The Hot Issue Could Be a Cold Shoulder From the Public
Rick Wade, senior VP for communications at the American Hospital Association, 202/626-2339
Expect to see healthcare issues in the public spotlight - in the media, government and public interest groups to name a few - as never before in 1998.
Americans will continue to be bombarded with conflicting and confusing impressions of what's going on and who's benefiting from the volcanic change taking place among hospitals, health systems, physicians, nurses, insurers, government and others who affect the amount and quality of care they receive.
Our billing practices with government and others will continue to come under scrutiny. Will they understand the complex systems we're dealing with and how hard we work at getting it right?
Americans will want more data about how and why we deliver care to patients differently in different places.
The American Hospital Association continues to do extensive public perception research, listening and talking to people of every geographic, demographic, economic and insurance status. If one thing is clear, it is that many of the people we serve do not see the wave of change benefiting them. They see the profit motive driving individuals and institutions and they are worried. Insurers and managed care companies are - in their view - controlling healthcare and patients, without individuals or organizations willing to be their advocate. These organizations are the losers.
The once strong bonds between doctors and patients and hospitals and the communities they serve are being tested to the breaking point and - in some instances - are shattering under the pressure.
The challenge? Enhancing the public's confidence in hospitals and health systems as committed to their communities and working to do what's best for patients in an era of shifting incentives and economic turmoil. Strengthening that historic bond of trust is work that simply cannot wait.
Hot Button PR Issues
Ilysa Levins, president of Grey Healthcare Group PR, 212/886-3058
Products are getting approved faster and getting to the market quicker. Market exclusivity continues to diminish. There is less time to differentiate brands and cement brand loyalty.
In this competitive environment, launching and landing on your feet during the critical first months after approval requires an integrated pre-launch strategy far earlier in a product's life cycle.
Marketers must adopt a new mindset and move from acquisition (getting patients on your brand) to retention (where target audiences choose your drug time after time). Programs that quickly establish personal, one-on-one relationships with consumers, physicians, pharmacists and payers can improve compliance, formulary acceptance and ultimately return on investment by retaining these customers longer.
Personal relationships are best achieved when messages come from respected influencers, such as advocacy groups. In about 10 years, the U.S. will be predominantly comprised of African-Americans and Hispanics-groups with a high prevalence of cardiovascular diseases and increasing rates of HIV/AIDS (both have high non-compliance rates). Because these groups get medical information from nontraditional sources (e.g., the faith community) advocacy relations must become a priority. Other special populations, such as women and seniors also require individualized communications, which can be achieved through highly targeted "micro" media relations.
We have seen PR's impact in test markets when publicity is "wrapped around" direct-to-consumer (DTC) advertising and coupled with direct mail.
Sales are greater in these markets with this tactical combination versus those that use DTC alone. Different media have varying effects on different audiences: minorities respond differently to national consumer media than do the elderly. That's why we must establish new standards and "metrics" for measuring media coverage as it relates to return on investment.
What High Quality Will Look Like
Josef J. Reum. executive VP at The American Health Quality Association,202/331-5790; email: [email protected]
Making sense of report cards; top ten/15/50 or 100 lists, surveys, accreditation visits, and outcome measures will demand every bit of creativity we can muster.
Real quality in any organization requires a cultural shift. It takes years to get to a secure place where, from top to bottom, quality drives the system.
Unfortunately most purchasers are looking hard at the next premium invoice, not the next decade. They tend to measure results in ways that will force us to make incremental progress simple and understandable to employers, employees, Medicare beneficiaries, Congress, and legislators in every state and territorial capitol. The year ahead will be about explaining ourselves and our long-term commitment to quality in short-term economic language.
Being clear about what high-quality care looks like regionally will emerge as the favored strategy for survival as plans and facilities continue to network and consolidate. Resulting increases in the total number of covered lives will present an important and long term opportunity for increased disease management and population based medicine efforts. These are the only remaining pathways for providers to realize the dynamic goals of improving quality and continued earnings in the future.
Job Outlook
Susan Dubuque, president of Market Strategies Inc., 804/783-8140;email: [email protected]
With the new year, I shutter to think of our colleagues who are pounding the pavement looking for jobs-due to no fault of their own. You know the stories: consolidations, mergers, downsizing, rightsizing. How many of our friends have fallen prey to this array of euphemisms - better known as losing your job?
Here are a few resolutions for 1998 to help protect your job this year:
- Spruce up the professional image of your department and everyone in it.
- Be accountable. Document your expenditures of both money and time. Track your results and scream about your department's successes.
- Conduct a post-mortem for each project. Did you achieve your desired results? If not, why? Was this project worth the time and money required? If not, change the scope or drop it altogether. Maybe it's time to get rid of that annual health fair that has attracted the same 17 Medicare patients for the past six years.
- Talk the talk. Learn healthcare finance lingo. Learn how to read a balance sheet and financial report.
- Let it be known you are willing to assume new roles and responsibilities. Get out of the "box" that is inhibiting your professional growth.
- Become your organization's managed care expert and consultant by working with managed care professionals, making marketing presentations to your board, administration and management and expand your professional network to include counterparts from insurers, managed care companies, employers and home health agencies.
Managing the Managers of Healthcare
James E. Lukaszewski of the Lukaszewski Group, 914/681-0000
Managed care and those who manage that care will face the most intense cynicism, criticism and credibility problems ever in 1998. Aggressive/defensive PR and active, knowledgeable management communications support will be needed. Here are the components of this challenge:
- Expanded government scrutiny and investigation of reimbursement programs will include accelerated prosecution.
- Physician unrest, conflict and confrontation will consume more of management's personal and public communication time.
- Nurses' long simmering dissatisfaction will pour out, exposing poor, silly and dumb management practices.
- National healthcare initiatives, pushed by religious and activists groups, will resurface to influence Presidential politics. The focus will be on embarrassing and exposing managed care organizations which made millions for some and hurt and ignored many more.
Managers will rely on healthcare PR pros for:
- Sound advice on operational solutions;
- Candid, direct engagement with emphasis on face-to-face, one-on-one communication that avoids traditionally suspect PR tactics and techniques; and
- Moving the process forward when everyone feels like a victim.
Federal Legislation: Confidentiality Of Individual Health Information
Michael E. McDermott, a partner Farrell, Fritz, Caemmerer, Cleary, Barnosky & Armentano, P.C., law firm, 516/227-0700
As required by the 1996 Health Insurance Portability and Accountability Act, the Secretary of Health and Human Services recently submitted her recommendations to Congress concerning the confidentiality of individually identifiable health information.
The recommendations contain general guidelines for the content of a new federal health information privacy statute. In addition to defining "healthcare information," the guidelines state under what circumstances health care information can be disclosed, the rights patients have with respect to their healthcare information, standards for electronic and magnetic writings, and sanctions for violations of a patient's privacy rights.
These recommendations clearly set the stage for what promises to be interesting debate in Congress in 1998 as legislators balance the need to provide a workable system of electronically stored and transmitted healthcare information against the patient's right of privacy.
Especially thorny issues include the linkage of health care information to other data, such as financial information, what safeguards will be put in place to ensure security of healthcare information, what penalties will be imposed for inappropriate use of private health information, and what effect federal legislation will have on state privacy laws.
It is clear, however, that without appropriate legislation, individuals will not have predictable, enforceable privacy rights and providers and payors will face an increasingly uncertain future as to their rights and responsibilities with respect to this information.
Reality Check
Kathy Lewton, director of Porter Novelli's national healthcare practice and HPRMN contributing editor, 312/856-8888
1998 may be the "Year of living in brutal reality" for those who run healthcare organization and those who use its services in this country.
- Providers will realize that in their haste to land managed care contracts, they've also been handed the risk along with the capitation arrangement, and will realize they may not know how to manage that risk.
- Hospital executives will realize that after a merger or acquisition and the new system "brand" is in place, the same old challenges remain - motivating employees, satisfying increasingly demanding consumers and building meaningful relationships (beyond the legal documents) with physicians.
- Business leaders will realize that they can't demand cost containment and flat premium increases while simultaneously telling health plans to offer more, more, more.
- As reporters write about the Columbia/HCA downfall, and the plight of major HMOs, they may begin to realize that if it sounds too good to be true - it probably is.
- Consumers will look for truth and candor in the midst of all of this, but whether there's any organization or institution with enough credibility left to provide answers remains to be seen.
The biggest question of all: Will consumers, legislators, business executives and the press finally come to grips with the fact that top-quality, full-choice, latest-technology healthcare, whenever and wherever they want it, cannot be purchased at bargain basement prices.
It's all about choices, values and trade offs, and in the post-Clinton reform and post-"managed care is a miracle" era, maybe the message will finally sink in.
Healthcare leaders - from for-profit and not-for-profit sectors, hospitals and physician groups, insurers and managed care organizations - will need to put aside their differences and work together to advance the candid, honest dialogue needed to get beyond the "quick fix" mentality. A serious discussion about what Americans most want and need from the system, what it will cost, and who will pay for it, needs to be reckoned with.