The Upstream Healthcare Audience Puzzle

In healthcare marketing, it’s often assumed high-visibility, consumer-facing communications are the primary areas of focus. But the healthcare ecosystem is complex, and there are multiple upstream influencers who determine the total number of consumers eligible to come to your hospital or physician network for treatment.

healthcare marketing

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:

Existing Patients/Members

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.

Author: Michael Crawford

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.

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