The marketing campaigns by the industry giants have put heretofore comfortable smaller providers into full defense mode as the two sides fight for customers who are getting more say in where they go for health services. While Columbia/HCA, Nashville, Tenn., has apparently won the advertising battle by blitzing the media recently with its $40 million ad campaign, smaller hospitals are hoping to win the war with aggressive marketing tactics. One of the generals fighting on the side of the smaller hospitals is Lee Snedaker, whose Snedaker Communications Group in Salt Lake City, Utah, creates "syndicated" advertising campaigns for local providers. But his support of smaller providers has not gone without a hitch. Last month his firm was fired by Columbia's Utah region for publicly helping its competition smaller hospitals. Snedaker said his company was dismissed "because of our obvious approach toward trying to help hospitals around the country to compete against Columbia." He said that to remain "alive in today's environment, smaller hospitals must be able to maintain or increase their market share." The ads created by his firm can be recycled and refitted for use by local hospitals around the country. "It's a real membership club. Membership fees get you access to all of the materials that we have developed and a number of hours of our consulting time," Snedaker said. Snedaker's current ads emphasize the theme that big health care's "factory" attitude is "high-tech low touch" while local "homelike, personal care" is "high touch low tech." "People believe healthcare is a cottage industry. They don't want national franchises; they don't want a McDonald's to provide healthcare," he said. The theme may be working; New York-based Intermountain Health Care, one of the country's largest hospital groups, is now touting itself as a "friendly, local company" as opposed to being the "large, high-tech hospital group" in the Utah market. On the other side are dozens of small, local hospitals such as Gunnison Valley Hospital in Sanpete County, Utah with limited resources and little to fall back on in lean times. "It's a really tough time. We need to be pulling out all the stops but we can't afford to," said Arthur Bullis, director of marketing for the hospital. Both sides are trying to attract customers who have more options in where they to go for health services. If there is an ad war going on, Columbia/HCA hasn't noticed it. Columbia's spokeman Jeff Prescott says that may be because his company works on a national level and he hasn't seen any national responses. "Healthcare advertising in local markets is nothing new," Prescott said. "What response I expect you should see would entail a shifting in messages rather than doing more, they'd be doing something different." All the new healthcare campaigns represent a marketing trend in managed care, according to the national Health Care Advisory Board in Washington, D.C. The think tank predicts the next era of healthcare in the U.S. will be directed by consumers pressuring their employers to pick a larger variety of facilities. In that era, name recognition of healthcare providers will mean the difference between business booms for their clients or business busts. Name recognition through advertising is also important because the market has been so active, according to healthcare consultant Dave Knoop of the Salt Lake City office of Johnson and Higgins. For instance, he asked, how many times has Holy Cross changed names lately? Some hospitals have changed so many times, Knoop suggests, that if you ask any major employers the name of the contracted hospitals on their managed care plan, they might not be able to keep the names straight. So will all this advertising improve market share? Until consumers have data that compares costs to medical outcomes, Knoop says advertising won't make a difference in quality. And there is a need to include marketing in the scheme because some hospitals provide just as good health care as others, but they just haven't been able to "sell the sizzle," Knoop said. "You have to have the data, the marketing, the consumer awareness all together," said Knoop, "Then you have all the cylinders hitting." (Columbia/HCA, 1/800/Columbia; Snedaker Communications, 801/355-2211; Johnson and Higgins 801/539-7400)

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