The rural population is more vulnerable to cancer than the general population, according to recent statistics, and yet proper care often is not available locally. By creating an outreach alliance program guided by service delivery concepts, marketers can reach this virtually untapped group of patients.
Setting up individual cancer care operations in rural areas is not always economically feasible, because the market potential is too small to support a group of oncological specialists, offices and equipment, said Miles Dechewski, a healthcare consultant in Washington, D.C.
Because full-service facilities must be in or near regional and urban population centers, there are two options: (1) bringing patients to the center for treatment or (2) a distributed approach in which the care is taken to the patient.
In 1994, the Rural Cancer Outreach Program (RCOP) in New York City, a strategic alliance between an urban academic medical center, Columbia University, and two rural hospitals, was developed especially to target the rural cancer patient.
It works by employing physicians and oncology nurse specialists to travel from the academic medical center to rural hospitals and provide the services each rural hospital needs, said Dechewski. In this way, the rural hospital "owns" the program and designs it to meet their specific needs for cancer care.
The resources of the academic medical center, including clinical trials, first and second opinions by experts, and continuing medical education, are available to rural physicians and patients at their own hospitals.
The program has seen more than 1,200 new cancer patients since 1989 and has served over 2 million miles of patient travel.
The rural hospitals have experienced growth from 50 to over 300 new patients yearly. Since the program is a partnership, the cost is minute.
"It's wonderful; patients receive state-of-the-art care, including national clinical trials of new cancer treatments," said Susan Blander, associate director of the program. "Patient and referring physician satisfaction appears to be high, with many rural primary care providers preferring this format to the rural hospital recruiting an oncologist."
RCOP is the one of the first programs to show results. Experts, however, contend rural alliances such as RCOP will grow.
The program has been financially viable for the rural hospital as well. The additional 300 patients now receive all their services (e.g., radiology, surgery, chemotherapy, laboratory, home health, hospice) through the rural hospital.
Such programs also adds profit to rural hospitals to subsidize other less profitable but needed services and has significantly reduced the yearly cost per patient from $10,200 to $3,800 by a better coordination of services and a shift to the lower costing rural outpatient areas.
In order to form such an outreach alliance program, you must have a collection of different organizations having the same goal or goals, common inputs, such as clients, mutually agreed-upon procedures, and shared outcomes.
For example, Duchewski said participating organizations contribute different resources to pursue patient health objectives.
Rural-based hospitals supply facilities, patient contact, familiarity with the case, and an established client-provider relationship, while the distant medical center contributes expertise, diagnosis, treatment and, sometimes, specialized equipment.
"Communications is key, as each partner's ability to meet their objectives is affected by the performance of others," said Blander.
Marketing problems with the alliance structure should not be a concern. Because of its outreach nature, the target market is not shared in the traditional sense.
For example, the rural hospital recognizes they are not prepared to provide the type of care cancer sufferers need. In fact, they would have attempted to send patients to the distant treatment center if local options were not available.
Elements of Rural Cancer Care Delivery Systems
The structure of the outreach alliance as an organizational system must be considered to achieve coordination and keep conflict minimal, said Duchewski. Both hospitals must set mutual goals and allocate functions and procedures. Financial returns, or losses incurred, must be shared, though not necessarily equally.
Hospitals must assume or be assigned roles and apply their capabilities within certain functional areas to provide needed services.
Duchewski identified three structural dimensions of interorganizational service delivery systems that impact role assignment and role expectations (such as the centrality of the centers, differentiation of the programs, and to make the relationships clearcut). Each of these must be considered in designing the outreach operation.
(Strategic Consulting Group, 202/786-9100; Rural Center Outreach Center, 212/230-1239)