Marketing Health Services 1 by Mary M. Flory

Patient data protection isn’t just an IT “thing.” Here’s how health care marketers can help build a culture of medical information security.

American MARKETING ASSOCIATION / ama.org / Fall 2014

Fall 2014 Volume 34 Number 3 Patient data protection isn’t just an IT “thing.” Here’s how health care marketers can help build a culture of medical information security.

american marketing association ama.org/marketinghealthservices

contents

AMERICAN MARKETING ASSOCIATION / AMA.ORG / FALL 2014

feature

Getting Started with Predictive Analytics Health care organizations are forging ahead into the newest frontier in Big Data: predictive analytics. Here’s what you need to know to implement a successful predictive model and boost your big-picture marketing strategy. By Lauren Drell

cover story

Hacking Health care Patient data protection isn’t just an IT “thing.” Here’s how health care marketers can help build a culture of medical information security.

By Marguerite McNeal

departments

k n ow l ed ge b as e

By the numbers

marketing Mix Timely topics in the health care space by julie davis

Case in point Offering Up Obamacare by Lauren Drell

Fast Track Danah Phillips by Melody Udell 08 in the trenches Let’s Talk by Diane Gage Lofgren

creative counsel Is Your Advertising on an Ego Trip? by Anne Moss Rogers

On point The Education Gap by eric N. Berkowitz

In other Words Programmed for Health By Lauren Drell

athenahealth’s Rob Cosinuke discusses the digitization of health care and its patient-led future By Melody Udell

Fall 2014 | Vol. 34 | No. 3 Phone (800) AMA-1150 • Fax (312) 542-9001 American Marketing Association Rick Dow Chairperson of the AMA Board 2013-2014 Dennis Dunlap AMA Chief Executive Officer | ddunlap@ama.org Russ Klein AMA CEO-elect | rklein@ama.org Editorial Staff Mary M. Flory Editor | mflory@ama.org Melody Udell Managing Editor | mudell@ama.org Julie Davis Staff Writer | jdavis@ama.org Lauren Drell Staff Writer | ldrell@ama.org art Kristina Zapata Art Director | kzapata@ama.org Vince Cerasani Graphic Designer | vcerasani@ama.org Advertising Staff Richard Ballschmiede Advertising Sales Director | rballschmiede@ama.org Catherine Eck Advertising Account Representative | ceck@ama.org Sally Schmitz Production Manager | sschmitz@ama.org

Marketing Health Services (ISSN: 1094-1304) is published quarterly by the American Marketing Association, 311 S. Wacker Dr., Suite 5800, Chicago, IL 60606. Periodicals postage paid at Chicago, and at additional mailing offices. The opinions expressed herein are those of the authors and not necessarily those of the editors, the American Marketing Association, its officers, or staff. POSTMASTER: Send address changes to Marketing Health Services, American Marketing Association, 311 S. Wacker Dr., Suite 5800, Chicago, IL, 60606-2266. CanadaPost Agreement Number: 40030960. Send Canadian change of address information and blocks of undeliverable copies to P.O. Box 1051, Fort Erie, ON L2A 6C7. Subscriptions: For non-members in the U.S., $105 per year for individual subscriptions and $140 for library, school and business subscriptions. (International rates vary by country.) Subscriptions for AMA members are $55. Single-copy rates: $20 individual, $22.50 corporate in the U.S.; add $1 in other countries. Canadian residents add 13% GST (GST registration #12747852). Members contact: AMA Subscription Department, 311 South Wacker Drive, Suite 5800, Chicago, IL 60606, (800) AMA-1150, (312) 542- 9001 (fax). Non-members: Order online at AMAorders.org, call 1-800-633-4931 or e-mail AMAsubs@ebsco.com. Permissions and reprint information: Copying for other than personal or internal reference with out expressed written permission of the American Marketing Association Publishing Group is prohibited. Requests for permission to reprint should be submitted by mail or fax to Permissions Editor, fax (312) 922-3763. Reprints in quantity are available by contacting Kristy Snyder, Sheridan Reprints, (717) 632-3535.

A note from our editor Welcome Back to Marketing Health Services.

It seems as though every week brings with it a new data breach, complete with exasperated marketing and IT professionals scrambling to “make it right,” a collective groan from consumers who have to (yet again) check on credit cards and change e-mail passwords, and apologetic company leaders pledging to “do better.” Every new data hack brings with it the same onslaught of questions: How can this be avoided? What’s the best way for a company to inform its customers that their personal information has been compromised? How can organizations stay one step ahead of the hackers to protect their customers, as well as their brands? How will this PR nightmare affect the next fiscal year, or the long-term financial health of the organization? The health care industry is overdue for such a breach, according to the FBI, which recently warned that the industry lags significantly behind others when it comes to addressing basic security flaws. Couple that lack of urgency to shore up potential hacker loopholes with the sheer breadth of data that health care providers collect, and it’s quite easy to see that a perfect storm is brewing. Our cover story (page 16) discusses the dramatic increase of electronic records and the dawn of health-information exchanges as they relate to the task at hand for health care marketers: building a culture of medical information security. Turn to page 22 for a primer on using predictive analytics in a health care setting while boosting your big-picture marketing strategy. And take note of the Affordable Care Act’s humor-based video marketing tactics and social media strategy to specifically target millennials (page 6). Finally, our columnists and Q&As with industry leaders touch on embracing the patient-led future of health care, boosting brand relevance, and reconciling patient satisfaction and the growing demand for transparency with a health care organization’s marketing resources. Stay in touch,

Advertising: Advertisers and ad agencies assume liability for all content of advertisements published, and also assume responsibility for any claims arising therefrom made against the publisher. The right is reserved to reject any advertisement not in keeping with the publication’s standards. 1-800-AMA-1150 ama.org

E d i to r ia l Boa r d

M ary M . F lory, ed i to r mflory@ama.org

LEONARD ACHAN, CCO/VP, Marketing & Communications, The Mount Sinai Medical Center / JUDY AKINS, SVP, Marketing & Communication, Mercy Health Ministry /

ELLEN BARRON, AVP, Marketing & Communications, University of Iowa Health Care / PETER BRUMLEVE, CMO, University Hospitals / KATHLEEN DEAN, System VP, Communications, Marketing & Public Affairs, PeaceHealth / KATHLEEN DEVRIES, VP, Marketing & Communications, University of Chicago Medicine & Biological Sciences / ERINNE DYER, VP, Corporate Communications, Marketing & Outreach, Carolinas HealthCare System / PATRICK DYSON, EVP, Strategy & Corporate Services, Borgess Health / DAVID FEINBERG, SVP/CMO, New York-Presbyterian / DIANE GAGE LOFGREN, SVP/CCO, Brand Communications, Kaiser Permanente / PRESTON GEE, VP, Strategic Marketing, Christus Health / BILL GLEESON, VP, Communications, Sutter Health / ROSE GLENN, SVP, Marketing & Public Relations, Henry Ford Health System / DEBORAH GORDON, CMO, Network Health / MATT GOVE, CMO/SVP, External Affairs, Piedmont Healthcare / DALAL HALDEMAN, Ph.D., SVP, Marketing & Communications, Johns Hopkins Medicine / MISTY HATHAWAY, Chair, Marketing Enterprise, Mayo Clinic / SUZANNE HENDERY, VP, Marketing & Communications, Baystate Health / JEAN HITCHCOCK, Corporate VP, Public Affairs & Marketing, MedStar Health / OREST HOLUBEC, SVP, Marketing & Communication, Providence Health & Services / DEBORAH ITALIANO, Executive Director, Marketing, Stanford Hospital & Clinic / SUE JABLONSKI, SVP, Corporate Marketing & Communications, Ohio Health / LINDA KALAHIKI, SVP/CMO, UHA Health Insurance / MICHAEL KILLIAN, VP, Marketing & Public Affairs, Beaumont Health System / MARK KLEIN, SVP, Communications, Public Affairs & Marketing, Dignity Health / DEBRA LANDERS, VP/CMO, Community Health Systems / CAROL LOVIN, President, CHS Management Company, Carolinas HealthCare System / MEGAN MANAHAN, VP, Marketing & Communications, Mercy / PAUL MATSEN, CMO/CCO, Cleveland Clinic / JUNE MCALLISTER FOWLER, VP, Corporate & Public Communications, BJC HealthCare / TERESA MURPHY, VP, Marketing & Communications, Fletcher Allen Health Care / SARAH NEWSON, AVP, Communications, University of Texas MD Anderson Cancer Center / MARK PARRINGTON, VP, Strategic Transactions, Catholic Health Initiatives / KIM REYNOLDS, VP, Marketing, LifePoint Hospitals / JOYCE ROSS, SVP, Communications, Catholic Health Initiatives / MARK ROTHWELL, VP, Product Marketing, Aurora Health Care / JULIE SHERMAN, Senior Director, Brand Services, Banner Health / STEVE SHIVINSKY, Corporate VP, Communications, Blue Shield of California / SUSAN SOLOMON, VP, Marketing & Communications, St. Joseph Health / DON STANZIANO, Corporate VP, Marketing & Communications, Scripps Health / TOM VITELLI, AVP, Communications, Intermountain Healthcare / HOLLY VONDERHEIT, VP, Marketing & Community Relations, IU Health / BETH WRIGHT, VP, Corporate Communications & Strategic Marketing, Capella Healthcare

marketing health Services Fall 2014

Industry vitals

Edited by Julie Davis

bn by the numbers

No. 1

87% Fitness app usage in 2014 is growing 87% faster than rest of the app market, according to research by Flurry Analytics, a business data provider focused on mobile applications.

20.8%

$ 250,000

Partially driven by the interest in wearable electronics and the advent of the Internet of Things, SEMI, a semiconductor trade research group, forecasts that the global market for the industry will grow by 20.8% to reach $38.4 billion by the end of 2014.

New drug launches typically take 10 to 14 years and cost $1.5 billion, but by repurposing existing drugs for new applications, online research platform provider Cures Within Reach says it can help researchers deliver new treatment options in 18 to 36 months with research costs of less than $250,000.

find out more at

Research by the Robert Wood Johnson Foundation, Harvard School of Public Health and National Public Radio states that health related issues, including disease, illness or death, are the No. 1 cause of stress in Americans’ lives.

2.3 billion According to Rock Health, digital health companies had received a total of 2.3 billion in funding at the end of the second fiscal quarter this year, which is 168% year-over-year growth from 2013.

ama .ORG

Recent AMA video Data-Driven Creativity: An Oxymoron? Robert Scaglione of OwnerIQ, Sandra Zoratti of Ricoh and David Dowd of Hootsuite discuss how to leverage data to drive better marketing campaigns. Watch now: ama.org/videos.

Recent AMA webcast How Multi-Channel Data

Now on AMA TV A New Breed of Health Care: Health care is going to the dogs as marketers unleash new tactics to promote pet insurance. Tune in: amatv.ama.org.

Drives Multi-Channel Personalization: Ensighten and Forrester Research partner up to discuss how to engage with digitally powered consumers and tailor your brand experience to their needs. Log on: ama.org/webcasts.

also find us on

Patient data protection isn’t just an IT “thing.” Here’s how health care marketers can help build a culture of medical information security.

Get Digital! MHS subscribers, you can read your latest issue on your computer, smartphone or tablet. Check out our digital edition at ama.org/digitaleditions.

AMERICAN MARKETING ASSOCIATION

/ AMA.ORG / FALL 2014

marketing Health services Fall 2014

Timely topics in the health care space

Edited by Julie Davis

marketing Mix

Growing Digital The Mayo Clinic, a leader in health care-based social media, is now creating video content that is accessible on the organization’s website and through the National Library of Medicine. Topics range from a lecture on Choline C-11 treatment for recurrent prostate cancer to step-by-step instructions for fecal microbiota transplants.

Rising Costs Health care spending is on the rise again according to PricewaterhouseCoopers’ Health Research Institute. The institute predicts 6.8% growth next year, compared with a predicted rise of 6.5% in 2014. This marks the first increasing growth rate in five years, although it remains much smaller than pre-recession inflation rates. The growing economy and influx of newly insured Americans are contributing to the growth, according to the institute.

Dentist on the Move A San Francisco-based startup is wooing customers to the dentist’s office by going mobile. Studio Dental’s office is housed in a trailer that travels throughout San Francisco. Customers follow the trailer’s location schedule online and set appointments for dates when the mobile dentist’s office is in their neighborhood.

marketing health Services Fall 2014

Mood Games Facebook has published the results of a 2012 moodmanipulation experiment in a study titled “Experimental Evidence of Massive-scale Emotional Contagion Through Social Networks.” The researchers changed the contents of users’ newsfeeds in order to measure the effects on their dispositions, and while Facebook has defended the legality of the study, the social media company’s methodology has stirred up controversy as consumers and the media question its ethics.

marketing Mix

Plan for Genetics Health data gets personal A new software provider is a taking genetic testing a step further by helping customers contextualize their data. BaseHealthâ&#x20AC;&#x2122;s Genophen platform allows doctors to integrate patientsâ&#x20AC;&#x2122; genetic and clinical data to develop personalized medical plans.

Health and Taxes Can a beverage tax help patients lose weight? Researchers found that tweaks to a beverage tax could impact consumer health and consumption habits. A study published by the American Journal of Agricultural Economics predicts that taxing beverages per calorie instead of per ounce would lead consumers to drink 5,800 fewer calories per person annually.

Quitting Time A study published by the American Psychological Association in July shows that warning labels encourage smokers to try to quit, even when they try to avoid the labels. Researchers surveyed 5,000 smokers in the U.S., Canada, the U.K. and Australia, and then followed up a year later. The researchers developed a model for understanding the effect of cigarette warning labels on quitting behavior and showed that larger, more graphic labels, such as those used in Australia, were better at getting smokersâ&#x20AC;&#x2122; attention and encouraging them to quit.

marketing Health services Fall 2014

CP Case in point

Offering Up Obamacare With the Affordable Care Act’s March 31 enrollment deadline looming, the Obama administration leveraged humor-based video marketing tactics and social media to target millennials by Lauren Drell, staff writer  ldrell@ama.org

Obama on his online-only parody talk show, Between Two Ferns, which routinely pokes fun at celebrities and issues in the media. True to the show’s form, Galifiankis and the president engaged in witty dialogue and shared satirical verbal jabs before Obama took a few minutes to plug Healthcare.gov and the benefits of signing up for the ACA.

When

March 2014

Who

The Obama administration

What

In an effort to boost registration for the Affordable Care Act, the Obama

marketing health Services Fall 2014

administration’s communications team devised a strategy for encouraging millennials to sign up for the government’s health care program: Recruit some comedic star power. The Hangover star Zach Galifiankis hosted President

Where Online

Why

“The first thing to know is that this group, [age] 18-34, represents

Case in Point

the largest share of the uninsured population,” says Jessica Barbara Brown, national communications director for Washington, D.C.-based Enroll America, a nonprofit group that educates and encourages consumers to sign up for health care. According to Brown, many young adults, especially those with entry-level or part-time jobs, lack health insurance because they don’t have access to employer-provided coverage. A lack of awareness and basic education about health insurance—especially if they were recently under a parent’s plan—also contributes to the amount of uninsured millennials, she adds. “It’s a time in life that people are starting out on their own in terms of their adulthood, so helping to start that journey of health literacy at that age is important for that age group,” Brown says. Jose Muñoz, chief marketing officer at state health insurance exchange Get Covered Illinois, says that the Obama administration might have created this last-minute marketing effort because the program needs young people. The economics of insurance depends on the pooling of risk, and since young people are typically healthier, getting them enrolled will help keep costs down.

“I think, in general, the insurance industry has a way to go before it’s perceived as being hip or cool, but what we can do and what we’ve started doing is trying to cultivate a perception, which is actually a reality among younger people, that it’s uncool to be uninsured,” says Jennifer Koehler, executive director of Get Covered Illinois. “Not having [insurance] means that you are not concerned about your financial well-being, and it means that you’re not concerned about your physical well-being, and we’re trying to get the point across that not caring about either of those two things is not cool in this day and age.”

On Tuesday, March 11, just hours after the President’s webisode went live on FunnyorDie.com, the video became the No. 1 source of referrals to Healthcare.gov, according to a tweet by White House senior communications advisor, Tara McGuinness. The next day, McGuinness announced that the video had racked up 11 million views and generated more than 980,000 visits to Healthcare.gov, which was a 40% increase in visitors from the day before the video was posted. And viewers haven’t stopped there—the ACAthemed video had more than 5,190,000 views on YouTube at press time. mHS

“The first thing to know is that this group, [age] 18-34, represents the largest share of the uninsured population.” —Jessica Barbara Brown, Enroll America

How

The Obama team knew that traditional ads and PSAs weren’t going to engage this younger, Web-savvy demographic. Instead, the decision to utilize humor and YouTube—both of which are popular tactics for engaging millennials—helped the administration target these “young invincibles.” “We know that young people are going to need multiple touches in order to get them to enroll,” says Brown. “The online things and the celebrity involvement—those were ways of touching young people.”

Talk show showdown: Barack Obama’s appearance on Zach Galifiankis’ onlineonly parody talk show was a strategic effort to engage Web-savvy millennials into a conversation about the Affordable Care Act.

marketing Health services Fall 2014

Career highlights in 60 seconds

by Melody Udell

Fast Track

2003

wellness is an important element of a productive workforce.

B.A., English, University of Minnesota-Twin Cities

2006-2011

Phillips started out as a premed student but turned to health care marketing instead: “The field really interested me because at the end of the day it’s about people and helping them, and that was important to me. But the medicine side of it wasn’t my love.”

Product Manager, CIGNA

Phillips was able to take all the feedback she heard from clients in her sales position to her new role in the product development department where she helped build in-house wellness programs. “As a PD lead, you’re sort of like a mini CEO,” she says.

2003-2005 Marketing Communications Specialist, CIGNA

After spending a few months in Italy studying art history, Phillips came back to the U.S. and found a job with Hartford, Conn.-based insurance company Cigna. “I was a little turned off at first thinking about insurance—I wanted to be creative. … The job or company wasn’t exactly what I had envisioned, but after meeting the people and learning what the company did—helping people be healthier—I was able to understand the job and get excited about it.”

2005-2006 Sales Associate, CIGNA

Phillips moved into a sales role and traveled the western half of the U.S., speaking with clients about why corporate health and

marketing health Services Fall 2014

2011-2012 Product Marketing Manager, Bloom Health

At Bloom, Phillips was brought in to think about what’s next for the health care company’s existing product and what markets and products they should develop in the future.

Danah Phillips Head of Marketing and Consumer Experience, Bloom Health Danah Phillips channeled an early desire to become a doctor into a patient-focused career in health care.

Present Head of Marketing and Consumer Experience, Bloom Health

“Being able to lead the designers and user experience team to make sure we’re meeting the needs of the consumers is really exciting. ... To really roll up my sleeves and figure out what’s going to work the best for the end consumers is rewarding.” mHS

in the trenches

COMMUNICATIONS

Let’s Talk Capturing and enhancing a client’s voice Diane Gage Lofgren  diane.lofgren@sharp.com

hether it’s a presentation to the board of directors, an e-mail to staff, a TED Talk, blog post, panel, presentation or tweet, staying true to a leader or executive’s voice takes more prep work than simply highlighting the talking points. It requires understanding a leader’s perspective, intent for the audience to whom they’re speaking, and, most of all, it requires capturing the leader’s voice. Like many of you, I entered the communications field with a background in writing. Over the years I’ve written many articles and books, but all of them were done on my own time. When it came to writing for an organization or a senior leader in the C- suite, I had to put my personal writing ambitions aside and tune into the corporate voice and style of the leader. As we develop a relationship with a client and better reflect his or her voice, we can also become a trusted counsel and provide opportunities to enhance the communication. Here are some ways to capture a leader’s voice and build from there:

Be a sponge. Although it’s

challenging to get access to a busy executive, make an effort to do so. Knowing what the person stands for, the leader’s preferences, and the way the

marketing health Services Fall 2014

person operates can help you get close to the way that person thinks. Being around the leader doesn’t necessarily mean a lot of one-on-one sessions—even though that would be ideal. Attend presentations, read past articles or watch previous presentations on YouTube because when you start to hear things repeated, a theme begins to emerge. Also, get to know the executive’s support staff and influencers. Ask them what that person likes or the best way to do something. They’ll often have intel that can turn out to be valuable insight.

Welcome the gift of feedback.

When you get feedback about a communication piece you’ve prepared, be open to the comments and welcome them like a gift—an opportunity to find a solution. As much as we try to mirror our client’s voice, we’ll never capture it 100%. We’re going to get close at times, but it’s just impossible to get into a person’s head. It’s natural for humans to be defensive or resist feedback that we might consider criticism. In fact, a recent study by psychologists at Kansas State University, Eastern Kentucky University and Texas A&M University reinforced the notion that employees hate negative feedback in performance

reviews, even among highperformance, goal-oriented workers. But continuous feedback—on both sides—can help to hone the communication and improve it so the message is clear. It’ll also help improve the relationships with our clients, creating trust and a bond that will make it easier to capture their voice the next time.

Don’t be afraid to find out what went wrong. When

something needs to be rewritten, we shouldn’t just go back to our desks and pound away. Take a moment to ask questions to get specifics about what’s missing. Questions like “What didn’t sound like you?” or “What didn’t you like?” can go a long way toward getting the details to help rework the piece. If we know our executive’s preferences and style, we can avoid repeating mistakes.

Ground it in research. We often work with leaders who are driven by results or data. When a client insists that a communication be worded in a certain way but it doesn’t connect with the brand, come into the conversation with supporting research to discuss. Simple surveys asking an audience what they would like more or less of in a presentation or written article can provide insights to the executive about what’s connecting with people. Having research at the beginning is smart, but testing throughout can also help to improve the communication along the way. Checking in with online panels or focus groups can help determine if changes are hitting the mark. Along with providing communications support, we’re tasked to be counselors to our executives, offering advice on how—

and sometimes challenging them—to be better. It helps in the beginning of a relationship to set expectations and lay out the kind of communications counselor you’d like to be. It’s a good way to test whether our style matches that of our clients.

Bring in outside experts. In some situations, it might be easier to remove ourselves and bring in outside help. They provide a fresh perspective and can give added expertise in a particular area. A vice president came to me asking for advice on improving her public-

speaking skills. After providing her with some starting suggestions, I also recommended that she bring in an outside consultant who specializes in public speaking. The vice president was open to the idea, and after working with the outside consultant, she now has several exercises under her belt to help better prepare for presentations.

Picture the possibilities. Along with providing counsel, it’s our job to open people’s minds to the possibilities. Be bold and suggest new ways to communicate something or point out things that can be presented

in an alternate way. Sometimes executives get comfortable with old habits, and it’s up to us to bring the possibilities forward. Capturing someone else’s voice often means putting aside our own egos and personal style. But that doesn’t mean we become mirror images of our clients. Our experience combined with an understanding of our executive can result in a voice that’s loud and clear. mhs ✒ Diane Gage Lofgren is senior vice president of marketing and communication at Sharp HealthCare in San Diego.

marketing Health services Fall 2014

creative counsel

BRA ND RELEVA NCE

Is Your Advertising on an Ego Trip? Digital marketing strategies to boost your organization’s brand relevance Anne Moss Rogers  amrogers@impression-marketing.com

ost hospital advertising is about the hospital—awards and ratings, centers of excellence, doctors and technology. Oh, and buildings, too. In other words, it’s boastful. Hospitals have done these types of campaigns for decades and since there wasn’t really a way to measure the results, there was no proof these types of ads weren’t working. Digital advertising is changing that. Eighty percent of all Google searches are related to health, and Google processes a billion requests per day. So nothing shows success or failure as pointedly as an online search campaign. If you take those offline campaigns and put them online, you’ll start to have data that proves whether or not your messaging is effective. Remember that consumers are besieged with information these days. And if your message is not relevant to them, they can easily dismiss it (and your brand along with it). In short, if you want to reach your goals, health care advertising should be about how your services benefit a patient.

marketing health Services Fall 2014

What Sparks Interest?

Popular advertising subjects like “cardiac excellence” have no relevance to patients. They are simply too generic. If your marketing goal is to increase cardiac patient volume, you should concentrate on how starved people are for legitimate information. If you are not producing it, they are getting it elsewhere. This is an opportunity for you to post relevant content and position your facility’s expertise. You have to get patients in the funnel before a health disaster strikes to make them aware of your service lines. If an aging parent dies of heart failure, all of a sudden the child of that parent will want to know his or her own risk factors.

Reaching Out

An ongoing health information initiative might translate into online assessment tools or smartphone apps, presentations, webinars and videos on subjects related to maintaining health or assessing risk based on health and family heart history. Your goal should be to get patients to sign up for something like a newsletter or to “like” or “follow” your social media

pages so you stay in front of those with heart health risk and stay top of mind when they do need a procedure. In terms of advertising or content marketing, campaign messages should focus on patient concerns such as their fear of having heart surgery or how procedures at your hospital have benefitted patients. “Cardiac excellence” and other generic phrases also aren’t relevant enough to grab attention. Once you engage them by addressing what they care about first, you can interject facts about your facility that validate their reason to put their health care in your hands. Another common example is da Vinci surgery. While this technology seems cutting edge, the name itself does not help the consumer understand why da Vinci procedures are better for them. Doctors, in particular, love ads that talk about their skill using this amazing piece of technology. And it is amazing. But first, you have to make the consumer care. They don’t care about how long someone trained if they don’t know how it benefits them. For example, when women have da Vinci single-site hysterectomies, they are out of the hospital faster, experience far less pain, and recovery is significantly improved. So, you need to use one of these messages to communicate the importance of the technology in patient terms. Once they know the benefits, they’ll be ready to listen to who does it and will want to learn more about it.

The Traditional Approach

Let’s say an executive or physician at your facility is really pushing his or her agenda and you know it’s not an effective approach.

First, you need to find out what it is that the doctor is looking for. More surgery cases? More notoriety? From there you can deliver a solution that benefits both the facility and the physician. Run the campaign the doctor or hospital executive wants in pay-perclick (PPC or Google ads) against a more patient-focused ad. Or, use a Facebook ad if you need to use a visual. Basically, you’re doing A/B testing—one ad against another. This 30-day test alone will run you all of $200, but it’s a good idea to test messages on a regular basis so you put the most effective messages out there. Digital marketing captures attention at the very point people are seeking

information. Nothing will tell you more about the relevance of a message like the clicks and follow through from a PPC or social media ad. Once you have results, you can put them in front of the interested parties to show them what’s working and what’s not.

Be the Choice

People hate going to the hospital and they only go because there is a health need. These days they have choices. If you want to be the choice, you need to engage early by offering things they care about so when the need arises, you are top of mind. Self-focused advertising does not accomplish this initiative. That doesn’t

mean, however, that you cannot publish press releases, blog posts and publicize an award. It simply means that your overall strategy needs to follow an integrated model of paid and unpaid media to cater to what potential patients are looking for so you can engage them and build trust. With sufficient brand awareness, you have a far better chance of having them answer a call to action and meeting your marketing goals. mhs ✒ Anne Moss Rogers, a former copywriter with 14 years of health care marketing experience, is cofounder and creative director of Impression Marketing, a digitally focused marketing agency that places the website at the hub of all marketing activities. Connect with her on Twitter, @ImpressionM, and at Impression-Marketing.com.

marketing Health services Fall 2014

ON POINT

PATIENT SURVEYS

The Education Gap Patient satisfaction in the era of transparency Eric N. Berkowitz  enb@Isenberg.umass.edu

“

he era of transparency”—it’s a phrase that may well define the challenge facing the health care marketer today, whether that individual resides in a health care system or a medical group. Hospital administrators are facing potential financial penalties from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) for negative evaluations from patients. The impact of these penalties will be felt in the coming years if hospitals do not respond in a proactive way. Yet beyond the HCAHPS program, transparency occurs through online ratings, insurance providers with patients scores, and the ever-present third-party sites such as Yelp, Angie’s List and the like. Not immune to this phenomenon are medical practices, which, in recent years, have seen patient satisfaction scores posted to the Internet. The University of Utah Health Care is implementing a novel initiative in which the organization is posting their own physician satisfaction scores. The organization displays each physician’s individual listing on its website, which, according to Cleveland Clinic chief experience officer James Merlino, is the newest trend. And Integris, the largest health care system

marketing health Services Fall 2014

in Oklahoma, plans to post satisfaction scores for 70 of their physicians by the end of October 2014. The organizational challenge is how to most effectively respond to this evergrowing aspect of patient satisfaction transparency, whether there are governmental reimbursement financial penalties or not. In fact, a marketplace penalty exists for an organization whose satisfaction and customer delivery is really below that of customer expectation. As we all recognize, there is no more complex entity to manage than a health care organization. Enter HCAHPS, where the margins are diminished further if the patient assessment is not satisfactory. While this penalty has not yet come to medical practices, it might only be a matter of time. But does the financial penalty even need to exist in an era of transparency and social media, when hospitals, states or insurers will post a medical group’s patient satisfaction scores? Or, when the patient or caregiver can publicly display their dissatisfaction on Yelp, Angie’s List or their blog? For HCAHPS, the response to date has been a financial investment, which includes improving the physical facilities—such as the upgrading of flat

panel television sets at East Orange Hospital in New Jersey, or focusing on key aspects of the HCAHPS survey questions and developing strategies to improve in critical areas. Providence Park Hospital in Novi, Mich., developed “quiet packs” to give to patients that contained ear plugs and relaxing lavender lotion. More importantly, they reduced the number of loud carts pushed through the corridor of the hospital. At Grady Memorial Hospital in Atlanta, the changes involved staff training, such as teaching physicians not to interrupt patients. While these organizations are all to be commended for their overt approaches to change and improvement, these actions are not often the norm. Hospitals more than medical groups have been moved to change. While change is important because it is the right thing for the patient, the reality is that for many health systems, the catalyst for change is the reduction in reimbursement under the HCAHPS rules. Those opposed to change now must listen and pay heed to the disciples of patient satisfaction and patient engagement strategies. If we don’t heed the need for change, our already thin margins in the hospital setting will get even smaller. That said, how does it impact those where change is slower but transparency is taking hold? Many health organizations, regardless of the satisfaction tool they use, survey their patients. In most medical groups, these surveys often are on a semiannual basis and occasionally on a quarterly basis. However, while there is increasing transparency through state or even organizational initiatives, for medical practices, there has been the luxury of reviewing the survey and

allocating budget dollars to purchase a TV set or quieter carts, or training staff on better patient interactions. Doing satisfaction surveys is the first step. Each quarter or six months, a summary of the survey results should be published on your organization’s website. Because we exist in complicated business environments, not every aspect of the operating environment will score high, which is a real concern for many health care systems. The wait times were too long, the telephone system for appointment scheduling was tedious, the doctors interrupt too often, etc. If the survey score is lower than you’d like, what next? The next critical link is on-going education of the patient. Post a link next to the score that provides your organization’s plan. It takes time for an organization to respond, but the key is to let the customer know that you were listening to their concerns, the organization took the issues seriously, and there is a plan in place to address them. Here’s the message: “Thank you for telling us! We heard you. Here is our plan. Tell us over the next several months if we are on our way to getting better.” The era of transparency is hard. We must constantly inform the customer that we are listening to them, taking their feedback seriously, and responding to their suggestions to improve. mhs ✒ Eric N. Berkowitz is a faculty associate at

either bemoaning the result, discarding it, or, ideally, making a change. And a similar response exists in hospitals and health care systems. Of the institutions cited in this column, all should be applauded for the

changes that have been implemented. However, all of us who have ever worked in a health care organization can imagine the countless hours spent in committee meetings to effect change, such as posting physician scores,

Babson Global, a division of Babson College in Wellesley, Mass. He is the author of Essentials of Health Care Marketing, and frequently speaks at medical meetings and leads medical staff retreats and educational sessions. •org For more on transparency in health care, check out “Sticker Shock” in the spring 2014 issue of Marketing Health Services.

marketing Health services Fall 2014

marketing health Services Fall 2014

Patient data protection isn’t just an IT “thing.” Here’s how health care marketers can help build a culture of medical information security. By Marguerite McNeal

marketing Health services Fall 2014

hen a Colorado man fell victim to identity theft, he didn’t rack up mysterious credit card charges for a new TV or a trip to Australia. Instead, he received a bill in the mail for a $44,000 surgery that he never received. In 2013, the health care sector accounted for 44% of all identity theft reported in the U.S., and its repercussions are far costlier than breaches in retail or financial sectors, according to the Identity Theft Resource Center. In the Target and Neiman Marcus credit card breaches in the fall of last year, retail customers received immediate notification and their cards were cancelled. Victims of medical identity theft, on the other hand, were paid an average of $18,660 for out-of-pocket costs such as reimbursements for services provided to imposters, legal fees and identity protection services, and it likely will take more than a year for them to clear up their medical records, according to a study from the Ponemon Institute. In April 2014, the FBI issued a slap on the wrist to health care providers with a private industry notification entitled “Health Care Systems and Medical Devices at Risk for Increased Cyber Intrusions for Financial Gain,” which warned that the industry lags far behind others when it comes to addressing basic security flaws. Breaches in health care data are more than just IT concerns or PR damage control cases. They undermine patient trust and harm the provider’s goodwill, and consequently, their bottom line. “A large scale breach or a consistent track record of breaches occurring can definitely damage a brand,” says Michael Frederick, vice president of assurance services and product development at the Health Information Trust Alliance (HITRUST), a Dallas-based provider of security frameworks. “If it gets to the point where a patient becomes uncomfortable and doesn’t feel like they can trust their provider, it impacts the provider’s ability to offer quality care.” While technology provides certain safeguards to secure patient data, at the end of the day, it’s humans who build security into their organization’s culture. Marketers are just as responsible as their colleagues in other departments when it comes to making patient privacy and security a priority.

marketing health Services Fall 2014

In addition to protecting the health data with which they interact, marketers also should help patients understand how to safeguard their personal data. “The hospital has a duty to inform the consumer about pitfalls and make sure that people are taking the appropriate steps in not sharing their information, and [know] about secure environments,” says Reed Smith, founder and president of the Social Health Institute, a San Antonio-based group that helps health care organizations leverage social media and digital communications strategies. A Perfect Vulnerability Storm

Officials have stressed the importance of protecting patient data privacy and security for years. Organizations were required to be in compliance with the HIPAA Privacy Rule, which regulates the use and disclosure of protected health information, by April 2003. And with the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act prompting the nationwide adoption of electronic health records, the health care landscape has continued to get more complex. In its warning to health care providers, the FBI noted that several factors have created a perfect storm for personal health information security—making patient data especially vulnerable to cyber attacks. First, health care systems are required by law to transition to electronic medical records by January 2015. The influx of digital records, coupled with the growing number of medical devices connected to the Internet, generates a rich new data field for criminals to exploit. Second, the industry lags behind its peers in other sectors, such as retail and finance, when it comes to cyber security standards. Finally, the black market offers a higher financial payout for medical records than for other personal data like credit card numbers. It’s a situation that’s ripe for data breaches, which could cost the U.S. health care industry as much as $5.6 billion

annually, according to a March 2014 report from the Ponemon Institute. Of the health care organizations surveyed, 90% reported at least one data breach within the past two years, with an average economic impact of $2 million per incident. Health care records are difficult to manage. They contain disparate data that ranges from billing information to family medical histories. And they’re held—and shared—across many different locations: hospital archives, clinical laboratories, insurance provider applications, and patients’ personal smartphones and tablets. And consider the growing popularity of a potential health care hacker’s dream hack: healthinformation exchanges, which are networks that permit health care providers to share and access digital patient records with the aim of providing more seamless and less redundant medical care. Blue Shield of California and Anthem Blue Cross, for example, recently announced that they would fund the first three years of the California Integrated Data Exchange, which aims to digitize and share among providers the medical history and data records of roughly 9 million plan members. “There are so many different systems involved in patient health,” says Ralph Echemendia, a so-called “ethical hacker” and security expert who has consulted for organizations such as the United Nations, Oracle, and hospital and financial institutions. “The ecosystem itself has so much technology deployed to handle our data that there are so many different moving parts to it.” Dollars for Data

Hackers who sold stolen credit card data from the Target breach likely

The Hidden Threat of Short URLs “We all look at Twitter and LinkedIn and Facebook as great sources of information, and a very powerful means to exchange information, but people don’t necessarily think in terms of the dangers that could happen, as well,” says Lee Kim, director of privacy and security Healthcare Information Management and Systems Society. When Kim gives presentations about the use of social media, people often are surprised to learn that shortened URLs can be particularly harmful, she says. Marketers frequently use Bit.ly, Ow.ly and other URL shorteners to squeeze more characters into tweets or LinkedIn posts that contain links to pertinent information. Shortened links may lead to a malware download or direct users to a phishing website, Kim says. Marketers can use sites such as LongURL.com to see where shortened links will direct them.

generated $53.7 million dollars of income on the black market, according to Brian Krebs, who broke the story on his blog, KrebsOnSecurity.com. And health care data is even more valuable to cyber criminals. With credit card information, a criminal is usually looking to conduct a single transaction—say, selling a television or a computer on the black market, Echemendia says. With security measures in place to detect transactional fraud pretty quickly, financial institutions will catch on and cancel the card. But a criminal who gets only one transaction from stolen credit card information is successful. “When Target got hacked, they knew who those credit cards belonged to. It’s pretty simple: They call up the customers’ banks and tell them to issue new cards. The problem isn’t going to happen again, at least with that credit card number,” Echemendia says. Billing and insurance records and medical files are the data most likely to be stolen from a health care organization, according to Ponemon Institute research. Criminals who access health information gain much more than a credit card number. They have lab results, medication records, insurance numbers, and even the pin numbers and security questions that patients use to protect their information. “You’re stealing enough information about a person’s identity where it would be very difficult for anyone to prove that you’re not that person,” Echemendia says. When health care data is stolen, it could be months or even years before a person even knows his

marketing Health services Fall 2014

identity has been compromised. A criminal could have applied for car loans and home loans using his social security number, for example, without the victim realizing it. While credit card theft might—if the criminal is lucky—result in a single purchase, stolen health information could result in dozens of transactions. That’s what makes the data so much more valuable. In some underground markets, cyber criminals receive $20 for health insurance credentials, compared with $1 or $2 for U.S. credit card numbers, according to Atlantabased cyber security firm Dell SecureWorks. When criminals compile entire health insurance dossiers, or “fullz,” of individuals, which combine health insurance credentials with bank account numbers, social security numbers and other personally identifiable information, they receive more than $1,000 for each package, according to Dell SecureWorks. In addition to fueling black market sales of information, criminals armed with patient data illegally obtain medical equipment, services, surgeries and prescriptions. “If you have that kind of information, you could very easily become a drug dealer, just by going and issuing prescriptions,” Echemendia says. The criminal jeopardizes both patient and provider security, using the physician’s credentials to prescribe the drugs or equipment, and the patient’s information to obtain it. This leaves doctors—and their associated hospitals and health care systems—liable for the crime. “The kind of information that can be accessed on a health care system isn’t only about the patient,” Echemendia says. “It comes all the way from the manufacturers of the technology itself all the way down to the janitor because security encompasses everything.” Providing the Know-How

While existing laws set the requirements for securing information, they’re vague when it comes to the nuts and bolts of carrying out those tasks. The HIPAA Security Rule does have standards and addressable implementation specifications, but it doesn’t go into granular detail in terms of what to do,” says Lee Kim, director of privacy and security at the Chicago-based Healthcare Information Management and Systems Society. “As a result, you have varying degrees of compliance and security because some health care organizations have regular risk assessments, and they regularly address those risks, scan for vulnerabilities and mitigate those. But others have more of a reactive posture.”

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More health care organizations are turning to information security frameworks to measure and address risks before they fester into costly breaches. These scalable programs include a prescriptive set of controls and supporting requirements that clearly define how organizations meet the objectives of the framework. “Most organizations do not have the resources just from head count, skill set and capital investment to be able to get that granular with how they manage their risk,” Frederick says. “They typically turn to a framework because a framework has somewhat already done that for you at a higher level.” The HITRUST Common Security Framework is the most widely adopted security framework in the U.S. health care industry, and it’s the only one that’s industry specific. Other commonly used frameworks include the Control Objectives for Information and Related Technology (COBIT) and the National Institute of Standards and Technology (NIST) Cybersecurity Framework. While Frederick says that IT staff are the most likely to interact with a security framework on a day-to-day basis, marketers will benefit from the oversight that the systems provide to secure their actions. The Human Factor

Even as health care organizations ramp up their technology to manage risks, there’s only so much that

Health Care’s Wall of Shame When 500 or more individuals are affected by breaches of unsecured protected health information, the HITECH Act requires that a list of the breaches is made public. Since 2009, more than 1,000 incidents have been reported on the U.S. Department of Health and Humans Services “wall of shame.” The public website shares information about the size and nature of each breach. Recent cases range from laptop thefts at small private practices to unauthorized e-mail access incidents at multistate health care systems.

fancy tools and systems can do. At the end of the day, people remain the biggest threat to patient data security. The primary cause of a breach is lost or stolen computing devices, a problem that’s often attributed to employee carelessness, and according to the Ponemon Institute, 75% of health care organizations say that employee negligence is their biggest worry. “We tend to think that because it’s digital, there isn’t an analog to that digital. That’s the human factor. The biggest issue with health care data getting out there is from the human beings who work within health care. It’s an insider issue and oftentimes the insider doesn’t realize that they’ve been hacked,” Echemendia says. Whether a hospital marketer leaves her work laptop on the train, or a nurse slips and inappropriately tells a visitor a patient’s room number, those human mistakes could have devastating consequences. The theft of two laptop computers from the administrative offices of Alhambra, Calif.-based AHMC Healthcare Inc. compromised the health information of 729,000 patients, including their social security numbers. “No matter how good your technology is, you also need to make sure that the human factor is addressed as well,” Kim says. Spreading the Security Word

At Boston-based Massachusetts General Hospital, the privacy department wants to make patient data security and privacy as second nature for hospital staff as washing their hands, says Allison Dolan, privacy project specialist at the hospital. From the moment they join MGH, employees receive constant communication regarding how to handle patient information. All new hires complete a required orientation that includes HIPAA privacy and security training. Dolan’s department sends out weekly e-mails and regularly attends other departmental meetings to update staff about patient privacy protection. Senior management at MGH wants to treat privacy and security as a recurring campaign that’s part of the culture, Dolan says. “It really has to be this regular, ongoing training,” Dolan says. “If it’s viewed as something that happens once a year, and in the meantime, nobody hears or sees anything about it, then it falls off the radar. People need to be continually reminded that if somebody keys in the wrong fax number, and [a fax] goes to a car dealership instead of another physician, that’s a breach and it needs to be documented and reported.” Marketers’ skill sets also are valuable when it comes to spreading awareness.

Frederick, who calls himself a security guy, leverages HITRUST’s marketing department to spread the word internally about protecting patient information. “[Marketers] are the ones who are responsible for producing annual publications to employees and local facility newsletters. We use those vehicles oftentimes to communicate our concerns and messaging as part of our awareness campaigns. The marketing team can help us hone our message and get it out there effectively,” he says. Damage Control

A data breach may catch a health care organization off guard, but its response shouldn’t be left up to chance. The HIPAA Breach Notification Rule requires staff to report breaches to affected patients, but there are right and wrong ways to carry out that task, Dolan says. While the law only requires the hospital to send patients a letter, Dolan and her colleagues call each and every person who may be affected by a breach to explain what happened and how the hospital is handling the situation. “That way the trust has not been violated to the same degree than if they just got a letter out of the blue,” Dolan says. For marketers, the best course of action is to be honest and transparent about the whole scenario, Smith says. “It’s not just reaching out once, but staying in contact. If it’s an issue that can be fixed, then [communicate regularly] until it’s fixed or [provide] continual updates relative to when you’ll hear from us again,” he says. Patient data will enter the hospitals and health care systems from increasing channels over the next few years, from personal devices like Fitbits to secure statewide networks like the Massachusetts Health Information Highway. Dolan says that her department needs to keep open lines of communication across the organization to understand the patient implications of all of these changes. To build a culture of security, health care organizations need more than a shiny new system implemented by IT or an internal campaign created by the marketing team. The effort takes a crowd. “Ultimately, the majority of the health care ecosystem isn’t necessarily a bunch of security people,” Echemendia says. “But security is something that really affects us all, just like safety. How did that become part of the culture? It took a lot of years, and it took involvement of all—from the highest levels of the organization to the lowest levels.” mhs ✒ Marguerite McNeal is a San Francisco-based journalist who covers marketing across several industries.

marketing Health services Fall 2014

marketing health Services Fall 2014

Gettin g Star te d wi th Pred i cti v e An aly ti cs

Thanks to increasingly open access to patient information, health care organizations are forging ahead into the newest frontier in Big Data: predictive analytics. But this datadriven approach isnâ&#x20AC;&#x2122;t just for doctors. Marketers, too, are using this foresight to better augment and tailor their marketing initiatives to patientsâ&#x20AC;&#x2122; future needs. Hereâ&#x20AC;&#x2122;s what you need to know to implement a successful predictive model using analytics and apply actionable insights to your big-picture marketing strategy.

By Lauren Drell and Julie Davis

marketing Health services Fall 2014

magine that you could pull out a crystal ball and predict the future of your health care organization. What types of insights would you ask to see? For medical professionals, seeing the future could mean predicting how

busy the emergency room might be in two weeks and adjusting the schedule in advance to make sure it will be fully staffed. For health care marketers, it could mean developing a safe jogging program that launches before exercise-related knee injuries are expected to spike. The health care industry is gaining this valuable, hyper-focused foresight by using predictive analytics, a technique that leverages data to forecast trends and behavior patterns. The insight gleaned from the resulting data could help organizations take a proactive approach in making accurate and timely health care decisions and allow marketers to target their health care initiatives accordingly.

P r e d i c t i ve A n al y t i c s P ri me r As the digital health revolution continues to unfold, electronic data flows from nearly every direction of a patient’s health journey, from electronic medical records to billing systems, prescriptions, social media and even wearable devices and smartphone apps. Marketers can use this data to get actionable insights about their patients, improve quality of care and patient outcomes, reduce costs, and boost efficiency—all adding to an organization’s bottom line. Eric Siegel, the author of Predictive Analytics: The Power to Predict Who Will Click, Buy, Lie, or Die and founder of the Predictive Analytics World conference, says that predictive analytics help marketers decide how to target an offer or which specific offer to give a patient population. “There’s an interesting parallel between marketing applications of predictive analytics and health care applications because in both cases, the whole point is to improve treatment decisions,” he says. There’s an important distinction to be made between what will happen and what could happen, adds Mike Gualtieri, principal analyst at Cambridge, Mass.based Forrester Research. “We’re always talking about probability,” he says. “So if we say we have a predictive model, it’s never about absolutes. It’s never 100%. There’s always some probability.”

marketing health Services Fall 2014

According to Gualtieri, two categories of patient data are critical for predictive analytics: 1) demographic information about patients, including their geographic location, hobbies and lifestyle; and, 2) the patient’s behavior, such as Web-browsing habits and hospital admission rates. Marketers and health care professionals, therefore, can use this information to predict certain actions, such as which patients will likely be readmitted to the hospital, which patients are least likely to follow through on their prescribed medication regiment, which patients are most likely to manage their chronic disease, and more. Health care organizations also use reports and trend analysis, patient results and recent studies to determine what could become a problem, says Karen Butner, an associate partner at IBM’s Institute for Business. “[It’s important to] be able to digest some of that information so that they have leading indicators as to what’s around the corner,” she says. “We can look at a lot of things, but the customer analytics … is what it’s all about.”

R eal- Wo r ld Ap p lic atio n s In The New York Times article “How Companies’ Learn Your Secrets,” author Charles Duhigg reported on how retail giant Target was using predictive analytics to determine which of their customers were pregnant.

According to Duhigg, Target’s statistician, Andrew Pole, analyzed customer data and noticed that although lotion is a popular item for all consumers to buy at the big-box retailer, the women on Target’s baby registry were buying larger quantities of unscented lotion around the beginning of their second trimester. Additionally, he found that pregnant women were purchasing supplements like calcium, magnesium and zinc within their first 20 weeks of pregnancy. According to Duhigg, Target used this data to create a predictive model that could deliver insights about customers who weren’t in the registry but exhibited similar characteristics, allowing the retailer to market to a larger swath of pregnant women. According to Duhigg, Target’s methods created a controversy after a Minnesota father reportedly found out his teenage daughter was pregnant after receiving pregnancy-related marketing materials from Target. Gualtieri insists that Target’s foray into predictive analytics is not a cautionary tale for marketers. Instead, he says it should be a reminder for companies to think through how they collect and use information. He recommends marketers first approach prospects indirectly and confirm that they may be interested, and then make additional offers. According to Gualtieri, a majority of consumers don’t mind if companies use their personal data to improve their targeted marketing efforts. “The risk of another competitor providing a more individualized service is higher than a customer being creeped out by a more personalized service,” he explains.

Brin g i n g P r e d i c t i v e A n al y t i c s to He a lt h C a r e Beaufort Memorial Hospital started incorporated predictive analytics into their marketing strategy in 2011 when the hospital partnered with Birmingham, Ala.-based health care data analytics company Medseek to determine the right audiences for their preventative care campaigns. “We don’t have the marketing dollars to compete with the major medical centers that are also targeting in our

“We wanted to make sure that we had the tools available to reach the right patients with the right message at the right time.” —Courtney M cDerm ott, Bea ufort M em oria l Hospita l

market,” says Courtney McDermott, Beaufort’s director of marketing and communications. “We wanted to make sure that we had the tools available to reach the right patients with the right message at the right time.” Medseek and Beaufort have executed a variety of campaigns, some as simple as reminders to come in for an annual check-up, and some, such as campaigns promoting new services, which tap into Medseek’s predictive tools. The team is currently working on a campaign promoting Beaufort’s new tomosynthesis or 3-D mammography equipment. Using its predictive data, Beaufort’s team is developing a direct mail piece that will target women who may be considering a mammogram. Some of Beaufort’s past campaigns have been so successful in drawing new customers that the hospital has actually had to put one campaign on hold until the organization had time to hire additional staff. Over a period of 13 months, Beaufort acquired 1,966 new patients and generated a total net profit of $696,331, according to Medseek. Health insurance companies have been using predictive analytics to estimate consumer health and medical expenses, but its move into health

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Bes t Practic e s fo r Pr edicting When putting a predictive analytics strategy together, Karen Butner of IBM’s Institute for Business says health care organizations should think of it no differently than undertaking a marketing campaign. “It’s not unlike Procter & Gamble selling Tide,” she says. “It’s a marketing campaign in that it communicates awareness—all those things—so that they’re increasing their [brand] loyalty, increasing their customers, and increasing their products and services.” In order to successfully incorporate predictive analytics, marketers should understand a couple best practices:

Outline the business goals.

Butner suggests to clients that marketers start with what IBM calls “a Big Data strategy,” which helps determine an organization’s vision and goal for using predictive analytics. Once you’ve outlined your vision, she says, make sure to communicate it with everyone involved. “We need to first decide what the business need is, what we’re trying to accomplish and, of course, work with our IT and researchers … to create the blueprint and say, ‘Here’s what we want to try to achieve, but to achieve that, this is the information we need,’ and get everybody on board with the overall plan,” Butner says.

Consider recruiting help.

Learn from the pros.

Leverage existing data.

The most logical, cost-effective place to look for new insights are within an organization’s existing data, says Butner, so start there. “Don’t try to boil the ocean. … [Wait] until you first tackle your existing data and bite off what you can chew and digest,” she says.

Most likely, you’re going to need someone to mine the analytics, or a tool to help define your predictive models, or both, says Forrester’s Mike Gualtieri. He suggests looking into software— such as programs by the SAS Institute or Alpine Data Labs—and consider hiring a data scientist or analyst if you really want to invest in your predictive analytics capabilities.

Build on your analytics capabilities.

Support the business case with proof.

Think about enterprise.

Butner says that building on analytics capabilities should all come from the organization’s original roadmap—its current needs and goals. By fitting a predictive analytics strategy within your already-existing parameters and business requirements, organizations can build out their analytics efforts appropriately. After you’ve taken on a project or two using predictive analytics, communicate your discoveries and insights with the business team. By doing this, Butner says, you’re ensuring active involvement and sponsorship from top-level staff members, which could pave the way for larger projects that could show more definite ROI. Keep in mind that you may need to scale your analytics strategy over time, says Graham Hughes of the SAS Institute Center for Health Analytics

and Insights. Once you get a five-year strategy in place, invest in a platform that gives you the ability to solve hundreds of different predictive cases. Don’t piecemeal yourself one at a time with different solutions, he says. “I think the most sophisticated organizations are looking at marketing automation and marketing analytics and marketing operations [using] customer intelligence platforms that will be able to cover a broad spectrum of predictive market analytic needs,” he says.

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Network with a marketing leader from another industry, such as a chief marketing officer or a digital campaign manager, to learn about their journey with predictive analytics, and then apply those learnings to your own environment, Hughes says.

care marketing has been more recent. Blue Cross of Northeastern Pennsylvania (BCNEPA) began using Deloitte’s predictive analytics models to target a direct mail campaign in late 2013 and early 2014. Paul Holdren, senior vice president of sales and marketing at BCNEPA, says there were 120,000 uninsured people in northeastern Pennsylvania, and by using predictive analytics, they targeted their outreach to a little more than 10,000 contacts and determined that 10-12% had a high probability of enrolling, according to BCNEPA. Holdren’s team implemented a direct mail campaign promoting BCNEPA’s individual insurance plans aimed toward patients eligible for the plan and who had a strong likelihood of being interested in the company. Holdren’s previous direct mail campaigns generated 1-2% enrollment, on average, but this campaign netted 20% enrollment. “I only wish I had it 20 years ago,” he says. “It would have made a big difference in how I spend my advertising and direct marketing dollars in order to secure people.” New York-based EmblemHealth’s use of predictive analytics has prompted the company to begin building an in-house analytics team. The team has supplemented the ongoing relationship between EmblemHealth and Columbia, Md.-based Merkle Analytics for the past year and a half. “An agency is primarily tasked with analytics around the campaigns, but we use analytics for lots of strategic purposes beyond running our direct marketing campaigns,” says Shirish Dant, EmblemHealth’s head of consumer marketing and market insights. “So our in-house analytics capabilities are really critical in doing those strategic analytics.” EmblemHealth saw strong results using predictive analytics for their Medicare open enrollment campaign in 2013. According to Dant, during the 10-week period of the direct mail campaign targeting Medicare members interested in switching health care plans, their costs per lead went down 50% compared with the previous year. The team was able to generate more leads while sending 25% fewer pieces of mail. As a business serving a large local market—New York City—EmblemHealth’s marketing strategy has always revolved around neighborhoods. “We are very specific

and very targeted when it comes to our marketing strategies and our campaigns,” says David Mahder, EmblemHealth’s vice president of marketing and communications. “Predictive analytics really fits right in because it allows us to be even more effective as we target these different populations.” The team is now working on incorporating more data—tracking not only responses, but also leads and conversions—to better refine their predictive models.

T h e An aly tic s Ed g e Making good use of data and analytics is a trait shared by the industry’s leading organizations, according to 2012 research from IBM. Among top performing companies, 65% use analytics for sales and marketing, compared with only 40% for lower performing health care organizations. Graham Hughes, chief medical officer at the Cary, N.C.-based SAS Institute Center for Health Analytics and Insights, says that seemingly small improvements, such as understanding high-risk patients more accurately or increasing retention or engagement by 5%, can be a huge advantage. “That translates into a phenomenal amount of differentiation if your competitor isn’t doing it,” he says. It’s not a perfect science, but it’s one of those things that one or two percentage points … can have a huge influence on understanding your business.” Many organizations are limited because they don’t understand the kinds of questions data can answer, Gualtieri says. He recommends companies look at their customer journey map and ask detailed questions. “Don’t constrain yourself,” he says. “Ask yourself the question, ‘What could I predict about this customer that would allow me to perfectly provide them some product information that they need to know?’ ” The availability of data will continuing to grow rapidly, but many health care companies will need to improve the way they make use of that data in order to reap the rewards. “We really wouldn’t be where we are today without predictive analytics, so it’s a really important tool,” Mahder says. mhs

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k n ow l e d g e bas e

As the senior vice president and CMO of Watertown, Mass.-based athenahealth, Rob Cosinuke helps the cloud-based health care solutions organization market its services to physician practices both large and small. Before his jump into the health care industry, Cosinuke co-founded the global database marketing ad agency Digitas in 1991 and served as the president of its Boston office. He has a B.A. from Haverford College and an MBA from Harvard Business School.

10 minutes with Rob Cosinuke By Melody Udell /

 mudell@ama.org

ob Cosinuke is on a mission to fix health care—and he’s starting with the providers. His company, athenahealth, offers a suite of cloud-based services that provide physicians and health care providers with tools to help manage their practices, from billing to patient communication to electronic medical records. As the senior vice president and CMO of athenahealth, it’s Cosinuke’s job to market athenahealth’s software solutions so that providers can spend more time helping patients and less time struggling with the day-to-day minutiae of medical practice management. Marketing Health Services touched base with Cosinuke to learn more about digitizing health care, barriers to entry for marketers and health care’s patient-led future.

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Q: athenahealth covers a wide range of health care business services, including electronic health records, billing services, care coordination, patient/ physician communication and business management— all based in the cloud. What was the impetus for rolling all these health care solutions into one cloudbased organization? A: Health care is inefficient, fragmented, and a poor reflection of our humanity. athenahealth’s core mission, which we live and breathe every day, is to be caregivers’ most trusted service and to make health care work as it should. We are about providing a seamless care experience and believe ... that we’re best able to support the patient care workflow. Via the cloud, athenahealth offers a ‘lightweight’ technology infrastructure that is accessible, affordable, scalable and, most importantly, is updated universally across our entire network of providers—everyone runs on the same single instance of software. This enables us to be nimble and responsive to keep pace with industry change, and introduce new innovations for our clients faster than any other model without the need for hundreds of millions of dollars and countless man hours in HIT expenditure. In comparison, enterprise software is static, has trouble keeping pace, and, too often, prevents the timely and ubiquitous sharing of health information. We think of ourselves

as the white glove approach to practice management and care coordination. We see this approach pay off every day, as our cloudbacked services allow providers to focus on what they do best: patient care.

Q: CEO Jonathan Bush has been quoted as saying athenahealth will become “the nation’s health information backbone.” What does this mean? A: Creating the nation’s health information backbone to make health care work as it should is part of our DNA and competitive strategy against traditional enterprise software. There’s really no reason why health care information can’t be delivered universally over the Internet using secure protocols. This is what we’re enabling: every patient with accessible records, in the cloud. Over the past 17 years at athenahealth, we have created a national network of more than 52,000 providers and 3,000 receivers (labs, pharmacies, imaging centers, etc.), all able to share data openly and support the care of over 50 million patients nationwide. The national health information network we’re building facilitates true health information exchange across all care settings, so providers can be fully informed in the moments of care, and patients can receive the best service possible. Unlike enterprise vendors, which in many cases operate in closed or limitedscope silos and are unwilling to connect with other systems, we are

knowledge base

about openness. Imagine a highly interfaced and integrated network that communicates at every opportunity possible. Hospitals should be able talk and share relevant (and secure) patient data with other hospitals, labs, private practices, and so on. The same way an ATM network does. This type of connectivity can save lives.

Q: athenahealth just ended its partnership with the Electronic Health Records Association, which represents the electronic health records (EHR) industry and its efforts to digitize health care. Why did you decide to end your partnership with the EHRA, especially with the looming 2015 deadline for converting paper medical records to digital? A: The short answer: Membership in the Electronic Health Records Association (EHRA) kept athenahealth playing in the sandbox with vendors that we don’t consider peers. The EHRA is comprised mostly of vendors whose customers host their own static software systems, while athenahealth maintains a single suite of cloud-based workflow applications on behalf of our clients. We are fundamentally different. As a cloud vendor, we frequently update our software— sometimes nightly—while non-cloud vendors might take years to release new versions. We found ourselves supporting positions that often went against the EHRA’s [opinions], which marketing Health services Fall 2014

k n ow l e d g e bas e

created confusion and obligated us to defend the ways we diverged from our trade association rather than focusing on our own position. Our focus is to support laws that allow for flexibility, and more often than not the EHRA advocates for federal legislation favoring enterprise software-makers at the expense of cloud vendors. For instance, with health data interoperability initiatives, the EHRA consistently balked at progressive standards, instead favoring lowering the bar and delaying technology implementation deadlines. This undermined our primary goal: to bring health information technology up to the standards of IT used across the rest of the economy. We knew it was time to leave and ensure that our advocacy for health data interoperability wouldn’t be held back.

Q: Why has there been a lack of tech innovation in

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the health care industry? What can health care marketers do to cross some of those hurdles?

A: Well-intended government

regulations prop up dinosaur technology—expensive legacy software that requires huge capital expenditures, multiyear installations, and still doesn’t advance information exchange. The government is essentially and unknowingly subsidizing technology that cannot meet the very standards of the program under which it is subsidized. As a result, meaningful adoption of advanced health care IT is slow, costs soar, and the pace of innovation remains flat. Also, there are too many barriers for new entrants—innovators and entrepreneurs—to find their way into health care. The corridors of the industry are overprotected and being run by incumbents who should be unseated with new

players who can do things more efficiently. Health care marketers can differentiate their products by highlighting true results that impact workflow and care. Organizations should compete on what they do best and be held accountable for their clients’ success or failure.

Q: Originally, your organization was founded in 1997 as a pregnancy and birthing center in San Diego. Why did athenahealth make the shift from a women’s-oriented practice to a software solutions company? A: [Co-founders] Jonathan

Bush and Todd Park found themselves inundated with paperwork, spending the bulk of their time just trying to get paid. Their solution was to bring in Ed Park, Todd’s brother, to develop software to streamline

and speed up the billing process. Basically, they built a very light version of what would become athenaNet, the cloud-based network that ultimately would become the backbone for medical practices across the country. It was clear that the network they were building was solving practice management and care coordination problems for their own business and could also help others in health care to operate smarter and more profitably. They shifted their focus and set out to fix health care on a broader scale.

Q: You’ve now grown into a publicly traded company with more than 52,000 providers in the athenahealth network and a staff of 3,000. What does this growth signal for the future of health care? A: The future of health care belongs to those who can efficiently and effectively facilitate care coordination within a group system and beyond. athenahealth leverages the power of the cloud in combination with a set of robust services to deliver back office services and care coordination in ways no other vendor has been able to achieve. As the industry moves from fee-for-service to value-based reimbursement, these services will become even more essential to improve outcomes. We have a huge opportunity now among hospitals and health systems, which can leverage our model to assess how their individual providers are performing and maximize their population health and care coordination initiatives. … Physicians and health systems of all sizes will need services to support care

delivery, administrative efficiency and patient engagement that are nimble and scalable enough to carry them through the 21st century and beyond.

Q: In 2013, athenahealth acquired the mobile health IT firm Epocrates. What does this acquisition mean for athenahealth’s mobile, app-based ambitions? A: Staying true to Epocrates’

original mission of helping health care providers make decisions with confidence and efficiency during moments of care, we released [antibiotic resistance mobile application] Epocrates Bugs + Drugs in October 2013. It helps clinicians identify bacteria types and resistance patterns in their local area. … As for the future, we are collecting data and insight about the highest performing medical practices and physicians in the country. This includes care outcomes as well as financial revenue and profit gains. We see an opportunity to provide high value content on the core application around the business of health care.

Q: athenahealth’s services are targeted toward the highest-level decision makers within an organization, whether it’s the owner of a small practice or a top-level health care CEO. What marketing challenges does that pose when you’re trying to reach these decision-makers, and how do you broach them? A: It depends on the segment.

… When you are trying to reach CEOs of the largest institutions, normal marketing channels do

not work. Traditional advertising or messaging is ineffective. What we do is concentrate on personal networking and the word-of-mouth model. We have created a machine that enables this word-of-mouth networking model by building deep engagement through highquality, custom content and events focused on managing change in health care and health information technology. We work in partnership with our clients and prospects to create a lot of our own content. For instance, we have a range of programs codeveloped with Harvard Business School Publishing, Harvard Business School faculty, and our own editorial and expert clinical staff that’s specifically curated to draw in the C-suite. When you’re pursuing small-group practices, it is a whole different challenge. The CEO is generally the doctor and owner and what’s top of mind to that small practice owner is running a successful and effective business minus the insanity. We have been pretty successful reaching them through smart online marketing and broad strategic partnerships.

Q: It’s clear that we’ve entered a patient-led health care reform, thanks to increasingly accessible data and improved patient/ physician communications. Where do you think this health care revolution is headed in the next 10 years? In the next 30 years? A: I see three things happening: appearance of lower-cost, higher-quality care; more patient accountability; and an increase in health care ‘shopping.’ mhs marketing Health services Fall 2014

IW In other Words

Revisiting Virtual Health Care

Programmed for Health

As virtual health is staking a larger claim in the health care space, patients might start hearing a different

version of that familiar waiting room greeting: “The avatar will see you now.” While the use of avatar or Intelligent Virtual by Lauren Drell, staff writer  ldrell@ama.org Agent (IVA) technology is still in the early stages, experts predict it will give health care providers a new set of tools to better manage patients, boost engagement, improve treatment adherence rates and reduce costs. But will patients form trusting relationships with a virtual caregiver? “Patients will interact with an animated character with a lot less trepidation because they know it’s not a real human who might be judging them based on the kinds of information they’re inquiring about,” says Dennis McGuire, CEO of CodeBaby, the Colorado Springs, Colo.-based software company that develops virtual assistants. Research shows that people view avatars like they view other people, says Matt Fieldman, senior account executive focused on health care at Valley View, Ohio-based Fathom, a digital marketing and analytics firm. “If they’re human-looking and have eyes and emotions, then people are treating them like other people, so they’re really opening up and they’re offering up really personal questions. ‘So, I’m having these symptoms, can you help me out?’” San Francisco-based Sense.ly, a health care IT startup, develops speech recognition and virtual assistant software to help physicians better manage patients with chronic diseases. The company built an avatar named Molly who was deployed at several hospitals in California, including San Mateo Medical Center, to coach patients who have a variety of physical and chronic illnesses. Molly interviews patients and asks specific questions about their conditions and progress toward recovery. “The whole idea behind Molly was to basically mimic the bedside manner of the doctor because that’s what patients are used to in their communications with the doctor,” says Adam Odessky, co-founder and CEO at Sense.ly.

As the use of virtual agents starts to expand, so, too, is the role that these avatars are playing within health care organizations. Some virtual agents, such as Hartford, Conn.-based Aetna’s curlyhaired virtual assistant, Ann, are being used to handle more administrative tasks in health care. Ann aids with call center volume, recalls patients’ medical histories and even helps them change policies. According to Mitch Lawrence, executive vice president of sales and marketing at NextIT, the company that developed Ann and other IVAs, nearly half of all members who log onto the Aetna website receive help from Ann. “When members engaged with Ann, there were 29% fewer calls in the call center, and that meant Ann was really helping them out with their needs.” The company also is working with a large pharmaceutical company to develop another virtual assistant that will have even more functionality than Ann, including answering commonly asked questions about a particular disease state, tracking how patients are feeling, providing medication reminders, and giving tips for a healthy lifestyle. “If they can engage the patient and provide the level of service that the patient wants in a way that they want to, that in of itself can be a win,” Lawrence says. “[To] drive compliance and persistence and adherence to the medication, you’ve got to take it beyond just badgering the patient with reminders.” mHS

Above is a portion of an article that ran in the AMA’s Marketing Health Services e-newsletter. In the column on the right, we expand on the original article with coverage about the increasing use of avatars within health care organizations.

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