Few other sectors rival healthcare when it comes to reputation challenges and regulatory complexities. And with direct-to-consumer interaction on the rise, communicators find themselves navigating thorny terrain riddled with legal and privacy considerations.
The Holmes Report partnered with ReviveHealth to dive deeper into these issues and glean best practices across several verticals within the healthcare industry. To do this, six senior-level communications and marketing professionals gathered in New York to share insights on the evolving nature of engagement in the healthcare sector.
The discussion spanned a wide range of topics from social media land mines to communicating internal wellness initiatives.
William Clark, SVP of strategic development at Brookdale Senior Living
Paul Wood, CCO at University of Pittsburgh Medical Center
Camela Morrissey, VP & CMO at the New York Hospital Queens
Tom Mitchell, VP of marketing at HealthTech Holdings
Holly Teichholtz, VP of marketing and communications at The Michael J. Fox Foundation
Brandon Edwards, CEO of ReviveHealth
Bob Berra, chief strategy officer at ReviveHealth
Paul Holmes, editor-in-chief at the Holmes Report
Aarti Shah, senior editor at the Holmes Report
Battling healthcare's 'dysfunctional' image
The most obvious -- and jarring -- tension exists between the healthcare sector’s mission to save and improve lives and its ‘dysfunctional’ reputation with consumers. The root of this, however, was ultimately determined not to be a pure PR problem, but instead, a consequence of a disjointed system often with competing, or misaligned, incentives. On top of this, the communication of Affordable Care Act has been rife with confusion and misinformation.
Mitchell: Healthcare touches every American and our GDP is so closely tied to it, but the perception is that it’s a dysfunctional system. There’s a lack of focus on primary care, we tend to rush to specialized care first, we tend to jump to emergency care first. You couple that with all the different elements of the regulatory environment of the last few years and you have Americans saying “maybe we do have a problem.” And we’re creating the problem ourselves from how we communicate. Look at how polarized healthcare reform has become.
Wood: When the Center for Medicare and Medicaid Services comes out with their data on what hospitals charge, you have coverage in the New York Times and Washington Post saying that one hospital charges $110,000 for a hip replacement, another charges $72,000.
They are making a big macro statement on how dysfunctional or broken the system is. But [most people with insurance] never pay those charges. It’s just the number that starts the negotiation with the insurance company, Medicare or Medicaid.
Clark: Also, it’s a siloed, fragmented industry and we are only attacking a small piece of that with the reform.
‘More transactional than relationship-driven’
Morrissey: We’re getting patients and families at their most vulnerable time. They have a lot to navigate and face and we’re expecting a whole lot of them.
We had the son of a patient who passed away write a terrible review about one of our physicians on vitals.com and show that to me. He said he couldn’t get a hold of anyone in our system to get certain information he needed. I said give me 10 minutes and I got someone to speak to him.
Berra: Patients question the motives of everyone fighting for their dollars. There are problems with insurance companies being publicly-traded and the HMO movement. Obamacare is trying to better align incentives, so it will be interesting to see how this plays out over the next few years.
Teichholtz: I’m coming at this from a position downstream and the misalignment of stakeholders is the single biggest issue we have to contend with. The misalignment we see in the delivery of care is mirrored on the treatment development side.
Clark: We haven’t talked about the role of the patient in their care. We treat the health system like something that’s done to them, payments are made by someone else, decisions are made for them. But with the fragmentation, we don’t make it easy for patients to be active in their own care.
‘Why are we so bad at communicating wellness?’
The Web has made it easier than ever for patients to take control of their treatments and request specific drugs. Anti-smoking and HIV prevention groups have relatively successfully changed behavior, while breast cancer and AIDS coalitions raised awareness levels to new heights. With such notable campaigns, has direct-to-consumer engagements changed the game for communicating health and wellness?
Morrissey: The sea change has been in the opening of direct-to-consumer communications -- and the pharma industry has been a lot more organized at this than the healthcare system. For delivery of care it’s still a black box. You get three bills if you’re hospitalized. The average patient that comes into our facility for an overnight stay touches 50 people during that time, 50 people. This is more complicated than just getting someone to take a pill.
Edwards: So, what’s changed? The population has gotten older, sicker and fatter in the last 10 years. There has been a basic demographic change and our system is being asked to do more with less resources.
Berra: The cynical outlook would be, we’ve spent billions dollars on wellness --- and diabetes, obesity and blood pressure are through the roof.
Edwards: The lifestyle choices we make are encouraged by a billion-dollar food advertising industry. Americans are notoriously resistant to changing their lifestyle for the better.
Teichholtz: That can’t happen at the individual level, it’s an infrastructure issue.
Berra: And remember, smoking was legislated out.
Teichholtz: And HIV was a death sentence, so the motivation was more immediate.
Edwards: Infrastructure is what business does well, for our transportation sector we have roads and such. But when you look at our society, we haven’t built a health infrastructure. As a society we have built a sedentary infrastructure.
‘Is it our job to make our organizations healthier?’
Borrowing from the adage “charity starts at home,” the discussion turned to internal communications and whether healthcare organizations have an added responsibility to devote resources to make their employees healthier. And at what point do policies become overbearing and result in employee backlash over a 'Big Brother' approach to wellness.
Wood: We do a lot of communications to our employees. If you get a flu shot or join a gym, you get a waiver towards your deductible. The idea is to bring the deductible down to zero.
Berra: I think the healthcare business can keep putting pressure on other businesses that impact our health, like requiring calorie counts to be listed at fast food restaurants. Corporate America - in addition to doing internal communications on health - needs to align to make a more effective health infrastructure.
Wood: It has to be clear that you’re not forcing people to do these things, but if they do, something positive will come from it.
Morrissey: Because there is so much fragmentation, on a local level, we’re working with community leaders to identify wellness needs based on neighborhood or population segment. We're also using the leaders as forays into the community to set-up micro programs, whether that be for smoking cessation or to combat an uptick in liver disease.
'Nobody feels like there is a social media safe harbor'
When it comes to social media, healthcare organizations often have their hands tied with legal, regulatory and privacy considerations. Yet, when it comes to health issues, the wisdom of crowd can also perpetuate misinformation. This leaves healthcare organizations often conflicted about whether to play it safe (and silent) on social media or try to -- at least -- put available information into context.
Morrissey: When you’re a physician and you know your patients will rate you online, the power shifts. And some physicians are ready for that and medical schools should be teaching how to handle that more and more. But right now, most are unprepared to drink from that fire hose.
Wood: The first time a patient goes on social media to complain, you’re in a privacy issue. The lawyers get involved. They don’t want us to talk about it. And the physicians sure don’t want to talk about it. But often patients are wrong. They got a basic fact wrong. But once that's out, it snowballs. On social media, you hope someone comes in and corrects, but it doesn’t always happen.
Berra: We’ve hit on a very important component -- the the legal system really puts handcuffs on professional communicators. We’re not allowed to go out and say certain things. But the patient, or the other side, can say whatever they want. Where healthcare reform fell short is legal reform. We are unable, as a professional communicators, to sit down with a reporter and give them the facts, the truth.
Morrissey: On social media, there are patients outing themselves. I can’t protect your privacy if you’re out there doing that.
Berra: Healthcare organizations can’t go out and talk about patients. But if patients opt to make their stories public, that ought to give the institution the safe harbor to say “they have gone on record.”
Edwards: Organizations will say, I can’t violate HIPAA because of a fine. But you can
choose to violate HIPAA the same way you can choose to violate the speed limit. And you can say, considering the reputation damage to my company from XYZ, it may be worth it.
It might be worth it to pay a $10,000 or $20,000 fine and violate HIPAA.
Teichholtz: We had a phase II clinical trial that we invested in that failed last month. When the announcement went live, we had three people on Facebook come on and say ‘I was in this trial and I did or didn’t get better.’ We sat and debated whether we could reach out to these people.
Nobody feels like there is that safe harbor, even if, in theory, there is. But these cases are good stories and we want to hear from people saying the trial was worthwhile.
‘You remember a story, not a statistic’
Edwards: You remember a good story better than statistics. Pharma does a halfway decent job of storytelling, but as an industry, we think transactionally, we behave transactionally and storytelling is all about a relationship.
Wood: We had a great story about a woman pregnant with twins and they had an always fatal syndrome. We had an innovative surgery where the doctor was able to go in and save both twins. Both are now healthy.
It was a great story that we shared with media and our marketing team did a commercial with the mother and the twins. We used this story to market ourselves rather than say we’re the best ranked hospital.
Clark: In senior housing, the biggest challenge we have is the number one search term for senior housing is still nursing home. That’s the negative perception in our industry, so obviously seniors don’t want to be put ‘into a home’ and we promise as adult children that we’ll never put them into a home.
So rather than build campaigns around features and benefits, it has to be emotional. We just finished filming several families in Colorado in which adult children had to become active in their parents’ care. It’s a paradigm shift for our industry that really tried to paint a cruise ship image.
Teichholtz: People get on social media to find people like them. You have to use direct meaningful stories and build platforms to let people share them.
Clark: On the mobile side it’s also worth talking about passive engagement, which is incorporating monitoring into the devices we already use. How can I use my remote control as a monitoring device? Or my iPhone without having to download an app? If we ask someone to step outside their workflow and do something different, it’s a challenge.