Featured Article from eHealthcare Strategy & Trends

Ask the Expert … with Susan Solomon

Susan Solomon has been in healthcare marketing for more than 20 years. She has taught at several California universities and was a Fulbright Scholar in 2008. You can reach her at Sussol [at] gmail [dot] com.

Dial back five years and a discussion of physicians and social media would have seemed quite odd. Did we really expect physicians asking to be “liked” on Facebook? What was next? Tweeting during surgery? Fast-forward to now, and the answers are “Yes” and “Yes.” Or, more accurately, “Been there. Done that. What else is new?”

According to the online physician learning collaborative QuantiaMD, 90 percent of physicians report that they use at least one social media site personally. And with so much personal use, the possibility of crossover into their professional worlds seems almost certain. Gabriel Bosslet, MD, an internist at Indiana University Health, describes the rise in interest in social media among physicians as “meteoric.”

Kevin Pho, MD, who writes KevinMD.com, the popular blog on physicians and social media, cites two compelling reasons for physicians to actively participate in social media: 1) Connecting with patients and 2) Reputation management.

Making connections with patients

Let’s start with establishing connections with patients. With eight out of 10 patients searching for health information online, there’s obviously a hunger for obtaining quick, accurate online healthcare advice. Unfortunately, some of those online users are going to unreliable sources and either ignoring important symptoms or scaring themselves silly. (Microsoft researchers defined the word cyberchondria as “the unfounded escalation of concerns about common symptomatology, based on the review of search results and literature on the Web.”) Clearly, doctors who regularly connect with patients online are much more reliable sources for information than Yahoo! Answers, which conspicuously disclaims any responsibility for the accuracy of answers provided by posters. And, with healthcare reform kicking in, it’s clear that patients have both clinical and administrative questions that demand reliable responses.

Pho says that his “aha” moment about the importance of social media happened several years ago when news began to leak about the arthritis drug Vioxx and its potential link to heart attack or stroke. Pho blogged about the issue at a time when he didn’t think his blog had many loyal followers. To his surprise, his own patients started thanking him for his informative pieces. “It struck me what a powerful tool I had to connect with patients,” he says.

In addition to Pho, there are many examples of physicians who have become masters of connecting with patients through social media. Jay Harness, MD, a breast surgeon at St. Joseph Hospital in Orange, CA, launched the website breastcanceranswers.com, which offers more than 200 YouTube videos of doctors (including Harness) providing health information. Visitors can also submit questions. Since their launch last November, the videos have been viewed more than 1.3 million times.

Of course, not all doctors will want to devote the time or consistent study of social media techniques to maintain a presence. However, they could join the editorial boards of established health information sites, form a discussion board with other medical colleagues, or partner with their affiliated hospitals’ social media efforts.

Additionally, social media provides an opportunity for physicians to connect with one another. Sermo, the exclusive online physician community founded in 2006, provides an opportunity for doctors to exchange clinical information, as well as discuss pressing issues such as healthcare reform.

Social media for reputation management

Now let’s talk about reputation management, which is becoming more critical for physicians in an age when doctors are receiving a plethora of online consumer ratings. The trick to online reputation management is to take control of the search engine process and literally “rise above” any negative reviews. That isn’t always easy, given the search engine dominance of HealthGrades and Vitals in most markets. As most physicians know, a HealthGrades or Vitals entry (often with consumer ratings) almost always rises to the top for most online physician searches. Even more disconcerting are the consumer sites such as Angie’s List and Yelp, which invite consumers to rate doctors right alongside local house painters and bistros. Unfortunately, comments are not always positive. As we all know in marketing, a customer who has a good experience will tell one friend, but if there’s a poor experience, that person will want to tell everyone.

In the old days, simply seeding personal website copy with key search terms was enough to take control of search engine marketing, but today it’s more complex. Google’s Panda and Penguin programs were originally designed to limit search engine spamming, but the latest updates also penalize many so-called “white hat” search engine tactics, such as adding multiple links or super-optimizing pages. Now, search engines give higher rankings to rich content, including video and participation in social media.

How can physicians ensure better search results and, ultimately, improve their reputation? A robust presence on Google+, for example, will result in optimizing one’s profile on Google. Physicians may also want to try the Google+ Hangout feature that lets them chat with up to nine participants (which may be perfect for a small patient information session). A presence on LinkedIn, too, is a good idea. Many physicians prefer LinkedIn to other sites because of its professional slant.

Advising doctors to have a Facebook profile is another issue. If they do want to go the Facebook route, then the advice is to keep a personal Facebook page separate from the professional one. Twitter is also another great tool that needs to be used with obvious discretion. We’ve all read about politicians and athletes misusing Twitter, primarily because they believe it’s a tool only for communicating with a close circle of people – it’s not, but it is considerably more powerful if used well.

Studies show that video is becoming one of the best activities for search engine optimization as well as patient engagement. Short, well-edited videos provide a total picture of the physician and come close to replicating the patient-doctor visit. Video is obviously also preferable for physicians who aren’t natural writers. For those who truly want to commit to YouTube, take a look at 1HappyDiabetic, the YouTube channel set up by vlogger Bill Woods. Woods is a patient, not a doctor, but he covers topics ranging from everyday living tips to advice for newly diagnosed diabetics. He also has extended the community to his website and responds to questions.

Is it socially acceptable to ask for good reviews? Online rating agencies such as Yelp discourage solicited reviews and warn that they will be filtered, right along with staff members who think they’re being helpful by posting reviews under pseudonyms. Instead, they suggest posting a Yelp sticker in the office and online. More realistically, it doesn’t hurt to ask a satisfied patient to recommend a practice on social sites. Just don’t provide the script of what to write.

Of course, there’s always the realm “where only the bold dare go,” which includes those new media marketing tools that may still be considered a bit more edgy. Groupon and LivingSocial, for example, have been filling up email boxes with daily deals since 2008. While dental cleanings, acupuncture, chiropractic services, and even vision exams may seem commonplace, other medical procedures and tests may raise eyebrows.

Opportunities for healthcare marketers

Clearly, with more physicians making good use of social media, it’s logical that marketers should also use these tools to communicate with “connected” doctors. Several health systems are already incorporating social media into their physician engagement plans. Here are a few trends we’re currently spotting:

1. App Technology. Physicians love their smartphones just like the rest of us. Popular apps for doctors include Medscape, Epocrates, iRadiology, MedPage Today Mobile, Medical Radio, and MedCalc. At my health system, St. Joseph Health, we just launched an app to take the place of the traditional medical staff newsletter. The keys to success of “The SJH Pulse” have been frequent content updates, robust health industry news, and links to the rounding tool for the system’s electronic medical record. Just to add some excitement to the app’s debut, we designed special smartphone covers with The Pulse logo. In the coming months, we also plan to add online continuing medical education programs to the app.
   Similarly, University of Minnesota Amplatz Children’s Hospital has an app provider directory for smartphones. The application is used by clinicians and patients to look up doctors. It features information about pediatric specialists, a list of specialties, and a pediatric dosage calculator.
2. Blogs. Doctors who love to blog are wonderful, especially for healthcare marketers. The Facebook page of Boston Children’s Hospital often includes links to blog posts from its physicians. Claire McCarthy, MD, is a frequent blogger for the hospital as well as for Huffington Post. Her entries are particularly insightful as she presents medical information from the perspective of both a doctor and a mother.
   Although rarer, doctor-to-doctor blogs are also valuable. Several years ago, MemorialCare Health System in Southern California used a blog to help physicians learn more about electronic medical record implementation.
3. Twitter. Hospitals are quickly learning that doctors are on Twitter and will follow a healthcare organization’s Twitter feeds if the content is relevant to capture their attention. Healthcare organizations should also look to partner with Twitter-enthusiast doctors. Currently, there are some 1,300 doctors who have added themselves to TwitterDoctors.net, a site that lists “the most influential doctors on Twitter.”Another helpful strategy is to assist doctors with setting up digital dashboards. For example, provide stats on visits to physician bio Web pages. And don’t forget to recommend Klout and other methods for busy doctors to monitor their own social media effectiveness.

Clearly, physician enthusiasm for social media will grow even more and, most likely, at exponential rates. Smart organizations will reach out to doctors and partner with them to make the most of their social media presence.

Featured Article from eHealthcare Strategy & Trends

by Theresa Jacobellis

Susan Kohari, Web manager at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, TN, found that in September 2012, the number of people using mobile devices to access her website had doubled over the same period the previous year. “In the last 30 days, 18 percent of all of our site visits came from people on a mobile device, but during the same time frame last year, 9 percent of visits came from a mobile device,” Kohari says. “I think those numbers are going to continue to go up.”

To stay ahead of this trend and create a satisfying online experience regardless of whether the user is on a mobile device, laptop, or desktop PC, Kohari incorporated responsive design into the launch of the hospital’s new website (www.childrenshospital.vanderbilt.org). Responsive design is an emerging technology that ensures that sites will dynamically conform to the device on which they are accessed. That means size, orientation, and even content and navigation may adjust to the specific characteristics of the user’s device.

More open, less brand control

Responsive design is an evolution in Web design, moving away from a static, branded medium toward a more functional, consumer-focused platform. Lin Borkey, president of ByteJam, a website and online application design and production company in Richmond, VA, says that responsive design will not work with what he calls a “print mentality.”

“It is not a pixel perfect paradigm,” says Borkey. “It is more open, more fluid, and more centered on making sure the content adapts itself to a situation, as opposed to brand design rooted in a brand persona.”

Depending on the specific screen size, design elements may shift to different areas of the page. Likewise, navigation elements may move to different locations or disappear altogether. This aspect requires that brand managers relinquish some of the control they enjoy with traditional Web page design.

“The design can’t be static. This is not a still life,” notes Rob Johnson, senior developer at ByteJam. “[The Web page becomes] a series of individual components that may be reorganized in ways the original designer may not have envisioned.”

Responsive design eliminates the need to create a parallel, mobile-optimized site. Instead, the main site automatically resizes and shifts orientation to conform to the screen on which it is viewed. Page design elements such as headings, number of columns, and column width may change.

Altru Health System in Grand Forks, ND, offers a prime example of responsive Web design in action. Visit its website (www.altru.org) from a desktop PC, and the site is a well-designed portal with Flash images and navigation bars linking to information for patients, visitors, providers, and job seekers. Visit the site via a mobile phone and the site automatically shifts to a palm-size version. The three-column desktop design is replaced by a one-column version in which the Altru logo takes the place of a gallery of photos across the top of the site. Immediately below the logo is a search box, followed by four navigation buttons customized to the needs of the mobile user. These are labeled “patients and visitors,” “find a provider,” “services,” and “locations.”

Along with shifting elements and page orientation, responsive design also allows for content customization. So, for example, an article may be displayed in its entirety to desktop users, while only an abbreviated version is shown to mobile device users.

With responsive design, navigation options may also be customized to ensure that the site is fully accessible whether the interface is a mouse, a keyboard, or a touch-screen. “So many navigational tools are dependent on using a mouse,” says Ben Dillon, vice president and e-health evangelist at Geonetric, a Cedar Rapids, IA, firm that specializes in healthcare digital communications. Responsive design techniques can shift site navigation from a mouse-dependent drop-down menu, for example, to a few simple buttons that respond to the tap of a finger for touch-screen device users. “With responsive design, the way users work through a site is natural and consistent, regardless of the platform,” notes Dillon.

Many benefits

Since the Vanderbilt Children’s Hospital site launched in July, Kohari has noticed a number of advantages of responsive design. “It works on any device or phone, with any browser. That’s very important,” she says.

Kohari also points out that a responsive design site is more “future-proof.” “As new screen resolutions appear in the market, the site will continue to work across the board,” she says.

Another benefit of responsive design, according to Dillon, is search engine optimization. “In many cases, mobile-optimized sites have their own, different domain names,” he says. “Responsive sites in part get an added SEO boost because the page is the same page with the same domain name and same URL, no matter what device it is being accessed on.”

One URL can lead to increased traffic because visits are not split between the main and mobile site, which can, in turn, lead to better page rank. In addition, Google penalizes sites for duplicate content, which occurs with a mobile-optimized site. Responsive design takes care of that issue.

Responsive design also simplifies the process of making updates and changes. “We used to have a separate mobile site to maintain, so if we made changes to one, we would have to go to another,” Kohari observes. “Now we just change things in one place.”

But more work at outset

On the downside, because the site design includes contingencies for multiple platforms, responsive design sites may take longer to plan and implement and could be more costly.

“There is more code, because essentially we have to build four sites into one,” says Kohari. “One of the things we had to spend a lot of time on was backward browser compatibility. We still have machines in the hospital and a small external audience using IE 6. Responsive design is really compatible with IE 7 and above.”

In developing Altru Health System’s site, which launched on August 28, Jennifer Neis, website coordinator, was pleased to find that all of her site’s interactive features could be adapted to responsive design. “We could pretty much do everything,” she says, searching employment opportunities, viewing the baby photo gallery, sending an e-card, making a donation, or paying a bill. “Nothing interactive had to be sacrificed [for the sake of responsive design].”

Consumer behavior shift

The technology to create websites using responsive design isn’t new. However, it wasn’t until recently that advances in hardware and increases in bandwidth contributed to a major shift in consumer behavior, driving the demand for responsive design.

Just a year or two ago, “we assumed that at home or in the office, people would prefer to use a desktop computer and not bother with a little tiny screen held in their hand,” Dillon says.

Those assumptions are no longer valid. “Tablet sales have overtaken traditional PC sales. People are doing their primary Web browsing on mobile devices,” says Johnson of ByteJam. “There is a huge audience of people who are consuming content through nontraditional means.”

According to Geonetric, across all industries, information-seeking behavior using mobile devices showed a 76 percent increase from December 2010 to December 2011. However, Geonetric found that the growth was even more pronounced in the healthcare sector, increasing more than 130 percent over the same one-year period.

“It is not uncommon for one in four visitors to a site to be using a mobile device,” Dillon says.

At the same time, Geonetric notes an overall increase in website traffic from all sources. “So it isn’t that mobile users are replacing traditional computer users,” says Dillon. “At least some of that traffic is mobile visits that people would not have thought to do later in the day at their computers.”

Outside of the healthcare realm, ByteJam’s Borkey points to the automotive industry as an early adopter of responsive Web design. Consumers are accustomed to checking car dealers’ websites for vehicle specifications and pricing information. Using responsive design, they can access the same information using their mobile devices while on the lot.

Information at patients’ fingertips

As patients become more savvy mobile online users, they will find that responsive design puts a world of personal health information at their fingertips. “A big driver in healthcare is the EMR,” said Borkey. “If a patient is at his doctor’s office and needs to pull up a piece of his record, then a mobile-focused solution for that is critical. That is a perfect application for responsive design.”

Altru patients already have access to this capability. Altru’s responsive website links up with MyHealth, the patient portal powered by electronic medical record provider Epic Systems. “Patients can look for their previous appointments, see their lab test results, look at past prescriptions, or pay their bill using the mobile site,” says Neis.

“Consumer expectations are getting higher and higher every day,” says Johnson. “We are going to have to be better and better.”

Theresa Jacobellis, MS, has more than two decades of experience in healthcare marketing. She is director of public and external affairs at Good Samaritan Hospital Medical Center in West Islip, NY. You can reach her at thjacobellis [at] optonline [dot] net.

Featured Article from Strategic Health Care Marketing

by Candace A. Quinn

Marketers have spent the past 10 to 15 years focusing on emerging brand development initiatives for their organizations. Marketers want the brand equity of a Cleveland Clinic, Mayo Clinic, or Johns Hopkins Medicine, yet most of them represent the typical community-based hospital or health system that is slugging it out with the other hospitals or health systems in the area.

I had the opportunity to speak with seven C-suite occupants who had either recently undergone efforts to redevelop their brands or were in the midst of doing so. From my own experience as a brand consultant, I knew that C-suite members typically have wide-ranging views on the value of brand development. The editor of Strategic Health Care Marketing and I thought it would be interesting to see if I could capture those thoughts.

The interviewees had the caveat that they could remain anonymous, recognizing that their brand strategies (and philosophies about the same) are among some of their most strategic assets. When relevant, I have provided a brief description of the organization, its marketplace, or other pertinent parameters within which to couch the subject’s comments.

Q. Your organization is in a very competitive market. How would you describe your brand position today? What prompted you to undertake brand development work? Has your brand changed since you began that work? In what ways?

A. Specialty hospital in a major metropolitan market with big-brand competition. Before our brand work, we were really misunderstood. The brand was sleepy and essentially unrecognized. Today—three years later—we are better understood by both consumers and providers. And it is leading to a better contracting position for us.

A. Large academic medical center. Our brand journey began over 15 years ago. It started with a focus on brand architecture and resulted in the creation of very new brand experiences. Today, we are a single brand across multiple entities and are applying our brand experience work across multiple centers of excellence.

A. Large Midwest system. We also started with a brand architecture project and recognized that our current brand had no solidarity of meaning and no real differentiation from any other organization. In fact, our system meant nothing; we were simply a collection of area hospitals.

A. Large community hospital in a two-hospital town. As competition heated up, and advertising wars were a way of life, we realized that differentiation was going to be even more critical. We knew what set us apart, but we suspected that our communities did not. A hospital is a hospital to the average consumer. We embrace some very special values as an organization, and we need to find a way to position this difference to resonate with our communities.

Q. Did your organization go beyond naming, logos, and external elements of the brand identity in your project? What role did the brand experience play in your brand development work?

A. While we did logo, look and feel, and external messaging, we also knew we had to go beyond great patient satisfaction scores. We had to set service standards based upon a process to identify a host of consumer expectations—we needed to match promises to practices and vice versa.

A. We found the voice of the patient to be a compelling and motivating agent of real change. In every instance where we have engaged patients in the experience design, we have found sustainable results.

A. We are always developing the experience. Our brand is built on the experiences of the people we serve. We tell our brand stories through the eyes of the patients and their caregivers. We have extraordinary stories to tell. We serve an enormously large population from across the country, and people come back to us because of the brand experience.

A. Our brand is based on a brand experience that no one else can offer in our market, so we empower every team in our organization to put that difference to work in its area. We are continuously overlaying the principles of “how” we do our work to show how we are different.

A. We had the great fortune to be able to build a new facility and took that opportunity to go beyond building a physical building. We wanted to build an experience. So we engaged Starizon, an experience design firm, to assist us in a formal design process that forced us to rethink every encounter, every touch point, and every aspect of the patient experience to determine if and how we could differentiate ourselves from the competition.

Q. Would you describe your brand position today as meaningfully differentiated from your competition? In what way?

A. We learned that spending more money did not equal better advertising. Telling better stories—tying back to our brand through warm and fuzzy stories—is touching, but our brand is also about serious medicine. Finding that balance and staying on brand have allowed us to put great distance between our brand and our competition. Fortunately for us, competitors are still trying to figure out what their brands stand for.

A. We’re getting feedback already from our community that our brand is really resonating. Our marketing initiatives have adapted to the new look and feel at the core of our brand, and we are seeing results. We recognized that all the advertising in the world won’t make a difference if our patients don’t have a meaningful brand experience. Case in point: Since we’ve focused on improving our brand experience in our ED, we went from below the 20th percentile in overall satisfaction to the 89th percentile—in just three reporting periods.

A. While we continue to differentiate ourselves around our triple aim of improving the health of the populations we serve, keeping health care affordable in our community, and improving the individual’s experience, it is really the latter that will truly differentiate us. Quality standards are so high today that patients are assured of reasonably sound levels of quality, and in a competitive market, cost or price is driven by the contracting parties. So in the end, it will boil down to the experience.

A. Meaningful differentiation—we are on the road to it. We want to be a national brand one day. To do that, we have to become a stronger regional brand. As we compete with full-service providers and other specialty hospitals in our specialty, we will need not only the best talent, the easiest access, the lowest pricing, we will need to deliver the best, most unexpected experience to capture a national audience.

Q. How are you measuring the value of your brand today?

A. We use HCAHPS scores, recommendation scores, consumer studies, and we trend market share across all service lines. We are intrigued by the concept of a Net Promoter Score, developed by Fred Reichheld, a business strategist at Bain & Company. In essence, it is derived by subtracting the percent of detractors from the percent of promoters. Determining whether one is a detractor or promoter depends on how one answers “the likelihood of recommending your hospital” question. An ideal score would be 100 percent. We have a way to go, but have seen improvement throughout the journey.

A. We are three years into our brand journey. We’ve seen 10 percent growth in volumes, two-point growth in market share in just the past year—but there is more to it than the numbers. I see value in the new confidence our physicians have in our future. They are prepared to invest themselves when they have other options for their practice. We have numerous business opportunities coming our way; it seems everyone wants to be our partner today. We are recruiting the best doctors in our specialty across the country, taking them away from some very prestigious organizations. I’m not sure how you “measure” that, but it’s very real.

Q. Looking ahead to health care reform, ACOs, and all of the market consolidation, what will be the impact of having a strong, well-defined brand? Do you anticipate any brand strategy changes?

A. We are already seeing the benefits. National employers are looking for national centers of excellence for specific services. Regionally, we are already at the top of the list for our specialty and are moving up in national rankings by every measure. We have to have a strong brand, meaningfully differentiated among our competition, because national contractors are seeking that out. We want to be on everyone’s short list for our specialty.

A. We have come to realize that it will all come back to relationships. Do we have the relationships with the providers that we need across the continuum, and what will be the basis for the relationship? We believe it will be shared values, shared philosophies, and at the core of that will be our brand experience. We can control how we treat one another, how we treat our partners, and how we treat our patients and their families. We are already a strong partner across our region and have had an overwhelming response to our brand experience, as evidenced by the number of new partners coming our way. I don’t see any major brand strategy changes on the horizon, but the dilution of the brand across new partnerships is a concern to me. We can’t leave that to chance and are working hard to put brand standards in place that transcend look and feel. Our brand standards will be about the experience.

A. I firmly believe that strong brands can demand more from ACO relationships. Regardless of the insurer, strong brands will be included in contracts because without the strong brand, the insurer can’t sell plans. I also caution my CEO colleagues to gain a better understanding of the cost/value equation. So often I hear about or see my colleagues slashing the marketing budgets in their organizations to reduce costs. In reality, their focus should be on growth—gaining share and improving overall financial performance with the kind of business that generates revenues, to support the business that doesn’t.

A. As a result of the Affordable Care Act, we anticipate the industry consolidating significantly. The advantage—if all else is equal, including financial and market share, and you have a strong brand and are living that brand—is that you will attract a strong, loyal patient base and that will attract strong partners. Aligning those strong brands across common shared value systems will result in strong affiliations. For so many of us, it’s not if – it’s when. We want to be in the driver’s seat when that day comes.

A. We’ve been watching and experiencing that consolidation already in our market. We have been in the control position for nearly two decades. But as a top brand, we can’t rest on those laurels. We continue to focus on our vision, but at the same time, we focus on how we treat our partners—our physicians, our employees, our payers, our customers. We stay on top of their needs, we develop new services only when partners that share our values can’t be found, and we continuously reach out to our customers and stakeholders as a strategy for continued growth and guidance. In return, these customers and stakeholders are our advocates and our catalysts for continued improvement. We believe that brands do evolve, and with growth comes a renewed focus on maintaining the core values of the brand. However, as consolidation continues to occur, we believe if we keep our customers and stakeholders at the center of our decision making, we will deliver on our brand promise every time.

Candace A. Quinn is CEO and senior consultant for
Brand=Experience in Loves Park, IL. You can reach Quinn at candace [at] brandequalsexperience [dot] com.

Featured Article from Strategic Health Care Marketing

by Michele von Dambrowski

“The growth of employed physicians has occurred so fast in some systems that … it has outstripped the ability of the marketing department to keep up,” says David Marlowe, principal of consulting firm Strategic Marketing Concepts in Ellicott City, MD. Marlowe’s observation comes in part from a qualitative “convenience” survey that he and Kriss Barlow, a principal with consulting firm Barlow/McCarthy, conducted recently.

Marlowe and Barlow interviewed representatives of 21 client and colleague organizations of varying size and number of physicians they employed – anywhere from less than 25 doctors to more than 1,000. “There [was] no consistent pattern” in their approach to marketing, Marlowe told attendees of the annual conference of the Society for Healthcare Strategy & Market Development held in Philadelphia in September.

In total, the organizations employed more than 6,800 doctors, including care extenders such as nurse practitioners. The majority of participants reported, somewhat unexpectedly, having a higher percentage of specialists than primary care physicians. Half of the organizations reported having a single employed group brand identity. In the case of the other half, “the marketer was desperately trying to get” a single system name, says Barlow, who commented during Marlowe’s presentation.

Less than one-third of the organizations stated they had marketing staff dedicated to employed doctors. Almost half had a dedicated marketing budget, with the remainder stating that dollars for marketing employed physicians was part of the overall marketing budget. The budget range per physician was huge, says Marlowe, from a paltry $55 to a princely $8,333.

Drawing on a 32-year career as a practitioner and consultant in health care marketing and planning, Marlowe also provided advice on how marketers can have a significant, positive impact in supporting employed physician groups and protecting their organization’s investment.

Understand practices

Given that hospitals are frequently criticized for not knowing how to run physician practices, Marlowe says, how can they be expected to know how to market them? Since there aren’t many role models for medical practice marketing, hospital and health system marketers need to spend time with doctors and practice administrators, attend Medical Group Management Association programs, and do other research and reading. “There’s a culture, and nuance, to practices that you must understand before you can effectively market them,” Marlowe states. Most practices are small businesses, he adds, and they run accordingly.

Getting inside the heads of physicians is also critical, such as realizing the emotional implications for doctors who cede control of their practices. Marketers also must grasp that their own job can involve more tactical thinking.

Critically, marketers must understand any given physician’s financial and legal arrangement with the organization. “Don’t assume that because you have 200 doctors in your employed group, they all have the same deal. Are they really employed? There are a whole bunch of contractual structures … and only at a certain end of the spectrum do they cross the Stark lines and allow you to [legally] market the practice,” says Marlowe.

Knowing the financial model is also important in understanding a physician’s goals. Marlowe notes that a doctor who is on a pure salary arrangement isn’t likely to resist having a new physician join the practice, unlike a doctor who is solely compensated on the basis of patient volume.

Balance employed and independent

“Strategically, it’s untenable for a hospital or health system to remain half independent and half employed [in makeup of the medical staff] for too long,” Marlowe says. “It will just tear your organization apart” in being confronted by marketing, political, and structural challenges. It’s his view that once employed physicians exceed 50 percent of the organization’s volume and revenues and the trend upward is clear, there is a need to commit to marketing the employed group.

Marlowe notes that more than five years ago, a real but unnamed two-hospital system fully committed to marketing its employed physicians – currently about 90 percent of the area’s primary care physicians. The system’s independent orthopedic groups responded by banding together to open a surgery center and eventually a hospital. The system countered by hiring its own orthopedic group, to which primary care physicians direct referrals. “This is a marketing issue,” Marlowe observes.

Deal with leadership promises

Hospital and system leaders frequently make marketing promises in their efforts to recruit physicians or negotiate practice purchases. As one New Jersey hospital marketing department found, the result was the acquisition of eight groups that each maintained its own name. “One group went out and bought radio ads,” says Marlowe. “Another wanted its own logo.”

The best practice calls for having a clear onboarding process that gives specific levels of support and has leadership’s blessing and backing. To head off potential chaos, the marketing department of one Midwest system designed a three-tier method of support. The third tier, representing physicians without any capacity for additional patient volume, receives only maintenance support. The first tier, representing high-opportunity growth services, receives two or three times the money of the second tier, including mass media advertising and customer relationship management support.

Handle physician expectations of marketing

“Your job is to show the doctors what they really need as opposed [to a billboard],” Marlowe points out. Among the areas to address are customer service, relationships with referring physicians, and access.

“Capacity is a huge issue,” he says. Mystery shopping of physician practices, he adds, “should be as routine as doing your consumer survey every year or two. If patients can’t get in to your channel of access … then you have a significant marketing problem.”

Efforts to open up more practice slots through changes in office hours and operations or recruitment of additional providers should come before promotional support. Addressing access issues “is part of the marketer’s job,” Marlowe observes.

Move to dedicated resources

As employed physician groups become larger, they will demand dedicated marketing support from the system, and failing to get that support, they will hire people on their own. Some organizations, says Marlowe, are viewing these groups as a service line and assigning marketing resources accordingly.

Boost familiarity and referrals within the group

Marlowe notes that it’s not unusual for physicians within newly formed employed groups not to know one another. Marketers need to delve into their basic toolbox to create social event opportunities, take physicians to meet other doctors in their offices, deploy print and electronic communications vehicles, and develop other avenues to promote intragroup cohesiveness and referrals. “One communication methodology between doctors doesn’t cut it,” he warns.

Barlow recommends that at the time physicians sign on, marketers assess the new physician’s familiarity with the other doctors in the group. “Inventory some of those referral patterns and begin right away to assign a liaison to start introductions,” she says. “The bad thing is that we sit tight for six months and let them continue with their old patterns.”

Limit leakage

Marketers need to keep close tabs on referral patterns for each provider, including nurse practitioners and physician assistants, and determine the reasons – and solutions – for referrals leaving the group. Is the driver of leakage a case of old habits that die hard? Lack of access on the part of in-group doctors? Absence of service capability in-house? Insurance requirements? Quality concerns? My-patient-requested-the-referral reasoning should be “taken with a grain of salt,” says Marlowe. “It’s true to a degree, but it’s rarely true to the percentage that you will hear it.”

In one case, Marlowe relates, a hospital found that many of its 125 employed physicians tended not to refer to the organization’s three employed urologists. After discovering that one urologist had a six-week wait for an appointment and the other two were of marginal quality, the hospital encouraged one of the marginal physicians to retire and recruited two new, high-quality doctors in the course of one year.

In the absence of quality or access concerns, dealing with a physician who continues to send only half of his referrals in-house begins with discussion and persuasion. An intermediate step might be to structure group financials, whereby the group is penalized by a member’s out-of-group referrals. Ultimately, the system can choose not to renew a physician’s employment contract, Marlowe notes.

Build a group brand identity—and value

“I don’t believe it’s a fatal strategic flaw to not have a branded über group,” Marlowe says. “But if you ever want to have the dominant physician brand in the market, it won’t happen if you have 28 different names.”

Marlowe reminds marketers that the brand also has to provide value to its market – a tough job given that most groups have been in existence for less than five years. He relates that a large group of 200 providers established its value by adding a number of desirable services and marketing them to consumers. The value-added services included full access to an electronic medical record, centralized scheduling, after-hours primary and urgent care coverage, and specialized screenings. A measure of the group’s success is the fact that it added 30,000 new active patient charts in a year. “You start differentiating your group from the other options in town,” says Marlowe.