The Re-Emergence of Centers of Excellence

Are you ready?
Ready for the re-emergence of Centers of Excellence under healthcare reform?
Centers of Excellence for the longest time were really nothing more than someone in a hospital or a group of doctors telling everyone that they were a Center of Excellence (CoE) for Cardiology, or Oncology, or Neuroscience, or Women's Health to name a few of the more "popular" CoEs. With little objective data- outcomes in areas such as financial, quality, satisfaction etc, many healthcare institution simply said they were a CoE for a particular service line. A little paint here, new wallpaper there, designate an unused hospital floor or wing the area, maybe even generate some fundraising and donation opportunities to name it after someone of community note and presto, a Center of Excellence.

Okay, that was probably a little overboard for some organizations took CoEs seriously and did have objective financial and quality measures which they communicated the benefits of to Board, payers, physicians and community. They built a brand that was sustainable. But as with most things over time, the concept was short lived and unsustainable as practiced across the healthcare industry.

I digress a little.....

Foolish me, thinking that this kind of practice has declined. Recently some of the smaller for-profit companies in the specialty pharmacy industry are doing the very same thing and making the very same mistake the hospital industry made in creating CoEs. Just because you say you have a CoE, doesn't mean it is one. When physicians and nurses are not involved in creating the care protocols (and that means more than one nurse and two doctors), just because you say something doesn't necessarily make it so. When its driven by Sales, the nightmare is beginning. Delivering a medication on time is expected and not a single CoE measure.

Now the game has changed
Due to healthcare reform, I am predicting that Centers of Excellence will be making a big come back. Healthcare organizations going forward over time will be paid based on quality, not quantity. That means quantifiable quality and best practice medicine. Indicators yet to be developed that are standardized so that all hospitals or clinics stating that they have a CoE for any service line, disease state or treatment will have to meet. Your reimbursement will depend in it.

Marketing needs to be at that internal product development table for the reemergence of CoEs. Pick what you do best.

What to do
First and foremost, learn from your past mistakes. And please, please do not use "world class" in your communications. Hint - if you are not treating individuals from around the world, you are not world class. Few healthcare organizations can make that claim. And the majority of you out there are not the Mayo Clinic, Cleveland Clinic or the University of Chicago to name a few.

Develop those outcome indicators based on current research and best practice for a service line or treatment and other quality, financial and patient satisfaction indicators. Identify your target market segments and messaging about what you are doing for physicians, payers, patients and community. Talk in real terms not fuzzy you love use because we are a CoE.

One last point, make your marketing plan strategic first, tactical second, and sustainable thirdly for over a long period of time. Use traditional and online channels. And most importantly of all, bring value; for the healthcare consumer of the near future will be buying based on price and quality. The sooner you start demonstrating quality and price, the better off you will be.

Mike Krivich is a Fellow, American College of Healthcare Executives and a Professional Certified Marketer, American Marketing Association. He can be reached at michael@themichaeljgroup.com or 815-293-1471.

>>> The Re-Emergence of Centers of Excellence >>>

Driving patient volumes and revenue via RN-based physician referral call center

Okay it is quiz time.

What is the fastest way to build brand awareness, drive patient volumes and revenues, reconnect with patients that haven't used your hospital in several years, build your physician practices and can be analyzed in financial terms to prove Return on Marketing Investment (ROMI)?

Hint- the answer is in the title.

That's right, physician referral brand building marketing activities via an RN-based call center.

Here's the premise and it's something that I have used successfully over the years to drive volume and revenue for all products lines. At the end-of-the-day, nothing happens in any way, shape or form in your healthcare organization without a physicians order. In the case of an ER utilization, the docs there already will be your surrogate for admissions, tests and follow-ups and for referral to physicians in the event an ER patient does not have one.

It is a classic push pull strategy.

Push the patients to your physicians, pull the physicians to your organization.

Inherent in the concept and activity is the process improvement you are undertaking internally to make your healthcare organization the easiest place in the known world for physicians to practice medicine.

For you see, with all the brand building marketing activity that goes on for a hospital or multi-hospital system, changes in market share are due more to physician admitting behavior than anything else. In longitudinal market research studies that I have participated in over too many years to tell, when you look at changes in the marketplace over time, competing hospitals market share only changes usually by one or two percentage points annually.

Sometimes the gain or loss is only for six months. It's the same one or two points among all competing facilities. Meaning that physicians are moving patients between competing hospitals. Patients don't move themselves, the physicians are. When all things are equal, the physician will tend to move to the hospital that makes it easier (i.e., efficient and effective) to practice medicine.

Also with your physician referral marketing, you need to run all community activities, wellness programs and events registration, speaker bureau opportunities and product-lines through your physician referral as well. It's all about capturing a patient name and getting them to your docs.

What follows now is an actual Return on Marketing Investment analysis that the CFO and members of the Finance department were involved in looking at an RN-based call center- physician referral, speakers bureau and event registration.

The method can be adapted to any campaign and provides you with the data fields and logical analysis you need. This has been heavily edited to hide the organization. The full report was quite large and contained an entire programmatic evaluation of the Physician Referral Call Center with recommendations for improvement to increase scope and capabilities. This portion is most applicable for today’s conversation.

PRCC ROI

An analysis was undertaken to look at the ROI of the Physician Referral Call Center. The analysis matched a database of call center name records for the period to financial records which had already been downloaded. The analysis produced the following results:

9,102 call records were matched with utilization and financial data.
9,102 calls resulted in a total of 9,121 encounters in the ER, Inpatient and Outpatient categories of service.

751 encounters were ER
177 returning encounters
573 first time encounters

1,105 encounters were Inpatient
530 returning encounters
699 first time encounters

7,267 were Outpatient
2,014 returning encounters
5,253 first time encounters

Total charges for all encounters equaled $22,522,649

Charges for new encounters all services totaled $16,085,198 or 71 percent of the total charges

Average charge per ER encounter $1,304

Average charge per Inpatient encounter $13,581

Average charge per Outpatient encounter $903

Gallup measures loyalty at 68 percent (would return for service) which means that for every 100 patients 32 would not return for care- therefore:
ED- 57 returning encounters captured that would not have returned
Inpatient – 170 returning encounters captured that would not have returned
Outpatient- 645 returning encounters captured that would not have returned

Incremental charges counted returning encounters not loyal
ER - $74,337
Inpatient- $2,308,851
Outpatient- $582,505
Subtotal charges counted: $2,965,693

Overall market share in primary and secondary service area is 14.53 percent. The number of first time encounters have utilized us above market presence is therefore:
ER 573 first time encounters, 83 not countered, 490 counted –
Inpatient – 699 first time encounters, 101 not counted, 598 counted
Outpatient – 5,253 first time encounters, 763 encounters not counted, 4,490 counted

Based on an overall market share of 14.5 percent the incremental charges counted for new encounters not because of market presence:
ER - $638,960
Inpatient – $8,121,438
Outpatient – $4,054,470
Total Charges counted: $12,814,868

Discount from gross charges for Medicare, Medicaid, Managed Care, Bad Debt and Charity Care @ 65% is $8,326,644

Net Revenue: $4,488,224

PRCC program costs: $233,410

Net contribution: $4,254,814
ROI 18.22:1

This is the one way that you can have an immediate and lasting impact in driving patient volumes and revenues. This is all about creating internal value and accountability. Here is value. Here is accountability.

Physician referral activities pay off in a big way.

I can be reached at 815-293-1471.

>>> Driving patient volumes and revenue via RN-based physician referral call center >>>

Don't forget about direct mail

Don't forget about direct mail

The other day I was going thru the mail and received a direct mail piece from a hospital system. Then the "news flash - film at 11" type of realization hit. It had been some time since I received any direct mail materials from any of the local healthcare providers. Truth be told, it has probably been a couple of years or more now that I remember receiving any healthcare related direct mail. And that is a mistake in my opinion.

If you have been in healthcare long enough, you can remember a time when besides newspaper ads, Sunday newspaper stuffer, billboard and radio campaigns, TV ads etc., that the majority of healthcare marketing was direct mail- health and wellness magazines, magnets, newsletters, postcards etc. Replaced today no doubt by facebook, YouTube, Twitter, LinkedIn, web sites, banner ads, emails and all other types of social media. Like lemmings rushing over the cliff, healthcare organizations fast abandon messaging distribution channels in favor of the new and more expedient methods of communicating. But is anybody listening, or should I say reading?

Not everyone clicks through on banner ads. Everyone is not on facebook. Not everyone has an Iphone. And guess what, people still read their mail and newspapers.

Are you missing an opportunity via a little used, or should I really say, "out-of-fashion" communication and distribution channel to get your brand messages in the marketplace?

An interesting question.

My opinion is yes, direct mail is still important and can strengthen your brand messaging in the market.

Your brand message needs to be communicated in multiple ways, using multiple communication channels. That would include traditional and online. The healthcare industry tendency is to abandon one communication and distribution channel in favor of another. Many reasons can be sited for not using direct mail, long production times, printing and mailing costs, list acquisition etc.

But if you are the only provider out there in that communication channel, then what is the value to you of having your brand message in an uncluttered healthcare messaging space?

If you think that direct mail is old and passé, then why do Verizon, Kohl's and other retailers continue to spend organizational resources in that medium? It might not hurt for you to take a look at your own mail to see who still uses the technique. Learn from other industries. You may find that your marketing communications plan to carry your brand messaging is not as integrated and comprehensive as it needs to be.

So as we rush to embrace all the new technologies and methods of communicating that our competitors are using, don't abandon the traditional side of marketing brand messaging channels. To do so is a missed opportunity to build your brand and shame on you for missing an important brand building opportunity.

You can reach me at 815-293-1471.

>>> Don't forget about direct mail >>>

A hospital admission as a defect in the process of care

A short while ago, I had a conversation with a colleague who relayed his conversation with a hospital executive around business development, innovation and growth. Hence the comment "We are in survival mode here."

My colleague also brought up the point to this same executive that somewhere, a group of entrepreneurs was looking at the process of care and have come to the conclusion that a hospital admission is a defect in the process of care.

Now that one stopped me dead in my tracks. Think about it.

The hospital admission as a defect in the process of providing care.

An attitude, much often too common in hospital executive leadership that we are just trying to survive. This is sad really, when innovation, growth opportunities and new business development initiatives are being left on the table because hospital executives can't get out of the "we're just trying to survive" mentality. Yep, leave it to the Walgreens, CVS/Caremark and Walmarts of the world to figure it out. Hint, they already have.

If your just trying to survive today without looking for market opportunity and finding ways to be more consumer-focused, innovative and non-traditional in providing care, then you are not going to survive.

The hospital is no longer and really for a very long time now, has not been the center of the healthcare universe.

Hospital executives can't seem to get out of the 70s and 80s mentality of build another patient bed tower. That will fix the problem. Instead, their response if they were providing any leadership at all, would be to the physicians, senior team and Board of Directors, let's find new and innovative, non-traditional ways to deliver care.

Infusion centers, retail clinics, pharmaceutical advances, free-standing surgery centers and diagnostic clinics, remote monitoring, home health care, sub-acute services, discharge management to prevent readmissions, medical device technological advances and many other services when taken together, have the potential to so significantly change the way that healthcare is delivered, it will make the hospital admission of today, a defect in the process of care tomorrow.

Does that mean hospitals will go away? No, there are limits to this concept of the hospital as a defect in the process of care such as surgical procedures that can only be performed in a hospital, and emergencies requiring an ER will always be needed. But the rest of it, maybe not.

Unless hospital executives and their marketing and planning departments start seeing the forest from the trees, just trying to survive is leading them away from innovation, opportunity and growth at a time when others, with non-traditional entrepreneurial backgrounds, will relegate the hospital to a place in the care continuum where an admission is a defect in the process of care.

So, are you still just trying to survive?

You can reach me at 815-293-1471.

>>> A hospital admission as a defect in the process of care >>>

Integrating Brand Messages Into Your Public and Media Relations

How much more effective would your marketing campaigns be if you made a conscious effort to frame your messaging in your Media Relations (MR) and Public Relations (PR) campaigns around the main brand messages you use in your marketing campaigns?

More often than not, brand messages in healthcare PR-MR rely on the "about us" statement to carry that weight. Little if any attention is given to using public and media relations as a strategic and integrative vehicle in the overall marketing effort.

And that is a missed opportunity.

As healthcare organizations, we are expected by our audiences to advertise, write white papers, create case studies, write impactful sales materials, partner with leading market research organizations to present "groundbreaking" topical surveys and results, as well as other materials. That is a given. People see and read, they (hopefully) advance the brand, maybe generate some sales leads or in some cases bring a sense of accomplishment to internal audiences because in the end, all of these materials are "about us". Activity measurement as opposed to outcomes measurement.

Now think. What is the value of these same messages being crafted in such a way through PR-MR to your organization? The more people say they don't believe what they read and see, the more that they believe what they read and see. A positive news story online, print or electronic carries with it a measure of credibility conferred by the publication, news organization or web content carrier that the story has some measure of truth and validity. Can't buy that in advertising, direct mail or contests.

PR-MR can be summed up by the following:

Presence Builds Preference

and

Perception- Leads to Opinion- Becomes Fact

PR-MR can provide you with a continuous brand presence in the market that you cannot afford through traditional or online paid efforts. It can successfully build positive impressions, solid opinions which after a while other companies and individuals will come to believe about your organization and, this is an important and... build relationships with the media and audiences that can be leveraged to your benefit in times of crisis.

In my experience, it is not uncommon to generate on an annual basis for small healthcare organizations $1 million plus in equivalent advertising through a PR-MR program. For larger companies, an aggressively planned and consistent PR-MR program generates $10s of millions of equivalent advertising dollars. Ask your Executive Suite for that kind of money for paid advertising in this or any economy and see what happens.

If you are not integrating your brand messaging into your PR-MR efforts, your losing the opportunity of a lifetime and potentially your markets.

PS. It's just not writing press releases.

If you need assistance or would like more information, you reach me directly at 815-293-1471.

>>> Integrating Brand Messages Into Your Public and Media Relations >>>

Tapestry Marketing - Weaving an effective hospital marketing plan

So what is Tapestry Marketing?

Is it an analogy? Maybe, depending on how you look at it.

Tapestry Marketing is a new way of looking at stand-alone hospital and multi-hospital system marketing. It encompasses the “traditional” aspects of marketing, but acknowledges the special needs of hospital, the interplay of physicians and their influence on the process, patient insurance coverage and limitations, the needs of the consumer and the healthcare organization.

Tapestry Marketing is new. You will not find it in any text books. It is not taught in graduate school. It is a concept. A philosophy of marketing that is designed to cut through the clutter and bring a hospital or multi-hospital system out of the run an ad, hold a community program, send a newsletter marketing mentality.

Tapestry Marketing is learning how to weave a colorful, comprehensive, integrated multi-channel marketing program that drives brand, generates revenues and dominates the competition. A methodology to achieve market success, show Return on Marketing Investment (ROMI) and bring you, the marketing leader, to the senior management table as a strategic player.

Please note: Tapestry Marketing is ©Michael J Krivich, FACHE, PCM 2010. All rights reserved.

A Tapestry Marketing plan is no longer than 10 pages.

That's it folks. Any marketing plan longer than 10 pages will not be implemented. Looks great but is generally a lot of words, to say what you will do when you will do it and how you will measure it.

Page 1: Mission and Vision Statement:
-A clear mission statement for the product line and the marketing plan will help to focus the efforts. The mission statement is the purpose and starting point from all which flows. It is important to evaluate your mission statement in light of changing environmental conditions and helps to keep you focused as an organization on what you are about. This will help you in evaluating the objectives you develop latter in remaining consistent with the mission of hospital or health system xyz.

Questions for guidance:
– Who are we? Who do we serve? How do we serve them? What are the limits of what we do? Does everyone have a shared understanding of our mission?

Page 2: Situation Analysis:
– Examine your current marketing program or examine your internal and external environment to understand where you are today and how you arrived at that point in time.

Questions for guidance :
– Describe your past experiences relative to the financial, human and capital resources as well as the strengths and weaknesses of your service/product line. Describe the cultural, societal, economic and demographic trends existing in your world. What other marketing opportunities can be identified from the strengths and weaknesses?

Page 3: Market Research:
– Surveys and discussion groups formal and informal, sales reports and market intelligence are the best ways to really understand your market for the purposes of developing a marketing plan. But a self-evaluation can also be helpful in answering the following questions and thus understanding your market. Here are some categories for self-evaluation: service/ product excellence; service/product attributes versus the competition; ease of use; customer service; service/product literature cost.

Questions for guidance:
- Why did insurance plans, physicians, employers and individuals choose our services/products? Why do some choose others? What does the industry and community think of us? What are competitors saying?

Page 4: Identify Target Segments:
– The goal here is to match your service and product line strengths with people most likely to be influenced by those strengths. Describe your target group in detail. Where are they located? What part of the service/ product value equation will influence them? Can they afford your services? What are their needs?

Questions for guidance:
- What types of customers are most likely to choose our services as it currently exists? What types of customers’ might choose our services if we make some affordable improvements or changes? What are the financial requirements in determining price and service?

Page 5: Marketing Strategy:
– Brainstorm for ways to develop and communicate the right messages for your service and for ways to create the right service or product line improvement/s. Develop measurable goals.

Questions for guidance:
- What are the quantifiable goals for the marketing program? How will they be measured? What will be offered to the key decision makers in relation to the Service or Product Line? How will the key decision-makers use the service Place? What is the message to be communicated to the key decision makers Promotion? What must the key decision-makers give up to purchase Price?


Page 6- 8: Marketing Tactics and Budget:
– When executing marketing strategies, it is important to get the basics right, be clear about who is doing what and track progress carefully. First and foremost, the strategy must be communicated and supported. All employees of the organization need to understand the message, including which elements of it are the main focus and which are the important facts supporting it. All employees need to understand their role in disseminating the message. All employees need to understand the goals of the marketing program and why they are important. Give a detailed account of each aspect of the strategy that will be put into operation.

Questions for guidance:
– What actions will we take? Who will be responsible for implementing each action? When is it to be accomplished and how much does it cost? What are the growth targets and how will we measure the results?

Page 8 - 9: Evaluate the Strategies:
– Your basic messages are unlikely to change dramatically from year to year, but your strategies should be evaluated quarterly so that weaknesses can be identified and strengthened, or strategies can be adapted to meet new market needs.

Questions for guidance:
– Did we achieve our goal/s? Which strategies should we continue? What have we learned? What are the new targets created from this evaluation?

Page 10: Next Steps:
- A wrap-up of major learning's including not only success but failures as well. You planned, you did, you checked, you acted. The PDCA process of the Dr. W Edwards Deming Quality Cycle. Now, what do you want to do next?

Questions for guidance:
-What do we need to do to take marketing to the next level? How do we communicate our financial contribution ROMI (Return on Marketing Investment) to organizational senior leadership to build the business case for more resources? How do we intend to use this planning format in our budget justification?

I can be reached at 815-293-7471 or via email michael@the michaeljgroup.com to answer any questions. I do have a Word template for this format and it is available. Contact me for pricing details.

>>> Tapestry Marketing - Weaving an effective hospital marketing plan >>>

The Future of Healthcare Marketing Under Reform

Why do we need marketing?

I can see it now, CFOs and other senior managers in hospitals and health systems around the country going … “Tell me again…why do we need marketing? After all by 2014, millions of uninsured will be insured. Sure we face reimbursement cuts, but we can weather that” and the conversation goes on……

Marketing will be more important than ever!

As we enter the brave new world of healthcare reform, several significant events will take place over the coming couple of years for which most healthcare organizations are not prepared for:

Transparency
Bundling
Value purchasing
Demand management
Consumer choice

What will be required is a refinement of marketing strategies, tactics, integrated messaging and excellence in execution for the brave new healthcare world. Marketing needs to be closely aligned with the organizational strategic, business development and financial plans

The new marketing environment.

Competition is not going by the wayside. It will only increase as more for-profit corporations with deeper pockets enter the market. Mergers and acquisitions will not go by the wayside either. As a matter of fact, I would not be surprised to see more mergers and acquisitions by healthcare organizations in preparation for 2014.

The most profound change due to reform is that you really no longer have patients. You have true consumers. The new “patient” is a consumer who is already or will be, price-savvy, quality-conscious, knowledgeable and demanding.

Hospitals have little if any experience in true direct to consumer retail marketing. I believe that reform finally takes the last step in commoditization of healthcare where people will buy on price and quality. The market equation going forward is BtoB, BtoBtoC and BtoC.

Strategic Marketing Plan, Tactical Marketing Plan and Flawless Execution.

You will need a strategic marketing plan leading to a tactical marketing plan for each of the following audiences that you must flawlessly execute. The market is a hash mistress and without these three components, you will find out how harsh the market can be. Your audiences are:

Consumers
Physicians
Insurance companies
PPOs
TPAs
Medicare and Medicaid
Legislators at the State and Federal Level
Employers
Your employees
Self-employed
Other health systems
Pharmaceutical manufactures*
Home Health agencies
Social Service Agencies
Community groups
Retail pharmacies
Ambulatory treatment centers i.e. infusion services

A little explanation about why pharmaceutical manufacturers as an audience is warranted here.

Over 600 drugs in the development pipeline are either infused or injected medications requiring medical administration that fall into what is known as the specialty pharmacy area. The cost of drugs and changes in insurance plans regarding physician “buy and bill” practices find very few physicians participating.

This leaves a market open to the Walgreens, Apria’s and others of the world who already have existing infusion centers and it can be assumed are planning to increase their presence in the healthcare market. Failure to enter this market in a timely fashion means you could be leaving potentially millions of dollars on the table to the likes of Walgreens and others who are refining and expanding those strategies and already have the pharma relationships that will give them access to these drugs.


Moving forward.

There will be more on healthcare marketing and reform going forward. But for now, a lot of work is needed aligning healthcare organizations and marketing departments to the new market under reform. That will require leadership, decisiveness as well as the ability to refine strategies and execute them flawlessly.

I can be reached directly at 815-293-1471 or michael@themichaeljgroup.com for healthcare interim executive management, marketing strategy development, public and media relations, and crisis communications services

>>> The Future of Healthcare Marketing Under Reform >>>