient infected with a deadly superbug.
It's a stark departure from the numerous celebratory press releases flying into my inbox from hospitals about making U.S. News and World Report's Best Hospitals list for 2013. Good news is easier and more fun to spread, but crisis communications has become a near-daily reality for healthcare organizations because of the speed at which information is shared.
A single Facebook post about nursing care, or the cleanliness (or not) of your mom's hospital room post-surgery could end easily end up on a savvy reporter's radar.
Smart marketing and communications departments keep a vigilant watch on social media platforms to catch isolated events before they can become a bigger story, but sometimes an issue is so big that an organization has no choice but to put all hands on deck to help manage the message that is eventually going to get out to the media and reach the public.
Such is the case with WellPoint. The Indiana-based insurer admits no liability [PDF], but has agreed to pay a $1.7 million fine to the Department of Health and Human Services to settle HIPAA violations that occurred in 2009 and 2010, when the personal health information of more than 600,000 individuals was breached.
The PHI breach occurred when a vendor was updating the company's online application process. Although the problems have since been fixed, and no one's identity was fraudulently used as a result, the incident continues to be played out in public because of the subsequent fallout.
A PHI breach is one of the most common crises for which healthcare entities must be prepared. In fact, many approach a PHI breach as a "when" instead of "if" situation. Dave Jolley, vice president of public affairs at Geisinger Health System in Danville, PA, which had a PHI breach in 2006, says having a solid plan in place before a breach occurs helps diminish the stress that accompanies a crisis.
"When these things happen, you move into warp speed, that's why it's important to have that plan and have the basics down early, so you don't have to start from scratch," he says.
At Geisinger, the PHI breach affected 25,000 individuals, a fraction of the number affected at WellPoint, but both organizations took the same course of action. They offered fraud protection and credit monitoring to those whose information was exposed. Geisinger extended its offer of protection for one year; WellPoint offered coverage for two years.
The situation at WellPoint is trickier because the story is now getting another life with recent news of the HHS fine. Cindy Sanders Wakefield, regional director of public relations for WellPoint, was the point person on the original PHI breach.
"Our philosophy at WellPoint, for corporate communications, is that we've got to be transparent and we've got to share accurate information to all appropriate audiences as quickly as possible," she says.
Wakefield was named as a co-winner of Crisis Manager of the Year in 2011 by PR News for the way she handled WellPoint's breach. The organization cited her leadership in "developing materials for internal teams to respond to and inform the media after the incident, helping to minimize the impact of this crisis."
Transparency and information sharing is key in developing crisis communication plans, whether it is for a PHI breach or a natural disaster, such as a flood two years ago that affected Geisinger, which caused the evacuation of a facility and forced hospice patients to be transferred.
"Between our hospitals and our other sites, we have probably over 80 locations," says Jolley. "So we'd be getting information out about our emergency room being available, and the state would be closing roads in certain areas, so we had to update our messages continually about which sites were open," says Jolley.
Geisinger's experience with a natural disaster also shows that crisis plans need to be firm, but flexible enough to respond to a changing situation.
Establishing a reputation for being upfront and transparent is also helpful when organizations have to rely on local and national media to keep patients and the public informed. Individual relationships with reporters in your local market are key to making sure that your organization's message is being portrayed clearly and accurately.
Building a relationship with the media is easier than you may think. A simple introductory phone call to the editor of a media outlet that has access to the same audience you need to inform will help when the news you have to disseminate isn't so good. Jolley says keeping the media up to date on what your organization is doing year-round establishes an ongoing relationship, which is key when you need to get in front of a story.
"I think first of all, it's a mistake not to respond to media," he says. "Sometimes, given the situation, PHI or whatever it is, we may not be able to answer every question, but I will tell them what I can. Even if you have a one- or two-person shop, it should be on your priority list. We'd much rather be in the story than the story take place without us."
Planning for a crisis, whether it's a natural disaster or a PHI breach, is the kind of process that you will probably do with your fingers crossed in hopes the plan doesn't have to be put into action; however, building a crisis communication plan that has a solid framework and is adaptable will be the beacon you look to when the inevitable happens, so be prepared.
"It has to be a living document that can be changed when needed," says Wakefield. "Be flexible, but thoughtful, about your flexibility."
Social media platforms such as LinkedIn, Twitter, and Facebook are continuously evolving, even when healthcare organizations aren't ready. The Mayo Clinic and Baylor Health have embraced social media and are sharing best practices with others.
No hospital or health system takes social media as seriously as the Mayo Clinic. Its peers have looked to Mayo as a leader in healthcare quality and medical research for decades, and now they turning to the Mayo Clinic Center for Social Media (MCCSM) for help with how to engage with patients and employees on blogs, Facebook, Twitter, YouTube, and an expanding array of social media channels.
"The whole idea is to help healthcare organizations figure it [social media] out," says Lee Aase, director of MCCM.
For some hospital marketers, nothing is more cringe-inducing than social media. It can seem overwhelming to "figure out," as Aase says, even though the premise of every social media channel, whether it is YouTube or Facebook is simple: Communicate with patients.
One of the reasons that social media is still such a hurdle for health systems and hospitals lies in the fact that the technology supporting it changes quickly, therefore changing the way the audience views carefully crafted content.
Take Apple's new operating system for the iPhone, iOS7. A new camera, web browsing capabilities, and file sharing features will impact the way content is viewed, meaning that marketing messages may have to be reconfigured to maintain a positive user experience and audience metrics.
Facebook and LinkedIn are two other platforms that are continuously evolving, even when organizations aren't ready. The rapidly changing pace of technology and quantity of ways to communicate is enough to induce not only head-spinning, but head-burying (in the sand). Healthcare organizations are aware of the industry's reputation for being latecomers to social media, and most are at least acknowledging the need to join the conversation because patients expect it.
Path to social media begins with one click
Mayo makes the transition from no-presence to some-presence on social media easy for hospitals, no matter the size. The center's resources are geared to helping novices and advanced practitioners.
Its Social Media Health Network, a project of MCCM, connects more than 130 hospitals and other healthcare related organizations to share best practices. And the members' names are not just a who's who of hospitals. It includes smaller facilities, too, such as Faquier Health, a 97-bed hospital in Warrenton, VA.
In the years since MCCM debuted with podcasting in 2005, Mayo's social media presence has grown to more than 570,000 Twitter followers. It's Facebook and YouTube presence is equally enviable. And there's no real "secret" to social media, says Aase.
Aase asserts that instead of thinking of social media as big ball of confusion, it should be thought of more like the USDA food pyramid. An organization's use of social media channels need to be balanced and focused toward specific goals.
Going Big
Of course, there are health systems that have jumped into social media seemingly fearlessly. Dallas-based Baylor Health Care System, which boasts multiple blogs, a strong Twitter, Facebook, and YouTube presence, has also used Google+ for some of its specific social media pushes.
In 2012, Baylor Health relied on the relatively new social media channel to host a hangout with one the breakout characters in its three-part documentary about cancer called Dallas Hope. Each 30-minute episode chronicled the lives of three cancer patients at a Baylor Health facility.
The aim of the program, which aired on a local ABC affiliate, was to increase awareness of the system's new Sammons Cancer Center complex. Promoting the show on its blog, on Twitter and Facebook, helped drive traffic to the show's landing page. The show's content definitely resonated with viewers. Baylor Health's Facebook reach doubled from 1,436 before Dallas Hope to 3,098, after the program aired. There were 200 #DallasHope Twitter posts, and 7,200 YouTube views.
Baylor Health's focus on social media paid off. An estimated 25% of the web traffic was driven by social media efforts.
Learning Curves
Figuring out social media a destination—there‘s no real end point. Instead it's a constant process of learning what is working for a specific organization at a specific time to reach a specific goal. And whether you consider your health system or hospital a beginner or advanced player, there is still a lot to learn.
In an interview, Clay Phillips, director of provider relations and communications for Blue Cross Blue Shield of Tennessee, acknowledges that the nation's healthcare system "is simply unsustainable in its current course," and discusses some of the challenges payers are facing.
The city of Nashville has long been associated with healthcare. In 1995, the city's chamber of commerce developed the Nashville Health Care Council to help bring together stakeholders in the healthcare and business industries.
Clay Phillips, director of provider relations and communications for Blue Cross Blue Shield of Tennessee
Over the years, the council has hosted high profile speakers and workshops for health leaders. It recently finished its most ambitious venture to date, the Nashville Health Care Council Fellows, a diverse group of 33 healthcare professionals representing payers, providers, government, technology, the pharmaceutical industry, and healthcare finance. The Fellows met for eight one-day sessions over four months in Nashville to discuss and learn about healthcare strategies and challenges.
Clay Phillips, director of provider relations and communications for Blue Cross Blue Shield of Tennessee and a Nashville Health Care Council Fellow recently spoke with HealthLeaders Media about the experience.
HLM: What did you get out of the experience?
Phillips: There was reconfirmation that the system is simply unsustainable in its current course. They brought a lot of information to bear, both with the payer and the provider, to illustrate that the industry is not going to last long term. We can't survive at 18% of GDP with poor outcomes. That's not a provider-bashing comment; it's simply a fact at this point.
The other thing I got out of it is there are things you can do—big things and things you can do on the edges—both of which matter because the system did not get into the condition that it's in overnight, and it's going to take time to turn the ship.
I came away more encouraged that we can do things within the provider community to soften the soil—from changing the way we pay to changing the way we measure how the system functions.
HLM: What were your expectations?
Phillips: My hope was that we could do two things. One, that we could have an atmosphere where the payer, provider, and financing structure of healthcare could come together to have an open dialogue without looking at each other like we have fangs, and they (Nashville Health Care Council) did that. The other thing I hoped to get out of it was learning new things that are coming down the path that can be game changers for the entire market.
HLM: What are those game changing elements?
Phillips: There are technology [examples] that can disrupt our market and force change. A specific example of that are the technologies that are available to monitor conditions in a completely mobile space. You can essentially use a sensor and deploy a network of other sensors to read conditions.
In-home care could be completely altered in the next five years, or how that technology can be distributed in a telehealth network that can completely change the face of primary care. Things like that have a way of forcing the market to wake up because they are game changers.
HLM: Changing how care is delivered will mean a change in how insurance companies pay for that care. How receptive is your industry to embracing these sorts of new technologies that can force that change?
Phillips: I think the industry is very receptive. The pressure to change is on us too, and not just on the premium side of the equation. The challenge is that the payer system is slower to change in some ways than the provider community.
You're talking about massive organizations that have heavy information technology infrastructures that are hard to move on a dime. Our challenge will be to keep pace and improve scalability and return on investment as fast as possible. So, I think the industry is receptive; I don't think the industry is prepared for it.
HLM: At some point, the health insurance industry will have to react, what do you think has to happen to catalyze their response?
Phillips: This is a particular challenge for Blue plans. We have to get into a posture where we can pilot quickly and fail quickly. We also have to be willing to come back around when we see modifications developed in the market that we can redeploy if they didn't work the first time.
A good example of that is disease management. We've had some effect on controlling costs, but not the effect that we wanted. If we tie disease management to the technology that was talked about, then we have another way of monitoring and engaging with the patient where we might actually be able to change the cost curve.
It would be incumbent upon the payer community to say, ‘I know the investment in disease management didn't go so well, but we may have been in that space before we had the capability to move the needle,' and telehealth is another example of that.
Phillips: Yes. We have to reformulate the way we think about things, and that's a good example of choosing a partner who can pivot quicker than we can. Our claims systems, [and] our payments systems are not necessarily designed to do that.
HLM: Does the culture of the health insurance industry also have to change in order to respond more quickly?
Phillips: Absolutely. Changing the culture has to happen. One of the speakers, Brad Perkins, MD, (Chief Transformation Officer/Executive Vice President of Strategy and Innovation) from Vanguard Health, approached the issue with what he called the Turkey Fable. The turkey is moving along, getting fattened up and happy, but unless the turkey convinces people he doesn't need to be on the Thanksgiving table, then he's got a problem.
All of it ultimately comes down to changing culture. That [story] illustrates one of the great benefits of the Nashville Health Care Council Fellows program. It's creating an atmosphere where you are not only forced to look at each other across the table, but also recognize that you bleed the same kind of blood they do.
HLM: What kind of work did you do with your healthcare industry peers?
Phillips: They would take us through case studies. They gave us homework assignments to read and we would have to be prepared to defend your concept or recommendations. We went through accounting exercises, and we also had to be prepared to defend the posture of our accounting mechanisms. When you critique case studies in a microscopic way, it forces you to think more like an academic and less like a business person.
HLM: Was your mind changed at all about anything?
Phillips: I became more of a believer in the distinct possibility of having the market disrupted. The market seems so entrenched in so many ways and it is hard to fathom a complete change, but look at the housing market. It's completely different after the collapse a few years ago, and so are the financing instruments behind it. So, when you look at it from that perspective, you can begin to see the healthcare industry differently.
Buying health insurance in the U.S. is not yet as straightforward as other consumer purchases, but that is changing. Health systems in Singapore, Australia, and New Zealand are far ahead of us in offering consumer choice and addressing health disparities.
Debbie Gordon, Chief Marketing Officer, Network Health
By this time next week, Debbie Gordon, Chief Marketing Officer for Network Health, will be in Singapore study how that country's healthcare system engages consumers. Gordon, who is one of nine 2013 Eisenhower Fellows, is also traveling to Australia and New Zealand during a five-week intense study of healthcare systems in other countries. The intent is to discover what the U.S. can learn from them.
Gordon leads the marketing efforts of the Medford, MA–based nonprofit health plan, which provides comprehensive health coverage for 215,000 state residents.
"There are market forces and government regulatory forces coming together, for example [health insurance] exchanges, and the rise of high deductible health plans," says Gordon. "All these things seem to put a lot of responsibility on consumers. So, my quest was to find countries or systems I could study that have not only mastered the cost and quality equation, but [have done so] specifically through the consumer angle."
In Singapore, which has recently been held up as a model of lower-cost, higher-quality healthcare, consumers have higher co-pays and are required to maintain an individual health savings account to help pay for their healthcare.
The cost of medical care is also completely transparent in Singapore, so consumers know what they are paying for upfront. U.S. advocates for medical price transparency have scored some victories, but U.S. health consumers are far off from Singapore's system of going online and comparison shopping.
"Singapore is a highly regulated place, but what is most compelling to me is that they have an out-of-pocket system, an insurance system, [and] there is a safety net," Gordon says. "There are features that you would recognize and at the same time one of the tenets of their healthcare system is 'personal accountability,' and I think that's what we're doing, almost inadvertently. What I imagine they've done is establish systems and supports for individuals to make good decisions for themselves and their families. That's what I want to learn from."
In Australia, Gordon is going to study how that country is approaching the health disparities that exist in its Aboriginal population. Life expectancy, disease rates, and preventable hospital admissions all lag behind the rest of the country's population significantly. Network Health is an approved Medicaid provider for its state, and Gordon says there could be opportunities to learn some best practices.
"From where I sit, in a health plan that serves a predominantly lower income and heavily minority population… I thought, 'I'd really like to go and learn how they are approaching these disparities in their population,' and the role that consumer empowerment has in that context," she explains.
Gordon will spend the bulk of her trip in Australia. She cites the vast size of the country as the main reason for spending about four weeks there versus one week in Singapore. Already, she has meetings lined up with hospitals and health plans as well as advocacy organizations and government officials.
"I think that we need to start thinking about our industry as a consumer industry and then approaching consumers as if we were selling computers, or smartphones, or clothing, or food, or consumer products that we are accustomed to shopping for," says Gordon. "We need to teach consumers how to shop for it [healthcare]; we need to establish mechanisms to enable that. And it's really about reframing our industry as a consumer market."
While buying health insurance is not as straightforward —yet —as buying an electronic gadget off the shelf, Gordon believes there are already products on the market that serve as a model for healthcare, such as car insurance or buying a house. One thing that is certain, says Gordon, is that health insurance exchanges will expedite the rise of consumer empowerment.
"More people will be buying insurance, or will be covered by insurance. Therefore insurance companies stand to gain just by increased volume," she says.
The increased attention on helping consumers eligible to buy insurance on the exchanges could serve the rest of the population well because it could force health insurance companies to become better at communicating clearly, something she acknowledges health plans haven't done very well, which could be a contributing factor to U.S. consumers being slow to take on more responsibility for their health.
"I don't think this is a market where people feel really confident about trying new things," she says. "It's hard to branch out, because, like your house, you've got to know that it's not in a flood zone, that the roof doesn't leak, that the windows work. There's a lot of uncertainty when you're buying a health insurance product. And I think we don't have great literacy, frankly, into the terms and conditions of a health insurance plan."
Gordon will be blogging about her trip to Singapore, Australia, and New Zealand. She leaves July 15.