The Upstream Healthcare Audience Puzzle
In healthcare marketing, it's often assumed high-visibility, consumer-facing communications are the primary areas of focus. After all, the response rates to these campaigns drive the Return on Investment (ROI) metrics shown in quarterly reports. But the healthcare ecosystem is complex and there are multiple upstream healthcare influencers who determine the total number of consumers eligible to come to your hospital or physician network for treatment.
Changes in influencer priorities or relationships can dramatically decrease or increase your pool of commercially insured prospects. So, a strategic approach to marketing requires being mindful of these upstream stakeholders, crafting aligned audience-based messages and conducting focused outreach that keeps your brand as a 'must have' in their decision-making.
Where Upstream Healthcare Influencers Come Into Play
For example, let's say there's a long-established manufacturer in your market with 500 employees. It's considered one of the best places to work because of advancement opportunities and good pay, so people stay a long time. Because of that, the workforce's average age has drifted up into the 40s. Some still use maternity services, but the claims history now includes more high blood pressure related encounters, hip/knee replacements and oncology care.
The cost of claims to the insurer rises to over 85 percent of total premiums paid by employer and employee. Months ahead of open enrollment, the insurer proposes a significant rate increase to the broker the company has relied upon for years. The company's CFO strenuously objects because the increase would squeeze its margins, forcing it to raise its own prices or cuts costs elsewhere.
The haggling between employer, broker and health plan begins in earnest and trade-offs are explored. These usually involve changing benefit structures, but in some situations, the manufacturer will change insurers completely or move to a narrow network product.
If your doctors and hospitals are 'high performing' and remain in-network, this can be a growth opportunity. For everyone else, that workforce and all those dependents just became unpersuadable through consumer advertising — they simply won't pay out-of-network rates to come to you.
I've seen these volume shifts undo the progress made through consumer-directed outreach.
How do your physicians, hospitals — and your marketing — influence this chain of events?
Yes, much of it is based on hard data about per-encounter costs, clinical quality, chronic illness management and readmission rates, but negotiations also have a perceptual side. What's the awareness and perception of your organization among these influencers?
Here's where a marketer's expertise can help:
Help your organization achieve quality and patient engagement goals by using your knowledge of persuasive techniques to improve shared-decision making efforts. According to Health Affairs, patients who are not engaged in their care incur costs up to 21 percent higher than patients who are very engaged.
Additionally, even small improvements in medication adherence, appropriate use of the Emergency Department, handwashing and post discharge follow-up appointments with Primary Care Physicians can pay off noticeably in quality and cost metrics.
A marketer's understanding of patient experience mapping, consumer psychology and communications tone can support patient and staff engagement efforts. Touch base with clinical and case management leaders and offer your help.
In the U.S, half of health insurance coverage comes through employer-sponsored plans. The yearly determination about benefits is a serious discussion that involves human resources/benefits, as well as finance/administration.
These functions are represented by individuals with distinct concerns.
The HR function, for example, knows that major changes in benefits or changes to provider networks can create significant dissatisfaction in the workforce. Do they know the scope of your hospital or physician group service area? Do you provide them with tools and information they can use to assist employees who need to select a doctor or facility? Are they familiar with your online or in-person shared-decision making efforts? Do they see you as actively improving care coordination for employees/dependents with chronic conditions?
If they view you as an ally in improving patient experience, managing unnecessary costs or as geographically dominant where their employees live, they will be more hesitation to break from you. Professional human resource chapters, events and publications provide a channel for you to raise awareness of your organization's efforts.
Because health insurance is complex, many businesses depend on brokers to evaluate competitive options. This practice is particularly true in small to mid-sized employers where decision-makers wear many hats. While the pricing on premiums — set by the health plans — is critical, they also know that chasing the lowest rate each year would involve too much workforce dissatisfaction for most employers.
Brokers should be aware of any new products in which your providers or facilities participate, your geographic coverage, efforts to reduce unnecessary healthcare costs and whether they can call on you to conduct employer on-site health events. Some brokers participate in local chapters of the National Association of Health Underwriters (NAHU) or may be part of large benefit firms that advise companies on a wide variety of insurance issues. These professionals can be reached through chapter activities, direct mail or account-based online marketing efforts.
Health plans tend to be large, matrix type organizations with influencers in clinical, underwriting and sales functions. The two best communication channels are health plan industry conferences focusing on Accountable Care Organizations, health management case studies, care coordination efforts and similar; and events organized by your Chamber of Commerce or leading business publications on healthcare-related topics also can be an effective channel.
In both environments, getting your clinical and executive leaders invited to serve on panel discussions or making case studies can elevate your organization's reputation as a thought leader and as a needed component in their provider contracts.
According to the Annals of Family Medicine, the average primary care physician has a panel of 2,300 patients. Health insurance contracts in combination with physician recommendations steer substantial volume for inpatient and outpatient services. Physician perception of your facility — and your marketing department's support of them — can shape volume and satisfaction.
Marketing's expertise can support recruitment of new physicians, provide easy-to-use and accurate provider directories that help providers be found by new patients, and through service-line marketing where consumers are more likely to slow down and consider their care options. Reach out to your physician recruitment function, contracting or medical staff affairs departments, and key clinical heads to assess needs and report on marketing efforts that support their interests.
In short, each of these upstream audiences significantly impact the number of commercially insured consumers who can access your services. When setting up your marketing budget, take an audience-based look at it and allocate some support to reinforce these important strategic relationships.
Michael Crawford became interested in healthcare listening to the conversations around the patio table as his parents and their colleagues talked about work. For the past 30 years he's used his marketing expertise to help medical groups, hospitals and health systems connect with consumers, physicians, employers, brokers and health plans. He advocates for a strategic approach to marketing, audience-based communications, coordination between marketing and customer service functions, and early inclusion of the marketing discipline when planning services. His work has earned more than a dozen awards over the past few years. He’s no stranger to healthcare reorganizations or healthcare reform, from the failed effort during the 90s to the implementation of the ACA to today’s efforts at repeal. His blog, Healthcare Marketing Survival Guide, offers advice for B2C and B2B healthcare marketers trying to chart their course during uncertain times. Connect with him via LinkedIn or follow him on Twitter @health_crawford.