The days of winning over Medicaid recipients through overly aggressive direct marketing incentives are quickly coming to an end, as more and more state Medicaid agencies are stepping up efforts to "protect the healthcare interest" of this low-income, highly vulnerable target.
A few years ago, when HMOs flooded the Medicaid marketplace with a flurry of managed care health plan messages, a few resorted to bogus giveaways and exaggerated promotional claims to generate a high volume of enrollees.
Isolated examples include stereo boombox giveaways in Illinois; Thanksgiving turkey handouts in Tennessee; and the loitering of sales agents around food stamp and welfare offices in Florida to sign up enrollees.
These marketing abuses, which added to recipient confusion and disenrollment rates, caused several states to regulate Medicaid marketing messages.
The most recent trend sweeping the country involves the use of state-issued health benefits consultant/broker-based programs that provide face-to-face counseling on healthcare plan selection for Medicaid recipients.
This latest power move of states becoming healthcare gatekeepers is being met with mixed HMO reviews. Like it or not, HMO plans are finding that playing by Medicaid's fast-evolving and increasingly restrictive marketing rules requires some staff retooling and innovative campaign gear-shifting. Reaching this hard-to-capture target of roughly 13 million Medicaid recipients (nationwide) from various ethnic backgrounds and challenging educational levels is top-of-mind for many managed care plan marketers. It was a hot topic at a recent industry conference of The Alliance For Healthcare Strategy and Marketing in Chicago.
Medicaid Marketing Don'ts
For most states that have managed care Medicaid marketing programs (currently about 48 states) direct marketing is out of the question. Essentially, this means no door-to-door marketing, cold calling or selling by an independent marketing agent, according to Mary Kenesson. She conducted a "Medicaid Managed Care Enrollment Study" of 40 states that looked at the number of states that use, or are planning to implement, health benefits consultant-based programs.
In fact, Kenesson predicts that as more states require reviews of printed marketing materials, marketers will have to shift to more broadcast- and community-based campaign strategies.
In Illinois, where 15 HMOs are fiercely competing for Medicaid business, achieving brand recognition is next to impossible, according to Marsha Church Herring, director of medical center marketing for the University of Illinois at Chicago Medical Center.
With a fairly new marketing presence, (UIC's HMO entered the marketplace in August, 1996), UIC's plan is to make noise in Chicago's highly saturated managed care Medicaid environment that still allows health plans to enroll recipients through community-based co-sponsorships.
"We are very different from our counterparts in that we don't do any a dvertising or direct selling to sign up new clients; we rely solely on our educational programs to generate word-of-mouth referrals about UIC's long tradition of service." said Herring. The marketing budget is $400,000.
But with a Medicaid enrollee goal of 20,000, Herring concedes that the plan is not close to meeting its objective (it now has about 5,500 current enrollees), for a few compelling reasons. Namely, UIC doesn't have any community-based physicians or sites in its network, and the top plans in the market do. Also, enrollees can opt out of plans every 30 days, so disenrollment is also a concern, but not as much of a problem for UIC, whose disenrollment rate is at 10 percent compared to the market average of 50 percent.
Although the other plans are using extensive ethnic-targeted radio, print, billboard and transit advertising vehicles to build awareness, Herring remains steadfast in UIC's primary marketing strategy of community-based educational programs. "This target won't make their healthcare decisions based on what they hear on the radio or see on billboards; they respond most to who's in their community and the service they receive once their signed up."
To this end, UIC focuses on enrollee retention through extensive training and fulfillment support of key point-of-contact staff like its nurses and sales force. Its most aggressive program uses nurses to make enrollee calls, field questions about the plan, and schedule physician appointments. "This provides a personal touch and commitment to the enrollee that our competition doesn't offer. We believe that high volume doesn't mean anything if they're in and out every month," said Herring.
In Pennsylvania, where a health benefits consultant program was recently implemented about a year ago, David Brown, president of Beach Advertising in Philadelphia, saw his Medicaid marketing business fall off. "It's very difficult for these [health benefits consultants] to give objective healthcare advice to 600,000 Medicaid recipients," said Brown, who pointed out how effective direct marketing was (when used appropriately) in introducing new health plans or a recently merged health plan to Medicaid communities.
Brown, who recently lost two healthcare clients, Total Healthcare (Baltimore) and Health Partners (Philadelphia) in the last year, has recently picked up The Community Health Network (TCHN), a physician-run health plan in Philadelphia. Like a growing number of other states that have implemented health benefits brokers, Pennsylvania HMOs have had to become much more programmatic in their marketing strategies, according to Brown. "[The legislation] is forcing marketers to focus more on actual benefits and services as opposed to the 'deal of the day' approach."
Since TCHN is a physician-based network and not an HMO, Brown currently has some direct mail latitude.
Once budgets are approved, he plans to use radio and print for mass reach but focus on a number of community-based programs and physician to physician direct mail efforts to build brand identity for his latest client that has 150,000 members, 90 percent of which are Medicaid recipients.
(Mary Kenesson, 540/882-4431; UIC Medical Center Marketing, 312/413-0026; Beach Advertising, 215/735-4747)