A Few Thoughts on Healthcare Marketing Amid Neverending Brand Crises

Today’s news cycle operates at breathtaking speed. Headline after headline shoves its way into the spotlight and then is forgotten almost as quickly. So what does it mean for healthcare marketing when every refresh of the web browser seems to include another story related to healthcare?

Today’s news cycle operates at breathtaking speed. Headline after headline shoves its way into the spotlight and then is forgotten almost as quickly. So what does it mean for healthcare marketing when every refresh of the web browser seems to include another story related to healthcare?

Poor healthcare access. Astronomical health insurance premiums. Surprise bills.Medicare for All. Single Payer. Universal coverage. The list of healthcare grievances and proposed solutions goes on and on. The near-constant presence of these stories indicates a level of societal frustration that should worry all of us who work in healthcare.

Pick any one of these stories, and we can explain it. Poor healthcare access? Well, it’s related to a bottleneck in residency programs, a growing shortage of licensed providers and low reimbursements. Unaffordable health insurance premiums? That’s because the cost of covered services is high and demographic trends are driving more consumption. Medicare for All? Don’t you know that would result in hospital closures and massive layoffs? Each well-reasoned explanation becomes another brick in the wall.

healthcare marketing image
Credit: Getty Images by Jeffrey Hamilton

The seemingly unsolvable complexity of healthcare creates an atmosphere in which incremental improvements are unsatisfying, and Hail Mary visions of massive reform start becoming more palatable. That’s a risky spot to be in for an industry that dislikes market uncertainty. Industries that remain tone deaf to societal pressures become targets for disruptors. It’s starting to happen in healthcare around the edges, where the barriers to entry are lower, such as primary care and telehealth. Meanwhile, established players pursue vertical and horizontal mergers to keep patient volume in their delivery systems, which doesn’t address the underlying affordability and access challenges driving public discontentment.

As marketers, it’s important to understand and respond to the changing competitive environment. As communicators, we respond to media inquiries and help people navigate our systems. Let’s also remember that our scope of responsibilities includes raising difficult conversations about external perceptions with internal stakeholders. Without that ongoing engagement and a willingness to try new things, we may reach a point where the “system” is transformed around us through legislative action or competitive disruption.

How to Fix ‘Surprise Billing’ Before It’s Damaging Your Brand

The issue of “surprise billing” may not seem central to your responsibilities in the marketing department, but it could be seriously damaging your brand, especially with patients of healthcare organizations.

Life is full of surprises,” as the expression goes; often said to someone who was caught off-guard.

Hopefully, it was a good surprise, but sometimes it’s a real brand-killer. The issue of “surprise billing” may not seem central to your responsibilities in the marketing department, but it could be seriously damaging your brand, especially with patients of healthcare organizations.

For instance, surprise billing occurs when a patient goes to an in-network hospital, but is seen by an out-of-network provider. Most often, this occurs in the emergency department, radiology or anesthesia — because hospitals often contract out those functions to third-party companies without requiring them to take the same insurance as your facility. But everywhere your patient looks, there’s your brand. Once the out-of-network provider delivers care, it generates a bill to the patient at higher rates. The patient’s insurance company may only cover what it deems to be “reasonable and customary charges,” leaving the patient to pay off the balance. Surprise!

What ‘Surprise Billing’ Does to Your Brand

We know from multiple studies that many households live paycheck-to-paycheck, despite external appearances that suggest they are well-off. A Henry J. Kaiser Foundation study found that only 47% of households would immediately be able to pay an unexpected medical bill of $500.

Some patients fight back, but others will either try to pay it off with great difficulty or allow the bill to go to collections. In either scenario, that person has not only lost trust in your brand; they are likely to be vocal about it. This damage occurs under the radar of most marketers, who are focused on new patient acquisition.

The March issue of Health Affairs points to the impact of surprise billing on hospital choice. It examined medical claims from obstetric patients who had two deliveries between 2007 and 2014 and employer-based insurance. The authors conclude, “women who got a surprise bill from their first delivery where 13% more likely to change hospitals for the next one.” And it adds, “… in many cases, women used the information they got from their first experience to make more cost-effective decisions the next time around.”

This impact on hospital choice — from the original patient, as well as those they tell about their experience — strikes right at the core of your brand. And that’s what makes an inquiry from the marketing function entirely appropriate.

What Marketers Can Do to Prevent Surprise Billing

Does your facility use third-party companies to provide or supplement providers in emergency, radiology, anesthesia or other services? Does your agreement with those firms require them to accept the same insurance as your facility? If not, how does your facility alert patients that a provider might not be in their insurance network?

Once you know the answers, your skills are well-suited to developing a communications strategy that advises patients on how to minimize the risk of being seen by an out-of-network provider. Better yet, work with the patient experience team and your contracting group to bring those providers in-network.

That way, more of the surprises your facility provides are ones that are for your brand.

The Value of Marketing Simplicity in a Complex World

How many times have you heard, “the average consumer is exposed to ‘X’ number of ads each day?” It’s marketing simplicity that can make your message stand out.

How many times have you heard, “the average consumer is exposed to ‘X’ number of ads each day?”

The cliché often accompanies a pitch for a creative platform or placement intended to stand out in a crowd. In competitive markets, this mindset can drive growth in marketing budgets, as people become preoccupied with share-of-voice metrics and prestige placements. That’s why it’s worth remembering the subtext of the cliché is simplicity.

It’s true that consumers are inundated with commercial messages in more forums and formats than ever. Stimulating demand in a saturated advertising environment requires reasonable frequency. More importantly, however, it requires messaging based on your audience’s motivations and interests, simplified for each stage in the awareness-to-conversion process.

Message simplification can be challenging in healthcare. Topics are often complex. Accessing services may vary, based on the type of insurance. Technical points of differentiation important to those in the subject matter domain may not be drivers of choice for other audiences. And enthusiastic stakeholders may view white space as a missed opportunity to shoehorn in additional details believing that it strengthens the value proposition, rather than making it harder to find.

To simplify your messages, adopt a nurturing approach with prospects, rather than attempting to “close the sale” with the first touchpoint. Many healthcare services are “considered purchases,” meaning prospects may delay taking action, even on services they need. For example, people with chronic hip pain may delay taking action on hip replacement surgery until discomfort, over-the-counter medications, heating pads and stretching exercises are no longer tolerable. Prospects, fearful of a procedure, may turn away from a “hard-sell” approach, but be open to learning about your orthopedics program in smaller, less frightening increments. By deploying bite-sized content over time, you create familiarity, build trust and place competitors at a disadvantage for consideration.

So how do you get others in the organization to understand and support a simplified messaging strategy? Take a traditional conversion funnel and customize it for your needs. Above the funnel, indicate the phases and questions consumers might pass through as they come to terms with their healthcare needs. Below the funnel, show how the content and timing of your messages align with each stage of the patient journey. Build in response mechanisms that allow ready prospects to advance to conversion, while other prospects continue to be nurtured at their own pace.

This funnel visual aid can help internal stakeholders understand why a paced approach with simplified messaging will be more successful than one that delivers too much information at one time.

How to Talk About Healthcare Marketing Strategy, Not Just ‘The Thing’

For many in healthcare, “marketing” is the department that produces fun stuff like brochures and giveaways, and not a strategic enterprise. The problem is that expertise is hard to see, while a brochure is in plain sight. How do you respond?

Does this seem familiar? A chief of service has been difficult to reach but then suddenly calls and wants to sit down to talk about “marketing.” At the meeting, it quickly becomes clear that all she wants is a brochure or an ad or a give-away item, not a marketing strategy. How do you respond?

Is Marketing Just for the ‘Fun Stuff’

For many in healthcare, “marketing” is the department that produces fun stuff. This reputation was well-deserved because healthcare marketers had been slow to pivot to data-driven, consumer-oriented methodologies used in other industries.

Once, a senior leader remarked I had “the best damn job in the whole place” because of all the fun he imagined we must be having in the department. He went on to describe a commercial where people avoided meetings with finance and operations but looked forward to going to marketing meetings because of the music and dancing. At the time I laughed outwardly and grimaced inside.

This legacy lives on. It persists despite the remarkable shift in healthcare marketing to research, strategy, technology, audience-based messaging, consumer journeys and understanding the operational and financial elements needed to generate ROI.

The problem is that expertise is hard to see, while a brochure is in plain sight. So internal customers will still call you for “the thing.” You can choose to view “the thing” as an albatross or an opportunity.

3 Ways to Change the Conversation

Now you’re seated around the table and realize they are using the term “marketing” very loosely. All they want is a specific type of deliverable. Do you fulfill the request? Do you interject a more accurate description, “oh so you are looking for a promotional piece”? Or do you try to steer them toward a bigger picture perspective? Ideally, the answer is all three.

Mentally you need to frame your approach as “yes, and…”

  • “Yes, we can do the brochure. And this gives us an opportunity to gain a deeper understanding of your audience and their concerns, so we can address them here and on the website. That would help increase the number of new patient appointments.”
  • “Yes, we can produce the give-away item for the conference. And we can also put together a nurture program that communicates with your audiences before and after the conference, so they keep you in mind for referrals.”
  • “Yes, we would be happy to do a promotional plan for your department, and if we included that as part of a broader marketing plan, we could help grow service line volume and show a positive Return on Investment.”

These responses can open the door to market research, audience cultivation strategies and less comfortable discussions about appointment wait time, revenue and contribution margin, and the patient experience. It may not work every time, but it conveys the actual value you can bring and positions your team as more than the ‘department of stuff.’

Why Healthcare Brands Should Push for Annual Wellness Visits

Open enrollment tends to consume healthcare marketing teams this time of year, but there is another piece of low-hanging fruit — the Annual Wellness Visit. By increasing the completion rate of AWVs by Dec. 31, you provide a meaningful service for patients, generate revenue for physicians and potentially boost your organization’s risk-adjusted reimbursements.

Open enrollment tends to consume healthcare marketing teams this time of year, but there is another piece of low-hanging fruit — the Annual Wellness Visit (AWV). By increasing the completion rate of AWVs by Dec. 31, you provide a meaningful service for patients, generate revenue for physicians, and potentially boost your organization’s risk-adjusted reimbursements.

Anyone enrolled in Medicare for longer than 12 months qualifies for a once-a-year AWV. This is a preventive health benefit offered at no cost to the patient. The AWV is a longer format office visit between a patient and provider to complete a Health Risk Assessment (HRA), discuss health concerns and document conditions that ultimately factor into the patient’s risk score. Because the visit is not associated with a specific health complaint and request for treatment, it can be harder for a patient or provider to see its real value. That may be one reason why only 14%-19% of senior populations typically have AWVs, but it offers four notable benefits:

1. The AWV Helps the Patient and Doctor Forge a Better Relationship

These appointments take 45 minutes to an hour, longer than a typical visit. The visit is a discussion that touches on family medical history, assessment for depression or cognitive impairments, a review of specialists seen by the patient, and other items. The appointment duration and nature of the discussion fosters a relationship that reduces doctor hopping and can improve word-of-mouth referrals.

2. Patients Who Have AWVs Tend to Have Better Health Outcomes

The whole purpose of the AWV is to translate information from the HRA into a Personalized Prevention Plan, all made possible by the extended conversation time. Because the approach is a form of shared decision-making, patients are more likely to feel an obligation to try and live up to it. And, as providers document specific clinical actions needed over the coming year, completions of those quality metrics also rise.

3. Some Medicare Plans Pay a Bonus

AWV is a focus of Medicare Advantage plans, and some provide bonuses to organizations that raise AWV completions

If your organization has an easily definable base of seniors, ask your contracting department if any of your health plan partners are offering AWV incentives. In some cases, you may be able to draw on health plan funds to offset your costs in promoting the service to your qualified patients. Mailers to patients, newspaper ads, messages via your patient portal, outbound calls and targeted digital ads are all ways to drive AWV appointments that occur by the end of the year. The end-of-year ‘expiration’ can be a motivating factor for patients who seek to maximize their health benefits while others find value in starting the new year off ‘right.’

4. More Time to Code Health Risks

The AWV gives the provider more time to code appropriate health risks and conditions into your EHR system, which can increase risk-adjusted reimbursements over the coming year.

Marketers focus on new patient acquisition, which is expensive, but may overlook substantive patient engagement tactics that impact reimbursement levels. Any communications directed to providers should indicate the Evaluation and Management (E/M) service code and a link for resources on how to bill if treatment or diagnostic modifiers need to be applied.

Although open enrollment is a natural focus for this time of year, a last-minute push for AWVs or a year-round strategy for communicating this benefit to older patients can yield financial and quality results for your organization.

Open Enrollment and the Reluctant Health Insurance Shopper

Many industries have seasonal patterns. If you are a marketer, you know the ebbs and flows of your industry and invest in a significant marketing presence during the peak season. In healthcare, the major season is “Open Enrollment.” From now through mid-December, consumers will see a surge in ads for medical groups, hospitals and health plans. Is it worth it?

Many industries have seasonal patterns. If you are a marketer, you know the ebbs and flows of your industry and invest in a significant marketing presence during the peak season. In healthcare, the major season is “Open Enrollment.” From now through mid-December, consumers will see a surge in ads for medical groups, hospitals and health plans. Is it worth it?

It should be. Open enrollment consists of three overlapping windows of opportunity:

  • Consumers who get health insurance through their employer will have an opportunity this fall to renew or change their coverage for 2019. This selection period, depending on your company, may begin in late August and usually wraps up by Thanksgiving.
  • Seniors who have Medicare Advantage or traditional Medicare can change plans during a window of time specified by the federal government. The open enrollment period is October 15 — December 7, 2018, for coverage changes that take effect January 1, 2019.
  • For consumers who purchase coverage through one of the exchanges, open enrollment starts on November 1. Those who use the federal exchange, Healthcare.gov, have a deadline of December 15, while some state exchanges have later deadlines.

That means most adults in the U.S. who have health insurance can evaluate their options and potentially make a switch this fall. So it is the peak enrollment season not only for health plans but also for the hospital networks and medical groups that want to persuade you to have them ‘in network.’

The problem is that that most people do not want to engage in comparison shopping for health insurance. In fact, a higher percentage of people will compare and switch auto insurance coverage than health insurance coverage — even though they spend far more on health insurance annually[i].

About 85% of people will just let their current coverage renew. At many companies, the percentage of roll-overs is much higher. Why? In general, people view open enrollment selections as complicated and likely avoid reconsidering options they may not fully understand. Knowledge of health insurance terminology varies. And people have difficulty evaluating the trade-offs between premium and deductible amounts in the context of their tolerance of financial risk. As a result, the comparison shopping behavior so common in other types of considered purchases is less pronounced when it comes to making healthcare-related purchases.

So is investing in open enrollment marketing worth it? It depends. Your competitors are pouring money into the market this time of year, as are other seasonal advertisers for elections, new automotive models, holiday decor and gift-giving. Rates for traditional and online paid media will climb significantly.

Healthcare requires both upstream marketing as well as direct-to-consumer seasonal marketing to convert prospects. The success of open enrollment depends on the efforts you have undertaken in the months leading up to peak season. If your conversion elements are not in place — effective online targeting, an easy to navigate website, a trained customer service team and a significant ground game — then you may be paying a premium that will make your return on investment metrics look even worse.

Note: [i] In 2014, 39% of auto insurance customers compared coverage and 29% switched carriers as a result, according to J.D. Power. That same year, only 15.8% of commercially insured adults who retained coverage made any sort of switch for all reasons (5% switching products within a carrier; 10% switched carriers; 2.5% dropped coverage), according to ACAView. That year the average annual cost of car insurance paid was $907.38 in 2014 according to Quadrant Information Services. The average annual contributions for health insurance for a single adult totaled $6,025, according to Kaiser Family Foundation

Customer Motivation: What Difference Does It Make?

The decision to undergo a healthcare procedure — and by whom — can be a complicated, emotional, non-linear journey. Understanding the customer motivation can make the difference between them moving forward with your provider, going elsewhere or simply taking no action at all.

Not long ago a marketing colleague remarked, “What difference does it make what their motivations are?”

To her, it was all about logic. A consumer in need of a healthcare service would conduct an online search, go to a website and move through the marketing funnel if the right engagement elements were in place. That made me wonder, are we losing sight of what makes a person tick? The customer motivation?

The rise of digital marketing makes it easy to track activity and measure conversions from the top of the funnel down through appointment-making. By using A/B or multivariate testing, you can make page tweaks to see if your throughput improves. But this data-based view of the world doesn’t provide visibility into the emotional context that drives some health care decisions.

There are different types of health care services, of course. Simple things like getting a primary care appointment or a flu shot can be based on convenience and almost transactional in nature. But many other health care decisions are ‘considered purchases.’

The decision to undergo a procedure — and by whom — can be a complicated, emotional, non-linear journey. In these instances, understanding the prospect’s motivations can make the difference between them moving forward with your provider, going elsewhere or simply taking no action at all. Understanding customer motivation is particularly important among the ‘aging in’ demographic where respect and sentiment are the norms.

We know this intuitively in other situations. When you are considering a purchase for home or work, you’ll look at information about features, pricing and warranty, but all things being equal, chances are you will buy from the company or representative who “gets you.” An organization that explicitly recognizes and embraces your customer motivation is building a bridge that you are more likely to cross.

5 Emotional Elements That Add Customer Motivation to Your Marketing

So how can you factor in emotional elements and conversion funnels in your marketing?

  1. Identify the services that are likely to be considered purchases. These are usually for chronic conditions where the consumer adapts by reducing activities, self-medicating or living in a constant state of worry.
  2. Use physician interviews or patient questionnaires in those service lines to probe for the length of time they have had the condition and ranking the factors (motivations) that drove them to seek treatment. Some patients may be willing to provide a video testimonial with the understanding it is intended to help others who are wrestling with a similar decision.
  3. Consider adding subtle variations to your online downstream content so that a visitor can see others with similar motivations. This provides validation to the prospective patient and places your facility in the context of ‘getting it.’ Tag your response mechanism from each section so any CRM nurturing campaign can leverage this insight.
  4. Use different motivating factors in your external messaging. Consider using call tracking so someone who is responding to a “play with the grand kids” message sees a different phone number or URL link than the consumer motivated by “being tired of the pain” or “wanting to travel again.”
  5. Segment your online reports so that you can see the volume generated by each type of message and rate of fall-off through the funnel. Remember, higher inbound volume doesn’t always equate to the highest percentage or volume of conversions.

Addressing Unspoken Fear in Healthcare Marketing

There’s a lot of fear in healthcare marketing — the unspoken fears that lurk in the minds of consumers, blocking their ability to absorb your content. Marketers who don’t address these nagging worries in the conversion funnel risk turning off prospects who are otherwise excellent candidates for that service line.

Healthcare Marketing Strategy
Credit: Pixabay by Gerd Altmann

There’s a lot of fear in healthcare marketing. I’m referring to unspoken fears that lurk in the minds of consumers, blocking their ability to absorb your content. Marketers who don’t address these nagging worries in the conversion funnel risk turning off prospects who are otherwise excellent candidates for that service line.

Fear is a funny thing. A little of it keeps you alert and causes you to be more careful. Too much fear and you cognitively shut down. The difference — in the first scenario you believe you can do something to minimize the danger, while in the other scenario you don’t know of a solution and you feel paralyzed.

Imagine marketing a service line for a serious health condition. Your reader may have insurance, but there’s a negative inner dialogue unfolding in his mind: “I will miss work. If I miss too much work, I might lose my job. If I lose my job, I won’t have life or health insurance. If I don’t have insurance or a job, I could bankrupt my family. They would end up with nothing.”

The prospect has catastrophized a possible outcome and now wants to avoid your messaging entirely out of both fear and guilt. And because these internal monologues are unspoken, it’s very difficult to get the kind of feedback that enables you to make improvements. If you have service line campaigns that are not performing, ask yourself if fear might be getting in the way and how you can break down those barriers to conversion.

You can address unspoken fears at several places along the funnel, starting right at the top and adding more detail along the consumer journey:

  • At the top of the funnel, consider adding a truthful, positive indicator into your outbound messaging that contrasts today’s treatment with what was available years ago. Advances in knowledge, techniques, and technology can help a fearful consumer move beyond legacy emotional assumptions and create a narrow window of reconsideration.
  • On your campaign page, proactively address common concerns while also streamlining navigational flow to your call-to-action. A generic FAQ link may be too subtle for consumers with nagging worries. Consider clearly labeled links such as “Time away from work,” “Insurance accepted,” “How outcomes have changed,” “Managing out-of-pocket costs” or similar topic-specific labels. Each item or grouping should conclude with your CTA.
  • System-generated emails triggered by user submissions as well as nurture campaigns should include links to content that normalizes typical concerns and provides reassurance that these can be discussed comfortably at the appointment. Some patient no-shows are caused by nagging worries that cause people to disengage even before an in-person consultation.
  • Consider adding a simple form at check-in that asks about the patient’s concerns and provides pre-populated topics to select. Patients can become surprisingly quiet when the doctor enters the room. If the provider knows what topics are weighing on the patient’s mind, the dialogue can be more meaningful and a foundation of trust developed.

And throughout this process, work with your organization’s best-performing providers as well as financial counselors, patient navigators, social workers and philanthropic foundation for insights that help improve responses to common patient concerns.