Trending in Rural Healthcare: Three Ways to Stay Competitive

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 clinics

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 care.

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 need.

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 collaborations

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 trends?

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.

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How to Meet the Demand for Primary Care

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 sources.
  • 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 diabetes.
  • 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 example.
  • 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 visit.
    • 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 discharge.

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."

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Insurance Industry Changes are Changing the Way Hospitals Communicate

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 sessions.
  • 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.

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Harnessing the Marketing Power of the Digital World

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 organization.

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:

  1. Building
  2. Protecting

"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 positive discussions
  • 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 reputation.

Click here to register today!



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Newly Insured Patients...Ready or Not, Here They Come

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 before.

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 referring physicians?
  • 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 receive care.
  • 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 subsidies.
  • 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.

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What's Up with Doc?

How to Talk to Physicians to Build Relationships

You say, "provider;" I say, "physician."  Potato/Po-tah-toe, right?

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 in jeopardy.

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 example:

  • 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 it consistently.

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.

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Connecting Your CAH to the Community

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 - your employees.

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 experience.

Here are two ways to help keep your employees informed and included:

  • 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 today!


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Marketers: Hit Your Hospital's 'Suite' Spot

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 speak "C-suite."

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:

  1. Financial challenges
  2. Healthcare reform implementation
  3. Governmental mandates
  4. Patient safety and quality
  5. Care for the uninsured
  6. Patient satisfaction
  7. Physician-hospital relations
  8. Population health management
  9. Technology
  10. Personnel shortages
  11. 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 four areas:

  • 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 results.

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.

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Five Steps for Survival: How to Prepare for Continued Independence

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 success.

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 organization.

If you are not able to attend, send me an email to receive a copy of the presentation.


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CAHs: Telemedicine Promotion=Profit Part 2

My 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 simply fail.

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 healthcare.

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 proposition.
  • 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, clinicians).
  • 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 efforts.

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.

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