Wednesday, September 29, 2010

Consumer Satisfaction in Healthcare Marketing

The dynamic has changed.

With the advent of HCAPHS and the Affordable Care Act (ACA) consumer satisfaction is no longer a nice too have but a got to have in healthcare. Difficult to achieve and tough to beat once you have it, consumer satisfaction with your medical services, regardless of the monikers we place on them, will drive volume and revenue. Revenue for the standpoint of Pay-for-Performance (P4P) programs and volume from consumers selecting you in a very "commoditized" and provider undifferentiated healthcare market place. As you create your networks, Accountable Care Organizations (ACOs), Medical Homes (MHs) and other yet undefined organizations, you have the opportunity to "get it right" this time.

For the past 10 years, I have been writing and working within healthcare organizations to improve satisfaction. Ten years ago, I had the opportunity to coauthor a book with Ralph Bell, PhD., on satisfaction entitled- How to Use Patient Satisfaction Data to Improve Healthcare Quality, American Quality Society, Quality Press . This past weekend I received a notice that the publication run worldwide is 843 copies to date and counting. The books relevancy today is even more so than it was when first written given the changes in healthcare in the U. S.

The healthcare consumer of today will view your services as: value= f(cost, quality, satisfaction) as compared to the near past where value= f(cost, quality). Value here is the defining moment and is a function of cost, quality and satisfaction with you.

Marketing Implic`tions

With the ACA and HCAPHS Hospital survey in play by reporting provider satisfaction as a common basis for measurement and consumer comparison, all the more imperative the focus on patient satisfaction. Healthcare is not an easy business by any stretch of the imagination. We work with people who are patients and their families that are at various states of emotional distress, caring employees (for the most part), good physicians etc. So satisfaction for so many different groups becomes interrelated.

Why is it important?

High levels of satisfaction are a powerful differentiators on your market, negotiations with insurance companies and your physicians.

Done correctly, your satisfaction program becomes the Voice of the Customer (VoC) to drive real organizational change.

It is a strategic and tactical edge for your brand and your marketing communication efforts.

Think customer evangelization.

Where does satisfaction start?

No surprise here - right in the executive suite. The CEO and senior leadership sets the tone, tenor and actions by what they do or don't do. How they treat others. How they measure and hold themselves accountable in the performance evaluation process. It's either part of the culture or not. People clearly trained, as well as understand the organizational rationale, policies, procedures for satisfaction and are part of the program, or they see it as the flavor of the day because so and so said so.

Satisfaction is a Process

Patient satisfaction is a process that is controllable and understandable. It is the voice of your customer. By listening to that voice, I mean really listening to that voice, you would be surprised at the improvements that you can make in your healthcare setting. Patients, physicians and others view the hospital experience not as a set of unrelated departments where things ard done to me, but as a coordinated whole in a continuous process.

Where do we go from here?

It starts with learning. It starts with an honest assessment of here is where you are. It starts in the C-suite. Commitment, compassion, understanding, listening, process control and improvement.

The choice is yours. The marketing implications, strategies and tactics are clear. Lead or be left behind.

You can continue the conversation with me on:


Michael Krivich is Fellow, American College of Healthcare Executives and a Professional Certified Marketer, American Marketing Association and can be reached at or 815-293-1471 for consulting services in strategic marketing, integration of sales and marketing, media relations and interim marketing executive leadership assignments. Huthwaite SPIN selling trained and a Miller Heiman Strategic Selling alumni, both highly respected and successful international sales training organizations , I can lead your organization though the challenge of integrating sales and marketing.

Most think health reform should have done more, AP poll finds

Even six months after the passage of major health reform legislation, you still hear almost daily rumblings that the American public is unhappy with health reform. Many view this unhappiness as a sign that health reform should be repealed. But is that what the unhappiness is really saying?

According to a recent AP poll, the numbers of Americans who think the law should have done more actually outnumber those who think the government should stay out of health care by 2-to-1. Further, about four in 10 adults think the new law did not go far enough to change the health care system, regardless of whether they support the law, oppose it or remain neutral, the AP poll found.

In both the "get out of healthcare" faction and the "do-more" group, broad majorities said health insurance, medical care, and prescription drugs all cost too much. In both groups, most feel that the system should aim to increase the number of insured people and let Americans get the care they need, while improving quality.

Despite the agreement between the “get-outs” and the “do-mores,” the differences become evident when it comes to the how this should be accomplished:

  • Only 25 percent of the "get-outs" favor requiring health insurance companies to sell coverage to people regardless of pre-existing medical conditions, while 54 percent of the "do-mores" support it. Health reform legislation requires insurers to cover children regardless of health problems starting this year, and that protection is extended to people of all ages in 2014.

  • Among those who want a law that does more, 68 percent favor requiring medium to large companies to provide insurance to their workers or pay a fine, a view that stands at only 28 percent among those who want the government out of healthcare. The law does not require employers to offer coverage, but companies face a penalty if any full-time employee gets a government health insurance subsidy.

  • The "get-outs" overwhelmingly reject the health care law's requirement that most Americans carry health insurance starting in 2014. But the "do-mores" are split, with 34 percent favoring the mandate, 33 percent opposing it, and 32 percent neutral.

For more information. For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.

Monday, September 27, 2010

Employers to address health reform’s effect in this year’s open enrollment materials

Now that health reform’s six-month anniversary has come and gone (and many provisions just took effect), you could be thinking that the hoopla over health reform might quiet down for a bit. Think again. For most companies, the health plan open enrollment season is rapidly approaching.

What will companies do in terms of talking about health reform in this year’s open enrollment materials? Good question and one that the folks at HighRoads, an employer health care compliance company, have just addressed in a new survey.

According to HighRoads, 75 percent of employers plan to address the effect of health-care reform in their open enrollment materials. In fact, 63 percent of respondents are creating new communication materials specifically for the communication of health-care reform. The companies responding represented communication practices for 1.5 million total employees.

“The changes demanded by the Health Care Reform Act and other recent legislation such as mental health parity and FMLA require employers of all sizes to make changes to their plans and to communicate these changes to plan participants in a timely manner,” said Kim Buckey, practice lead, ERISA Communications, HighRoads. “While open enrollment materials and other short-term communication vehicles can meet the immediate need, it’s critical that employees and their families have an up-to-date, comprehensive guide to using their benefits.”

Other survey highlights:
  • The biggest change expected in the next few years is updating summary plan descriptions (SPDs) for plan design and health-care reform changes, with 71 percent of respondents expecting to do so within the next year.

  • 71 percent of respondents—up from 65 percent last year—have no idea how much they spend to create, store and distribute SPDs to their participants.

For more information. For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.

    Friday, September 24, 2010

    Insurers Critique Grandfather Provision, And Feds Provide Some Relief

    The Department of Labor's Employee Benefits Security Administration (EBSA) will temporarily disregard certain changes in an insured group health plan's contribution rate which normally would cause the plan to lose its grandfathered plan status under health reform.

    In newly released guidance (in the form of frequently asked questions (FAQ)) on implementing the Patient Protection and Affordable Care Act, EBSA addressed a variety of issues raised by employers and insurers, including insurers' concerns that they do not always have the information needed to know whether (or when) an employer plan sponsor changes its rate of contribution towards the cost of group health plan coverage.

    This is important because the interim final regulations on grandfathered plans provide that a group health plan or health insurance coverage will cease to be a grandfathered health plan if the employer decreases its contribution rate towards the cost of coverage by more than 5 percentage points below the contribution rate on March 23, 2010.

    According to EBSA, until the issuance of final regulations, an insured group health plan will not be treated as having ceased to be a grandfathered health plan immediately based on a change in the employer contribution rate if the employer plan sponsor and issuer take the following steps:

    Upon renewal, an insurer requires a plan sponsor to disclose its contribution rate for the plan year covered by the renewal, as well as its contribution rate on March 23, 2010; and

    The insurer's policies, certificates, or contracts of insurance disclose in a prominent and effective manner that plan sponsors must notify the insurer if the contribution rate changes at any point during the plan year.

    For policies renewed prior to Jan. 1, 2011, insurers should take these steps no later than Jan. 1, 2011. If these steps are taken, an insured group health plan that is a grandfathered health plan will continue to be considered a grandfathered health plan.

    Similar relief is available to multiemployer plans that do not know whether (or when) a contributing employer changes its contribution rate as a percentage of the cost of coverage.

    The relief is terminated when the issuer knows that there has been at least a 5-percentage-point reduction.

    Other Issues Raised

    EBSA's new FAQs address a number of other issues in the Affordable Care Act, including these:

    Grandfathered plans. Current rules state that grandfathered group health plan status is lost if the plan changes carriers. EBSA notes that implementing agencies will soon address the circumstances under which grandfathered group health plans may change carriers without relinquishing their status as grandfathered health plans.

    External review. One of the standards set forth in a recent technical release on external claims reviews  requires self-insured plans to contract with at least three independent review organizations (IROs) and to rotate claims assignments among them (or to incorporate other independent, unbiased methods for selection of IROs, such as random selection). The FAQ noted that "a self-insured group health plan's failure to contract with at least three IROs does not mean that the plan has automatically violated PHSA Sec. 2719(b). Instead, a plan may demonstrate other steps taken to ensure that its external review process is independent and without bias."

    EBSA also noted that the technical release does not require a plan to contract directly with any IRO: "Where a self-insured plan contracts with a TPA that, in turn, contracts with an IRO, the standards of the technical release can be satisfied in the same manner as if the plan had contracted directly. Of course, such a contract does not automatically relieve the plan from responsibility if there is a failure to provide an individual with external review. Moreover, fiduciaries of plans that are subject to ERISA have a duty to monitor the service providers to the plan."

    In addition, the IRO is not required to be in the same state as the plan. Plans may contract with an IRO even if it is located in another state.

    Dependent coverage of children. Plans may limits health coverage for children until the child turns 26 to only those children who are a son, daughter, stepson, stepdaughter, or an eligible foster child (IRC Sec. 152(f)(1)). For any other individual, such as a grandchild or niece, a plan may impose additional conditions on eligibility for health coverage, such as a condition that the individual be a dependent for income tax purposes.

    Out-of-network emergency services. PHSA Sec. 2719A generally provides, among other things, that a group health plan must cover emergency services without regard to whether a particular health care provider is an in-network provider with respect to the services, and generally cannot impose any copayment or coinsurance that is greater than what would be imposed if services were provided in network. At the same time, the statute does not require plans to cover amounts that out-of-network providers may "balance bill." Accordingly, the interim final regulations under Sec. 2719A set forth minimum payment standards to ensure that a plan does not pay an unreasonably low amount to an out-of-network emergency service provider who, in turn, could simply balance bill the patient.

    The EBSA FAQs noted that if a state law prohibits balance billing, plans are not required to satisfy the payment minimums set forth in the regulations. Similarly, if a plan is contractually responsible for any amount balance billed by an out-of-network emergency services provider, the plan is not required to satisfy the payment minimums. In both situations, however, patients must be provided with adequate and prominent notice of their lack of financial responsibility with respect to such amounts, to prevent inadvertent payment by the patient. Nonetheless, even if state law prohibits balance billing, the plan may not impose any copayment or coinsurance requirement that is higher than the copayment or coinsurance requirement that would apply if the services were provided in network.

    For a comprehensive analysis of the Patient Protection and Affordable Care Act, including the full text of the law and additional information on health reform and other developments in employee benefits, just click here.

    Thursday, September 23, 2010

    Online Healthcare Marketing, Making the Customer Experience Exceptional

    In the new world of healthcare where price and quality are the key drivers of an informed consumer, sharing a much greater burden of the cost, will begin to demand experiences online that they commonly have with other companies.

    Online represents a great opportunity for consumer directed healthcare organizations to break from the pack and create an online healthcare experience that is memorable and exceeds an individuals or families experience, expectations.

    Are you ready for the challenge?

    Most healthcare sites today are static containing the usual about us, our services location, etc., etc., etc. Little use of video or other creative ways to engage the customer. Notice that I said customer and not patient. Not everyone that comes to your site is a patient or will be a patient. They are consumers looking for information. Could be a competitor too.

    In any case, when you look at your site, does it:

    Delight your customer?

    Create sustainable differentiation?

    Is adaptable to new opportunities?

    Leverages your investment?

    Deliver in every situation?

    This is the lens that you need to look through to objectively evaluate your site. If it's not doing these things, then chances are you are not delivering an exceptional online experience. But for that matter, neither are your competitors. In a the world of healthcare which is too much "me too", the online healthcare experience is pretty boring.

    Don't take me wrong, healthcare sites are usually pretty good if people internally have been paying attention to them. They can be described as warm, comfortable, informative, friendly. They can be described as "good enough". Not exceptional. Not delivering anywhere near to the capability inherent in an online presence.

    I would suggest to hospitals, IDNs, nursing home, home healthcare operations and many others, that you look outside of the your segment of healthcare to pharma, medical device and other companies, viewing the type of online presence they have. Look to healthcare organizations in Europe and Asia. Look at retail organizations.

    Make your online presence not just "good enough" but exceptional.

    The time is now. The opportunity to change is here.

    You can continue the conversation with me on:

    Michael Krivich is Fellow, American College of Healthcare Executives and a Professional Certified Marketer, American Marketing Association and can be reached at or 815-293-1471 for consulting services in strategic marketing, integration of sales and marketing, media relations and interim marketing executive leadership assignments. Huthwaite SPIN selling trained and a Miller Heiman Strategic Selling alumni, both highly respected and successful international sales training organizations , I can lead your organization though the challenge of integrating sales and marketing.

    Tuesday, September 7, 2010

    Assume a spherical cow

    You know that joke about the farmer whose cows are not producing enough milk? A university panel gathers under the leadership of a theoretical physicist. They analyze each aspect of the problem thoroughly and carefully, and after much deliberation produce a report, the first line of which is "First, assume a spherical cow in a vacuum". This joke has become short-hand for some of the reductionist thinking in theoretical physics, but it can just as easily personify the field of statistics, upon which we rely so heavily to inform our evidence-based practices.

    Here is what I mean. Let us look at four common applications of statistical principles. First, descriptive statistics, usually represented by Table 1 in a paper, in which we are interested in understanding the measures of central tendency such as the mean and median values. I would argue that both measures are somewhat flawed in the real world. As we all learned, a mean is a bona fide measure of central tendency in a normal or Gaussian distribution. And furthermore, in such a distribution 95% confidence intervals are bounded by 2.5x the standard deviation from the mean. Although this is very convenient, few things about human biology are actually distributed normally, while many cluster to the left or to the right of the center creating a tail on the opposite side. For these skewed distributions a median is the recommended measure to be used, bracketed by the boundaries of the 25% to 75% range of the values, or the interquartile range. But in a skewed distribution it is exactly the tail that is its most telling feature, as described so eloquently and personally by Stephen J. Gould in his "The Median Isn't the Message" essay. This is especially true when more specific identification of characteristics precipitates the numbers dwindle; e.g., if instead of such general measures as blood pressure among all-comers you want to focus on morning blood pressures in such specific group as African-American males with a history of diabetes and hypercholesterolemia who attend a smoking cessation program, say. And this is important because at the level of the office encounter each patient is a universe of his/her own risk factors and parameters that does not necessarily obey the rules of the herd.  

    Second, analytic modeling relies on the assumption of normality. To overcome this limitation we transform certain non-normal distributions to their log forms, for example, to normalize them in order to force them to play nicely. Once normalized, we perform the prestidigitation of a regression, reverse-transform the outcome to its anti-log, and, voila, we have God's own truth! And even though statisticians tend to argue about such techniques, in the real world of research, where evidence cannot wait for perfection, we accept this legerdemain as the best we can do.

    The next example I will use is that of pooled analyses, specifically meta-analyses. The intent of meta-analyses is to present the totality of evidence in a single convenient and easily comprehended value. One specific circumstance in which a meta-analysis is considered useful is when different studies are in conflict with one another, as for example, when one study demonstrates that an intervention is effective, while another does not show such effectiveness. In my humble opinion, it is one thing to pool data when studies suffer from Type II error due to small sample sizes. However, what if the studies simply show opposite results? That is, what if one study indicates a therapeutic advantage of treatment T over placebo P, but another shows the exact opposite? Is it still valid to combine these studies to get at the "true" story? Or is it better to leave them separate and try to understand the potential inherent differences in the study designs, populations, interventions, measurements, etc.? I am not saying that all meta-analyses mislead us, but I do think that in the wrong hands this technique can be dangerous, smoothing out differences that are potentially critical. This is one spherical cow that needs to be milked before it is bought.    

    The last cow is truly spherical, and that is the one-on-one patient-clinician encounter, wherein the doctor needs to cram the individual patient with his/her binary predispositions into the continuous container of evidence. It is here that all of the other cows are magnified to obscene proportions to create a cumbersome, at times incomprehensible and frequently useless pile of manure. It is one thing for a clinician to ignore evidence willfully; it is entirely another to be a conscientious objector to what is known but not applicable to the individual in the office.

    But let's remember that I, as a health services researcher and a self-acknowledged sustainability zealot, am in awe of manure's life-giving properties. Extending the metaphor then, this pile of manure can and should be used to fertilize our field of knowledge by viewing each therapeutic encounter systematically as its own experiment. The middle way is that between the cynicism of discarding and blind acceptance of any and all evidence. That is where the art of medicine must come in, and the emerging payment systems must take it into account. Doctors need time, intellectual curiosity and skills to conduct these "n of 1" trials in their offices. If the fire hose of new data insists on staying on, this is the surest way to direct "conscientious and judicious" application of the resulting oceans of population data in the service of our public's health. And that should make the farmer happy, even if his cows are spherical.