From ACA to Medicare: 5 Answers to Healthcare Marketers’ Legal Questions About Insurance

As healthcare marketers and communications professionals, this swirl of forces hits close to home. Are you able to describe the various paths of reform to internal or external audiences?

In the spring of 2010, healthcare marketers saw the Patient Protection and Affordable Care Act (ACA), nicknamed ObamaCare, become law. It was the largest expansion of health insurance coverage since the establishment of Medicare and Medicaid in 1965. More than 50 years have passed since healthcare became more accessible, yet it remains a fiercely debated topic among politicians and is now the No. 1 concern among voters, according to a new poll from RealClear Opinion Research.

The tug-of-war between those who view healthcare as a guaranteed right and those who believe the government should have a minimal role is shaping up to be a driving force in the 2020 election. The processes used to “right-size” the government’s role shows we remain deeply conflicted. Court cases in different jurisdictions return victories and defeats to both sides. Voters generally approve Medicaid expansion when it’s on a state ballot, but elect federal representatives with divergent views. Why is this still so complicated?

The U.S., which has the world’s most powerful armed forces, spends 3.6% of its gross domestic product (GDP) on the military. Contrast that with the 18% of GDP spent on healthcare, and you start to get a sense of the scale of the industry and the Rubik’s Cube nature of how its pieces depend on each other. Those who view healthcare as a matter of seeing the doctor when you are sick tend to see the upside in expanding coverage. Those who think of it in economic terms tend to worry about potential disruption to jobs, given that healthcare is the largest source of employment in many towns. And those who view it as a commodity tend to think the marketplace should be left alone to sort it out.

As healthcare marketers and communications professionals, this swirl of forces hits close to home. Are you able to describe the various paths of reform to internal or external audiences?

  • The ACA (today’s status quo): For Americans who do not receive health insurance through their employer, the ACA removed restrictions on individual policies, such as exclusions for pre-existing conditions, lifetime limitations on benefits, and widely divergent premiums based on your health. Of course, the ACA also set up online exchanges where you could see if you qualify for certain subsidies to help you purchase different levels of gold, silver, or bronze coverage. Some people objected to the “individual mandate” that penalized taxpayers as a means of encouraging them to get coverage. Since its passage, the penalty for the mandate has been reduced to $0.
  • Single-Payer: Single-payer refers to the federal government reimbursing physicians and hospitals for services provided to patients, but doesn’t explicitly tie the reimbursement amounts to those of an existing program, such as Medicare or Medicaid. The uncertainty creates financial uncertainty for providers. Single-payer would, for the most part, eliminate the role of health insurance companies, which advocates believe would save money on administrative “waste” and opponents see as removing choice from the marketplace. Consumers who have “skimpy” health coverage might have more services covered under single payer, while those with richer benefits through commercial insurance might have fewer services covered.
  • Medicare-for-All (multiple flavors): Medicare-for-All is an expansion of an existing federal program accepted by almost all providers. Several proposals generally fall under the “Medicare for All” moniker, making it more complex to sort out. The name gives the impression the covered benefits would be similar to original Medicare parts A&B, but most proposals envision benefits like those available through Medicare Advantage, with benefits for vision, dental, and prescription drugs. Some proposals use traditional Medicare as a starting point for calculating reimbursements, while others use a more ambitious “global payments” approach for hospitals and standard rates for other types of providers. Consumers could purchase supplemental insurance to access services that are not covered. There would be no monthly premiums because tax revenues would cover costs. Medicare, Medicaid, and CHIP would be discontinued in favor of Medicare-for-All.
  • Medicare Buy-in: Medicare Buy-in is a smaller expansion of Medicare than envisioned under Medicare-for-All. This proposal would allow people 50 years old and over to pay a premium for the coverage provided under traditional Medicare or Medicare Advantage. The buy-in premium would be expected to cover 100% of administrative and benefit costs, although the enrollee may qualify for subsidies that bring down monthly premiums. Consumers could also purchase supplemental coverage, preserving a role for commercial insurance companies for that segment, as well as for younger consumers. Reimbursement rates for providers would mimic Medicare payment rates.
  • Universal Coverage: This is a goal rather than a pre-defined approach. As the name implies, Universal Coverage means everyone has access to healthcare, but it does not necessarily mean all services would be covered and it does not specify which of the above methods would be used to achieve it. In some countries, Universal Coverage also means that the government would control pricing, which critics say leads to an overall decline in the quality of care and advocates view as being more socially equitable.

As the debate over healthcare heats up — yet again — it may produce confusion and fear among people who have come to depend on specific programs, even if those programs have well-known flaws. Real change isn’t likely until after the 2020 elections, and the direction of that change will depend on who voters send to D.C. to represent them. In the meantime, be prepared to answer a lot of questions from worried patients.

Benchmarking: There’s No Such Thing as an Average 2% Response Rate

It seems easy enough to answer the question: How to know if a marketing campaign measures up? But managing client expectations (whether they’re internal or external) is sometimes more fuzzy

It seems easy enough to answer the question: How to know if a marketing campaign measures up?

Often enough, there are predefined business objectives, acceptable margins for profit and cost, and a marketing return on investment that is straightforward enough to calculate. If one is able to know any and all of these markers, then one can know if a marketing campaign, or even a single tactic, is making the grade.

But managing client expectations (whether they’re internal or external) is sometimes more fuzzy. And a marketing execution doesn’t always go according to plan, prompting investigations on what might have gone wrong. (I’m still surprised how testing is underutilized, for example.)

On the happier end of the spectrum, stellar results might prompt a whole other set of questions: “Did we really beat the long-standing control? This campaign performed gang-busters, how does it measure up to efforts of our industry peers? Is this campaign award-worthy?”

As a public relations professional in the world of direct response, I’ve often been asked to help an agency or marketing client understand how good or bad a particular marketing result might be. When the question is about results that are less than expected, there is often internal wrangling about the creative, the list and/or the strategy — any of which might be the culprit. When the results are fantastic, clients often want to know, are we beating whatever the competition may be up to.

In both scenarios, among go-to options are various industry research sources. Anyone who has a subscription to Who’s Mailing What! archive (direct mail, email), or taps eMarketer or Econsultancy (digital and mobile information), or steps up to Gartner, Forrester and the like for subscriptions to qualitative reporting, certainly has access to great data and idea stores.

I personally keep a copy of “DMA Statistical Fact Book” (annually published) and “DMA Response Rate Report” close at hand. The “DMA Response Rate Report’s” 2015 version is recently published, and is available at the DMA Bookstore. Both are understandably Direct Marketing Association top-sellers.

The “DMA Response Rate Report” aggregates data from respondents — providing a true benchmarking resource. And it breaks response data out by media, and by industry (selling cars is not selling clothes) which gives marketers a helpful guide of what to shoot for and expect. It’s worth a whole other post to delve into its insights, but IWCO Direct and SeQuel Response recently offered some. A quick inspection of the report can let marketers know what they might expect from an otherwise well-executed campaign.

And I’m happy to say to some clients, too, as another benchmark, that they should enter the International ECHO Awards. It’s perhaps the best way to be recognized for achievement (beyond the paycheck). With judges inspecting the world’s best in data-driven advertising, an ECHO trophy says that a marketing team, agency or organization knows its stuff. This year’s competition deadline for entering is July 10, and DMA is offering a Webinar on May 19 to give tips and insights from the judges themselves (speaking will be yours truly, joined by fellow Target Marketing blogger Carolyn Goodman of Goodman Marketing Partners and Smithsonian’s Karen Rice Gardiner). Have only five minutes to spare? You can always hear directly from Carolyn here about the entry process.

Enter early and often! I’d love to point to your campaign as a “benchmark” later this year.

Money Loves Speed

“Money loves speed.” This phrase has been quoted so often that it’s difficult to know who should be credited for coining it. In an “always-on” digital world, it’s a saying that reminds us that we need to encourage fast action to make a sale, and to act fast when a customer needs help. Today, I contrast the customer service of two digital companies—both household names and both who serve direct marketers—and suggest four money-attracting recommendations

“Money loves speed.” This phrase has been quoted so often that it’s difficult to know who should be credited for coining it. In an “always-on” digital world, it’s a saying that reminds us that we need to encourage fast action to make a sale, and to act fast when a customer needs help. Today, I contrast the customer service of two digital companies—both household names and both who serve direct marketers—and suggest four money-attracting recommendations.

One of the many aggravations for any customer is the inability to get fast answers from a company when help is needed. It’s especially a problem with online merchants. In the digital age, it’s too easy to hide behind an online form.

The contrast of service and responsiveness from Facebook and Google, in my experience, is significant. Both are digital mega-corporations, both provide advertising platforms for marketers, and both are tremendous resources of online metrics for direct marketers.

Facebook is a content marketer’s dream. Gain a fan following at little or no cost, share news, videos, how-to information and much more to your audience. In social media, your audience does your work of sharing and evangelizing for you. Facebook has evolved and requires “pay-to-play” if you want your fans to see your posts. In my view, it’s completely acceptable for Facebook to say that if you want your post to float toward the top of a newsfeed for a day that you’ll need to spend a few bucks.

I pay for posts often for an organization with a vibrant social media presence. The Facebook promoted post budget isn’t huge, but over a year’s time it runs into the thousands of dollars.

The rules for including an image with a promoted post allows up to 20 percent of the image to contain text. Recently, one of my promoted posts was rejected because Facebook technology image scanners thought there was more than the 20 percent amount allowed. But with the human eye, it was apparent looking at the photo and text that we were not over the allowed amount of text. Surely Facebook would reconsider, I thought. My credit card was ready to be charged.

The only way I’ve found to contact Facebook is via an online form. So I filled one out, asking them to reconsider the image for my promoted post expecting a quick response. After all, it took them only about 15 minutes to reject the ad, so surely as an “always-on” social media platform with thousands of employees, someone will respond quickly. Well, it took nearly 24 hours to get a reply to my request. They agreed with me and approved it. But by that point, the timeliness of the news item had passed and myself, and our followers, had moved on.

But then another rejection happened a few days ago. This time, a photo of sheet music didn’t fly. The culprit? Apparently treble clefs, staffs and rests. Once again the rejection was in minutes. I immediately asked Facebook to reevaluate it, thinking that my prior experience of 24 hours for a reply may have been a fluke. It wasn’t. The reply to this second request came in at 1:51 AM the next day, more than 24 hours later, with an approval. But again, the news cycle for this event had ended.

Bottom line: Facebook customer service is pokey. They are leaving advertising money on the table with an apparently cumbersome internal review process.

Contrast Facebook with Google. I manage Google Adwords for another client with a respectable budget. Google has assigned a representative to me. We talk. They rotate representatives every few months so I get different points of view and ideas. And if I need to contact Google, they offer a phone number for me to call where I can actually talk with someone in just minutes, enabling the ads to continue without delay.

Facebook repels money. Google attracts money.

Bottom line points for marketers:

  1. Give the customer options, such as phone, online forms, chat and more to contact you.
  2. Don’t hide behind an online form. Sure, a call center may be more expensive to operate, but it’s surely less expensive than losing sales.
  3. Be responsive. If you decide an online form is less expensive than a call center, fine. But then make sure you have a customer service representative available 24/7 who can quickly answer customer questions.
  4. Remove internal bureaucracy. Sometimes movement is brought to a halt because the internal process is too cumbersome.

In an “always-on” digital age, customers can be impatient. And for goodness sakes, if your business is in technology, act fast! It’s expected.

Money loves speed.

Are You Mad About Your Internal Culture?

Sometimes we forget that great brands start inside. Before companies can show and tell the outside world about their awesome products and services, they must pay important and mindful attention to the team members who create and are responsible for engineering those amazing brand experiences. Internal branding can sometimes be overlooked or lower on a corporation’s list of active priorities than it should be.

And by mad I mean actually passionate about your work in a good way, in a can’t-wait-to-build-the-brand-in-some-new-way-today kind of way?

Sometimes we forget that great brands start inside. Before companies can show and tell the outside world about their awesome products and services, they must pay important and mindful attention to the team members who create and are responsible for engineering those amazing brand experiences. Internal branding can sometimes be overlooked or lower on a corporation’s list of active priorities than it should be.

As I lead interdepartmental meetings these days with my clients, I often hear comments like these from our face time “group genius” gatherings:

  • “We really should connect as a group more often.”
  • “I now understand your department better.”
  • To a co-worker: “I never knew what you did!”
  • “Oh, that’s why we do that! That makes sense now.”
  • “How come I never heard this before?”
  • “We need to tell the rest of the team this!”

Building passionate brand ambassadors and an engaging culture should be high on every brand leader’s “must do” list. Companies like Southwest Airlines and Zappos.com consider these internal branding strategies core to their successful business models. Gary Kelly, CEO of Southwest Airlines, says, “our people are our single greatest strength and most enduring long-term competitive advantage.”

And these Zappos’ core values lay the groundwork for its notable and enviable culture:

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I’m blessed to work with clients like these who are positively mad about what they do! I recently had three experiences of working again with long-term clients. I hadn’t been on-site to their respective offices for almost a year. I smiled as I saw reconfigured offices to allow for more collaboration, customer comments boldly displayed on walls, brand storytelling by happy customers sprinkled throughout the entire office and profiles of customer segments/personas highlighted throughout the company. These brand leaders were so thrilled to show me how they’ve elevated the importance of internal branding and what it’s meant to their employees. Internal branding matters.

Sara Florin, senior director of creative services for SmartPak, the Zappos of the equestrian industry, was delighted to share one recent event she led to help the rest of this fast-paced entrepreneurial organization learn more about all that her talented department handles. Here’s how she describes it: “Our energetic, passionate creative department is constantly working on bigger and better ways to market our products, but not everyone in the company understands the scope or details of what we do. We wanted to take time to celebrate our accomplishments and show off our capabilities in a fun and formal way. Inspired by the hit show “Mad Men,” we hosted an open house and cocktail hour so we could show off our “mad style.”

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“We dressed up to fit the era, served 60s-inspired food and cocktails to encourage attendance, and set up displays of our recent work. With over 50 people from other departments attending throughout the hour, we were able to demystify the creative process and present ourselves as a polished, professional in-house creative team that could rival any external agency. And we got to have a lot of fun doing it!”

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Activities like hosting a “Mad Men”-themed party may not fit your brand personality, but why not brandstorm some ideas that might help your team members empathize more with all the various roles and responsibilities needed to create your brand experience. Identify activities that engage co-workers from cross-functional areas, inspire collaboration, and just plain add fun and playfulness to all the hard work in building remarkable customer experiences.

So go ahead, get mad … in a good way!