Health Care Marketing Matters, Winter 1999

Make it easy to use

Barbara Bix

Talk to any health care administrator about clinical initiatives--practice guidelines, disease management, alternative medicine--and you're likely to hear familiar complaints about physician resistance. Yet in a recent survey of 103 Massachusetts primary care physicians, Dr. Dennis Ross-Degnan and colleagues from Harvard Medical School and Harvard Pilgrim Health Care found that their probe of clinical practice guidelines (CPGs) attracted far more positive comments than negative ones.

Ross-Degnan launched his study to understand why CPGs, implemented with such high expectations, had so often failed to improve clinical practices. In addition to the usual suspects—physician reliance on their own clinical experience, fear of lawsuits, distrust of the CPGs' clinical depth amd quality, reluctance to embrace guidelines to which they themselves hadn't contributed—Ross-Degnan had expected to find that conflict between competing guidelines from different organizations might be part of the problem.

But most of these assumptions—many of them shared by the administrators who implement CPGs—proved to be dead wrong. In fact, over 50% of the responding physicians said that CPGs provide useful day-to-day algorithms and are effective tools and teaching reminders. Yet, despite their positive feelings about CPGs, Ross-Degnan discovered that most physicians don't use the guidelines that he studied; and thus never notice that competing guidelines often conflict.

The study showed that CPGs fail not because of physician resistance, but because doctors cannot use the CPGs as they are presented to them. The failures fall into three major categories:

Access
Physicians told Ross-Degnan that guidelines need to be brief, organized and accessible; they cannot be expected to dig through a mountain of paper to retrieve appropriate CPGs. Some doctors recommended laminations or wall charts. One suggested using the Internet.

Credibility
Physicians need to trust the information handed to them, and look for source citations to establish credibility. In general, they preferred guidelines from professional associations to those issued by MCOs. They trusted the associations to place greater emphasis on clinical judgment than cost considerations.

Packaging/Presentation
Perhaps most important, a full 65% favored CPGs that weren't text-heavy with dense paragraphs. Physicians asked for bullets, outlines, and flow-sheet summaries. As one doctor noted, "Graphs are better than paragraphs."

In sum, CPG programs were not as successful as they might have been because administrators had not provided what physicians needed: guidelines that respect their time, intelligence, and communication requirements. Had the administrators conducted up-front market research with their physician targets, they would have learned what Ross-Degnan learned—and would have had a better chance of achieving greater physician acceptance.

Going Direct, Getting Past the Gatekeepers
One of our clients, a company that depends on physicians reading and using the educational materials they publish, found that only 20% of their target audience was consistently ordering these materials.

The marketing department attributed low order rates to lack of awareness—especially since surveys showed that users liked the products. The decision-makers were open to using direct mail to gain visibility, but their first attempt at a renewal self-mailer failed to attract responses.

After considerable review, they revamped their direct mail campaign, top to bottom, with a special focus on getting past the gatekeepers—often secretaries or administrators--who are expressly charged to throw out "junk mail." Here's what they did:

• First they reached their audience by working with current addresses. While all mailing lists are prone to decay, physician lists are especially troublesome because doctors change addresses so frequently. The company minimized list problems by mailing to physicians at the time they updated their addresses. These fresh addresses lowered the number of "nixies" or returned mail.
• They sent "dimensional" mailings, distinctive packages that did not look like junk mail and were, therefore, more likely to get past gatekeepers. · They hired a graphic artist and copywriter with health care experience who were able to create messages specifically designed to appeal to physicians.
• They offered multiple ordering methods and multiple means for receiving the educational material; the doctors could "have it their way."
• They overcame hesitancy by including product samples with the offers.

Result: After months of flat response, orders increased by 20%. By overcoming the underlying communications obstacles, the company connected to more physicians.

Giving Them Information That Hits Home
All health plans encourage physicians to improve quality and reduce costs; many have Web sites to communicate to physicians and other constituents. But few have leveraged the Web—or other media—to stimulate physician action. Health Partners is one plan that has found a way.

Try this test: Visit the Web site of just about any plan to get information that will help you select a physician. Then click on http://www.healthpartners.com to see something distinctive.

Most health plans simply publish general advice on selecting a physician or provide a directory with contact information. Health Partners goes much further, allowing members to select providers by location, price, specialty, hours, and services.

Better still, Health Partners actually encourages individual members to use their own selection criteria to compare physicians' performance. Choices include everything from "amount of time the doctor spends with you" to specific clinical measures such as the "percentage of women between the ages of 21 and 64 who were continuously enrolled for the last three years and who had a Pap test during that period."

Then, drawing on recent patient satisfaction surveys, Health Partners presents side-by-side, apples-to-apples comparisons of providers' performance in easy to understand tables and graphs. After examining an introductory table, that assigns one to three stars based on level of satisfaction (one being lowest, three best), visitors can drill into the data with subsequent mouse-clicks to review response rates to specific service and satisfaction issues.

Consequently, consumers and physicians can instantly see how provider groups rate in their patients' eyes. Mary Brainerd, Executive Vice President of Care Delivery at Health Partners, says, "Although we designed our web site for members, physicians are among the greatest users. Our physicians want to demonstrate excellence, not just avoid outlier status. We find that physicians use the patient satisfaction data to evaluate how they can improve service and focus their practices on patient needs."

While it's difficult to measure the web site's impact on physician behavior, the site's appeal is clear: its public rankings affect patient volume, a direct pitch to physicians' interests.

Conclusion: More Than a Better Mousetrap
From what we've seen with service initiatives, it's not sufficient to build a better mousetrap--sometimes it's even more important to make that mousetrap easy to find, understand, and acquire.

Most health care service programs, for example, won't work without physician buy-in. To achieve physician acceptance, the means of distributing the message--marketing--should be an integral part of the service itself.