Sustainability and health care on parallel tracks

For me, the biggest takeaway was that sustainability professionals face the same challenge that is starting to top the list at health care institutions.  That is, motivating lots of individuals to change their behavior.

In health care, the focus is on motivating patients to comply with their treatment plans.  In sustainability, it means motivating employees to make lots of small changes such as re-using and recycling both at work, and at home.

From central control to broad engagement

As one panelist pointed out, from a sustainability perspective, leading organizations have done the simple things that they can control centrally (e.g. redesigning and retrofitting buildings).  Now they need to turn their attention to broad employee engagement.

Another panelist provided confirming evidence from a conference she attended the previous week on energy and climate change.  There, she learned that “improving employee engagement” is now the top priority for Chief Sustainability Officers.

Behavior change techniques that work

So, although there was lots of fascinating content at the breakfast seminar, this post centers on techniques for changing employee behavior to increase sustainability–that have, or may have, parallels in health care.  Examples include custom incentives, social influence, use cases, gamification, sequencing, and erecting barriers to undesirable behavior.

Custom incentives

One of the panelists advises others to “meet employees where they are”–advice near and dear to this marketer’s heart.  She’s found that employees are often resistant to changes that employers may see as desirable.  For example, employees may be eager to adopt organic mattresses or gardening practices, but not as keen on taking public transit.

Health care organizations have reached similar conclusions.  Many now provide custom incentives to motivate patients to reorder medications and comply with treatment plans.

Some hire third parties to analyze past behavior to determine what they need to do achieve optimum outcomes.  Then, they customize incentives accordingly.

Social influence

Perhaps the best quote of the day was that people prefer “fitting in” to rewards.  In both sustainability and health care, practitioners are finding that people are motivated to match their peers’ behavior.  One of the panelists credited social media for making sustainability “visible” and “personal”.

Use cases

Susan Hunt Stevens, CEO of Practically Green, noted that behavior theory recommends showing people how “someone like them” made a change.  Her company’s blog uses individual storytelling to “bring an action a day to life”.

Gamification

Often closely related to social influence is gamification.  Sustainability and health care professionals alike are experimenting with games that enable individuals to compete and earn rewards and recognition for exhibiting desirable behavior or achieving preferred outcomes.

Sequencing

Moderator Jim Nail told us that he learned to market using the AIDA acronym: Attract, Interest, Decide, Act.  Today, he says sustainability professionals are finding it’s often effective to get people to act first, because individuals often identify with the actions they take.  I know professional fundraisers employ this technique by seeking small  donations first.   I don’t know if there are health care examples but we’ve all heard to “fake it until we make it”.

Erecting barriers to undesirable behaviors

Monica Nakielski, Sustainable Initiatives, Partners Healthcare said that her organization also sometimes just prevents undesirable behavior.  For example, departments can no longer order certain toxic supplies. Health care parallels may be safety caps on medications or stocking the refrigerator only with nutritious food.

Other techniques

Panelists discussed two techniques that have changed behavior at a macro level, rather than at an individual level.  Frank Marino, Corporate Environmental, Health and Safety Manager, Raytheon, told us that his company had executed sustainability initiatives in MA and NJ, but not in Tucson, where there were no regulatory incentives.  In health care, it took regulation and federal incentives to accelerate EHR adoption.

Several panelists discussed the impact of data transparency.  They noted that “greenwashing” is less common, now that reporting requirements make it easy to spot inconsistencies in sustainability execution.  Health care advocates are also seeking data transparency to stimulate competition and drive behavior change.

Kristine Kalaijian, Director, Environmental Compliance and Sustainability, Philips Electronics NA emphasized the importance of integrating sustainability into everything the company starting with the company’s overall business objectives.  This practice provides a stretch goal for other organizations desiring to achieve sustainability–and the health care industry as a whole.

Related posts:

1. Fresh perspectives in health care
2. Putting health care EMRs in the cloud
3. Health care social media is in its infancy says panel
4. Can B2B marketing strategies for the complex sale help improve health outcomes?

So, it is with great interest that I attended the Massachusetts Technology Leadership Council’s seminar  on How Technology is Enabling Dynamic Community Care Teams.  My goal was to learn more about:

• the kinds of care providers are delivering at patients’ homes and in the community,
• why pundits view home and community-based care as essential to improving health outcomes and minimizing costs
• which technologies contribute to delivering these results and why

Care delivered in the community

As it turns out, the patients most likely to receive care in the community are those that are well, recuperating, or have a chronic condition.  For these individuals, the key to getting better is ensuring that their care progresses according to plan.

Usually, a health care provider develops the plan upon examining the patient in a clinical setting.  The community-based care centers around:

• ensuring patient compliance,
• monitoring specific measures to ensure that patient is achieving desirable outcomes, and
• alerting providers to either problems or unanticipated delays in recovery.

Why community-based care is cost-effective

Community care is cost-effective because its administration doesn’t depend on the technical or human resources available only in higher-cost inpatient or outpatient settings. Instead, providers can address patients’  needs with a combination of media, remote monitoring, and lower cost community care providers.

Technology can aid in delivering media and remote monitoring, and sometimes reduce the number of visits lower-cost community care providers need to make to the home.  This means that patients can receive care where they prefer to get it: in a familiar setting and among friends and family.

It’s all about the relationship

Perhaps the greatest surprise of today’s technology conference is that the importance of human relationships took center stage.  According to keynote speaker, Rick Siegrist, CIO at Press Ganey, patients’ satisfaction  and health outcomes depend most on the emotional connection with the caregiver.

As the speakers explained, patient engagement matters more than anything else.  Patients need to understand their care plan.  They have more control over their recovery than anyone.

Some need a personally meaningful goal to motivate them to act.  As one speaker said most patients are more interested in attending an upcoming family event, such as a wedding, than improving the level of a medical statistic.

Patients  need confidence that they can manage the disease process.  And according to another speaker, there needs to be a sustained connection, so that patients can interact with their health care providers when needed.

Technology is great when it works

As the speakers noted, technology can help providers deliver the right information at the right time without requiring a separate home care visit.   And, equally important, technology helps strengthen connections between the patient and the care team by facilitating the exchange of information each party finds valuable.

Technology also helps enforce clinical protocols.  For example, it can prompt providers to get answers to important health status questions they might otherwise forget to ask.

Desired improvements

Nevertheless, both panel and audience members expressed frustration with technology gaps and complexity.  At present, much of the technology is still hard to use. Moreover, it floods caregivers with data–rather than presenting just the information they need, the way they need it.  There is also a need for industry standards.

For technology to be truly useful, caregivers  need filtering, the ability to customize content and presentation by user, and full integration with their own and others’ systems.   Regulation will drive some of these changes.  As one panelist said, “Look for future releases.”

Related posts:

1. Putting health care EMRs in the cloud
2. Health care reform: people, processes, data, oh my!
3. Health Care Information Technology: The prescription for successful implementation
4. Health care social media is in its infancy says panel

The topic of the 8th annual Connected Health Symposium was timely: Driving Quality Up and Costs Down:  New Technologies for an Era of Accountability.  Nevertheless, what made it a great conference were the fresh perspectives it brought to the fore.

Measurement, analysis, and communication are imperative

Brent James, the Chief Quality Officer at Intermountain Health Care, set the stage by describing how he and his employer, Intermountain, have succeeded in simultaneously improving health care quality and decreasing costs.  He credits this achievement to the incorporation of baseline protocols into the clinical workflow, followed by continuous improvement.

According to James, despite the explosion of knowledge and technology over the last 200 years, modern medicine has continued to rely on individual’s judgment rather than measurement.  James observes that this ongoing dependence on subjective recall has led to tremendous variation in the practice of medicine, a paucity of valid clinical knowledge about best treatments, long lags between identification of best practice and its dissemination (more than 15 years), and a “striking inability to do what works”.

The solution, James argued, is building standard baseline protocols into clinical workflows, which individual physicians are then free to override.  James says that this methodology is effective because standardization allows clinicians to spot what works–something they can’t do when everyone practices medicine a different way.

Then, it’s a matter of iteration.  Over time, employment of this process has helped Intermountain achieve better quality and lower costs than many of its larger, better-funded peers.

Better health depends on reducing income disparities

Next up was Kate Pickett, co-author of The Spirit Level: Why Greater Equality Makes Societies Stronger.  Her perspective is a macroeconomic one.

Drawing on a number of statistics, Pickett argued that income disparity is the most powerful predictor of health at a societal level.  Displaying chart after chart, she demonstrated that citizens of countries such as Denmark and Japan have better health, and life expectancies, than citizens of wealthier countries such as the US and the UK where the income gap, from richest to poorest, is greater.

In a follow up interview, she offered possible explanations.  Among these are that inequality erodes trust–and that people in lower strata of society experience anxiety and stress when they believe there is no hope of upward mobility.

Many more perspectives covered

This post summarizes some of the insights from the first two keynotes.  Over the course of two days, each presentation added a different way of looking at the issues related to improving health care quality and cost.

The business of health care

There were sessions about reimbursement, medication adherence, accountable care, and financing health care.  And, there were lots of demos on innovative technology.

The psychology of motivating change

In addition, however, there were a number of talks about motivating desirable behavior.  Examples included sessions on using games to promote better health, biofeedback, self-quantification, and even tips for effectively communicating health information to the distractible multi-tasking consumers of health information that make up the next generation.

Connecting the dots

I found that I spent much of the conference thinking about not just the topic at hand, but about the implications of each talk for other topics discussed at the conference.  Luckily, the event producers recorded many of the panels, and presentations, as there was a lot to absorb in just two short days.

Related posts:

1. Enabling health care delivery in the community
2. Motivating Behavior Change: Where the rubber hits the road in health care and sustainability
3. New social media site invites users to review public health care services
4. Putting health care EMRs in the cloud

About the panel:

The Racepoint Group hosted the session. Larry Weber (who just published Everywhere: Comprehensive Digital Business Strategy for the Social Media Era ) served as moderator.  The panelists included Dr. Kevin Pho, MD, Barry P. Chaiken, MD, MPH and Ashley Serotta of Sermo.

Most physicians are not active on social media during the work day

Most physicians are not active on social media.  Until recently, they didn’t have easy access to information technology during the workday because they don’t work at desks.

Now, thanks to shared workstations and portable platforms such as smart phones and tablets, they are beginning to incorporate information technology into their workflow.  Nevertheless, their now paperless workflow mimics the paper world.

Reimbursement, or lack thereof, has been a major factor limiting online communications with patients. That said, physicians do use social media in their personal lives.  I believe the panelists said that 58% of surgeons are on Facebook and 25% are on Twitter.

New financial incentives will drive greater clinical use of social media

Physicians are likely to become more active in social media.  Already, there are pilot projects where physicians receive reimbursement for electronic visits.

Moreover, once physicians receive reimbursement based on care quality, rather than care volume, there will be less incentive to bring patients into the office.  Dr. Chaiken noted, to my surprise, that already 60% of physicians are employees (who receive a fixed salary, regardless of volume).  Both these trends will likely drive greater use of social media for patient interactions

Some practices have begun to use social media

In response to my question about practices that are currently using social media for patient interaction, Dr. Pho noted that the MacArthur OB/Gyn practice established a Facebook community to communicate with teens about avoiding pregnancy and STDs.  In information, I found later on the web, Dr. Livingston of the MacArthur practice noted that he reaches out via social media and then uses his practice portal to communicate with individual patients in a HIPAA-compliant way.  Dr. Livingston found that while increased communication has helped him brand and increase his practice, it’s also helped establish a greater connection than he can in a 10-minute office visit and enabled him to have a greater impact on the community

Physicians use peer networks to seek advice and learn best practices

Ms. Serotta noted that physicians in Sermo’s peer network spend about 50% of their time discussing patient-centered and clinical issues.  There, they can compare notes with others in their specialty or learn about best practice from other specialties.

Too much information

The panelists also discussed information overload–and the need for filters.  Dr. Chaiken said this problem will exacerbate once medical devices directly download data to the EMR (electronic medical record)

Conclusions

The panel concluded that medical social media is in its infancy, but shows promise.  My impression was that they believed that the speakers see reimbursement, speed, and information overload as far greater impediments than concerns about HIPAA, especially because physicians are already well-trained to act in a HIPAA-compliant way.

Learn more about BB Marketing Plus health care marketing consulting services and social media marketing consulting services on the BB Marketing Plus website.

Related posts:

1. New social media site invites users to review public health care services
2. Social media works—more than 600 attend Boston health care conference
3. Putting health care EMRs in the cloud
4. Enabling health care delivery in the community

This morning, I attended a program at the Massachusetts Technology Leadership forum featuring John Lewis, Regional VP of Sales, of athenahealth. John’s presentation centered on his company’s  experiences of selling what he referred to as health care’s first cloud-based service.

Following on the heels of recent conversations, I’ve had with CIOs, about placing confidential patient data in the cloud; I expected John to tell us how he overcomes this objection.  Instead, he spent the morning convincing us that operating in the cloud is his company’s competitive advantage.  John supported this thesis with figures, facts, and logic.

The figures

athenahealth supports 33,000 health care providers and processes $5 billion in collections/year.  The company has a 30% growth rate.  This growth rate is an indication of satisfaction–since as a SaaS provider, athenahealth’s success depends on client renewals.

The company also offers an Electronic Medical Record (EMR) application and a patient portal.   John told us that the majority of recent prospects have been buying both the revenue cycle and the EMR products.

The facts

Health care standardization has been slowly evolving for the last twenty years.  Nevertheless, it is still largely a world of “one off” transactions.

Each patient is different, has different ailments, and therefore requires different treatments.  Each health care provider has a different system for treating patients and recording the services and results.

Some of this variation is attributable to the differences between patients.  Some is an artifact of a largely manual system that has made it difficult to group like patients and develop standards of care.

To complicate matters, each health care payer pays differently.  This is because payers’ rates take into account volume discounts.  Furthermore, health care providers sometimes need to collect payments from more than one payer for a single patient.

Knowledge management

John argues that by providing services in the cloud, one of the main advantages athenahealth offers its customers is simplification of a complex process.   Because the company process claims for thousands of practices, it collects a lot of data and can spot, and respond to, trends quickly.

Visibility leads to continuous improvement

The company’s original goal was to speed up revenue cycle payments and reduce receivables.  They did so by reducing the number of claims that payers reject.

The company constantly analyzes the revenue cycle to identify hiccups in the system.  Each time a payer rejects a claim for any of its practices, athenahealth updates a central rules set.

Anything the company learns on behalf of one practice benefits all the practices.  Today, the company flags most errors before the claims reach the payer.  Because claims go in right the first time, practices also save on small claims that its clients wouldn’t formerly have bothered to reprocess.

Meaningful use

athenahealth also uses knowledge management to help its clients comply with meaningful use criteria.  For example, the company noticed that a lot of clients were falling behind in measuring demographics.  Once it spotted the problem, athenahealth developed a program that taught users to ask patients about their races, so that the practices could then qualify for greater reimbursement.

Streamlining workflow

athenahealth now reviews the data to spot opportunities to streamline practice workflow.  For example, they now batch all their clients’ claims before delivering them to payers.

There’s power in numbers

What struck me as interesting, is that John indicated that because, athenahealth serves so many practices, they are–or will soon be–in a position to negotiate with other parties about the way in which the two entities exchange information.   If so, this may be an important step in accelerating data standardization in health care.

Responding to change

John points out that his company’s cloud-based solution is particularly compelling when you consider how quickly health care is changing.  Since everyone is running on the same instance of software, athenahealth can respond to changing rules quickly–without requiring clients to install new software.  For example, when athenahealth obtained certification for its software, all of its users received certification at the same time.

Readiness for bundled payments

When someone asked whether bundled payments would erode athenahealth’s competitive advantage, John responded that the company already supports capitated practices.  He said that while fees may decrease on the revenue cycle side, the complexities associated with health care payment will merely shift to the clinical side.

Will cloud solutions triumph?

The jury is out.  Hospitals are under pressure to contain costs, but patient privacy remains important.

Even though IT professionals in other regulated industries are also beginning to move data to the cloud, John admits that his is still a missionary sell.    Nevertheless, the facts, figures, and logic that John presented convinced me that athenahealth offers advantages that many practices find appealing.  The bonus will be accelerated data standardization if athenahealth gains sufficient market power to influence some of the parties with which it exchanges information.

See examples of how BB Marketing Plus works with health care clients in the health care marketing section of this website.

Related posts:

1. How will Electronic Medical Records (EMRs) improve quality and reduce costs?
2. Health care reform: people, processes, data, oh my!
3. Health care social media is in its infancy says panel
4. Enabling health care delivery in the community

Since I couldn’t keep up with the information flow, I’m looking forward to reviewing the slides once they’re up later this month.  In the meantime, the next few posts provide snippets from several sessions.

I hope you’ll find it as interesting as I did.  This one focuses on the first session:  Clinical Decision Support: Technology at the point of care.

The pluses and minuses of alerts during the prescribing process

Electronic Medical Records systems alert physicians when their prescriptions may conflict with best practice.  Physicians then have the option of changing their orders–and overriding the alerts with an explanation of why they did so.

One problem is that if these systems provide too many false alarms, physicians just override all of them.  Another problem is that overriding alerts can expose the physician to malpractice claims.

The goal is to provide useful information, without impeding work flow

Michael Lee, Director of Clinical Informatics at Atrius Health, spoke about the steps his physician group is taking to provide physicians with tools they can use, at the point of care, to avoid medical errors.  Dr. Lee explained that one of his organization’s goals is to strike the right balance between providing useful information–and impeding physicians’ work flow.

Steps to success

Dr. Lee and his organization have addressed these concerns in a number of ways.  For one, the organization asked clinicians which alerts were driving them crazy.  Then, it formed a clinical panel to determine how important each alert is and which alerts the organization can suppress.

To ensure, however, that physicians have the information they require at the point of care, Dr. Lee has worked with Up-to-Date, a publisher of evidence-based guidelines, to incorporate a “quick reference button” .  This button enables physicians to access Up-to-Date’s content directly from the electronic medical record .  As an incentive to consult this data, the organization provides physicians with Continuing Medical Education (CME) credit for the time they spend using Up-to-Date.

To expedite the work flow, the organization has also identified which decisions the physicians must make themselves.  The support staff makes the remaining decisions.  Future goals include decision support for high cost imaging services and involving patients more in their own care.

Automation of med delivery:  From brain to vein

Next, Dr. Daniel Nigrin, the CIO at Childrens Hospital introduced us to the Childrens Hospital Applications for Maximizing Patient Safety (CHAMPS) using medication administration as an example.  Here, the goal was to automate all aspects of the process “from brain to vein” and across multiple actors (i.e. physicians, pharmacists, nurses, technicians, and couriers).

Children have special needs

Dr. Nigrin, began by pointing out that children are at especially high risk for medication dosing errors.  They are smaller than adults; and there is a wide spectrum of patients, from premature babies to 18-year-old football players.  Because of this variation in patients, there are more than 1000 custom order sets, representing 70% of the total.

Better systems, in combination, reduce errors by 50%

The organization tracks the status and locations of the medication at each step of the process.  Since Children’s implemented this process, there has been a 50% reduction in medical errors.

It uses barcodes to ensure delivery of the right medication, location codes to help nurses keep track of where the medication is, and time stamps to find bottlenecks.  The tool also provides alerts about doses that occur too often to prevent overdoses.

CPOE, alone, had a modest effect.  It was the combination with bar coding, that enabled Childrens Hospital to sustain the decrease in medical errors.

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2. Software value proposition for prospective health care customers
3. Health care social media is in its infancy says panel
4. Putting health care EMRs in the cloud

Evidence shows that patients often forego treatment that could save their lives

The implication, although not explicitly tied to this finding, was that better engagement would increase the likelihood that patients would be less likely to foregoing life-extending surgery.  (The article references an earlier AMA study that showed that 1/3 of patient people diagnosed with early-stage non-small cell lung cancer opted not to have surgery that would extend their lives by 400%–from one year to four years.)

Would B2B marketing strategies, for the complex sale, apply to health care?

Assuming engagement matters, which one intuitively would believe it does, what was missing from the post were details about effective engagement.  In short, it begs the questions who, what, when, where, and how–the questions that business-to-business marketers focus on daily as they aim to change behavior in complex sales situations.

5 questions B2B marketers might ask before determining how to influence patient behavior

According to last year’s Pew study, the number one and number two sources people turn to for health counsel are their physicians and their social circle.  Follow up questions to the study cited in yesterday’s article (or at least the post about the study) include:

1) Who must communicate the information to increase the likelihood of engagement? The patient’s health care providers?  If so, should the communication be with the specialist, the primary care provider or another clinician?  Or, is it more important that family and friends engage with the patient?

2) When must communication occur? On the day of diagnosis?  A week later?  On an ongoing basis?

3) What communication is most effective? Statistics about health outcomes?  Recommendations as to how to proceed? Explanations of what to expect before, during, and after treatment?

4) How should communicators relay the information for maximum impact? In person?  Over the phone?  Some form of less personal communication?

5) What would make the communication more credible and powerful? Reprints of articles with information that patients may find useful? Videos of others’ experiences with the same condition?  Family members’ concerns about the impact it will have on their lives?  A Q and A session with the clinician–or the clinical team?

What’s the best way to influence patient behavior?

Have you seen other studies that address these questions?  If so, are B2B marketing techniques helpful when it comes to aiding patients (who are really consumers) make the complex decisions associated with choosing appropriate medical care?

Related posts:

1. Motivating Behavior Change: Where the rubber hits the road in health care and sustainability
2. How will Electronic Medical Records (EMRs) improve quality and reduce costs?
3. Enabling health care delivery in the community
4. Health care IT: Lives depend on good design

I started working in health care in 1994 in Boston, after working in high technology since the early 1980s.  One of the first things that struck me was the relative lack of competition in the local health care industry.

Few distinctions between health care “competitors”

There was relatively little differentiation, from a prospective patient’s perspective, between hospitals–other than care level and location.  When I polled my friends and colleagues, I realized that they could distinguish between Boston’s famous tertiary hospitals and the community hospitals–but couldn’t cite differences within either group.

By the same token, there was little differentiation among payers.  From an insured’s perspective, they all had the same provider panels and offered pretty much the same benefits.  As for employers, at that time, they had to patch together national networks, since, at the time none of the local payers offered a comprehensive national network.

As a newcomer, I wondered about this.  Why didn’t one hospital brand itself as the choice for women requiring surgery as they approached middle age?  Why didn’t one HMO promote its coverage for snowbirds?

Focus on market dominance

Since then, ambulatory centers have carved out some of the hospitals’ most profitable services as improving technology has enabled them to do so.  Hospitals consolidated, and partnered with community hospitals to gain market control–ultimately squeezing out some of the smaller, weaker players.

Eventually, the tertiary hospitals spread out to the suburbs, competing with the community hospitals, to control the supply chain.  At about the same time, hospitals invested in technology and new construction to build Centers of Excellence in a belated attempt to distinguish their institutions from the competition.

Value remains constant, prices rise

Nevertheless, I never witnessed the level of differentiation, or increased value, that usually accompanies competitiveness in other industries.  As a business owner and a consumer, my observation was that care was good (although there was greater and greater reporting of quality problems) and prices kept rising.

As for payers, I can’t comment on their competitiveness.  As a small business owner, I’m not in their target market–larger employers.

Will the next decade bring increased competition?

This morning, however, I got a very different impression when I attended the Massachusetts Technology Leadership Countcil’s Health Care Seminar: Using Technology to Improve Care While Right-Sizing Costs, via Better Health Analytics.  That said it was only half way through the presentation that I grasped the full impact of the ARRA incentives to implement electronic medical records.

I had been reading for years that the hope was that electronic medical records would lower health care costs, reduce medical errors, improve access to data, improve health care quality, and improve care.  Nevertheless, I’ve been waiting for evidence.

Will EMRs fulfill the promise of improved quality and decreased costs?

I live in MA, which already has relatively high EMR adoption (40% compared with 20% nationwide).  Nevertheless, quality has been difficult to measure and costs have risen, rather than dropped.  Moreover, one of my colleagues, a physician at a hospital system, suspects that at least some of his peers don’t review records–given the number of duplicate tests, he sees ordered on a regular basis.

What I hadn’t taken into account, however, is that the existence of medical records opens the door to competition.  This dawned on me as I listed to Dana Gelb Safran, the Senior VP of Performance Measurement and Improvement at Blue Cross Blue Shield of Massachusetts.

Motivating cost-effective care

Dr. Safran talked about the rising cost of health care, the relatively poor health outcomes the US gets for its health care dollar relative to other countries, and the problems associated with paying for services rather than outcomes.  She then discussed some of the steps her organization has taken to motivate cost-effective care.

BCBS of MA will be contracting with hospitals and physicians together offering global payments across the continuum.  It will tie payments to growth in the CPI and offer significant incentives to improve care and reduce waste.

Apples to apples comparisons

What really caught my attention, however, was when Dr. Safran spoke about what she saw when her organization looked at physician treatment patterns across very narrow episodes of care.  By looking at otherwise healthy patients, who have a single ailment in common, they are effectively able to compare apples to apples.

This ability addresses a major concern, that physicians have had in the past.  That concern is that patients are not widgets, and co-morbidities make it difficult to understand and compare treatments and cost-effectiveness.

What BCBS has found, much like Wennberg before them, is that there is tremendous variation in treatment patterns (even within a single health care practice).  Consequently, BCBS has asked physicians to come up with tighter guidelines for best practice.

Publicly available comparative data may spur competition

At that moment, the power of automated medical records became clear to me.  In addition to providing caregivers with complete information about a patient, automating and centralizing medical records facilitates comparisons across patients, and also across providers.  Once comparative data becomes publicly available, there is the potential that competition will spur health care quality improvements and drive down health care costs.

Physicians under pressure from all sides

The next speaker, Todd Lowthers, Manager of Physician Services, Northeast PHO, spoke about the increasing pressure that health care providers are under due to the threat of Medicare payment reductions, increasing federal and state legislation, and requirements of insurers’ contracts such as those described by Dr. Safran.  It was then that another piece of the puzzle hit me.

Changes to Medicare may also drive competition

As the largest health care payer, Medicare effectively determines payment rates.  Up until now, Congress has intervened to prevent Medicare from reducing physician payments.  If Congress allows Medicare to reduce payments, or includes all physician services in global payment rates, it will have a huge impact on competition.

Despite EMRs, lots of missing data impedes progress

Mr. Lowthers’ talk highlighted some of the gaps in data that make it difficult for physicians to measure and control quality.  Examples included the ability to see what was ordered but not who ordered it or whether the patient acted on the order, the lack of a single patient portal,  the inability to get aggregated data sets for patient panels across all payers, and a national master patient medical number that would enable accurate association of all of a patient’s health care data.

EMRs also require clinical integration

The final speaker, Dr. Jonathan Niloff, Founder and CEO, Medventive and a gynecology oncologist spoke about the need to design EMRs for clinical integration–and the steps his company has taken to do so, and to address some of the issues that Mr. Lowthers raised.

See examples of the work we do with health care and technology organizations.

Related posts:

1. Putting health care EMRs in the cloud
2. Can B2B marketing strategies for the complex sale help improve health outcomes?
3. Software value proposition for prospective health care customers
4. Health Care Information Technology: The prescription for successful implementation

Press release lead paragraph

“Simmons College’s Department of Health Care Administration launched a new website that will gauge the experiences of Boston-area healthcare users who have their services paid for by public programs. USisUS.net, which stands for the United States is Us, aims to reach out to minority populations and healthcare users who receive aid through programs such as Medicaid, VA, Commonwealth Care and others.  Users of the site can review these comments and ratings about particular health care providers.”

The many faces of Barbara Bix, Managing Principal, BB Marketing Plus

This post discusses my observations from several perspectives including that of a health care marketing consultant, a social media marketing consultant, a user of services, a citizen, and a taxpayer.  So, please join me now as I switch hats and weigh in from each of these roles.

Health care marketing consultant

The topic was also of particular interest to me as a health care marketing consultant.  There’s a lot of debate about what constitutes health care quality.  It’s hard to measure since we’re not widgets.  Each of us comes to our health through a unique combination of genes and behavior–and at different stages of wellness/illness–before health care providers even begin administering care.  For another, most of us don’t have the medical knowledge to assess the relative quality of our treatment regimes or outcomes.

Nevertheless, user perspectives are important; and health care providers have begun to seek them out over the last decade or so.  For one, we’re the only ones who know how we feel.  For another, we are qualified to rate some of the more visible aspects of our care–as well as our overall experience during the care process.

User of services

I see this site as a “Yelp” for government services.  The interesting twist is that citizen reviewers are not only users of the services and prospective users of the services, but also citizens who pay for the services–whether they ultimately use them or not.

As soon as I heard about this concept, my first reaction was, “We need this for our town”.  As a user, I think it’s a great way to hear from trusted citizens about new services of which I might otherwise have not been aware–as well as to get recommendations for which services to use when I have a choice.

Taxpayer

As a taxpayer, I’d find it useful to have information that helps me evaluate our programs and help me determine for which enhancements to advocate.  Today, I read about controversial decisions in the local newspaper and wish I could get a better understanding of the pros and cons from the people these decisions will most affect.  I also love the idea that administrators of those programs have a way to get specific actionable feedback on services without extra effort.

Social media marketing consultant

One of the best ways to develop superior offerings is to collaborate with clients, and prospective clients, to design and then improve the services you deliver.  A frequent “unintended consequence” is that users then feel more engaged and more involved, just because someone sought their feedback.  This engagement often leads to even greater satisfaction.

The magic of social media is that you can so easily, and inexpensively, reach so many of the people you aim to serve, get instant feedback, and have a forum where they can work as a group to refine that feedback.  This aspect is often referred to as the “wisdom of the crowd”.

Bias

Yes, there will be bias.  You’re most likely only to hear from those who are “high responders”, extremely satisfied, or extremely dissatisfied.  The hope is that, as with many other social media, “the crowd” keeps the conversation centered and useful.  I know that when I’m the user, I look to the crowd for overall sentiment, and to individual reviewers’ comments only for the details that they will bring to my attention.

Your perspectives, please

What’s your take?  Have you used any programs that evaluate public services?  If so, what value have you derived?  What reservations do you have?  What feedback do you have for USisus.net as they start to spread the word?

Find out how to make the most of your social media opportunities

Interested in learning more about how social media can add value to your organization?  Download the social media primer.

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One of the issues our team has been trying to address is, “How do you attract and retain new community members—when these prospective members start out with little in common with current members?”

Luckily for me, I attended a social media breakfast in Boston(#15) this morning. There, Communispace CEO, Diane Hessan, was the last speaker at an event entitled “SMB15: The Power and Peril of Online Communities.

If anyone has deep insights into the power and perils of online communities, it’s Diane Hessan. Her team at Communispace has been building online communities for ten years.

Today, Communispace hosts vibrant communities for some of the biggest brands in the US—companies like GlaxoSmithKline, HP, and Hallmark. This morning, however, Diane told us that her company didn’t achieve success overnight.

As Diane began to speak about lessons learned, I quickly realized that my client could learn a lot from her experience. Yes, my client’s community is a conventional offline community. Yet, I believe many of the same principles that the SMB15 speakers presented will apply.

Online communities are like cocktail parties

One of the speakers likened an online community to a cocktail party. As with a cocktail party, the success of a community depends on a lot of effort on someone’s part.

This effort includes welcoming guests when they arrive, encouraging them to stay by introducing them to others, including them in the conversation, and giving them a great experience so that they come back again.

In short, as the first speaker, Bryan Person, Social Media Evangelist at LiveWorld pointed out, it takes a great host to throw a great party. He then remarked that in an online community, the host is the community manager.

Community managers play an important role in on-line communities

Up next, Rachel Happe, Principal at Community Roundtable, spoke about the important role the community manager plays in building a strong community. Both Rachel and Diane suggested hiring an event manager for this role.

Just as at a party, this person needs to set the tone. Online or offline, it’s important that this individual engage with other members of the community directly.

People are attracted by other people. Diane said that just as you’re asking community members to share their thoughts, ideas and/or experiences, it is important for community managers to also reveal a little bit about themselves.

Social glue binds on-line communities

Another related concept is “social glue”. Social glue is what holds communities together, and keeps participants coming back. Diane noted that the more involved people are in the community, the stronger the social glue.

The key to involvement over time, therefore, cannot fall to the community manager alone. Instead, community managers need to stimulate conversations between members.

For some communities, these conversations come about quite naturally. As an example, Diane referenced one airline’s frequent fliers. These road warriors spend all their time on planes–so the airline and the passengers’ travel experiences are top of mind.

It’s much harder to build a social community around brands that are central to peoples’ lives. Diane described the challenges a toothpaste company faced when trying to build the strong ties among their members.

Since most people spend relatively little time thinking about brushing their teeth, it was unlikely that they would bond over their brushing experiences. Hence, the community manager encouraged conversations by reaching out to a subgroup of young mothers.

The community manager then engaged these women in conversations about their family lives. As Diane explained, dividing a large disparate community into subgroups makes it easier to nurture the “social glue” it takes to hold a community together.

Building on-line communities takes patience and sustained efforts

One of the cautions that Rachel offered, and Diane reinforced, is that communities take a long time—and sustained effort–to build. In Rachel’s experience, it’s not uncommon to see relatively low flat participation for a long time.

Sometimes, there are spikes when a community manager initiates an effective campaign. Yet, the overall trend is still flat–until the community reaches a critical point. Then, if everything goes right, growth will accelerate.

Would be community builders, such as my client, therefore should prepare to make a sustained effort for a long period of time before things take off. My sense was that that time period can be a year or longer.

Listening is an underrated marketing strategy

The need to sustain one’s efforts throughout brings me to the next point. Diane quipped that “listening is an underrated marketing strategy”.

Communities are a great way to learn about what matters most to members. On the other hand, once you set the expectation that you care about what others think, it’s important to follow through. If you don’t sustain your efforts, and respond to their recommendations, you’ll just alienate your community.

When you do listen, however, it pays dividends. Diane told us about the first time one of Communispace’s early clients experienced a spike in traffic. The SWAT team–that Diane assigned to figure out what created such a high level of engagement—identified critical success factors and what Communispace and its client could do to achieve even better outcomes in the future.

Case Example: Millenials and Gen Xers

Toward the end of her presentation, Diane provided some specific case examples. My ears perked up when she began discussing the experiences that Charles Schwab had when it first tried to attract younger investors.

I began to listen very hard, when as an aside, she mentioned the difficulties that financial service companies, and for that matter health care providers, face in getting social media communications approved.

This was of particular interest to me because this is something my health care clients and financial service  clients worry about a lot. It is also one of the questions that my colleague, Robert DeSimone, of Medicomm Inc., and I are currently querying medical device companies about in our survey about medical device companies’ use of social media–but I digress.

Diane quickly reviewed what Charles Schwab and Communispace learned when they set out to attract millenials and Gen Xers. For one thing, terms such as “retirement” and “no load funds”–which are part of the vernacular for baby boomers–mean little to the next generations. Retirement is far away. Since, as it turned out, most young people use checking accounts as their primary investment vehicle, “no load” was not a term with which they were familiar.

Different communities require different marketing tactics

Communispace and Schwab also learned that communicating with young people is fundamentally different. This population is “always on” from the very moment they awake in the morning. Moreover, the technology of choice is likely to be a mobile phone.

Once again, “listening” paid dividends. Schwab introduced a high-interest checking account that was a great success.

What does this all mean for would be community builders?

What does all of this mean for my client? It appears that if they want to attract individuals from a younger generation, they may have to do things differently—and it may take a lot of time.

On the other hand, if they are patient, invest in applying some of the best practices the SMB#15 speakers recommended, and sustain their efforts, they have the potential to attract and retain the prospective members they most want.

Social Media Breakfast: Go directly to the source

Thanks so much to Bob Collins, who hosts Social Media Breakfasts in the Boston area, event sponsors LiveWorld and Communispace, and the speakers that made this a fantastic event. This is just a taste of what they served at breakfast. You may want to check out hashtag #SMB15 on Twitter to get all the details

Interested in learning more about how you can use social media for maximum impact?

Download the social media primer to explore ways that social media can add value to your company and its prospects.  Or, check our social media services.

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