Health Care Marketing Matters, Fall 1998

Who's doing what on the web

Barbara Bix


Health care organizations are turning to the Internet, especially the world wide web, to market their goods and services. While the movement to digital communication is clearly in progress, the objectives behind this new involvement can be more obscure. Some organizations seek greater "awareness"; some want deeper customer relationships; still others hope to deliver services directly on-line.

Whatever the goals, the questions remain the same: What do we hope to accomplish on the web? How will we know if we have succeeded?

Our study

Last summer, Health Care Marketing Plus conducted in-depth interviews with 14 health care professionals in Bosto—an area that leads the country in both the health care and high-technology industries.

Our goal: to get a snapshot of how Boston-based health care organizations are using the Internet to support strategic marketing objectives.

Using an interview guide with over 30 questions, we engaged in conversations 15 - 45 minutes long with people representing: 3 community hospitals; 2 specialty hospitals; 3 tertiary hospitals; 2 health plans; and 4 health care-related companies who are using the Internet to conduct one or more aspects of their core business. We gave all respondents the opportunity to review and correct the interview notes prior to publication.

Hit The Highway: Why the Internet Will Matter

According to our research, health care professionals develop web sites for the following reasons:

• To expand their market presence (with, for example, international prospects).
• To tailor information to the consumer's needs.
• To engage in two-way communication with target audiences.
• To find a cost-effective way of distributing current information to users.

But for health care marketers, there is one overwhelming reason why the Internet is important: because our consumers tell us so. Consider these important observations:

"Doctor, According to This Study I Found on the Web Last Night . . ."

Consumers are already turning to the web to find information and take greater control over their own health. As the web continues to grow, and more people gain home access to the Internet, this trend is likely to continue.

Consumers Are Voting with Their Wallets

Consumers are not tied to getting care through the traditional channels we've devised for them. They're interested in other options-- and they're spending the money to prove it.

According to Dr. David Eisenberg's ground-breaking article in the January 28, 1993 issue of The New England Journal of Medicine, "Unconventional Medicine in the United States," in 1990 more Americans visited providers of unconventional medicine (homeopathy, acupuncture, herbal medicine, etc.) -- an estimated 425 million visits -- than visited their primary care physicians (388 million visits). They spent approximately $13.6 billion to do so, 75% of which ($10.3 billion) came out of their own pockets.

As consumers seek alternatives, we run the risk of losing new opportunities. More important, we may lose existing revenue streams as consumers seek therapies through alternative distribution channels -- such as the Internet.

Man the Lifeboats: Women and Elderly First

The population segments in which Internet use is most rapidly mirrors the population that health care marketers most want to target: women and seniors. Women are an important target, not just because of maternity and mid-life health needs, but because they are often responsible for making the purchasing decisions for the entire family. Medicare Risk products, for instance, are just one of the competitive health care products aggressively marketed to an increasingly growing elderly population.

Information is the Antibiotic of the 21st Century

As John Lester, Information Systems Director for the Department of Neurology at Massachusetts General Hospital, points out, chronic disease is a game of care, not cure. For years, the chronically ill have found treatment and support by exchanging information with their peers—an exchange in which the Internet, unrestricted by time and space, excels.

The combined impact of the above factors makes the Internet a logical intersection for consumers and providers in the contemporary marketplace. So how are we responding?

What We Found

Most of the respondents that we interviewed had launched web sites, or sites with deliberate marketing objectives, only within the last year. As a result, most of the respondents noted that they are in the early learning stages.

While many of the respondents acknowledged having had a web presence for some time, these earlier efforts tended to represent individuals or individual departments. Their current web sites, on the other hand, mark the first time that the marketing department has made an investment representing the entire organization.

Even though just about everyone we interviewed has launched, or is thinking about launching, a web site, most respondents are not making major investments relative to other marketing programs. The notable exceptions are companies who market Internet-related products. As expected, none of the community hospitals in our sample, who generally operate under tighter budgets, have invested funds in web-site development.

When asked to evaluate the success of their sites, participants responded with answers that reveal intriguing paradoxes:

• About half of those who had a site described that site as "successful," yet many respondents said that they have not yet implemented ways to measure success.

As one respondent noted, we don't currently know how to measure ROI -- and without knowing what you and others have invested, it's difficult to measure the relative success of various approaches. This is reminiscent of the HEDIS war song: "If you can't measure it, you can't manage it."

• Over half the respondents said they had received positive responses to their Internet efforts, including email feedback, requests for more information, participation in on-line services and registration for appointments. While most said they were satisfied that the web site had worked, they were uncertain about the implications for the future: As responses grew, how would marketing keep pace in a timely fashion? What level of resources would it take to realize the full potential of the Internet? ·
• Almost two thirds of the respondents cited increases in leads, call volume, referrals, orders or requests for information -- yet most did not appear to have a mechanism for distinguishing web-related responses from responses they would have received from other channels anyway. Is the web adding to, or merely replacing, consumer responses from other sources?
• In some cases, there was only a weak correlation between what respondents indicated as the purpose of the web site and what they wanted visitors to do once they got there. Half of the hospital respondents who said that they created their web sites to "raise awareness" later said that they wanted customers to use the web to schedule appointments.
• Although two thirds of the respondents cited increases in call volume and requests for information as measures of success, only one said that the volume was so high that it was difficult to respond on a timely basis.

Despite the Internet's potential, most of the respondents said that they didn't expect their web presence to give them a competitive advantage. Rather, they said that they were there because they had to be there to remain competitive.

Summing Up

The study indicates that:

• Boston-area health care companies are relatively new to the Internet marketing game.
• For the most part, they are putting a toe in the water before diving in with large-scale investments.
• They are not yet really sure how to gain maximum benefit from this valuable tool.

Jared Spool, founder of User Interface Engineering, a leading research firm on web-site usability, says that the results of the study mirror trends that he has seen in other industries.

"We've seen three stages of evolution. First, people don't do anything with the Internet because they don't know what to do. Then, they make limited investments to try and figure out what works.

"In the third stage, someone (often an 'outsider' with a different way of conceptualizing the sales and distribution cycle) comes in with a new model of doing business and grabs market share from conventional competitors. Take, for example, the way Amazon.com flipped retail book sales on its head by selling books on-line. Or how Travelocity, a site that sells airline tickets on-line diverted sales from travel agencies.

"In this last stage, everyone else tries to catch up. Unfortunately, they have a tough time because the innovative company continues to advance along the learning curve and stays ahead."

Is health care ripe for an Amazon.com? Can we anticipate the intrusion of a web-based business that has the potential to disrupt the current channels of health care distribution -- and steal significant market share in the process?

Acknowledgements We'd like to thank the following organizations for contributing to our article. Please return the favor and visit their web sites.

Beth Israel Deaconess Medical Center www.bidmc.harvard.edu

Brigham and Women's Hospital www.bwh.partners.org

Dana-Farber/Partners Cancer Care Institute www.dfci.harvard.edu

InStream Corporation www.instream.com

Massachusetts General Hospital (Neurology Department) www.mgh.harvard.edu

The Massachusetts Health Data Consortium, Inc. www.mahealthdata.org

Spaulding Rehabilitation Hospital www.spauldingrehab.org

W3Health Corporation www.w3health.com