Author: Lee Aase

Husband of one, father of six, grandfather of 15. Chancellor Emeritus, SMUG. Emeritus staff of Mayo Clinic. Founder of HELPcare and Administrator for HELPcare Clinic.

Leveraging the Internet in Health Care

This morning Jane Jacobs and I are presenting a Mayo Clinic case study at a half-day workshop entitled, “New Media Requires New Strategies: A Marketer’s Primer.” Our co-presenters include Kathy Divis of Greystone.net and David Bennett of the Medical University of South Carolina.

Kathy gave the overview of trends in healthcare and the internet in general, from the rise in broadband penetration to the consequent explosion of on-line video and the various Web 2.0 applications.

She cited a Harris poll that said about 75 percent of people are interested in asking questions that don’t require a visit, schedule/cancel appointments, refill prescriptions and receive test/lab results, and more than a third are willing to pay for the ability to do this (an average of about $10/month).

About 40 percent of rural Americans have high speed access at home. The number of text messages sent and received each day exceeds the population of the planet.

She said the healthcare industry will have no choice but to engage and develop social media if it is interested in helpoing people find accurate and helpful information online, and that social media may shift control of healthcare brands to the masses, and those who ignore it are placing their organizations at risk.
Here’s and example of a health care video on YouTube

[youtube=http://youtube.com/watch?v=x2M3o0FB0SI]

…and another one

[youtube=http://youtube.com/watch?v=q7MssseGxO0]

The issue she raised is there is no control over who shares your page on YouTube, and by that I think she means the “Related” videos.

Clinical wizards and marketing avatars are multi-media files that combine text, audio, video and/or animation with interactivity and decision logic to educate the user about a specific condition or marketing campaign.

Kathy’s best estimate is there are over 700 health and fitness podcasts currently available, and now about 12 percent of internet users say they have downloaded a podcast.

Only three people in the audience have personal blogs. She made a good point that whether a hospital sponsors a blog or not, that doesn’t stop people from blogging about you. She cited High Point Regional Health System as one with patient blogs.

Next Kathy went into RSS (Really Simple Syndication), Wikis, and Tagging. See for example the social bookmarking site del.icio.us. The great thing about tagging and social bookmarking is it indicates that real human beings have looked at content and assigned it a relevant keyword, so searching based on tags gives results based on what users have found helpful, not what some site architect mapped out.

David went into depth on clinical wizards, and one in particular that they did for heart risk. They used targeted Google adwords to promote geographically, and in one year had more than 6,000 people take the assessment, of whom 4,000 signed up for eNewsletters, 2,300 individuals were identified as “at risk” and 123 (extremely conservatively estimated) scheduled appointments. He thinks it was likely 3x that amount. Total investment was about $40,000 per year, for likely 10x the revenue.

He next moved into podcasting and gave some price ranges for ways of approaching it, from bare bones to in-house studio to outside-produced content. Rmail is a way to get podcasts by email instead of RSS, which can help since people are more comfortable with email than RSS. They do about 20 audio podcast segments a week. They develop for a local TV program, and then use different versions for the web, cutting into multiple segments.
They use a Content Delivery Network CDN for delivery of all their online video (Akamai). They have put about 100 videos on YouTube. Here’s one:

[youtube=http://youtube.com/watch?v=d4S6k3OEIkg]

They use text messaging with an interesting application for weight loss, in which they send a daily reminder to people who sign up, asking them to text back their weight that day, which is tracked and plotted over time.
Jane and I discussed our definition of new media (anything that doesn’t require an FCC license) and how we are incorporating resources, such as our Mayo Clinic Medical Edge syndicated products, that we have produced for traditional media into these new channels. We have podcasts available from mayoclinic.org and on iTunes, and a Flash presentation on Mayo Clinic’s history. More recently we have begun using Flash for Medically Speaking web video, in which various experts who treat patients with a given condition share perspective on symptoms, diagnosis and treatment. In February, we launched a cell phone service in conjunction with Digital Cyclone, to provide health information and news videos to people on the go.

Here’s a video we used for pitching the launch to journalists:

[youtube=http://youtube.com/watch?v=1YkDSjclEws]

John Eudes of Greystone.net illustrated decision support wizards with examples from Rush University Medical Center’s Sleep Center (a company called Jellyvision produced it.) One problem is you can’t back up and another is you can’t jump ahead to make an appointment. A breast cancer risk self-assessment wizard from Central Health systems is improved because it has an interactive navigation box at the bottom that solves some of these problems. Emmi Solutions does an on-line informed consent program, and John showed the coronary artery bypass graft version. The purpose is to improve the patient experience and help with risk management. Patients have expressed satisfaction with the system and say they feel more informed and more confident.

John concluded with a strategy overview, with options ranging from purchasing syndicated content, repurposing what you’re already doing and custom content creation for the web. Mayo is doing the second and third options, but with a focus on the repurposing end and producing custom content at the same time as we are producing the mass media content.

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And Now, A Word from Our Competitors

The late-morning session featured James Blazar and Marilyn Wilker from Cleveland Clinic. Their presentation was entitled “Branding as a Key Strategy for Success in Healthcare.”

Cleveland Clinic’s brand position is “Complete Confidence.” A brand is a promise. A pact between an organization and its audience. Strong brands uphold the promise at every customer interaction. An organization has a responsibility to fulfull this promise or risk the consequences (e.g. Firestone). A brand influences business systems, processes and policies. An example was Hampton Inn, where they gave a night’s stay free to someone kept awake by a youth softball team.

Brands matter because they provide meaningful differentiation, create a preference and reinforce an experience. If it can work for water, it should work for healthcare.

Cleveland Clinic’s re-branding was initiated by a change in leadership, growth of organization, marketplace changes and a new strategic plan. Their goal was to close the gap between their brand’s power and those of Mayo Clinic and Johns Hopkins. They mentioned that Toby Cosgrove, their CEO, stopped doing surgery in December 2006. They bought the naming rights to the Cleveland Cavaliers’ practice facilities, which are called Cleveland Clinic Courts, because LeBron James is the second-most recognizable athlete in China.
Mr. Blazar described the Brand Driver Workshop process they undertook, which led to their choice of Complete Confidence as their brand platform.

Complete Confidence is the opposite of the fear people feel when faced with life-threatening illness. Brand characteristics they emphasize are: understated confidence and leadership, compassion and comfort, approachability and professionalism.

They changed their logo typography and simplified it to make it more contemporary. To get it through their approval processes, they showed how other organizations like Shell Oil, IBM and NBC had changed their logos over time…and that their beloved logo had not been handed down on stone tablets.

They developed a Brand Architecture to create a clear, organized system of brands. It’s similar to what Mayo Clinic does. Principles: Keep it simple, keep a customer perspective, align architecture with business strategy, minimize levels and keep it clear. Their ad agency implementation/tag line is “Find the confidence to face any condition at Cleveland Clinic” in the Letters to Tomorrow campaign. They have done a national cable TV buy for their ads (which I’ve seen.) We saw four of their ads, which were very well done, but didn’t seem to fit the “understated” part of their goal when the tag line said “World Leader” or “#1.” At Mayo Clinic we let others say “world renowned” and don’t say it ourselves.
Results: National awareness has increased from 62-71 percent, and awareness of advertising has increase (I think it was from 16 percent to 22 percent, but I may have that wrong.) Income generated from patients who have responded to the advertising is between $1.2-1.6 million. Calls have come from all 50 states, and the campaign has positively impacted philanthropy.

In response to questions, we learned that their marketing budget is 3 percent of their overall revenue, and that the consultanting firm fee for the re-branding was several hundred thousand dollars. They did not disclose the size of their advertising buy. It would be interesting to know whether the advertising has been directly profitable, although I don’t doubt it has helped in branding.

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Building a Strong Services Brand

Disclosure: This presentation is by Kent Seltman from Mayo Clinic’s Division of Marketing. I’m also from Mayo Clinic, where I work with National Media Relations, Research Communications and New Media. We’re both probably biased. But here’s our story and we’re sticking to it.

Kent’s three lessons (which are in the book he is writing with Len Berry) include:

  1. Attend to the Values
  2. Play Defense, not just Offense
  3. Turn Customers Into Marketers

A related article appears in the current issue of the journal, Business Horizons.

The Presented Brand is what the organization controls, and directly affects brand awareness. Examples are advertising, brand name, logo, web sites, employee uniforms and facilities design.

External Brand Communication includes Organization-influenced communication. Examples are media relations and word-of-mouth, which we can somewhat influence but cannot control. Presented Brand and External Communication influence brand meaning, but indirectly.

Customer Experience is the cumulative experience with a company, and is directly and disproportionately influential in creating brand meaning. Nothing trumps the customer’s actual experience in creating brand meaning. Customers’ actual experiences have large influence on word-of-mouth communications.
“Mayo Clinic” is created every day on the fly by every employee in every interaction with every patient. (I also would add that this applies to interaction with other clients such as, in my team’s case, news media. And news media give word-of-mouth with a megaphone.)Over 37 percent of Americans know someone who has been a patient at Mayo Clinic.

Brand History: In the 1890s Dr. Will and Dr. Charlie Mayo gained notoriety for good surgical outcomes because they were early adopters of aseptic surgical techniques, and in 1905 Dr. Will became president of the American Medical Association.

Journalists at the turn of the 20th century wrote several articles that made the Mayo brothers extremely uncomfortable, making outlandish claims about how wonderful they were, like “not a single patient died under their knife” and that they were “the court of last appeal for the sick of all the world.”

Kent observes that “The Mayo Clinic brand became the leading healthcare provider brand in the United States WITHOUT a marketing department or brand manager, just a combination of outstanding healthcare and vigilance to preserve a great REPUTATION.” I agree with him to a point, except when he says “just” outstanding healthcare. Those early newspaper articles played an important role in building the reputation, even though there was no media relations team. The Mayo brothers didn’t like the articles because they created animosity among other physicians. But there’s no denying they played a role, because Mayo Clinic is still seen as that “last hope” for many patients.

Lesson I: Attend to Values First. Key values are “The needs of the patients come first” and “Teamwork.” Here’s a case in which both of those values are exemplified, and infrastructure such as the integrated medical record (since 1905) which is now electronic, vertical buildings, wide halls and priority paging infrastructure helps teams collaborate.
Lesson II: Play offense (extend the brand appropriately) and defend it against well-meaning internal people who might dilute it and against external groups that want to trade on Mayo Clinic’s name.

Lesson III: Turn Customers into Marketers. In our studies, 95 percent of our patients said “good things” about Mayo Clinic after visits to an average of 46 people, and 90 percent advised people to come to Mayo and claimed an average of 7 actually came.

Capitalizing on Word-of-Mouth (WOM) requires providing a service that exceeds customers’ expectations. “The real brand heroes are those industrial engineers and other leaders who design the service processes and the line employees who perform – often on the fly – their individualized service for patients.” Efficiency of care correlates most highly with patient satisfaction at Mayo Clinic.

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The Empowered Consumer

Today’s presentation was from Wayne Sensor, CEO, Alegent Health, who gave what he calls: A Marketer’s Call to Action.

Mixing metaphors, Wayne says our industry is “at a crossroads” and “facing a gathering storm:” rising cost of healthcare, number of uninsured and questions about whether not-for-profit hospitals are keeping up their end of the bargain. He says this will be the age of the consumer.

Consumerism isn’t new in America, but it is for health care…and it has reached its zenith in TiVo, iPods, consumer-generated Super Bowl ads and you/me being the Time Person of the Year.

He says our choice is whether we embrace or deny consumerism. We need to have Tools to empower consumers, Access Points (e.g. clinics in grocery stores) and Incentives for good behavior.

He discussed some of the drivers of rising costs, including pharmaceutical costs, defensive medicine, aging population, lifestyle choices and failure to practice evidence-based medicine.

He outlined solutions in three categories:

Tools – Reporting meaningful quality data, with composite scores based on CMS data. Alegent’s first set of quality ads showed performance data that were below the regional average. Now the scores have gone up because they focus on what creates the scores at monthly clinical practice meetings. They publish their scores on the Alegent.com web site, and report that they not only have surpassed regional competition but also national levels of some elite centers.

Another tool they are developing is a personal cost estimating tool. “Instead of a list price we provide the consumer with the ability to find out how much tests and procedures cost and how much they will actually pay.” The program asks the consumer to enter their insurance plan and checks the co-pays to give a bottom line estimate. This is another big blue button that says “My Cost” on the Alegent.com site.
Access — studies said consumers generally like the care they get (but can’t afford it), but it doesn’t look anything like what they would really want: quick, convenient, with easy-to-understand costs. They developed Alegent Health Quick Care to give care in grocery stores, for everyday illnesses such as sore throats, sinus infections, etc. Nurse practitioners provide the service for $24-$52.

Incentives: As more employers offer Consumer Driven Health Care, we will see consumerism take control. More premiums and co-pays are being pushed to employees, which makes them unhappy but doesn’t necessarily really engage them. Wayne says we need more than that to be truly effective. We need to have programs to encourage preventive care and lifestyle modification.

For Alegent Health’s 8,500 employees, 88 percent chose consumer-driven options. Here are some of the plan elements:
If it’s preventive care, it’s free. Use of preventive care among employees is now 40 percent above the national average.
Healthy Rewards: All employees get an opportunity to do a health risk appraisal, which kicks out a list of risk factors. They get $100 in their health savings account just for doing the HRA (although this may be only for those at higher risk), and if they have significant risks they get lifestyle coaching. If they get to within 10 percent of the healthy level on that risk factor, they get another $400 in their HSA.

Early results: those participating in the weight loss program have averaged 15 pounds lost, the workforce is healthier, and Alegent spent less on health care than the previous year. They also gave a $750,000 rebate of premiums to their employees because the goal was health improvement, not saving money. Sort of a “profit sharing” plan for health.

These are some interesting thoughts, especially in an environment in which we’re seeing double-digit cost increases. The quick clinic and employee health plan perspectives are particulary relevant for the Health Policy/Health Reform debate.

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