Cover Story : Truth in Advertising

Mayo Clinic puts straightforward direct mail creative to the test

Plug the words "Mayo Clinic" into any search engine and thousands of news results pull up. Most of them concern medical breakthroughs, and all are dated within the past month.

The Rochester, Minn.-based nonprofit medical practice—with operations in Minnesota, Phoenix and Jacksonville, Fla.—readily admits that it specializes in treating complex illnesses. Heads of state, literary greats, athletes, actors and musicians have all sought treatment at its hospitals.

Yet the institution that recently provided a liver transplant to Gregg Allman, a founding member of the Southern rock group The Allman Brothers Band, will hardly be shouting that news from the rooftops.

This conservative, professional attitude—coupled with its cutting-edge expertise—appears to be expected from Mayo Clinic by the general public. That's true, at least, if results from test after test performed by its marketing department, which regularly seeks out subscribers for its two newsletters—Mayo Clinic Health Letter and Mayo Clinic Women's HealthSource—are any indication.

However, much like its thousands of physicians, scientists and researchers, the clinic's marketing department regularly finds breakthroughs and produces results. In its latest achievement, the marketing team tweaked its direct mail creative for its newsletter subscriber campaigns and saw a 28 percent lift in response over its control. Putting this achievement into context, the response lift coincided with a 23 percent newsletter price increase, postal rate increases and a then-looming recession.

"What I decided was, I wasn't going to ignore the elephant in the corner," says James Hale Sr., marketing director, patient and consumer market, global products and services. "And I directed our lead copywriter … to take the tough economic issue and actually acknowledge it and demonstrate the good value and wisdom in buying our newsletter."

Tried and Found True
Copy, offer and format are among the many elements Senior Marketing Manager Gary Peterson includes in the 10 to 15 tests he performs each quarter, Hale says.

During recent tests, it's become crystal clear what Mayo Clinic's newsletter consumers expect from the institution.

Health Letter readers, who learn about disease and conditions, tend to be 60 or older. Women's HealthSource readers tend to be 55-year-old females. For them, the subscriber offer is enclosed in an 11" x 14" manila envelope package, in-line produced and containing an eight-page letter printed on lined notebook paper.

While those internally may wonder why the envelope has to be so big, Hale points out that the marketing team recently ran a test and found that a standard, 8.5" x 11" business envelope lost 30 percent in response. Even a small change—just half an inch during a 10.5" x 14" envelope test, which the team repeated for verification, resulted in a 5 percent decrease in response, Hale says.

An even louder alarm bell rang when the subscription letter went from eight to six pages, reducing response rates by double-digit percentage points, he says.

As if there needs to be further proof that consumers want Mayo Clinic to approach them in a professional manner, tests show that personalizing the prospecting letters doesn't work.

"The best copy approach tends to be the best across segments," Hale says. "And, I'll tell you, that was a great relief ... because [it's] hard enough that we have two publications. We have the Health Letter, we have HealthSource and we have 10 to 15 tests a quarter to deal with. Could you imagine, now, if we had multiple control messages?

"Now, we'd have done that if it paid for itself," he explains. "But we did certain elementary segmentations to see if different copy approaches would yield a better result. So we had a male version and a female version. We had a patient version, because we know where there are patient relationships vs. a general public. But all groups tended to respond most favorably to the best offer presentation. And variations within that theme didn't appear to help. And we tested it in a number of different ways. Certainly, nothing ... rose to the level of significance where we would want to do things differently."

To clarify, Hale says, the marketing team did rule out a male vs. female personalization for the Health Letter prospecting copy. But, obviously, the HealthSource copy is geared toward women.

"But when we took the Health Letter," Hale explains, "and said, 'OK, now. What would happen if, to John Smith, we only talked about prostate disease and other ailments that mainly affect men? And for women on the list, we're only going to talk about women's health issues. Does that make a difference?' And it hurt us.

"And the only thing that we could conclude [was] that when John got our mailing, his wife opened the package," Hale continues. "When we wrote to women only or heavily focused on that, she didn't see enough value to her family to want to consider it. So when you had both elements in there, it just tended to work better."

So, basically, Hale found out he and his team were doing it right.

"We were getting all kinds of feedback from consultants," Hale says. "'You need to be more promotional. You need to have the word 'free' out there. You need to use bolder copy, bolder colors.'

"I'm telling you," Hale continues, "I was able to get permission to do some small testing to see if these elements were, in fact, critical. And then we were going to have to evaluate, 'Should Mayo Clinic be changing its guidelines somewhat, in recognition of what the market needed?' But every time that we tested sensational things—shout-out copy, 'Get your free issue,' or to have a flier in there that was canary yellow with a red headline ... things that consultants were advising that we do, we would see a decrease in response. When we act like Mayo Clinic and the perceptions that people have for a prestigious medical institution, people are more responsive to it. I guess it makes the communication more credible. … That's why, maybe, my packages don't look as sensational and fluffy as you might think a large package ought to be."

Facing the Truth
"These days, you don't usually get much for $1.97. But that's the price for what could be one of the most valuable purchases you ever make," writes freelance copywriter Mark Johnson, in a newsletter subscriber offer that would change history for the Mayo Clinic.

This lead in the September 2007 Health Letter prospecting letter solved many challenges by facing, head-on, the main one consumers were experiencing—the recession that was officially recognized as beginning in December 2007.

But the letter had more to solve. In July 2007, Mayo Clinic increased its one-year price for the Health Letter from $23.64 to $29.55 and implemented the change in its September 2007 promotion. Bumping up the cost was supposed to offset the postal rate increases involved in sending, at the time, five million pieces quarterly and a total of 20 million annually.

"I did it as a reaction to, 'The economy is tanking. We need to do something about it,'" Hale says. "And I suggested that we try a tough times approach. So that's what drove the change in the creative."

In the past, Hale says, Mayo Clinic charged only for the 12 monthly issues. That included three free special reports. Now, the special reports are included in the price increase, which means that $1.97 multiplied by the 15 issues equals $29.55.

The creative highlighting the change seems to have worked. Hale says the September 2007 test resulted in a 28 percent lift over the control, which was already a solid performer.

"[The result] just completely blew us away," Hale says. "In fact, it was such a strong consumer response that we violated our own rules, which say 'When you test, you've got to do a validation test before you roll out.' I said, 'When I see 28 percent, I'm going to go with that. And I'll back-test the [former] control as a test panel ... in the next wave.'"

Since then, 2009 saw a net paid response of 2.3 percent, second only to the tied results of 1996 and 2006—which were 2.34 percent, the highest in the 27-year history of the Health Letter.

The creative even made its way into the renewal notices, causing a rise in response there, too.

Mailing Smarter
But the creative needed to be coupled with smart mailing tactics. Enter Mayo Clinic List Manager Greg Shevlin.

"I've had Greg running in circles trying to figure out, 'How are we going to keep our direct mail metrics calibrated so that we continue to mail profitably?'" Hale says. "So Greg has done a couple things. He's worked on creating an in-house expire model that takes a look at people that had previously purchased our newsletter and then failed to renew. And working with some analytical consultants, we've come up with models that allowed us to go as deeply as 10 years back in time and revitalize subscribers. So that became a major new source of names to supplement the loss of names that were available to us from the outside, because a lot of publishers reduced their mailings in the wake of the economy and in the wake of the postal increases. So we were having less lists available externally ...

"The other thing that Greg worked on that I think was kind of a breakthrough for us was taking a look at individuals that ordered our free trial issue," he continues. "We found that there was a whole class of lists that loved the freebie, [but] wouldn't pay. So we had high gross, low pay. But the high grosses were such that, 'Gee, if there were only a way that we could capitate that list,' which is when you take the better part of it. So we worked and created, basically, ZIP decile models that we were able to run against certain high gross, low-pay lists. And sure enough, [we] were able to make those work. So we were able to take some of these lists that we had to park on the side and bring them back into the pool."

With a customer database of about 9 million and a new approach to copy, Mayo Clinic's newsletter subscriber acquisition program came through the recession strong.

Hale says: "Product sales were $30 million prior to recession, they dropped due to our cutbacks in marketing in 2008, and then climbed back up to [more than] $28 million. But in 2009, we served fewer subscribers at higher price points, and so our net income was about the same as before [the] recession."

In other words, the results from 4 million quarterly subscription promotion pieces yield as much profit as the old campaigns. And 600,000 Health Letter and 180,000 Women's HealthSource paid subscribers provide about as much net operating income as 2007's 900,000 total subscribers once did. "Our results continue to get better now as the economy's improving," Hale adds.

Continuous Improvement
Fully committed to testing, the Mayo Clinic's trial balloon acquisition letters do still come out duds sometimes.

Hale says during the health care reform debates, his team tested a letter acknowledging the situation.

"It was a disaster," he says. "We tried to put a positive spin on it. We said, 'We don't really know where health care is going to land and how it may affect you. But one thing is certain, you do need to maintain and take better control over your own health.'

"Literally, it was right on the heels of the big debates," Hale continues. "And we got slammed. I mean, it was double digit[s] behind."

But some concepts are worth pursuing, despite initial failures.

Mayo Clinic introduced the online edition of the Health Letter with its January 2008 issue, meaning that the Health Letter website actually went live in December 2007.

"When we first introduced [copy to this effect], 'And, by the way, not only do you get this great monthly newsletter, but you'll also have an archive, free of charge,' [the direct mail promotion] actually lost response," Hale says. "And I think it's because we got in the way of the simple premise, 'We have a newsletter. Would you like to subscribe?' We threw in this Internet component. And maybe the folks that we were reaching really weren't quite comfortable with the Internet. They were really magazine buyers and newsletter buyers. So we kind of backed off on that, but then reintroduced it. We were kind of tenacious. I felt that was an important element of our future. So over time, we've been able to find ways to either introduce [the website and online archive] as a response-neutral element or as an enhancement to response."

And newsletter efforts are evolving in more ways than the Mayo Clinic's publishing channels.

"Direct mail certainly continues to be the [acquisition] king," Hale says. "We see steady, incremental gains in Web orders; particularly since we introduced the online edition, because I think that does reach people that are Internet savvy and comfortable with that medium. And we're just seeing, gradually, more and more demand coming through the Web."

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