Surveyors from the Centers for Medicare & Medicaid Services are expected to finish their inspection of Dallas-based Parkland Memorial Hospital later this summer. A civil suit stemming from the death of a patient has been approved to proceed by a federal judge.
The patient death that sparked a federal investigation into Dallas–based Parkland Memorial Hospital could continue to shape the hospital's safety policies long after surveyors from the Centers for Medicare & Medicaid Services finish their inspection of facility later this summer.
U.S. District Judge David Godbey issued a 36-page ruling last week that the federal civil suit brought against Parkland by the deceased patient's mother, Jane Pena, may proceed, based on her claims that her son's civil rights were violated.
Pena's son, 49-year old George Cornell, died in a seclusion room at Parkland in February 2011. Cornell had schizophrenia and arrived at the hospital complaining of chest pains. After being admitted, three psychiatric technicians allegedly held Cornell down on the ground of the seclusion room for 15 minutes to administer anti-psychotic drugs, then left him there without being monitored. He later died.
Pena's suit names the three technicians as well as hospital leadership who were ousted after the incident, including former CEO Ron Anderson, MD; former CMO John Jay Shannon, MD; and former nursing director for psychiatric services, Nancy Schierding, RN, MSN.
An investigation of Cornell's death by the Dallas Morning News caught the attention of CMS, which found numerous patient safety violations upon inspection and led to Parkland's systems improvement agreement, an action CMS reserves for hospitals with the most egregious errors.
The SIA required a third party to be onsite while Parkland's corrective action plan was being implemented. It's the only way the hospital was able to continue receiving Medicare reimbursements, which is still at stake until CMS agrees that Parkland has sufficiently improved.
The hospital has been preparing for the CMS inspection for 18 months. By April, the hospital proclaimed it was ready for CMS surveyors. They had said they'd be onsite by April 30, but then changed course. Instead, CMS inspectors showed up June 17, but left after only five days on June 21, without finishing their inspection.
David Wright, deputy regional administrator for CMS, did not say why surveyors left mid-inspection, only that they will return.
"The survey is still ongoing," says Wright. "Surveys always include both onsite and offsite reviews of information, and we can go back at any time, which allows us to have a more comprehensive sample in terms of both time and findings."
Wright says at least 14 CMS surveyors were at Parkland for a top-to-bottom inspection of changes. The date of their return remains unknown to hospital officials, just as the initial visit was.
"They will not tell us when they are going to return," says Mike Malaise, interim senior vice president of external affairs for Parkland. "That's part of the surprise element."
To get ready for the CMS survey that determines whether Parkland will continue to receive federal funding, the consulting firm that oversaw the hospital's CAP surprised Parkland staff with two mock surveys. The results of those surveys are confidential, though Malaise says the hospital has improved significantly from 2011 when an analysis found that patients were in imminent danger.
"Everything we have done has steadily made this a safer place for patients," says Malaise.
It's not clear what parts of the hospital CMS surveyors spent time in while they were onsite in mid-June, though Malaise says they looked throughout the system. Parkland's offsite locations are also covered under the SIA, so surveyors can inspect clinics, physician offices, and the Dallas County jail, where Parkland oversees the healthcare of inmates.
While Cornell's death sparked a massive investigation into the hospital, its patient safety practices, and culture as a whole, it is not the first time Parkland has faced federal review for treatment of psychiatric patients.
The Joint Commission reviewed two other cases in which psychiatric patients died in 2010. The Texas Department of Health also hit Parkland with a $1 million fine in 2012 for patient safety errors and other issues that included the sexual abuse of a patient by a nurse.
In addition to the nearly 500 action items in Parkland's CAP that address CMS concerns, the hospital is attempting to drive change by tying compensation to performance. It's a practice that Parkland previous engaged in but abandoned the same year CMS began its oversight. The Dallas County Commissioners Court has final say over approving a bonus plan; the hospital's board also has not approved the measure.
Parkland officials are under tremendous pressure to regain their footing with CMS and the public. The findings from CMS are expected to be issued before the end of August.
"We did complete the action items that were within the corrective action plan," says Malaise. "Clearly the hospital is higher quality and a safer place than it was two years ago. We're hopeful that the results come back and reflect that.
Research indicates that consumers are ready to take on more responsibility for their own health—that translates to patient engagement. To capitalize on this, healthcare marketers, like Sherpas, should offer guidance, trust—and emotional rewards.
Arnold Worldwide, the Boston-based advertising and creative agency that is responsible for creating memorable campaigns such as Volkswagen's "Drivers Wanted," and Progressive's "Flo," the perky auto insurance spokeswoman with the blue headband, has new data that is directly relevant to healthcare marketers.
In an Arnold study released this month, Sherpa Brands: Guiding Consumers to New Heights, the agency details what consumers are looking for in their brands, and the results are tailor made for hospitals.
According to the Arnold Strategic Insights Group, which surveyed 2,400 adults in the U.S., U.K., Brazil, and China, consumers want brands "to provide increased guidance, empowerment, trust, and emotional rewards."
The study argues that economic pressure and the vast amounts of information available to make decisions have left consumers feeling overwhelmed and somewhat out of control. According to its survey, consumers are focusing on satisfying more personal goals.
For example, when respondents were asked to list their priorities over the next 12 months, 39% said they planned on focusing on their health; that answer was second only to increasing financial stability (41%).
That statistic alone should be enough to get hospital and healthcare marketers excited because it indicates consumers are ready to take on more responsibility for their own health. In healthcare marketing lingo, that translates to patient engagement.
But, an even more meaningful finding that gets to the heart of healthcare marketing is that 68% of U.S. consumers say it is important for a brand to help them make better decisions. Like the Sherpa who are experts at navigating the tricky Himalayan terrain, the study says brands can do the same for consumers.
Arnold's study cites well-known brands such as Loews, Monster, and Fidelity as being Sherpa brands. As an example, the study's authors say Monster is different from other job search sites because its Career Mapping tool, which is in beta testing, helps job seekers understand the steps they need to take to attain a position in their desired career.
A health system or hospital should be included, too, but it's not. Why? That's another column (or two, or three); however, it may be easy to pinpoint hospitals' weaknesses when looking at the four things consumers want that Sherpa brands deliver:
Guidance
Empowerment
Trust
Emotional rewards
The guidance, empowerment, and trust are all elements hospitals strive for and marketers try to communicate. Those roads are being well-traveled. But, that last detail—emotional rewards—is harder because it's not easy to define. What is the emotional reward a patient receives as a result of a hospital stay?
As the C-suite knows, simply fixing a patient's knee, delivering a baby, or stitching up an arm in the emergency room isn't enough. A patient's satisfaction with how a hospital delivers its care is at the top of the priority list of most hospital and health systems today.
It's a struggle to figure out the right balance between clinical and caring, and then communicate it in a way that is meaningful and stands out from other hospitals and health systems. Images of smiling nurses and sleeping babies, and ED wait times are on pasted brilliantly on billboards and websites… but they kind of all look the same.
One way to communicate the emotional reward a patient feels from a hospital stay is simple. Ask the patients. That's what Altru Health System did. The Grand Forks, N.D.-based nonprofit system has a blog called Altru Moments that is dedicated to letting patients tell their own stories of what happened during their hospital stay.
Lindsey Reznicek, who is part of Altru's corporate development and PR team, says every two weeks, a 4-5 minute video is posted of a patient that highlights service, quality, and access, which are also three strategic goals hospital leadership identified in 2011.
"The videos make them [patients] relatable," she says. "They are people first, not their diagnoses."
Reznicek says the system wants to show that it values a patient's experience in the hospital. The stories are compelling, and Reznicek says she works with nurses, physicians, and administrative staff to identify patients who have a good story to tell. Reznicek says she also encourages patients who are picked to tell their story to include the names of the physicians, nurses, and other staff that helped during the hospital stay.
What makes the videos on the Altru Moments blog unique is that they are not quick and simple storylines that show a patient talking about how good the doctor was or how quickly a nurse responded to a call light. The video is also accompanied by a blog post written by Reznicek.
For example, one of the most popular videos features Peggy Vanyo, an outgoing polka dancer who came in for a same day surgery but wasn't fully discharged until four months later.
Reznicek says Altru, which maintains five different blogs, aims to have 3,000 page views per month, with an average site visit lasting 2 minutes. Peggy Vanyo's video had 761 page views with an average duration of 4:49 – the actual video itself is only 3 minutes. Vanyo's video may also be viewed on Altru's YouTube channel.
The video does not feature animation. There is no coupon for free valet parking. It is simply a patient recounting her harrowing health journey and how the staff, in Vanyo's words, "never gave up on me."
Instead of trying to think of the right questions, it may be time to rethink who we're asking. Patients are waiting.
Nursing staff, physicians, and executives can be a hospital or health system's best brand ambassadors. Don't overlook them when you're planning your next strategic marketing or advertising campaign.
While hospitals and health systems search for more likes and shares on Facebook and followers on YouTube and Twitter, they may be missing a ready and willing audience—their own employees.
But, more and more organizations are realizing that workers, whether they are clinicians, administrators, or volunteers, are some of the best brand ambassadors. Here are three recent examples of hospitals using their employees in marketing and advertising campaigns.
1. Tennova's Rebranding Campaign Created in 2011 when Health Management Associates (HMA) bought Knoxville, TN–based Mercy Health Partners, this six-hospital system was renamed Tennova. But, instead of just announcing the new name with a press release, HMA used it as an opportunity to kick off a full-scale branding multimedia branding campaign that featured physicians, chaplains, and volunteers in its ads.
Jera Sangworn, marketing and communications manager for HMA's Tennessee Division, says using employees in the elevator wraps and billboards to announce the new name along with the tagline, "It's Good!" also helped longtime employees of the Mercy system accept the new name and new direction.
"It was a good opportunity to make sure they were involved in a lot of the advertising that we did because that's really important to us—to make sure that they come along side us." Getting your employees on board makes it easier for the community, and therefore patients to go along with you, too.
2. P4 Health at Ohio State University's Wexner Medical Center This campaign, launched at the end of 2012, was aimed at "4 P's" of health and wellness: Predictive, Preventative, Personalized, and Participatory, hence the name, P4 Health.
The effort was first introduced to the 17,000 faculty and staff at OSU Wexner via a microsite. The marketing staff said it was pushed out to employees so they could serve as an example to the community of living healthier and kicking bad habits.
Each time an employee pledged to be tobacco free, exercise, eat better, or reduce their stress, her name was placed on a large graphic that included other employees who had also pledged. Employees could also choose to remain anonymous, but the point was to show there is strength in numbers, and encouragement from fellow peers, even in a large system like OSU Wexner.
Employees who had made a pledge were also featured in YouTube videos produced to show support for participation in the P4 Health campaign. Engaging employees in this wellness effort shows the organization's commitment to the health of its employees and community.
3.Advocate Sherman Hospital's Heart Healthy Facebook campaign To celebrate American Heart Month this past February, Sherman Hospital (formerly Sherman Health Systems) launched a daily heart health tip.
The 28 tips were pushed out daily in a Facebook post that featured a high quality photo of a hospital staff member holding up a brightly colored heart with the daily tip on it. Examples featured everyone from the CEO, who held up day 11's tip, "Eat your veggies," to a surgical nurse holding up day 23's tip, "Fiber Up."
Tonya Lucchetti-Hudson, director of public affairs and marketing for Sherman Hospital, says featuring the hospital's staff and volunteers helped patients relate better to the message that heart health was important. "It gave heart health a face," says Lucchetti-Hudson.
"When you have an actual person who is working at the hospital giving you a heart tip of the day, it makes it real, puts a face on it and makes it personal, and that's the perfect venue for social media because [you're] engaging at a very personal level."
Since the main venue for the daily tips was Facebook, the posts were shared, liked, and commented on by the staff member's own Facebook network, increasing the reach of the campaign. There are many other ways to engage and include the staff in marketing activities.
They are an untapped resource as potential blog writers, Facebook posters, but mainly, brand ambassadors. Show employees how committed you are to communicating with them, and they'll spread the message for you.
"There's no reason to have [a smartphone] app unless it's meaningful for the user," says a former vice president of marketing for a three-hospital nonprofit community health system.
By now, you've heard the ubiquitous phrase, "There's an app for that!" And it's likely true, from teaching toddlers their shapes, to measuring your heart rate, to recording what you say in your sleep. There is mobile application for almost everything.
But some hospital and health system marketers may be tired of hearing the phrase because every time it's uttered, they are reminded that their organization hasn't yet developed an app.
But that might not be a bad thing. Jim Rattray, who developed a smartphone app for New Bedford, MA–based Southcoast Health System when he was vice president of marketing for the three-hospital nonprofit community health system, says an app needs to solve a specific problem.
As an admitted early adopter of technology, he wanted Southcoast to jump on the app bandwagon with the iPhone's debut back in 2007. "On one hand I thought, 'Wouldn't it be cool if we had an app?' but, on the other hand, I didn't want to just put something out there," he says. "There's no reason to have an app unless it's meaningful for the user."
Now an independent consultant, Rattray says if hospitals approach the decision process with how the patient can and will use the app, then it becomes a tool that can not only solve a problem, but it can also enhance patient engagement.
"One of our biggest issues was medication reconciliation. It dawned on me when I was taking my mother to the doctor that she had a tattered list of her medications, some were even out of date," says Rattray.
"There were a lot of apps to keep track of your medication. We wanted to combine that with information about Southcoast."
So, in 2011, Southcoast introduced its free app to iPhone users. Called, SouthcoastMyHealth, it's a prescription tracker that allows users to keep up with medication for multiple people. In addition to the prescription name and dosage, there are also reminders as well as a field to enter in the prescribing doctor, pharmacy, phone number, and other key health information, such as allergies. It's like a mini-medical record for the user.
It sounds simple, but it solves a complex problem, one I lived through with an ailing grandfather who was in and out of the hospital. Every time he came home, his prescriptions changed, as did the dosages and frequency. I was also just one of several people helping to take care of him. Rattray, who was experiencing a similar issue with his mother during the app's development keyed in on this and thought his solution would be helpful.
"There is a built-in sharing function. You can email the list of medications and key health information [to others]," he says. "For example, I would go to the doctor with my mother, and when the doctor changed the dosage on a medication, I could change it and email my sister. More and more people have smartphones. We decided the sharing function would be the one feature that would incent people to keep the app on their phone."
It sure sounds better than the ad hoc Post-It note schedule we laid out on my grandmother's kitchen counter.
"This isn't the most powerful app in the world," says Rattray. "But it does one thing really well."
The app got to 1,000 downloads in six months. Two years later, it's been downloaded 10,000 times.
"Most apps might get 500–1,000 downloads, so when we went over a 1,000 I was ecstatic, when we went over 5,000, I was over the moon," Rattray says.
Giving a patient a tool that helps them solve a specific problem gives them a reason to actively engage with your health system. In some ways, SouthcoastMyHealth is similar to a physician locator, which many hospitals focus on as part of their website and app, but the Southcoast app digs deeper, though there is also a physician finder and a news feed, but that's not the app's focus.
The app simply attempts to have prescription information in an easily accessible place that can be shared with others who need to be informed.
But, don't let its simplicity app fool you. There was very careful planning about who specifically the user was likely to be. Knowing that women control most healthcare decisions, Rattray says the app was developed for the mom, the caretaker, and the spouse.
"We are about 65–70 % Medicare/Medicaid. I wasn't expecting everyone on Medicare to carry the iPhone, but I thought their children might. So we developed the app for a female, aged 30–50."
As a person who is a spouse, mother, and former caretaker (my grandfather passed away late last year), I know that when I want a new doctor, I employ several sources, such as word of mouth referrals, online ratings, and network coverage. So, the availability of an app may figure into my decision about which doctor to choose, but maybe not.
However, when I need a solution to a specific problem, like letting my grandmother know that my grandfather's doctor changed dosages on one of his prescriptions, I do what works quickest, hence the Post-It note solution. Had the hospital he frequented offered some sort of app, it's likely we would have used it.
Another issue that was solved for Southcoast was getting patients used to technology without creating privacy issues. "SouthCoast has no access to the data," says Rattray. "The patient puts their information in, and it is stored in their phone. There is no privacy issue at all."
Apps now do not have the novelty they once did, but with smartphones seen as a must-have instead of a nice-to-have, a well-designed app that helps patients solve a specific problem may be the first step toward having them think of a hospital or health system as a partner instead of a place.
By working closely with its network physicians who are on the frontlines of demystifying health information for seniors, health insurer Cigna is doing things that could reap the company long-term marketing benefits.
Change is tough for all of us. But when it comes to selling health plans to seniors, even a name change can be a bumpy transition. That's where a health plan's relationships with physicians and providers can pay off.
Cigna's new logo
This week, Cigna is running television advertising spots announcing Cigna-HealthSpring, the new name for its Medicare Advantage plans in 14 states and Washington D.C. The rebranding is a result of Cigna's $3.8 billion acquisition in 2012 of Nashville-based HealthSpring, a Medicare Advantage plan provider.
But the real work of helping current Medicare Advantage plan members transition to using the new name and new logo began months ago, in the doctor's office.
"We spent a lot time prior to the launch with physicians and providers," says Mark Tinsey vice president of marketing for Cigna-HealthSpring. "This population is unique and special and one of those kind of special components is [that they] have a very close relationship with physicians."
By working closely with its network physicians who are on the frontlines of demystifying health information for seniors, Cigna is doing a couple of things that could reap the company long-term marketing benefits.
First, the health insurer is building goodwill among its providers by empowering them to answer questions from patients about the name change. That could lead to physicians viewing the payer more favorably as a partner because Cigna is reinforcing its physician-centered culture.
While there are other, more technical and substantive benchmarks physicians use to judge its relationship with any payer, helping physicians maintain good relationships with their patients is a win-win.
Secondly, in addition to educating members of the rebrand, Cigna is also pushing out consistent messaging to members that even though the name is changing, their doctor and their benefits aren't.
"When you think about our consumer, probably the most important thing that they need to hear is, 'My plan is the same; my doctor is the same; nothing is changing in terms of how I'm receiving my healthcare.' We had to use other contact points that are relevant and appropriate… so when the consumer talked to them, the talking points were lined up and ready to share," says Tinsey. "That gives the consumer the confidence and the comfort."
The message that only the name is changing is used prominently both in the television spots airing now, and on the flyer (PDF) that Cigna's network operations team made available to physicians to display in their offices.
To get physicians ready for the new name and logo, Tinsey says it was a two-phase, two-month process. In March, Cigna-HealthSpring started to educate network operations team on the name and the logo. Over the course of a month, the team, which goes out to educate physicians, put together a presentation for providers, a list of FAQs for physicians' offices, and a flyer that would be left for physicians to have available for patients.
The second phase, which lasted for three to four weeks, included visiting physicians and telling them what would be happening and what types of questions to expect from patients affected by the change.
"We tried to put ourselves in the minds of the customer," explains Tinsey. "[It's] for the physician and the physicians' staff to make sure they all felt properly prepared."
Tinsey says other key stakeholders were the sales force and brokers. They got an equal amount of attention to make sure that they were comfortable and confident in explaining the transition and name change to potential clients.
Frequent contact with physicians allows Cigna to track how the name and logo are being perceived, too, though he is confident both are being received well, based on feedback from the focus groups it conducted before choosing a name.
"If people were aware of the name Cigna, it [the brand name] scored very high. If people were not aware of either Cigna or HealthSpring, then the name HealthSpring, scored really well. So we really felt by bringing together the names, we had a great one-two punch… names that if you're aware of them, they're powerful, and if you're not aware of them, then the name Healthspring can really resonate," he says.
The new logo uses Cigna's imagery of the tree of life as well as the company's blue and orange colors. While it does entirely replace HealthSpring's logo, it won't be a huge change because the HealthSpring logo was also an illustration of a tree that isn't too dissimilar from Cigna's.
The name change is going to be a little harder for Bravo Health customers in Philadelphia. Bravo Health was bought by HealthSpring prior to the sale to Cigna. When HealthSpring bought Bravo Health, the name stayed the same, so it will be the first time for customers in the Bravo market to hear or read the name HealthSpring, but not Cigna, as Tinsey points out.
"Bravo Health had a good strong brand in Philadelphia, where Cigna is also well known and well-regarded," he says. "That's one of the reasons we felt good about the transition."
Tinsey says Cigna-HealthSpring is running two TV spots in the Bravo market to help get consumers and members familiar with the name and logo. Both are sixty-second spots; both convey a call to action to contact the company for more information. It's meant to be a lead generator for the Cigna-HealthSpring sales force, especially on the ramp up to open enrollment this fall.
In addition to the traditional television and monthly newsletter to its members, Graham Harrison, director of communications for Cigna-HealthSpring, says the company will be keeping track of consumer and member engagement via social media.
"Facebook is the channel we will focus our efforts on," she says. "We know that seniors are on Facebook; it's definitely the channel we're relying on most."
Tinsey says he anticipates doing another survey of brand awareness and brand acceptance for the new name in about six months.
"I want to get through the annual enrollment period," he says. "When that dust settles, that will give us another opportunity to measure how well the brand did."
Being descriptive in healthcare marketing can be a challenge when you stop using the seven words that no longer have the power to distinguish your organization or its services from those of your competitors.
In the early 1970s, stand-up comedian George Carlin delivered what would become the bit he was best known for, "The Seven Words You Can't Say on Television." Google it and you'll be treated to a filthy and hilarious not-safe-for-work rant.
Hoping that a portion of that phrase stands the test of time, Paul Szablowski, vice president of public relations, marketing, and communications for Dignity Health, and Rob Rosenberg, president and brand strategy director for Springboard Brand & Creative Strategy, have developed their own list of words to avoid in healthcare marketing.
This "seven deadlies" list was part of their presentation on brand building with internal communications at the 18th National Healthcare Marketing Strategies Summit in Arizona held in early May by the Forum for Healthcare Strategists.
According Szablowski and Rosenberg, healthcare marketers should avoid using the following words in marketing messages, both internally and externally:
1. Comprehensive
2. Integrated
3. Continuum
4. Advanced
5. Care
6. Close
7. Multi-disciplinary
"These [words] are not distinguishing characteristics," says Szablowski. "This is what people expect you to be. We need to find words and use words in ways that families understand what we're doing. Put an experience around each of these words."
Being more descriptive in healthcare marketing can be a challenge because, as Szablowski rightly notes, hospitals want patients to know that the care they are receiving is comprehensive. So, how do you communicate that? At Dignity Health, one of the country's largest healthcare systems, Szablowski started by making sure that employees were engaged and that internal stakeholders were included in meetings to determine strategic marketing platforms.
"For example, physicians didn't know the other specialties we offered," he says. Employees, too, were unaware of all the services available and couldn't refer friends and family, or take part in themselves, thereby causing leakage, which according to Szablowski and Rosenberg, ranges from 30%–40% at some organizations.
Rosenberg, who works with clients in Chicago, where mergers and acquisitions are high, says he always does internal stakeholder interviews and is astonished by what they don't know.
"Hospitals need to talk to employees about their services," he says.
Having engaged employees will not only lead to less leakage, they argue, but it also builds on the foundation of delivering a positive patient experience, which we know from the HealthLeaders Media 2013 Industry Survey, is a top priority at healthcare organizations across the country.
Getting every employee to "live the mission" or "live the brand" is a frequent theme in patient experience strategies. Szablowski believes what is working at Dignity is something they started at least four years ago.
"We'd get letters from patients, and we'd take one of those letters once a month, invite that patient and their family, the caregivers, and the leadership from the hospital and have that person read the letter in from of everyone," he says.
The emotional connection was so powerful that Szablowski says Dignity is now working on videotaping the patients reading the letters and storing them in a video library to use for motivational purposes before leadership meetings.
"Each story is really different. Some are about little things, big things. There is an unbelievable range," he says. "The value of it is people come in and talk about what led up to the [hospital visit], the care, and afterwards. You recognize that it's the totality of the experience. All those little things matter." At the end of the letter reading, everyone who was involved in the patient's care gets a certificate of appreciation from the CEO.
"It's the fundamental articulation of the brand, and the brand isn't the logo or the architecture. It's a living thing and everyone plays a role in it," he says.
So far, Szablowski says he feels like Dignity has done a good job focusing its internal communication to raise employee engagement. It's measured by the participation rate of Dignity's annual employee survey, which Szablowski says has been between 80%–90% for the last five years.
"It's gone from a survey to an engagement strategy," he says.
Before each employee survey, posters are put up around Dignity's hospitals pointing out results from last year's survey and how the hospital responded. There are also multiple ways employees can return the survey to increase participation.
"We set laptops all over [the hospitals] in kiosks," says Szablowski. "We also [provide it] on paper, in Spanish—whatever we have to do."
Dignity's focus on communicating effectively and precisely to its employees reflects its commitment to talk the same way to its patients.
Szablowski says he tries to avoid using the seven deadly words at all cost because while "comprehensive," as an example, means something to healthcare marketing professionals, it doesn't necessarily mean the same thing to patients, or consumers. A better description of "comprehensive," according to Szablowski is, "[having] the ability to successfully track all the points of care so we can make sure you're getting the right care, at the right time, and at the right place."
"The real key is that they're our words," he says of the list.
Now it's up to other healthcare marketing professionals to stop using them.
Small businesses pay higher premiums for buying coverage on health insurance exchanges because employers subsidized too many unhealthy individuals, research on employer-sponsored health plans in Massachusetts shows.
The math on employer-sponsored insurance in MA. Source: PwC
Seven years ago, Massachusetts passed a law that what would become the blueprint for the federal Patient Protection and Affordable Care Act. Now a study of employer-sponsored health plans in Massachusetts offers insight for the nation's workforce wondering what the future holds post-PPACA.
PwC's Health Research Institute has issued the first of two reports examining how businesses and workers have fared since the Bay state passed its universal coverage law.
This is neither the first nor the last study examining the sweeping healthcare reform in Massachusetts. The Kaiser Family Foundation issued a six-year report card in 2012 showing that the state's uninsured rate decreased while access to healthcare increased. This is what PPACA is supposed to do, too.
The President's re-election dampened the argument over why the nation needed PPACA, but how the country reaches the goal is still being debated by groups, such as the Association of Health Insurance Plans and most recently the Retail Industry Leaders Association. RILA represents the nation's biggest names in retail (and in some towns, employers): Walmart, Target, Dollar General, Walgreens, and others. The list reads like a yearbook of strip mall, big box, and retail corner tenants.
Along with the National Restaurant Association and the Food Marketing Institute, RILA sent a letter to North Carolina Republicans Robert Pittenger and Richard Hudson last week supporting their U.S. House bill to repeal the automatic enrollment mandate in PPACA. Both Pittenger and Hudson are freshmen members of Congress, without much power. But the bill may gain traction because the GOP is eager to dial back the PPACA, especially if many of country's largest employers are on board.
On behalf of its members, the trio wrote:
"We are concerned that automatic enrollment may create additional confusion for our employees in an already complex benefit area, and could result in unnecessary hardship if they find themselves automatically enrolled in a plan in which they do not wish to participate."
The letter was signed by 88 state and national business associations as well other retailers.
Under the PPACA, companies with more than 200 employees must automatically enroll their workers into health plans, unless an employee opts out of coverage. Employers with 50 or more workers will pay a $2,000—$3,000 penalty per employee for not offering health insurance coverage.
Here's the upshot: The Congressional Budget Office estimated in February that employer-sponsored insurance will decrease by 8 million people (3%) by 2019.
Overall, that's not what happened in Massachusetts, which also has employer mandates, though there are differences. For example, employers in Massachusetts with 11 or more workers pay just a $295 per employee penalty for not making a "fair and reasonable" contribution toward a worker's health insurance coverage.
The financial burden on companies under the healthcare law in Massachusetts is less, but they have to start offering health coverage help with a much lower threshold of employees—just 11 compared to 50 under PPACA.
Even with those requirements, PwC's HRI study found that under Massachusetts law, employer-sponsored coverage rose from 70.8% in 2006 to 72.1% in 2011 while the rest of the nation saw a decline in employer coverage by nearly nine percentage points.
But, the retailers and others are on to something. Dig a little deeper into the HRI's findings, and two of the three industries that saw declines in employer-sponsored coverage were retail and service. Service occupations saw a 5.1 percentage point decline; sales and related positions saw an 8% decline in coverage. The findings don't specifically speak to the industry's concern, but it does give them another, viable, talking point.
Like the health insurance exchanges that are being developed for 2014 now, the law in Massachusetts also provided an exchange for individual and small groups to buy health insurance. John Hurst, president of the Retailers Association of Massachusetts told PwC that small businesses paid a price (read: higher premiums) for buying coverage on the exchange because the employers subsidized too many unhealthy individuals.
Hurst called the move a "very big mistake," and the HIX dynamic in Massachusetts is one health insurers are wary of seeing happening nationwide next year.
But what HRI's also points out is that it is cheaper to include health coverage with an employee's salary because of tax exclusions. Employees also benefit, as the study's authors found take home pay increased when their companies offered health insurance.
The second report from HRI on the Massachusetts Experience will be out later in May, and will show possible implications for hospitals, physicians, and insurers.
In the news this week: Payers continue to move toward health insurance exchanges with limited enthusiasm. Results of a study examining the effectiveness of health insurance on Medicaid recipients are inconclusive. And IPAB is going nowhere, at least for now.
Rarely does a week pass by without news about the federally mandated health insurance exchanges. As the October deadline for open enrollment inches closer, lately that news has been coming with a hefty side of doubt from insurers.
There are still some provisions of the Patient Protection and Affordable Care Act that insurers are still fighting such as age rating, but last week's big reveal from the nation's largest health plans likely got the attention of the feds because it could have implications on the price exchange participants will pay.
Insurers Walk, Don't Run Toward HIX
States, the feds, and insurers have been waiting to find out just how many insurers planned on offering products on the health insurance exchanges. According to an analysis by Reuters, despite the millions of new customers (24 million by 2016, 7 million in the first year) who will be shopping for individual policies in October, health insurance companies are not venturing too far from their comfort zones.
For example, Cigna, one of the nation's largest insurers is planning on entering a "limited" number of exchanges. Even UnitedHealthcare says it will cap the number of HIX it will participate in at 25. The other big boys in the industry echo similar stands, citing they are slow-walking to exchanges because of uncertainty about whether the exchanges will be ready in time for a quickly approaching open enrollment date of October 1.
States that already have a robust and competitive marketplace are likely to fare better than those who only have a few insurers currently covering the population.
Effectiveness of Health Insurance Still Uncertain
A study examining Oregon's Medicaid population in 2008 showed that having health insurance had little impact on the health of enrollees. Results from the first year of the study were published in 2012, but there was no definite determination made about the correlation between health and health insurance.
This time, with two years of results, the study's author, MIT economist Amy Finkelstein, was ready to point to the data with the conclusion that having health insurance is no guarantee that the health of the person covered will be better.
The study followed two groups of Medicaid patients. One group of patients was covered; the other was not. The study found what it characterized as "no significant improvements" in the health of those who were covered by Medicaid, though some healthcare analysts may argue that the increased rates of diabetes detection and management as well as lower rates of depression are significant.
Oregon's study isn't the first to point out that health insurance doesn't necessarily lead to better health. But, the study could have a chilling effect on patient engagement activities if health systems and hospitals don't believe the small improvements made are significant enough to put a dent in chronic health conditions.
As Ezra Klein, writing in the Washington Post puts it, "The problem with the Oregon study is that it doesn't help us figure out how to make health care or health insurance better."
IPAB Stalled, For Now
The Independent Payment Advisory Board, created by PPACA and detested by Congress and the healthcare industry, will not start cutting Medicare spending in 2015, as was expected. The reason is surprisingly nonpartisan and based, astonishingly, on common sense.
Essentially, the component of the law that created IPAB also has language delaying the board's authority when Medicare spending doesn't outpace the Consumer Price Index (CPI).
Since Medicare's spending has slowed in recent years —a fact lauded by Secretary of Health Kathleen Sibelius—and that pattern isn't projected to change by 2015, the chief actuary Medicare notified the Center for Medicare & Medicaid Services that the IPAB wasn't needed yet. It'll be interesting to see how temporarily this delay lasts.
Hospital and health system leaders continue to have a poor opinion of WellPoint and UnitedHealthcare.
An annual survey of hospital leaders' opinions of large health plans, released Wednesday, shows both organizations fighting for last place among their peers, Cigna, Aetna, Coventry, Humana, and independent Blue Cross Blue Shield (BCBS) plans. WellPoint ranked worst in overall favorability for the second consecutive year.
"It's, in some ways, statistically astonishing that a health plan that only directly contracts in 14 states can be perceived as having the worst reputation overall," says Brandon Edwards, CEO of Revive Health, which released the National Payor Survey.
WellPoint is the country's second largest insurer, and is coming off a rocky 2012 that included CEO Angela Braly's resignation and five consecutive quarters of earnings decreases, though it seems the company's financial forecast has turned around with its most recent earnings report showing higher-than-expected gains.
The survey questioned 373 hospital and health system leaders responsible for negotiating managed care contracts. They ranked independent BCBS plans as the most favorable health plan to deal with, which is ironic, since WellPoint is the BCBS licensee for more than a dozen states. It shows that a company can't take for granted a strong brand name. It has also to deliver on the brand promise.
Independent BCBS plans were also ranked best at dealing with hospitals, paying claims promptly, and partnering with hospitals on new initiatives. Hospital leaders, however, ranked the health plan as paying the lowest reimbursement rates, proving there's no correlation, in this case, between rates and overall satisfaction.
Edwards likens BCBS to Medicare, saying that providers don't like the rates, but "they know what they're getting." The positive ratings some BCBS plans enjoy could position the carrier to weather the uncertain environment in 2014 when health insurance exchanges will be in full effect.
Here's the overall favorability ranking according to the survey results:
1. BCBS
2. Cigna
3. Aetna
4. Coventry
5. UnitedHealthcare
6. Humana
7. Wellpoint/Anthem
Interestingly, the hospitals' opinions of the large health plans mirror those of physician practices. MGMA-ACMPE conducted a similar survey of its members in November 2012. They ranked UnitedHealthcare last in overall satisfaction. In fact, the bottom three in that survey are the same bottom three in Revive's polling.
Historically, the relationship between health plans and the hospitals and physician practices has not been great, to put it mildly. Is communication between them at an all-time low? Probably not, but it doesn't bode well on the near-eve of health insurance exchanges, value-based care incentives, and other payment models that require providers and payers to share more information to aid in better value, care, and quality for patients.
And the survey shows hospitals moving toward more collaborative models of care with payers. Last year, only 36% reported being in a phase of ACO implementation; this year that percentage jumped to 51%.
There was also an increase in the number of hospitals reporting that they have two or more payer contracts that included established quality criteria. In 2012, 37% of hospitals said those contracts existed; this year, it rose to 47%—nearly half.
Despite the increase in hospitals and payers participating in some type of collaborative agreement this year, the lowest contracting priorities are the industry's top buzzwords: bundled payments, ACOs, and population health strategies.
The survey was conducted between February and March using a combination of phone and online portal interviews. Revive says respondents were screened to "make sure they were responsible for negotiating contracts with major health plans."
Of those responding, 17% were identified as C-suite executives, 19% were VPs of managed care, 37% were the equivalent of a director, and 27% were responsible for either contracting or revenue cycle activities.
America's health consumers are five months away from the government's grand health insurance exchange experiment. The idea of an insur ance exchange isn't new, but it's never been done on such a large scale, and some wonder if the exchanges aren't too much too soon.
Connecticut, which aims to "set the standard for state health exchanges," is one of 18 states running a state-based HIX, called Access Health CT. Its CEO, Kevin Counihan, a veteran healthcare industry leader, says his state's HIX won't be perfect, but it will be ready, and so will its Small Business Health Options (SHOP) program, despite receiving federal permission to delay SHOP until 2015. Counihan recently spoke with HealthLeaders Media about Connecticut's HIX.
HLM: Why is Connecticut moving forward with its SHOP exchange when the federal government has told states they could delay the program?
KC: We had planned to offer this as part of a federal requirement, so we built that into our business plan. I come from that SHOP/vendor world, so I knew firms that we could outsource to [that] would be more efficient than if we were to have our system integrators build it from scratch.
Most of the state-based exchanges are building this from scratch and I believe that, at least for our state, that was probably not the most efficient move. We could get up and running faster and cheaper by outsourcing, which is frankly, our operations strategy in general. So because of that planning, we were able to do it and it just seemed there was no reason not to offer it.
HLM: Are you afraid the small business owners will not be there without the weight of the federal government making it known that SHOP is an option?
KC: Not really. The reason why is because the small business market, like so much of the insurance business, is really driven by brokers, and the brokers are the most trusted advisor to small businesses on insurance purchasing. They're going to be the one business will turn to when they ask if this program is right for them, and they're very influential in the purchasing process.
HLM: Does outsourcing a large portion of Access Health CT's exchange make sense for Connecticut because it is a small state?
KC: No. It's really more of a strategic decision. We, on our team, believe that value rests more in marketing and outreach relations with health plan and product designs than it does with operational issues. Our goal is to look at focusing on those competencies that we think add value for our target market of individuals and small businesses, and outsource those things where we don't think we add as much value.
HLM: What kind of outreach will Access Health CT do?
KC: Our sense is that this push is best made as reasonably close to open enrollment as possible. The reason for that is because it's not a sexy purchase, like buying an iPhone, or a smartphone, or a car, or some new electronic gadget.
It's a category that, for a lot of people, they find it dull, expensive, and they associate it with less than good things. With health insurance, there's this thought that 'I'm only going to use it when something bad happens'. We're taking a consumer products approach to the marketing of the exchange, which means that we are looking at brokers, navigators, and in-person assisters as very valued distribution channels. We also think that's appealing to population segments, whether they be racial, ethnic, geographic, or other.
It's probably the most effective way we can make our message known, supported by an appropriate spend on media around sponsorships, around corporate affiliations, and around services that are going to make our exchange attractive to individuals and small businesses.
All the exchanges have got a key advantage, which is that we are the only channel for people to access tax subsidies. We think roughly 80% of our membership is going to come in that way. But, it may not necessarily stay that way, because I personally think that exchanges are a megatrend.
They enable defined contribution models for employers, so we're going to see the 401k of health insurance. So, given that model, we're looking at consumer marketing as segment-based, and to be frank, I'm going to see if we can start developing messaging in tandem with some of our neighboring states. A fear that I have is that with media market overlap, a Massachusetts message can be different for us than the Connecticut message, but the buy in Springfield, Mass., is going to spill over into Hartford, Conn. And vice versa and [we] run the risk of message confusion to enrollees.
On media purchasing, I think there's much better opportunity if several of the states come together and buy media together. We can get much better deals than if we buy it on our own. I think there are a lot of different ways we can be efficient, a lot of ways we can unify our messaging.
HLM: How confident are you that these exchanges will be up and running for open enrollment? And do you think that states, like yours, who are running their own HIX will be ahead of the curve?
KC: I really don't know the answer to that. It's a very complicated question. To be frank, we have got enough [of a] challenge getting our own state-based exchange up, and I'm much more aware of what our peer states are doing than the partnership states of the fully federal states.
Connecticut is going to be up and running on 10/1. Is it going to be running perfectly? No. Will we have contingency plans for it? Yes. I do think that this is a three-year project being moved into 10 months, and I got called by a pretty low level person at the White House about two months ago asking what they could do to help.
I said, "Give us another year." The integrated eligibility piece is very complex. It's never been done before like this. I'm very pleased with the progress we've made.
HLM: Do you have qualified health plans ready and willing to participate?
KC: We've received nonbinding letters of intent from five health plans. We're waiting to see by the end of April who firmly commits. It's a very complicated decision. Our strategy has been to be very collaborative with the plans. We don't believe in being top-down heavy or highly prescriptive, so we brought them in early to look at things such as eligibility formatting and data submission guidelines, and they've appreciated it.
That goes a long way in terms of building partnerships with [them]. We view ourselves as fundamentally a distribution channel that encourages informed choice, ease and simplicity of shopping, and a means to leverage our enrollment to start helping promote the discussion of lowering costs. So, if we had three to four health plans commit, I'd be very happy, and I think we'll get there.