The rural healthcare system has changed dramatically over the
past decade due to the implementation of the Affordable Care Act.
However, overall resources still remain relatively inadequate. Many
rural hospitals continue to experience shortages of physicians,
reimbursements, financial strains and new information technology
requirements. In fact, nearly 50 rural hospitals have closed their
doors since 2010. But is it all doom and gloom? Not if we stay
ahead of these three trends:
TREND 1: Telemedicine, EMR and digital
We have to embrace technology. We can no longer deny it,
especially since telemedicine - the use of telecommunications
technologies to support long distance healthcare - has become more
common and isn't going away. It helps tackle the problem of
physician shortages by connecting patients and providers over long
distances, as well as increasing your patients' access to specialty
Telemedicine is also a great use for extended therapy; patients
can do sessions from their home, using video game consoles and
telecommunications with therapists, hopefully saving more money
than they would if they went into clinics.
Electronic medical records were mandated by a 2009 federal law,
but many rural hospitals have still not gotten on board. Electronic
medical and health records are not only easier to organize and
understand, but they also allow different doctors' offices and
clinics to collaborate on patients' care and better understand
their patients' medical histories, especially those with chronic
illness. Not to mention, this kind of technology helps rural
hospitals attract more physicians.
A third digital trend is the digital health clinic, which
increases access to care while reducing costs. This allows patients
in rural areas who don't have access to specialists, or those who
can't leave their home, to get the treatment or advice they
TREND 2: Prevention, education and outcomes
Generally speaking, rural hospitals care for an older, sicker,
less educated, less-affluent and more overweight population. That
can pose many challenges when it comes to the shift of
reimbursements from fee-for-service toward pay-per-performance.
As healthcare becomes increasingly outcome-based, evidence and
definitions for high-quality outcomes will be in high demand. We'll
also see pressure to deliver better outcomes at lower cost. Rural
healthcare providers must acknowledge and confront this challenge
by emphasizing prevention.
TREND 3: Mergers, acquisitions and
We're seeing this across the board in Wisconsin. And the
strategy for many of the mergers and partnerships is to negotiate
now, from a position of strength, rather than waiting for market
pressures to force a move. In order for rural hospitals to survive
in the changing climate, we must focus on the development of
innovative delivery models that promote integrated, quality
healthcare within budgetary constraints. Resource sharing,
integration, and joint venture arrangements with regional partners
can yield benefits without surrendering independence.
What can you do today to stay on top of the
1. Keep track of market share to determine how many patients are
leaving town for care.
2. Use surveys and/or focus groups to understand your weaknesses
so you can improve your community perception.
3. Develop messaging strategies based on your strengths.
Want to discuss
any of these trends in more detail? Send me an email or give
me a call at 920-544-8102.
Under the Affordable Care Act (ACA), primary care has taken
center stage - and for good reason. Reorienting hospitals and
clinics toward primary care is a fundamental step in making
healthcare more accessible and affordable. It can decrease ER
visits, reduce hospitalizations and even lower mortality rates.
But as the number of PCPs continues to shrink, the demand for
primary care continues to rise. That begs the multi-million dollar
question: How can rural hospitals keep pace?
The answer is far from simple. In fact, there is no "one"
answer. All hospitals, especially rural hospitals fighting to
compete with bigger healthcare systems, will need to take multiple
steps to help offset the increased demand for primary care
services. That brings us back to the question of, "How?"
I'll sum it up in one brief but critical statement: By turning
their focus on prevention, patient education, diagnosing and
managing chronic diseases, as well as alternative approaches to
delivering care. Here are some examples:
- Offer virtual learning opportunities and build out your website
to include risk evaluation surveys and general health information
- Implement web-based screening and treatment reminders.
- Create and promote programs that teach self-screening.
- Develop a medical home program that coordinates patient care
across all settings. Primary care physicians could manage a team of
non-physician practitioners; an advanced-practice nurse could
conduct follow-up visits with patients with chronic diseases, like
- Create a health action team that includes leaders from all
sectors of the community to discuss local health issues.
ThedaCare's Community Health Action Team (CHAT) is a good
- Consider the role of transitional care nurses (TCNs). A TCN is
generally an advanced practice nurse with a master's degree in
nursing. After a patient is released from the hospital, the TCN:
- Conducts weekly home visits for a certain period of time and is
available to the patient seven days a week via phone.
- Accompanies the patient to the first post-discharge physician
- Helps patients and caregivers successfully manage the patient's
care at home.
- One evidence summary shows a 30-50% reduction in
rehospitalizations, and net savings in healthcare expenditures of
approximately $4,000 per patient, within 5-12 months after patient
It's not a matter of "if" these and other steps need to be taken
by CAHs. It's a matter of "when." And that answer can
be summed up in one word: "Now."
The Affordable Care Act (ACA) has opened the floodgates to
changes in the insurance industry. You already know about the
Health Insurance Marketplace and other insurance exchanges. But
have you heard about fast-growing startups like Zenefits?
Long story short, companies like Zenefits are tapping into the
post-ACA insurance market. They're giving small to mid-size
businesses and their employees new options to buy insurance online.
No news there - but …
Now that consumers can easily compare coverage and costs, many
are choosing plans with higher deductibles and out-of-pocket
expenses. That means "value" is a hot button. But you know as well
as I do that "apples to apples" comparisons rarely exist in the
complex world of specialty services and surgeries.
Changes in the insurance industry also pose another challenge
for hospitals. Many newly insured will have limited knowledge about
their coverage or how the healthcare system works.
So what's a CAH to do? Change the way you communicate.
- As more and more consumers begin to shop for "value," it's
critical to provide them with information about quality of care as
well as price.
- Different patients need different types of pricing information
based on their insurance coverage. For example, consumers with
covered hospital services may be concerned about out-of-pocket
expenses and may want to compare your hospital with another. Make
it easy for them to get the information they need. If you don't,
they'll simply move on to the next choice.
- Consider creating videos to address frequently asked questions
that consumers and patients can view from home or even on a tablet
in your waiting room. You may have featured physicians in previous
videos. This time, focus on FAQs that are answered by your billing
expert and front-office staff on a daily basis. For example,
feature a brief tutorial on basic insurance terminology.
- Partner for prevention. You may already attend local health
fairs to talk about nutrition or to give free blood pressure
screenings. Consider inviting professionals from different health
plans to join you and answer questions. Another option is to bring
health plan representatives to your hospital for Q&A
- Take another look at how you're advertising. As more
patients gain coverage, hospitals can benefit from advertising to
the newly insured with targeted messages.
Healthgrades. Facebook. Angie's List. Twitter. These are only a
handful of online sites where prospective patients can learn about
your healthcare organization and current patients can share their
experiences. The power these sites have on consumer decisions can
be intimidating, but also incredibly beneficial to your
So needless to say, it's important to not only be aware of these
places, but to also take an active part in the conversations -
which can be done through strategic digital marketing efforts.
When approaching marketing in the digital world, there are two
areas to think about:
"Building" covers the development of online elements you can
control, like your website and online advertising. These tools
ensure your audiences have access to accurate information about
your facility and providers. They also help audiences form their
first impression of your organization.
"Protecting" is managing online features you are not in complete
control of, such as review sites or comments on social media. We
call this online reputation management, and it involves:
- Monitoring review sites and social media
- Engaging with your online audiences to address negative and
- Being honest and transparent in communications
But you shouldn't think of "building" and "protecting" as two
separate efforts. They go hand-in-hand when it comes to ensuring
your organization is well represented online.
If you are interested
in learning more about healthcare marketing in a digital world,
attend our webinar this Thursday, January 15 at noon
(CST). We will take a deeper look at several strategies to
build your organization online, including modern web design and
SEM, as well as effective ways to protect your online
Click here to register
Health exchanges are here - and so are millions of newly insured
patients. That means your CAH has a decision to make. Do you "duck
and cover" or come out fighting to gain some much-needed ground
from your competition? If you choose to leverage this opportunity,
be prepared. These aren't your "typical" patients.
The truth is, many newly insured patients will have plans that
pay lower rates to your hospital. But there's a flip side to this
downside. These patients' plans are required to cover a broader
range of services. Services your CAH can provide to grow revenue
from consumers who have never walked through your hospital's doors
Here are some ways to optimize this opportunity:
- Promote prevention, wellness and diagnostics
as volumes will shift in this direction. This goes beyond the
"norm," like colonoscopies and mammograms, to include diet
counseling and other wellness services. Another thought: Could your
CAH benefit from extending your marketing strategy to include
- Define your hospital's role in
outreach and develop and promote programs that will
educate the newly insured. With limited knowledge of the healthcare
system, these new patients are more likely to use ER services. Work
with your marketing department to develop programs and materials to
educate new patients on the best way to manage their health - and
- Address patient access issues. With more
complex billing, eligibility and collections processes, it's
critical to confirm eligibility and review obligations with the
patient upfront. This may include incorporating new tools to verify
coverage and screen for Medicaid eligibility and exchange
- Train "financial counselors," "care navigators" or
"insurance assisters." Whatever title you choose, you'll
need knowledgeable staff to help individuals fill out paperwork and
determine eligibility for coverage and subsidies.
- Don't lose sight of patients with employer-sponsored
plans. As you address the needs of the newly insured,
don't overlook the fact that employer-sponsored plans are shifting
more responsibility to the patient. You'll need to adjust your
marketing strategy to address the needs and demands of these
consumers as well.
How to Talk to Physicians to Build Relationships
You say, "provider;" I say, "physician."
While it may seem like a matter of semantics, healthcare
marketers need to choose their words wisely - especially when
talking to physicians. One internist summed it up this way: "Today,
doctors are called providers. I didn't go to provider school."
But choosing a complementary common noun is just the beginning.
Today, many hospitals - caught up in service model mayhem -
overlook one critical fact: Doctors are faced with similar
challenges and they're concerned about the future. In fact, six in 10 say that the practice of medicine is
While it may sound disheartening, rural hospitals can turn this
concern into an opportunity to strengthen physician relationships
and increase referrals. But just as the healthcare landscape is
changing, so too, are the mindsets of physicians. That means the
way healthcare marketers talk to them also needs to change. For
- Show empathy (but be careful not to patronize). Assure
physicians that your hospital understands the additional pressures
they face today, and maintain direct dialogue as new payment models
and integrated care methods are developed.
- Profile physicians so you can personalize and specifically
target your message to them.
- Free online tools like SurveyMonkey can help identify
physicians' interests, challenges and concerns.
- Consider investing in research and/or a medical staff
satisfaction survey to help clarify physicians' opinions about a
variety of issues relating to their practice and their relationship
with your hospital.
- Develop key messages around physicians' wants and needs as well
as how your hospital is addressing those issues to benefit them and
their patients. You may find your messaging may relate to some of
these areas that physicians feel strongly about:
- Developing patient relationships.
- Protecting and promoting the health of individuals.
- Interacting with colleagues.
- Match your values to physicians' values. What's important to
your CAH is most likely important to doctors as well.
- Speak in a language physicians understand. Most physicians are
logical thinkers, so getting them to act often comes down to
evidence-based conclusions. Stick with the facts; they'll help draw
physicians to the conclusion you want them to reach.
- Establish each doctor's preferred communication method and use
The 2013 Deloitte Survey of U.S. Physicians found
that nearly two-thirds of physicians believe doctors and hospitals
will become more integrated in the next one to three years. That
can be a golden opportunity for your rural hospital - if you know
how to talk to physicians to build trust and relationships.
Watch for my upcoming blog on how to talk to patients in a new
era of healthcare.
The building blocks of a bridge to your community
What are the key elements in making a solid bridge? Support
beams to hold it up. A solid surface for crossing. And guard rails
for safety. Only together will these items create a connection that
is strong and safe.
The same principle applies when your critical access hospital is
building its connection with your community. In this case:
- The support beams are your employees
- The solid surface is community residents
- The guard rails are local business leaders
These are the three key audiences you have to build
relationships with to ensure a strong and stable connection to your
community. And the strength of these relationships will
significantly impact the trust, confidence, loyalty and support
patients and prospective patients have for your facility.
So how do you begin building? Start with the support beams -
Employee engagement and satisfaction is how your CAH creates
strong support for your bridge to the community. When physicians,
nurses, therapists and other employees who directly interact with
patients are happy and positive, they will provide better service,
which ultimately results in a better overall patient
Here are two ways to help keep your employees informed and
- Employee forums - regular meetings between
senior leadership, providers and administrative staff keep everyone
up-to-date on important hospital information such as overall
performance or changes in policies or operations.
- Employee involvement in marketing - ask
managers or nurses to help you select patient testimonials when
marketing specific service departments. Then, feature providers
from that department in the advertising (when appropriate) as
opposed to using stock images.
Learn how to successfully construct the other
elements of your bridge by attending our upcoming webinar,
Connecting Your CAH to Your Community, on November 5 at 12
pm. Click here to register
How to talk to your C-suite executives
Have you ever had a deer-in-the-headlights experience when
you've presented an executive summary? You meet with the CEO and
other C-suite members. You've got a rock-solid marketing campaign
to help meet your hospital's business goals. But when you start
presenting - BLANK STARES - all around the room.
What just happened?
You led with your right; not your left - brain that is. We in
the marketing profession need to remind ourselves that CEOs and
others in the C-suite line are in the problem-solving business. If
we want to capture their attention, we need to provide hard-hitting
solutions to their healthcare concerns, and we need to know how to
First, what are the concerns of hospital CEOs these
days? According to the American College of Healthcare Executives,
these issues are at the top of CEOs' lists:
- Financial challenges
- Healthcare reform implementation
- Governmental mandates
- Patient safety and quality
- Care for the uninsured
- Patient satisfaction
- Physician-hospital relations
- Population health management
- Personnel shortages
- Creating an accountable care orgnaization
If you can effectively address one or more of these concerns in
your marketing plan and executive summary, you can turn that
dreaded deer-in-the-headlight stare into "The Buck Stops Here"
buy-in from the top.
How to talk to your CEO
Once you get in front of your CEO, CFO and the like, it's time
to set creativity and colorful dialogue aside. Cut to the chase
with succinct, black-and-white C-suite speak. In other words, don't
get bogged down in details. Think "big picture" first. Provide a
brief summary - sans marketing lingo or clever campaigns. Stick to
what CEOs and other executives need to know by highlighting these
- Objective: What are we trying to accomplish?
What behavior are we seeking to change? How does this initiative
support your rural hospital's strategic plan?
- Messaging strategy: What is our message? This
doesn't mean you need to provide the exact copy. Just clearly
explain what your approach will be.
- Timing: Share when the campaign will be
launched. Again, forego the details. Stick to the key dates of when
you'll hit your target audience(s).
- Results and measurement: Let your CEO know how
all of this will benefit the hospital and how you'll report on
Watch for additional posts in my "How to Talk to …" series for
insights on how to more effectively communicate with your rural
hospital's other key audiences. If you have any specific questions,
I'd be happy to talk with you.
If you got lost in the woods, ran out of food or got
confronted by a bear, do you know how you'd react?
These unexpected challenges of hiking and camping - and the
reactions they produce - can be very similar to the obstacles
critical access hospitals (CAH) and other small or rural health
organizations are facing. But instead of getting lost in the woods,
your organization may be struggling with how to balance quality,
transparency and affordability. Instead of running out of food, you
may be running out of budget dollars. And you probably aren't
facing a bear, but one or more larger competitors.
To overcome all these difficulties, all you have to do is follow
five steps that I like to call "Survival of the Smartest." These
steps help you take a comprehensive deep-dive into both the
business and marketing perspectives of independence and
Step 1: Size up the situation
Understand what you're up against by determining your strengths,
weaknesses, opportunities and threats.
Step 2: Have a positive attitude
Don't let the challenges or misperceptions leave you hopeless.
Actively decide that you are willing to take the steps necessary to
survive and gather the support of employees and the community.
Step 3: Navigate negotiations
Sometimes being 100 percent independent isn't possible, but be
sure to stand your ground when establishing beneficial partnerships
for a modified independence.
Step 4: Chart your course
Create a business development and marketing plan that will guide
you in increasing awareness, market share and patient volumes.
Step 5: Make yourself visible
Develop a strong brand and position, and then market your
strengths in your target service areas.
Interested in learning more? If you are attending the National Rural
Health Association (NRHA) CAH Conference on October 1-3 in
Kansas City, you can attend the speaking session, "Survival of the
Smartest: How to Retain Independence" on October 2 at 2 p.m. Lisa
Schnedler, CEO of Upland Hills Health (UHH), and I will present a
case study of how UHH used these five steps to create unique
partnerships and gain market share to become a
financially-independent and award-winning healthcare
If you are not able to attend, send me an
email to receive a copy of the presentation.
last post discussed some of the "clinical" aspects of
telemedicine and the benefits rural hospitals can expect from a
well-implemented program. But there is one caveat to those
statements of success.
Most consumers won't fully understand the value of telemedicine
unless you effectively deliver your message - and continue to
reinforce it. Successful telemedicine programs do this well. On the
other hand, hospitals that take an "If we build it, they will come"
approach realize a minimal return on investment, at best. Others
Just like the services your on-site providers offer,
telemedicine is a marketable service line. Do it right, and your
hospital will not only increase awareness and utilization of your
telemedicine program, it will improve your reputation as a leader
and provider of innovative, high-quality, comprehensive
Here are some - and I emphasize "some" - major marketing to-dos
that you'll want to check off your list as you implement your
telemedicine program. I'll go into more detail during my upcoming webinar.
- Conduct a market analysis to ensure your
program has a sustainable service model. It will help you define
your program and identify and describe your key customers,
competitors and potential partners.
- Create a climate for success. Even though
telemedicine services have been available for some time, the
concept will be new to many of your patients, clinicians,
administrators and others. An effective marketing and promotional
program can help ensure your telemedicine program is highly
accepted by major stakeholders and the community.
- Identify specific marketing objectives. Be
sure to link them to your overall program goals.
- Create a messaging platform. Determine how
you'll differentiate yourself; create a unique selling
- Develop your marketing strategy. Using
identified customer groups, value to these groups, concerns and
barriers, you can determine the best strategies and mediums to
target each audience (e.g., patients/consumers, staff,
- Develop promotional materials. Once you have
clearly defined your program, customers and external environment,
you can begin to develop the materials and activities to promote,
communicate and educate your target audiences.
- Monitor results. No marketing strategy should
be set in stone. Monitor results and be prepared to adjust your
As I mentioned, I'll be taking a deeper dive into the marketing
aspect of a successful telemedicine program during our upcoming
webinar, "Building and Marketing a Telemedicine Program,"
on Tuesday, September 9 from 12 - 1 p.m. (CDT). Donna Jennings,
vice president of Valis - a telemedicine consulting and solutions
firm - will join me and lead a discussion on the clinical and
financial side of telemedicine.