Cardiovascular Marketing and Your Cafeteria as an Extension of Your Brand

While Julie is on vacation, Susan Levy, Publisher of wellfedheart.com and dedicated reader of The Main Artery, will contribute as a guest blogger.

Does your cafeteria reflect a heart-healthy marketing message?

Not long ago I visited a “top 100 hospital” and went to the cafeteria. The special that day had creamy gravy over a biscuit and not wanting any of this cardiac center’s specials, I turned to the packaged foods. I didn’t know whether to laugh or cry when I spotted the bag of fried “chittlins”.

Leadership in healthy choices

You’re branding the XYZ medical center as the best place for cardiovascular care, diabetes, or cancer. You create strategies and tactics for external marketing opportunities. However, the best strategy could be within your own building. The cafeteria is the single biggest gathering place in a hospital. It’s where you nourish your employees on a daily basis. And, don’t patients and their families need the best foods when they are at their most vulnerable? I would argue that the cafeteria can become a centerpiece for any institution’s commitment to healthy living, and thus an extension of your brand. So, why is it that only the rare institution actually showcases its cafeteria as a place of thoughtful eating choices with good health and nourishment?

Where marketing meets dietary

Like all lasting initiatives, this one takes teamwork and a long-term commitment. One of my favorite examples began almost a decade ago at Providence Health System in Oregon. Dietary services were already distributing the NW Guide to Heart-Healthy Living booklet in cafeterias, classes and discharge packets. Then, the marketers and dietitians got together and asked themselves how they could integrate the messages in the booklet into their culture. That question began the process of integrating heart-healthy food messages with actual available choices.

Here are three elements in their ongoing success:

Get consensus. 

Create an annual meeting of all the hospital chefs and managers to discuss consumer food trends and ideas on how to extend their NW Guide to Heart Healthy Living beyond distribution in the cafeteria. Annually, recipes are picked that work in the home kitchen, and at least half are featured in the cafeteria food line as well. One of the most popular is salmon cakes.

Toss out conventional wisdom.

Dietary began with just one breakfast item. Conventional thinking was that if people didn’t buy it in the past, they wouldn’t buy it now. New thinking prevailed: let’s try again. Today the yogurt parfait is a mainstay as a breakfast/to-go snack.

Highlight healthy options.

Place pictures from the booklet above the healthy item in the steam line. Post the nutritional labels and information for healthy options.

So my question is this:  “Do your dining facilities deliver on the promise of your heart-healthy brand?”

Susan develops strategies and marketing tactics for health care organizations. With more than 20 million in print, her customized heart-healthy booklet of recipes has been used by cardiovascular centers in more than 35 states. Due to its success, and at the suggestion of hospital chefs and dietitians, The Well-Fed Heart online library was created. Susan’s blog, In My Experience, links current news in health care, research, and trends to her life as a baby boomer.

ACO Vocabulary Words for Cardiovascular Marketers

Figuring out what the long-awaited accountable care organization (ACO) guidelines really mean may require some study.

The federal government finally delivered its much- anticipated guidelines for ACOs.  Even though the program is voluntary and will be limited to only about five million Medicare beneficiaries when it opens next year, many healthcare experts have a sense that things have changed forever.

The guideline document is huge – 429 pages and 116,000 words, accompanied by an 8,700-word statement on the proposed ACO anti-trust enforcement policy.

Even for people who’ve been anticipating and researching ACOs for a while now, this could be overwhelming. It seems we all need to familiarize ourselves with a host of new terminology and acronyms.  I came across a great article in HealthLeaders Media that outlines “13 Hot ACO Buzzwords” we should all know.  Here’s a quick summary, but read the article for full definitions.

1. The Paperwork Reduction Act of 1980 (PRA) – Bottom line, it won’t apply to ACOs because of more patient “opt-in” provisions vs. “opt-out” and the resulting new paperwork that will follow.
2. Safety Zone – This is promise that federal anti-trust agencies won’t challenge ACOs if provider participants have a combined share of 30 percent or less of each common service in an ACO participant’s primary service area. Of course, exceptions apply.
3. Primary Service Area (PSA) – the lowest number of contiguous postal zip codes from which the ACO participant draws at least 75 percent of its patients for that service.
4. Retrospective Assignment – Each ACO will retrospectively be assigned groups of 5,000 beneficiaries to prevent them from picking only the healthiest, easiest-to-manage patients.
5. Procompetitive – The Department of Justice and Federal Trace Commission are more likely to approve, and less likely to scrutinize, ACOs deemed to be “procompetitive” vs. “anticompetitive.”
6. Rule of Reason – The guidelines that will be used to ensure procompetitiveness.  Pure price-fixing is clearly out, but joint price agreements among competing health providers that are deemed “reasonably necessary to accomplish the procompetitive benefits of integration” may be okay.
7. Taxpayer Identification Number (TIN) – Each ACO will use this number to signify who would be paid shared savings.
8. Dominant Provider Limitation – This would apply “to any ACO that includes a participant with a greater than 50 percent share in its PSA of any service that no other ACO participant provides to patients in that PSA. Under these conditions, the ACO participant (a “dominant provider”) must be non-exclusive to the ACO to fall within the safety zone.
9. Mandatory Antitrust Review – Most ACOs will be subjected to mandatory federal scrutiny if its share exceeds 50 percent for any common service that two or more independent ACO participants provide to patients in the same PSA.  Of course, again, exceptions apply.
10. Group Practice Reporting Option (GPRO) – the proposed method to calculate results for the first year of the program.  Beneficiaries’ lab results and other clinical information will be reported using this tool to determine shared savings.
11. Domain – categories for the 65 quality metrics that will be the basis for determining shared savings.  There are five domains: patient or caregiver experience, care coordination, patient safety, preventive health and at-risk population/frail elderly health.
12. ACO Professional – Physicians, osteopaths, physician assistants, nurse practitioners and clinical nurse specialists, not limited to primary care.
13. Eligibility – The proposed rule says that the following groups are eligible to participate in an ACO:

• ACO professionals in group practice arrangements.
• Networks of individual practices of ACO professionals.
• Partnerships or joint venture arrangements between hospitals and ACO professionals.
• Hospitals employing ACO professionals.
• Other groups of providers determined to be appropriate by the Secretary of Health and Human Services.

Wow.  I’m definitely not ready for the quiz yet, but you can bet I’ll be figuring out how to use GPRO in a sentence soon.  Good luck.

Why Your Biggest Cardiovascular Marketing Competitor May Not Be Another Hospital

Retailers are putting the squeeze on hospitals and health systems when it comes to leading the charge in wellness, prevention and education.

Take this example:

Walgreens is launching Walk With Walgreens, a program that will sponsor 5,000 community walking events around the country.

Program participants can earn prizes from national brands like Unilever, Coke, Johnson & Johnson, Lifetime Fitness and Famous Footwear through logging their steps on a dedicated website that offers a host of digital tools.  Those who walk in live events will also get a pedometer and logbook.

The program also includes forums, videos and social-networking opportunities.  In addition, Walgreens is investing in a major media blitz with outlets like Dr. Oz, the “Today Show” and “Good Morning America.”   And, they have Biggest Loser host Ali Sweeney pounding the pavement as an ambassador.

“Walgreens’ brand purpose is to inspire wellness… we’re not just saying we stand for wellness in an ad, we’re getting out into local communities and proving it,” said Leslie Meredith of the marketing services firm that created the program.

This sounds like a good program, so why am I concerned?  I think it’s a real wake-up call for traditional cardiovascular marketers.  Wellness education and prevention have long been important ways to engage patients and prospective patients.  “Inspiring wellness” has been part of our brand purposes.   We’ve been the ones “getting out into local communities” and proving that we care about people’s health.  In fact, more than one of my clients has sponsored a walking program over the years to “prove it.”

Clearly, Walgreens and other retailers are recognizing that these strategies work in gaining share of mind (and share of wallet) with consumers.

Walgreens says five million people shop in its stores every day.  In addition to the walking program, Walgreens, both through its pharmacies and its Take Care Clinics, has been intensifying its wellness commitment in recent months, including free screenings, $35 sports checkups for kids, and a $100 million commitment to testing and preventative health care in its communities.  If these are successful, it’s a sure bet they’ll expand the screenings to include more in the area of cardiovascular health.

And Walgreens certainly has a hefty marketing budget to raise awareness of these services.   Sounds a little like it’s trying to sneak in on our territory – both from a patient relationship and revenue standpoint.

What do you think?  How are you dealing with increased retailer involvement?  Are you fighting them or partnering with them?   What about referrals?  Some of the people who receive screenings in a retail environment will certainly need referrals.  What are you doing to make sure those referrals go to your physicians?  Thoughts please.

Practice Management Issues for Cardiovascular Marketers

Marketing support is becoming an increasingly critical differentiator in physician recruiting efforts.

To that end, understanding practice management issues can be an important piece in building strong physician relationships.

Economic downturn, technology mandates and health reform continue to cause stress.  The resulting administrative costs and reimbursement challenges continue to be major areas of concern according to the results of a survey recently reported in Cardiovascular Business.

Here are some survey highlights:

• 41 percent of doctors reported their practice is doing worse this year compared to last year; 26 percent reported their practice is doing better than last year and 31 percent reported no change.
• 73 percent reported the computers in their practice are more than three years old on average and 21 percent are five to six years-old.
• 69 percent of doctors reported being satisfied to extremely satisfied with their career despite these challenges.

Doctors were also asked to report their practice’s top negative pressures and positive trends in a series of open-ended questions.

Issues relating to practice administration (31 percent), insurance and reimbursement (26 percent) and difficult patients (11 percent) were the top negative pressures on the practices.

Positive trends were led by advancements in medicine (22 percent), patient quality (19 percent) and improvement in the healthcare workforce (15 percent).

As marketers, we would never develop a consumer campaign without a thorough analysis and understanding of key insights and attitudes.  We would never craft a message without addressing consumers concerns.

Yet, so many hospitals and health systems have been using the same, tired physician recruiting and development strategies for years.  This survey is a good reminder to use the same discipline we employ with consumers in creating physician campaigns.  Health systems that understand physician challenges and provide leadership in developing tangible solutions to ease their pain will certainly come out ahead.

Helping Cardiovascular Patients Overcome Fear

Some of the same principles used to motivate corporate executives may help cardiovascular patients achieve more positive outcomes.

I recently had the pleasure of interviewing James Mapes, an authority in the psychology of “applied imagination.”  James has spent much of his career as a performance coach and consultant who helps people understand that success is dependent upon an understanding of the mind so we can bypass fear and create a lasting vision.

Recently, he was challenged to put his theories to the test in a personal situation, when he underwent unexpected open-heart surgery.  During his hospital stay, he interviewed physicians, nurses and other staff about their observations related to patient attitudes and recovery.

From his experience, James has developed an interactive learning experience for cardiovascular patients aimed at reducing fear and anxiety, managing negative stress and creating a healing consciousness for recovery.  He is currently working on a pilot program with the Aortic Institute at Yale, and he hopes to offer his presentation to other hospitals as well.

Mapes says that during the sessions, patients will discover how the application of “positive imagery” will help them successfully manage even the most difficult challenges.

“Attendees will be able to use specific techniques to improve their sense of well-being and be able to move towards their procedure with calmness, hope and an understanding of the mind-body connection.”

The program will include five lessons Mapes learned from his open-heart surgery:

1. MAKE FRIENDS WITH REALITY – If you can accept the reality of the situation, you can turn fear into positive action and control what can be controlled.
2. ADJUST YOUR ATTITUDE – Having a positive attitude affects everyone – from the patient to family and friends to the hospital staff.
3. CREATE A SOLID SUPPORT SYSTEM – Surround yourself with people who have a positive attitude and have your best interest in mind.  This includes choosing an advocate to act on your behalf.
4. ASK FOR HELP AND EXPRESS YOUR GRATITUDE – Friends and caregivers need to know you need them.  Set aside your ego and ask for help because that is what friends and caregivers provide – comfort and peace of mind.  Say “Thank you.”  Gratitude is a surprisingly powerful force for good.
5. CREATE A VISION THAT WILL CARRY YOU THROUGH THE CRISIS – Unleash the power of imagery to quiet stress and fear and create a positive expectation (hope) for the future.  Visualization is a very helpful tool that will serve you for life.

Sounds positive to me.  To learn more, go to www.jamesmapes.com

Speed-Dating for Cardiovascular Marketers

Some hospital marketers in Texas are growing business through doctor-patient “speed dating.”

At “Doc Shop” events at Texas Health Harris Methodist Hospital Hurst-Euless-Bedford, patients and physicians sit paired at tables. The physicians describe their practices and specialty areas and the patients explain their situations and discuss what they are looking for in a doctor. After five minutes, the patients rotate and begin another conversation with the next physician.

So far, they’ve done it with OB/GYNs, pediatricians and primary care physicians.  Would this work for cardiologists?  I’m not sure.

Potential patients were informed about the events through e-mail and social media.   Physicians were alerted via e-mail and administrator visits.

“Younger physicians and physicians that want to build their practice are more interested,” said Mary Lou Wilson, director of women’s services.

Kristen Vallery, MD, FACOG, is an OB/GYN on the hospital’s medical staff who decided to participate in a Doc Shop because she was the newest member of her practice and was looking to gain patients.

“The Doc Shop helps you see what may be the concerns of the patients currently seeking healthcare because there’s usually a trend,” Vallery said.

Apparently, Vallery has gained about 12 new patients as a result of the program and even more through new patients referring friends.

The effort is certainly affordable, as each Doc Shop costs only about $600, most of which is spent on lunch for physicians and patients.

Clearly, the effort seems to be working for these primary care areas, but could it work for a specialty like cardiology?

Maybe.  As positive outcomes for cardiology patients continue to rise, cardiologists are increasingly becoming long-term health advisors.

Patients who have an initial incident that require an emergency procedure and/or hospitalization are becoming more savvy when it comes to choosing a physician to manage their follow-up care.

Dr. Vallery of Texas says the program’s value goes beyond attaining patients.

“The cool thing is you know when the people come to you they’ve already prescreened you, so the barriers are down to begin with,” Vallery says. “You’re able to get a lot done when they come in. It streamlines things more than it would normally be.”

Are You Including This New Specialty in Your Cardiovascular Marketing Efforts?

Promoting CardiOncology, expertise in treating cancer patients with cardiac problems, could be a solid differentiation strategy for your hospital or health system.

A lack of evidence-based treatment guidelines has historically meant cancer patients who also have heart issues might not be treated as aggressively as they could.

The International CardiOncology Society started in January 2009 to close the knowledge and treatment gaps in this patient population.

Because cancer patients are living longer and are increasingly presenting with cardiac diseases, Daniel J. Lenihana, MD, Vanderbilt University in Nashville, Tenn., with colleagues from the University of Milan in Italy, wrote in the September/October issue of Progress in Cardiovascular Diseases:

“An emphasis on ‘personalized’ therapy will continue to make collaboration between cardiologists and oncologists important.”

Some examples include:

• Oncologists want to stymie vascular endothelial growth factor (VEGF) in cancer patients to limit tumor growth. Yet, VEGF can have beneficial effects for ischemic myocardium.
• Stem cell therapy is another overlapping area of intense research.
• Cardiologists have added to the understanding of cardiac toxicity associated with anti-cancer drugs that have helped refine breast cancer treatment.
• Input from cardiologists has also helped manage cardiac problems associated with anthracyclines.

“There is burgeoning evidence that cardiovascular risk factors may have a substantial impact on the cardiac toxicity of cancer chemotherapeutic agents and the preventive treatment of cardiovascular-related comorbid conditions can have a significant benefit on all-cause mortality and cardiac-related outcomes.”

The International CardiOncology Society has multiple goals, including eliminating cardiac disease as a barrier to cancer therapy and preventing the development of heart failure.

The group also hopes to establish a database and to develop web-based educational tools, as well as disseminating multidisciplinary guidelines.

“All this represents a big challenge and stimulating incentive for both the cardiologist and the oncologist,” Lenihana and colleagues concluded.

I think it represents an interesting opportunity for marketers too.

Cardiovascular Marketing Question: How Soon is Too Soon?

Getting patients “back-to-normal” faster seems to be a trendy marketing message these days.

A competitor in one of my client’s markets has seemingly blasted this message on every airwave, outdoor board and print ad available.

At first blush, it seems like a great strategy.  After all, isn’t that what we’re all trying to do?  Help people regain the ability to live “normal” lives again?

If I’m a provider with data to back up that claim, why wouldn’t I want to capitalize on it?

Maybe because “faster” isn’t always really better in the long term.

A recent news report says that two weeks after having a mild heart attack following an overtime victory, Michigan State Coach Mark Dantonio coached the Spartans’ game against Wisconsin from the hospital.

“Coach D was with me the entire game,” the defensive coordinator Pat Narduzzi said. “I won’t show you any of the texts, but he was texting and calling the entire game. I’ve never been on the phone so much during a game, so he was with us the entire game.”

Seriously, Narduzzi was asked, Dantonio was calling plays?

“Good God, yes!” said Narduzzi

Really?  Those of you who know me personally understand that I am a huge sports fan.  I get that the duties of a head coach are incredibly serious. However, I have to say that I was taken aback by this report.

Shouldn’t this coach be resting?  The guy had a heart attack while coaching a game.  Now he’s doing the same high-stress activity while he’s still in the hospital?

Clearly, I do not have a detailed understanding of Coach Dantonio’s case, and I am not medically qualified to judge his actions.

However, I do think I’m qualified to question the wisdom of certain messaging strategies.   And Coach Dantonio’s story definitely makes me cringe a little at focusing a strategy on getting people back to normal faster.

By the way, Michigan State won the game 34-24, in case you’re wondering.

Empowering Patients Through Cardiovascular Marketing

Highlighting your practices for patient empowerment could become a meaningful point of differentiation.

Patient empowerment has been on my mind a lot lately.  For the past several months, I’ve watched a close colleague struggle with her husband’s health challenges.  Following a series of surgeries, set backs, readmissions to the hospital and some fairly shaky home health routines, I’ve watched her anxiety and exhaustion grow.  Trying to coordinate his care among a team of multiple specialists, nurse practitioners and others nearly became a full-time job. So many times, she has wished that someone could just evaluate the whole picture and guide her to make the right decisions.

As uncertainty about healthcare reform continues to create angst among patients, providers and payers alike, the concept of patient empowerment is likely to be a big part of the discussion.

A new book by longtime medical correspondent for CNN, Elizabeth Cohen, “The Empowered Patient” tackles these issues.

“The Dr. Marcus Welby days are over, and you really have to advocate for yourself. This system doesn’t work perfectly. Sometimes it doesn’t even work very well. You have to step in sometimes and make things right,” says Cohen.

I doubt that any of us would argue that the “Dr. Marcus Welby days are over.”  However, I’m equally certain that this quote would make most of my clients cringe just a little.

As health care professionals, I know that we don’t want our patients to have to go to undue lengths to advocate for themselves and their loved ones.

In her book, Cohen advises patients to “find people to go to when things aren’t working out. You just have to know how to do it and how to think through your options.”

In fact, patient satisfaction is so important to many of us that we’re establishing procedures and protocols to address these concerns – to help patients easily find these “people” to go to when things aren’t going as planned.

Several of my clients have nurse navigators or family advocates that go beyond the traditional hospital ombudsman.  We’ve also touted the concept of “longitudinal care,” meaning that patients see the same physician and/or nurse practitioner throughout the duration of their lives.  These programs work, and in some cases are relevant differentiators from a marketing point of view.

To me, few service lines are in greater need than CV when it comes to needing programs that empower patients.  Who has examples that are working?