High Stakes Archives

Tired of Being Your Hero

Orange text that reads "The Quick Think" over a kaleidoscope-patterned background

Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

Healthcare workers are leaving.

They’re citing burnout, stress, safety, moral harm – and in some cases a desire for “personal freedom” over all else. They’re answering the question, “Is it worth it?” with a decisive, “No.”

Many are leaving because they cannot spend another day watching patient after patient die unnecessarily. Others have decided their career isn’t worth the vaccine. Logs on that particular fire? President Biden’s new mandate for large employers that will force even more people to make a choice. All told, the consequences for healthcare are severe – moral injury for healthcare workers, frightening staff shortages for providers and the public and long-term questions that will likely affect how all of us receive care.

Our latest Special Report homes in on the massively complex problem of clinician burnout. It’s a big read with some strong takeaways – definitely worth taking 15 minutes to digest.

Meanwhile, for a fascinating behind-the-curtain look at how doctors and nurses are expressing their burnout online, check out our Q&A below with Dean Browell. He’s a digital ethnographer and principal at Feedback, a social listening firm that digs into how what we say in the digital realm translates into how we behave in the physical world. And, he’s been tracking the issue of burnout among the healthcare workforce for years.

The Genie’s Out of the Bottle: What Clinicians Are Really Saying Online

(Five-minute read)

Jarrard Inc.: You’ve been tracking burnout in the healthcare workforce for years. Give us a bit of the back story.

Dean Browell: There’s been two different arcs with nurses and physicians, which have developed a little differently over the past 18 months.

Browell

Starting with nurses, about this time last year there was a larger burnout effect that in some ways was getting stoked by the heroes messaging that was finally starting to get a little stale. The pushback started with nurses, who are the most vocal group in healthcare, maybe even more than patients. They have their own message boards and have for years. They had some of the first Facebook groups because they all had .edu email addresses.

This time last year there was this perception that all of healthcare was being treated the same publicly, but in those groups, nurses were asking whether it really was the same to work in one organization or the other. For providers this meant that nurses considering a move represented an opportunity to attract and retain or a threat that the grass might be greener somewhere else.

Jarrard: What are the nurses expressing today?

DB: There’s more outright discussion that, “Maybe this entire industry isn’t for me.” What was first anger towards a larger or more nebulous idea – like administrators or how people are handling things on a macro level – is now towards the patient. Before, it was being angry at the virus and potentially how your hospital handled something. Today people are wondering if they can continue and serve a public that is, in their mind, willingly putting themselves at risk and creating this situation. It’s a very different burnout. And it’s a much harder equation from a retention and a recruitment standpoint for providers.

Jarrard: How are nurses talking about those concerns?

DB: In the beginning, nurses often had two distinct online personalities. There’s the online personality of “capital N” Nurse in front of everyone on Facebook versus on the American Nurses Association message board where they’re talking amongst themselves. Last year, those two faces began to collide. What we saw for the first time last fall was nurses on Facebook talking about union meetings. Typically, that would be relegated to the nurse message boards or discreet groups. We saw nurses not just take the platitudes about heroes and say, “Thank you. It’s been a lot. We have to push through this” like they did last summer. Instead, suddenly, you had them openly criticizing things they normally never would have discussed with their public-facing persona.

Jarrard: What’s the background on physicians?

DB: Usually what we saw is that physicians would pop up every now and then during a career change asking about the schools or nightlife in a particular city they were considering. “Hey, I’m thinking about moving to the city, what’s the orthopedic scene like?”

In August of last year, though, we saw physicians poking their heads up for the first time with the general public. They were offering their own statements and being a bit more forward with their own name at stake. That was different. And we saw this happening in some unusual places like threads of Reddit – that almost never happened before.

Jarrard: Same question – where are physicians today?

DB: They stepped out last August and they’ve stayed out in the public square since then. Now, like nurses, we’re seeing that they’re not just saying, “Hey, I have a stake in this, and I’m trying to help you navigate misinformation.” It’s not just a benign educational leadership approach like it would have been a year ago. Now it’s taken on an angrier or more exasperated tone that we haven’t heard out loud.

Jarrard: Nurses and doctors are coming from different professional and financial statuses. Does that affect how they’re able to respond?

DB: It manifests in the freedom to talk in a certain way. The physician discussion we’ve seen has still been very high level. “Here’s my take on what’s happening” as if they’re giving a comprehensive analysis of the moment. Contrast that with the nurse that says, “I just took my first break in eight hours.” Physicians take more of a punditry angle, whereas the nurses’ perspective is more in the moment.

Jarrard: Is this shift in tone and the level of engagement permanent or will it recede?

DB: For the most part I expect the physicians-as-pundits to eventually fade. Their level of connection online may stay, they may reappear when there’s something big they want to speak their mind about. But from a day-to-day perspective I’d expect that genie to go back into the bottle.

On the nurse side, I doubt the genie that will go back in the bottle – because of how open nurses are being today – is this idea of the two personas. There’s the happy-go-lucky, “I love that I’m in healthcare!” and “Here’s why I’m a nurse,” that is presented to family and friends, versus what they were saying in private among peers. You can’t unwind that clock now that they’ve been this exasperated publicly.

Jarrard: What does it all mean for the healthcare workforce going forward?

DB: This will have a freezing effect of some sort. It’ll be fascinating to watch enrollment in nursing programs. It was on a fast track for the last three years in order to meet the demands. We do a lot in higher education and there are some robust nursing programs having trouble meeting their enrollment numbers.

The question is turning into, “Who do you want to do this for?” And the feelings of betrayal and burnout change that conversation. I think it’ll have a freezing effect on the creation of a new nurse population.

Jarrard: We’re also seeing indications that people at the other end of their career are getting out. What does the situation you’ve described mean for them?

DB: It’s how many people leave the industry completely and how many leave the center of the industry. It’s people saying, “I’m going to find a nice, quiet CVS somewhere.” There’s this idea of decentralization of demand for healthcare services where it’s coming out of the hospitals and moving to those outer rings. It’s dangerous for hospitals because there was already attrition due to these alternative models. But now and over the next 18 months the threat is greater with people looking to leave completely or say, “How about I just not stand in the center of the storm?”

Jarrard: How can healthcare providers respond to this shift?

DB: Health systems have an opportunity to do better because of their sheer size. They can talk about what it’s like to work for the system in different roles. People will gripe about robbing Peter to pay Paul, but showcasing lateral movements that improve quality of life is one way that systems can cope.

Jarrard: What about smaller hospitals?

DB: Community hospitals will be the hardest hit because there’s almost no lateral movement available. For them, it will be about improving the situation. Maybe it’s investment in telehealth or to try and not be so ER-focused to remove some of that constant pressure. But it’s not an easy solution.

Jarrard: Last category: What’s the approach for those non-traditional or health services providers that aren’t in the center of the storm?

DB: We just finished a study for an orthopedic group that’s branching out towards a major metro area where they’ll be competing with some big systems. They’re going to have a fantastic story because they can recruit nurses who are desperate to get out of the ER by showing them what it’s like in an ortho urgent care by comparison. For these specialty practices it’s saying, “Hey, stay in nursing but come out of the storm.”

Jarrard: One of the consistent themes in our interviews is that it’s not about the money, but money is a major factor. Where does compensation come into all of this?

DB: Something that hasn’t come to healthcare is the concept of hazard pay. Of all industries you’d think it would be there for healthcare. That may start to happen, especially in systems that can only offer so much lateral movement. Maybe it comes into play between telehealth and in-person care in the ER or trauma.

Jarrard: Anything else? What are we missing?

DB: We may see an effect on M&A, too. If a system is looking at three different hospitals with similar profiles but one is an absolute powder keg in terms of its workforce, that would probably make it very easy to choose a different acquisition. It’s a different metric than most systems have looked at in the past. The focus has been on heads in beds. But looking at the distressed asset from the workforce standpoint will change the game a bit. The question will be, “What can our system sustain in terms of volatility, whether it’s attitude or behavior? Can we repair the culture or, even though it makes sense on paper, should we walk away because it will never fit?”

david_shifrin In High Stakes, , Strategic Positioning

Special Report: Clinician Burnout and Managing the Unsolvable

“No go, unfortunately.”

That was the text from a contact saying her spouse wouldn’t be able to talk to us for this piece. As a critical care physician who’s spent the last year and a half treating COVID-19 patients and is now taking an extended sabbatical to recover, he was the perfect source for an article looking at the current state of the healthcare workforce – the accelerated burnout, the frustration, the fear and the sheer exhaustion. We had questions lined up: What do doctors and nurses need today? How much does monetary compensation play into the equation versus other types of support? Do the rumblings about an exodus from healthcare represent a real threat? Where do you hope to be after your time away?

But no, we would not be asking those questions. And maybe, that makes the story more powerful. Because the reason that this elite physician couldn’t talk to us wasn’t a matter of practicalities and scheduling. It was because he has given everything to save as many people from COVID-19 as possible and has nothing left. “He just shuts down when we talk about COVID,” the spouse said.

That absolute exhaustion encapsulates the problem our entire healthcare system is facing today. It clarifies both the human cost and the operational challenges facing provider organizations.

This report, based on interviews throughout the Jarrard Inc. network of clients and experts, triangulates the trends, draws conclusions about the future and offers thinking on how to manage an issue that’s gone past the boiling point.

That’s the public side, though. How much do the headlines reflect what’s happening behind closed doors? And, how much of an impact are we seeing from the visible PR battle combined with the results of closed-door negotiations? What’s the public perception of providers and payers? Does it even matter?

To determine whether payer-provider relationships are under more strain than usual, we spoke to experts in our network, checked in with our team and polled the public.

What we summarized: The cold war is heating up. There’s pressure on and from both sides, and a growing feeling of “Us” vs “Them.” Publicly, the balance of the PR is weighted towards payers, thanks to the campaigns mentioned above. But the insurance industry has a way to go to convince the public of its good intentions.

What We’re Hearing

Overall, payers and providers are getting more aggressive. Historically, negotiations tend to follow a set arc, with long, tense conversations bumping up against the expiration date only for a deal to be struck at the eleventh-and-a-half hour. While that remains largely true, the tone of more negotiations is getting hotter, the demands bigger. And in some cases, according to sources, the conversations nastier and more personal – with some individuals pointing fingers at the people across the table, not the organizations represented. That’s a problem.

As both providers and payers get bigger, it makes sense that the stakes would get higher. Each side is looking for leverage, and size is leverage. There are many reasons why hospitals pursue mergers and partnerships. Strength to push back against payers is certainly one of them.

An Elephant in the Room

Or, ahem, at the negotiating table.

Last year, as the CMS price transparency rule loomed, a big question was how the posted data would be used. Providers were concerned the data would be of marginal value to consumers – but a gold mine to competitors and other industry stakeholders. Eight months on, that’s looking more likely.

Sources tell us those numbers are beginning to come into the national discussions around price. While the data are far from perfect – in some cases they’re not even that great – they could begin to affect payer-provider negotiations.

M&A skeptics (including the White House) like to note that “The top 10 health systems now control 24 percent market share,” according to Deloitte. Yes, and, the five biggest health insurance companies control 44 percent of the market. Half as many players controlling almost twice as much relative territory. So, joining forces with a larger system that can help balance the weight makes a lot of sense for a smaller provider.

Document with the White House signet with text that reads "FACT SHEET: Executive Order on Promoting Competition in the American Economy"

Still, it’s not all brass knuckles. “I’m seeing more candid discussions and true attempts to find middle ground,” said James Kennedy, a Tampa-based shareholder and chair of the healthcare practice at Carlton Fields. Greg Maddrey, director at Chartis and president of Chartis Consulting, said he’s seeing a mix of discussions:

“We see very collaborative discussions in some parts of the country and contentious discussions in other regions. It depends on the payer and market. One system just negotiated a significant value-based program, and they are exploring additional opportunities for JVs/collaborations. In other areas, the negotiations seem like traditional zero-sum game models.”

Things Usually Work Out, But…

We’ve also seen recent examples of things falling apart, eleventh hour or not. As the players get bigger, so do the numbers of patients who will suddenly find themselves walking into an out-of-network facility. Then comes the finger pointing as both sides try to pin the blame on the other. “They’re too expensive!” says the payer. “They’re raking in profits and want us to take less!” says the provider. “We’re trying to find a solution for our patients,” both exclaim. Meanwhile, patients are left scrambling, confused and footing the out-of-network bill.

Fortunately* for providers, the public is on their side. Or at least, more on their side than on the side of payers. We recently fielded a survey of American adults to get past the noisy headlines and figure out what the public actually thinks.

Do You Think Healthcare in the US Costs too Much?

Pie chart showing 85% "Yes" and 15% "No"

Who is Primarily Responsible for the Cost of Care?

Pie chart showing 12% "The System," 15% "Doctors," 13% "Hospitals," 30% "Insurance Companies," 16% "Government," and 10% "My Choices"

Most everyone (85 percent) agrees that healthcare is too expensive, and 30 percent of consumers believe the insurance industry is to blame. Only 13 percent blame hospitals for the high cost of care. Makes sense, then, that insurance would want to reposition itself in softer, friendlier light. It also follows that health insurance advocates would want to shift some of the blame to hospitals.

*About that asterisk: Hospitals should be pleased that they retain more of the public trust than other healthcare stakeholders. But they shouldn’t take that trust for granted. While the headline-grabbing ongoing campaign against hospitals doesn’t seem to have taken hold in the public’s mind yet, nothing says that it won’t.

What Happens Next

On paper it looks like providers are facing a multi-front battle, with skirmishes breaking out in places and tensions rising in others. How do you, as a provider, prepare for the impending charge? By going on the offensive.

Publicly

Explain your value. Repeatedly. Specificity is the antidote to speculation. Be aggressive in presenting data that shows how your organization contributes to the community it serves. Patient visits, lives saved, babies delivered, cancers caught early, people employed, economic impact. If your hospital reflects the local demographics, if you have a career development program to help improve diversity at the upper ranks, if you have a unique recruiting program to bring in more diverse physicians – talk about it. (If you don’t, start working in that direction). Talk about what you do with the revenue that comes in. Explain where that four percent margin you make is reinvested.

But don’t get mired in the data. Personalize it. Use stories to illustrate the numbers. Need a sign that stories are effective? Look no further than the “other side” of this debate. Hospital critics have been far more effective using stories to illustrate purported patient harm. They’re masters at personalizing the numbers they’re attacking. The public can see and hear patients and the pain they’re suffering. In contrast, providers, so far, tend to speak in numbers and vague platitudes. It’s no contest.

Explain how healthcare finance works. Did you cringe? Fair. Explaining the complexities of healthcare is brutal and daunting. But it’s on you to simplify the complex (or call in the experts to help you with that). Clear is kind, right? The more absurdly dense something is, the harder you need to work to explain it clearly, and dispel any sense of covering up, hiding facts and being opaque. Your patients and the public will appreciate you for that.

More Smart Strategies

Keep these tips in mind to navigate public disputes with payers

Advance preparation is key

Strike first to frame the issue

Clear, patient-centric messaging is most powerful

The messenger matters most: Clinical spokesperson is key

Establish a single source of truth online early on

Tactics & tone must match culture

Marcom obviously plays a lead role here. It’s time to develop educational materials to explain how insurance and billing works, and what patients’ options are. Not the inscrutable, low-quality papers that look like they came off a 90s copier, but attractive resources that explain in simple language what the terminology means, where people should look for information and how to interpret what they find. Video is helpful, or even social media posts to talk through the basics. Finally, work with your rev cycle team to ensure that anyone who might interact with patients on billing is trained to answer questions…in a friendly way.

One more thing here. While you’re translating the basics healthcare finance to your patients, think about going public. Seek out opportunities to talk in public forums. Use the media. Be a resource for reporters who are covering these issues. Don’t wait until they call you with tough questions. Position yourself proactively as the one offering information.

Privately

Get networking – now. Weak or nonexistent relationships sit at the center of problems around the negotiating table, according to experts who provided insight for this article. As noted above, some negotiations include personal attacks – an odd, dispiriting development. Without relationships, there’s no built-in trust, no ability to read the other side’s actions or words – typical buffers that prevent conversations from turning nasty. In the legal world we hear of plaintiff and defense attorneys having lunch together, meeting for drinks after court. On the surface, it feels strange to be dining with the enemy. But the outcome is often far more amicable and productive in legal proceedings. Healthcare could use the same approach. It’s time to network and meet with counterparts regularly so that the personal relationships can help soften the rough edges of negotiation.

The need for better relationships extends to employers and brokers, as well. As providers struggle to match up with payers, the employers who are effectively paying for care and whose employees make up the patient base can be strong allies. In our experience, this doesn’t happen nearly enough. Same thing for insurance brokers, who are often so key to connecting the various pieces of the how-do-we-pay-for-care puzzle.

In all of these networking conversations, providers must always take the high road. Everything should be about improving the health, access, experience and comfort for those receiving care. It’s all too easy for patients to get lost in the skirmish, but providers must intentionally make them the focal point.

Profanely

This is a no brainer. Just @%!# do it.

Providers save lives. They drive innovation. They employ millions. The provider side of the industry is not without its faults, and we should not hesitate to call out problems and bad actors. Ultimately, though, it is the providers who deliver care. Make that point in public and in private. Step up efforts to ensure every aspect of your organization is aligned with its mission. Make the case with data and stories, and don’t behave in ways that could give critics fresh ammunition.

As insurance companies increase the pressure, consolidate and integrate with providers of their own, delivering on their mission and showcasing how they’re doing it is the best way for hospitals and health systems to maintain trust take the financial steps necessary to keep the doors open.

Ian Petty In High Stakes, , Quick Think

Now’s a Good Time to Not Say Dumb Stuff

Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: The Science of Masking Kids at School Remains Uncertain

Inconclusive doesn’t mean invaluable. True, inconclusive results from scientific studies often get put on the back shelf and don’t make their way into published results. But last week when the CDC skipped over results from studies casting doubt on how much masks really do benefit young kids – it was a flat-out communications snafu.

What it Means for Your Health System

(3-minute read, 22-minute podcast)

Brilliant, experienced people across the country keep forgetting this basic lesson: Pause. Consider the consequences. Speak.

Examples? There are plenty:

The CDC is “file drawering” data that shows the science of masking kids in schools might not be as settled as they’ve maintained.
Hospital advocacy groups are responding to specific, reasonable questions about price transparency with, “It’s really hard.”
The FDA gave accelerated approval to a “blockbuster” Alzheimer’s drug against its own committee’s recommendation and then responded by doubling down.
Last year, public health leaders told everyone to hunker down at home in all circumstances – with a sudden carveout for social justice protests.
Local officials reopened bars and restaurants before many other businesses with convoluted explanations why drinking on a Saturday night was totally fine as long as it concluded by 10 PM. Cheers? Maybe not.

Each of these decisions was made with good intent. Some on compressed timelines with uncertainty swirling. Others were crafted in the heat of the moment – but here’s the problem: Often, those moments were either avoidable or could have been at least somewhat predicted.

On top of that, these conversations are happening at a time where people are inured to bad news. We’re sapped emotionally to the point we aren’t responding normally to tragedy – in fact, we’re not responding to tragedy. We’re out of empathy. That means getting a critical message across may be harder than ever because people either won’t respond or will respond with skepticism.

This bleak picture coupled with missteps by the groups mentioned above are a warning to communicators about the risk of being unclear. Here are five pointers that hold true whether dealing with the heat of a crisis or a thoughtful explanation of a long-running issue like pricing:

Get accustomed to overexplaining things. Don’t assume your audience knows everything. The CDC and FDA, should know by now that very few people deeply understand science; therefore, simplicity and repetition are key. Same goes for the rest of us. Hand waving and saying, “It’s complicated but trust us” doesn’t cut it. Use simple language and repeat the message with empathy toward your listeners.
Know your audience. Understand who you’re trying to reach, their concerns, barriers to communicating with them and whom they trust. Prepare to communicate with them on issues that matter to them through their preferred channels.
Slow down (a little). You know to “tell your story or someone else will.” That doesn’t mean “say anything just to fill the space.” You may feel like you don’t have time, but trust us, you’ll spend more time cleaning up the mess if you’re sloppy the first go around. Pause to give everyone at the table a moment to consider and make sure you’re addressing the real issue.
Consider the consequences. Having understood your audience and slowed down to consider what you’re doing, think through how the message you’ve crafted is likely to be perceived. Anticipate questions. What holes will people on the receiving end try to poke in your message? Responding to questions by saying something is “really hard,” or that “hospitals are trying but maybe we should scrap the whole system,” looks like you’re spinning. You’re certainly not addressing the concerns of actual patients whose lives and wallets are at stake. To be clear: Don’t shy away from offering the kind truth and standing up for what you think is right. Acknowledge concerns; don’t brush them off.
Don’t be just truthful. A favorite phrase around Jarrard is “responsible transparency.” It’s the idea that we should offer more information than we’d like to because it builds trust and gives our audiences a more complete picture. Even when the information might not be what we want it to be. When the CDC fell down with the masking story, they weren’t fudging the numbers or hiding data that showed masking has negative effects. It appears they were just trying not to muddy the water. But this is a national debate about the safety of our kids and, despite the insane heat of that debate, it’s crucial to show your work, warts and all.
Know that some people will misconstrue, misrepresent and mislead. There are trolls and click-bait artists who will come after you no matter what. You can’t reach them. Don’t let them stop you from doing the right thing.
Speak with kindness and empathy. We know, a lot of us are running out of empathy. Here’s good advice from a commentary in The Wall Street Journal: “Healthcare professionals have a challenging obligation to work to understand where people are coming from, build a relationship, address their fears to help them understand, gently correct information that is wrong, admit when medicine was wrong and medical authorities misled people, motivate them based on their needs, and develop networks of support in the community.” Amen to that.

Ian Petty In High Stakes, , Quick Think, Strategic Positioning

Payers Singing from the Same Hymnal: A Q&A with Wendell Potter

Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

Editor’s Note

Call it perfect timing. Last week, when the nation’s largest provider in California and Anthem Blue Cross finally inked a deal after months of escalating friction, we’d just dotted the final I and crossed the final T on our Special Report on payer-provider tension. Check it out and then chase it down with our Q&A with noted author, speaker, Congressional witness and consultant Wendell Potter. He spent years leading comms and PR at Humana and Cigna before leaving to advocate for healthcare reform and shine a light on how payers operate.

Jarrard Inc.: We talk a lot about the increased scrutiny on providers, and not just from insurance companies – also from media, advocacy groups, Congress and the White House. What are you seeing?

Wendell Potter: There’s a decline in favorability because of news coverage over the past several weeks, months and even years. Part of it is the result of an ongoing campaign by payers to point the finger of blame away from them. Insurance companies are quite adept at shaping the conversation. They’ve spent a lot of time trying to make the public think that they are largely blameless for any ills in our system.

Jarrard: What is it about providers that makes them a target?

WP: One thing is that they have brick-and-mortar facilities. They’re seen, they’re ever-present and we need them. Insurance companies are not that way. People can assume they have good coverage and pay little attention to the name on their insurance card. So it’s less visibility, less awareness, even on lawmakers’ minds. A decade ago, during the debate on the ACA, insurers were under more scrutiny than they had been in a while or have been since. But a lot of the attention has been shifted in subsequent years to rising healthcare costs. The insurance industry has been quite successful in getting everybody to focus on rising cost of hospital care and pharmaceuticals. It’s playing out in what Congress is paying attention to right now.

Jarrard: Why are health insurance companies so good at creating this public narrative?

WP: They’re able to get everyone to sing out of the same hymnal. It’s interesting because AHIP has a pretty diverse membership – non-profits and for-profits of different sizes. But they’ve been good at forcing message discipline and being perceived as the ones wearing the white hats.

For them it’s an absolutely necessary strategy where it might not have been for others in healthcare. I don’t think others have understood the vital importance of doing what the insurance industry does day in and day out. Essentially, insurance companies are not necessary. We’ve got evidence around the world that health systems can get along quite well without them, so they have to have an ongoing campaign to make people believe they offer a very good value proposition. And they’ve been hugely successful in doing that.

Jarrard: We recently asked the public who they blame for the high cost of healthcare. Insurers came in at 30 percent with providers at around 15 percent. People trust their doctors and are more likely to blame insurers than hospitals, but in our view, providers need to cultivate that trust, not rest on it.

WP: I think that’s absolutely right. If you were to do a comparison of what you’re finding now, versus what it was a decade or two ago, you’d see some changes in attitude. The losers have probably been on the delivery side. Insurance companies have always brought up the rear in terms of public opinion. We want insurance to pay our bills and get out of the way. There is a lot of work that needs to be done on the part of provider organizations to rebuild trust with the American public.

Jarrard: How do providers do that? What can they do to tell better stories?

WP: It goes back to value proposition. There needs to be renewed focus on crafting messages that resonate with the public about what the value proposition really is. It’s always useful to have individual stories and throw in data. But if you just lead with data, people’s eyes glaze over. So it has to be packaged in the right way.

Jarrard: What are two or three types of data that providers need to really build that message?

WP: Something along the lines of population health. Talk about what your system is doing to improve the quality of life in the communities that they serve. You can get into wonky topics like social determinants of health without using that term. It can be important for community leaders at every level to understand what you’re doing, how the work that you’re doing improves quality at the individual level and for people who live in the area that you serve.

Another thing is highlighting good work. When an insurance company is giving money to a group in whatever city, they’ll have a press release. They’re always out showcasing their charitable contributions and what they’re doing. You can’t overstate the importance of things like that.

david_shifrin In High Stakes, Special Report, Strategic Positioning

Special Report: Payers and Providers Square Off

“They” can be a powerful weapon.

It can conjure the other side, the opponent, the adversary against whom “we” are fighting. That word is being bandied about between providers and payers in the escalating feud over the high cost of healthcare. And it suggests that behind closed doors, negotiations between those two parties are getting nastier as the cost of healthcare comes back into focus.

Case in point: “That doesn’t mean they’re not going to try to use this,” said USC healthcare professor Glenn Melnick earlier this year while suggesting hospitals are abusing COVID-19 relief funds. His apparent purpose was to assign blame and set providers as the adversary.

Scanning headlines, it’s obvious that the intense public spotlight pointed at hospitals pre-pandemic has returned (remember surprise billing and hospitals suing patients?). Talk of healthcare heroes is ebbing way, with chatter flowing about the evils of consolidation and health systems driving the cost of care while focusing on profits over patients. Hospitals are being framed as “Them.” Unfortunately, the newsworthy stories about poor billing practices, limited access or other non-consumer-friendly behaviors are self-inflicted wounds by specific hospitals that create opportunities for other actors to paint with a broad brush, undermine providers’ positions and cast doubt about their motivations.

Meanwhile, the insurance industry is working to remake its image from a poorly understood and disliked group to the torch-bearers for patient-centric care. “We.” “Us.” It’s even rebranded its trade association to “AHIP” and is using broader messaging to get away from the focus on insurance. All of this appears to be part of an orchestrated campaign, that’s quite frankly, a savvy PR move.

Ian Petty In High Stakes, , Quick Think

Delta Survey Says: People Are Angry, Patients Are Nervous

New Jarrard Inc. Poll: Six Insights into What Healthcare Consumers Are Thinking

(4-minute read)

As the Delta variant raged hot this week and hospitals began to curtail services, we asked 1,200 US adults about their thoughts and feelings about the pandemic*. Here’s what stood out:

Nearly three in 10 people say the current COVID-19 situation has them less likely to seek in-person care.
Telehealth is sounding better to many, with more than four in 10 saying today’s environment makes them more likely to go that route.
About half of those who aren’t vaccinated are dug in to their position. In fact, they’re so dug in that many of them say they’d leave their jobs rather than comply with an employer mandate.
Sixty percent of the people who are vaccinated harbor some ill will towards those who aren’t.

Several questions continue threads we’ve been pulling in our various consumer surveys over the past 16 months. In each, we want to understand people’s feelings of safety in different settings. (See findings from last April, August and this January.)

Here’s the latest healthcare consumer intelligence:

In-person care has some people nervous. We asked consumers if the current COVID-19 situation has changed the way they’ll seek non-emergency care – in person and via telehealth. Twenty-eight percent said they’re less likely to pursue in-person care. A smaller proportion is actually more likely to seek in-person care. (Yeah, we don’t get that either. Maybe they think wait times will be shorter?) But, the largest shift is in the wrong direction – a tough situation for providers who had a taste of returning volumes this year and now may be facing the need to scale back services due to the latest surge.

Does the current COVID-19 situation affect the likelihood you’ll seek non-emergency medical care in person?

Bar chart representing individuals' levels of comfort in-person

On the other hand, it looks like providers can expect an uptick in patients seeking remote appointments, as 44 percent said the current situation makes them more likely to pursue the virtual route. It’s a great reminder that telehealth needs to stay front and center. Marcom teams should play a strategic and tactical role here, helping shape public perceptions of safety, comfort, convenience and different options for care. It pays to keep patients abreast of any changes along the entire care process – from scheduling to arrival to checkout and billing.

People feel a bit safer in public places now vs. January and continue to feel safer in medical settings over other locations. We’ve been asking this question for the past year. Overall, people’s feelings of safety are up roughly one point from eight months ago, based on our 10-point scale with higher meaning safer. It’s something, but not a lot to bank on.

On a scale of one to 10, how safe do you feel going into…

Horizontal stacked bar graph representing individuals' feelings of safety

Vaccines and masks help allay fear. Many providers are already taking valuable safety approaches that their patients appreciate. But we wanted to dig deeper into respondents who are iffy about their feelings of safety in medical settings.

Asked what factors might help them feel better about in-person care (for non-emergencies), one of the top signals that cohort is looking for is a vaccine mandate.

We’re well-aware that many hospitals are struggling with the decision to implement mandates for employees. It’s a tough call. Still, in the public’s eye, mandates are vital to ensuring their comfort in your facility. Almost eight in 10 respondents in our January poll said that vaccinations should be required for healthcare workers – and this remains a consistent theme. So if you’ve got one in place, make sure you let the people know.

Other top factors in increasing feelings of safety were:

Isolation of infectious diseases in separate facilities
Masking requirements for everyone in the facility

Vaccine resistance is hard-baked for a small but notable percentage of respondents. Almost 70 percent of respondents said they were either fully or partially vaccinated, perfectly in line with CDC data out this week. We asked the remaining percentage about things that might help move them towards vaccination. For about four in 10 – or 13 percent of all respondents – the answer is, pretty much nothing. In fact, we asked if an employer mandate would increase their likelihood and phrased the options as “Yes – I’d do it to keep my job,” “No – I’d leave my job,” and “unsure.” Forty-six percent of the unvaccinated said they’d leave their job rather than comply with a mandate.

For providers, that unfortunate finding is a reminder to spend time and resources where you can make change happen, because there are corners of the community where you can’t.

Would you be more willing to receive a COVID-19 vaccine if…

Stacked bar graph representing what changed individuals' minds on getting the vaccine

Those who are vaccinated aren’t thrilled with those who didn’t get the jab. No surprise, our country is divided. Sixty percent of the vaccinated said they’ve become angrier at those who aren’t since news hit of the Delta variant surge. That anger extends to the medical community, including the doctors and nurses caring for those patients who made the choice – sometimes loudly – to avoid vaccination. Each day, these professionals see the accusations and misinformation. Then they come to work to deal with the avoidable consequences of it all.

Marcom leaders need to continue keeping open lines of communication with staff, keep support resources in place and simply be aware that it’s happening.

Have reports of the Delta variant changed your opinion of those who choose not to get vaccinated?

Bar graph with navy bar representing 51% "I'm more upset," orange bar representing 10% "Wasn't upset but am now," green bar representing 17% "I'm less upset," and light blue bar representing 23% "I'm not upset"

People think the worst is behind us…barely. On a brighter note, a slight plurality – 39 percent – said that they think we’re on the right side of this pandemic. Wishful thinking? TBD. Let’s hope they’re right.

Do you believe the worst of COVID-19 is behind or ahead of us?

Donut chart with green color representing 30% "unsure," orange color representing 39% "behind us," and navy color representing 31% "ahead of us"

*Online poll of US adults ages 25 and up, fielded Wednesday, August 4

Gender: 53% M / 47% F

Ethnicity: 67% white / 13% Black / 12% Latino/Hispanic / 4% Asian

This piece was originally published over the weekend in our Sunday newsletter. Fill out the form for full survey results.

Ian Petty In High Stakes, , Quick Think

Death by Misinformation: Five Ways Providers Can Fight Back

Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

Scroll to the bottom for a podcast and question of the week.

The Big Story: Surgeon general issues warning about sharing health information on social media

Male with grey hair in U.S. Surgeon General uniform sitting in front of a blue backdrop with the words "State of the Union" repeated; play button hovering over face

The US Surgeon General urged social media companies to do more to combat rampant sharing of health misinformation. It was a slight walk-back from the President’s earlier comments that tech companies are “killing people” by allowing misinformation to be propagated on their sites. (Biden has also softened his statement.) Then, on Thursday, Senator Amy Klobuchar put forward a bill that would “strip online platforms such as Facebook Inc. and Twitter Inc. of their liability protections if their technologies spread misinformation related to public-health emergencies.”

What it Means for Your Hospital

(2-minute read; 18-minute podcast)

Can your clinicians go toe to toe with Dr. Facebook? Yes and no.

Yes, doctors and nurses remain highly trusted when it comes to health information. But both younger and lower-income demographics express less trust in their doctor. Fewer young adults have a primary care provider than do older generations. And the percentage of people who consider healthcare overall in the U.S. “good or better” has dropped below pre-pandemic levels.

There’s been a shift in the relationship between patients and the medical community. It’s less personal, more transactional. At the same time, people are forming strong online relationships, turning to Facebook and the like to find, validate and act on information.

The national buzz is heating up on how we should combat misinformation and the relative contribution of individuals, tech companies and government.

But closer to home, do local healthcare providers have a responsibility to step in and correct misinformation their patients may be receiving? And how can the marcom pro on the ground help stem the tide of misinformation on vaccines or any other topic? This may help:

Get in the fight. After an exhausting year putting out hour-by-hour information, many marcom teams have refocused this year on other critical issues facing their organization. But you’re needed, spreading as much good information as possible.
Activate your existing supporters. You can’t do it alone. The good news is that you have an army of brilliant and enthusiastic people with credibility to help. Your clinicians and your patients themselves. Help them all to spread the word. Provide tip sheets with do’s and don’ts for talking to friends and family.
Similarly, use relationships where they exist. On the latest Touchpoint podcast, pediatric gastroenterologist and digital health expert Dr. Bryan Vartabedian said while he’s not normally involved in the vaccine conversation with patients, he has persuaded many skeptical teens to getting the COVID-19 jab just as part of the “one-on-one connection, the grassroots-level conversation” during a visit. So, yes, despite the trends we noted above, the doctor-patient relationship isn’t dead, yet. And that white coat can also exert significant influence outside of the exam room – with friends and neighbors.
Go where they are. You’ve got a well-designed Facebook page for your organization. But just how accessible, friendly and conversational is it? Review your online properties and make sure you’re not just using them as a bulletin board to highlight Heart Health Month. Then, see where you can expand – we’re looking at you, TikTok. Create engaging posts for the channels where your patients spend their time. Might feel weird at first, but it puts the information in the right spot – and your team might have some fun along the way. Be sure to tell your patients about these channels so they know to look for you and spread the word.
Partner up. Early in the pandemic we saw public collaboration between otherwise bitter rivals. Now might be a good time to bring that back. Think about how powerful it would be for the public to see two competing hospitals standing side-by-side. Then, call your peer down the street and invite them to join forces. Maybe even choreograph some TikToks together.

Want more? Check out the 18-minute conversation featuring Jarrard Inc.’s Kim Fox and Tim Stewart:

Ian Petty In High Stakes, , Quick Think

Six Critical Ways to Address Falling Short on Community Spending

Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: Major nonprofit hospitals’ community spend falls millions short of tax break savings, report says

The Lown Institute last week released its naughty and nice list of hospitals based on their community benefits and found that 72 percent of not-for-profits spent less on the community than they received in tax breaks. The report ranks hospitals as community partners based on spending for charity care, community health initiatives and Medicaid revenue. In a first, it also assessed “fair share spending,” which compares private non-profit hospitals’ spending in those categories against the value of their tax exemptions.

Impact on Your Hospital

This failure to cover the tax exemption is red meat for critics of our industry…And where it’s true, it should be. Let’s address what you can do to safeguard your reputation if your organization is one with a deficit in “fair share” spending, at least as Lown figures it. A couple of points to set the stage before we do that:

First, this is real money we’re talking about.

The value of tax breaks for nonprofit providers is significant, with the national aggregate a whopping $24 billion in 2011; experts say it’s likely double that today – do the math, that’s something around $50 billion.
Roughly $17 billion.That, per Lown, is the cumulative deficit from the almost three-quarters of the 2,400 nonprofit hospitals reviewed that spent less on overall community benefits than the value of their tax break (as they calculate it, at least).

Second, “community benefit” is notoriously difficult to define and is inconsistently calculated across the country.

Does it include charity care? Of course. Does charity care include just the cost of the care delivered or the margin lost as well? And that margin is based on what charge? If you’re an academic medical center, does it include the cost of research? (Lown says it does not). While we’re at it, how do you determine the potential tax relief you’re receiving as a not-for-profit? What’s included in that calculation?

The days are passing when providers can rely solely on the great, historic strength of their branded reputations to push aside pointed criticisms of our industry based on thoughtful research like we see in the Lown report.

The visibility of the study demonstrates again that if providers aren’t defining their value to the communities they serve, someone else will. And it won’t be to their benefit.

This story is the latest in a series of critical spotlights on the performance of providers, and it will not be the last. Indeed, there’s more data from Lown on the way – the institute said it will release its full hospital index later this year.

Providers need to do well, of course, and be true to their mission in every investment made and in service to the community.

They also need to know how well they do, how they can prove it and then tell that story. It’s not creating a conversation. It’s joining (and shaping) a conversation already in progress.

What Communication Must Happen Today

Shaping that conversation requires intentional focus on both the work of Community Benefit itself and how you talk about it. It means defining the terms and demonstrating how you’re applying them. Because, in our experience, the apparent discrepancies picked up by the Lown report often happen when individual decisions are made in near isolation, without enough connection to or consideration of the larger issue – in this case, Community Benefit.

Therefore, as you dig into the work and the message, consider the following:

Know your value. How do you calculate your community benefit? Work with your leadership team, including finance and clinical leaders, to create the formula that reflects your orgs true value.
Know your numbers and the story they tell. What does your formula tell you about your organization; what comprehensive narrative do the numbers reveal? Frame it.
Tell your story. Set the table so the value of your organization is clear and defined by you before others do it for you. Engage proactively and consistently with the community through your own channels and the media to show the incredible ways you’re meeting their needs and fulfilling your mission.

And then, as you move forward, keep these three tactical considerations in mind:

Plan ahead. Work with leadership to determine in advance your charity care and community benefits spending – and then plan for how you’re going to measure and publicize this. Marcom leaders, as connectors between community and hospital, should play a vital role in discerning what people want and need. Focus keenly on your community health needs assessments and prioritize spending to mirror needs. Then do it and get the word out.
Stay in the loop and keep others looped in. Your board will be asked about your organization’s policies and actions, especially for community hospitals. Report out regularly on this issue, involve them. After all, as board members they are accountable. Meanwhile, stay vigilant to ensure your organization isn’t engaging in predatory financial practices that are harmful to people and undermine your collective community benefit.
Document everything. If it wasn’t written down, it didn’t happen. There’s a decent chance your organization is doing a lot of community benefit work that’s slipping through the cracks and, therefore, you’re not getting credit for. Capture it all – every community meeting, screening event, health fair, hour donated by employees on the clock, etc. Use that documentation to share what’s being done and spent.

Ian Petty In High Stakes, , M&A, Quick Think, Strategic Positioning

Cartels or Safe Havens?

Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: Biden executive order calls for action on hospital consolidation, price transparency

The President issued an executive order on Friday “telling the Federal Trade Commission to prioritize hospital consolidation in its enforcement efforts. The order will ‘underscore that hospital mergers can be harmful to patients and encourages the Justice Department and FTC to review and revise their merger guidelines to ensure patients are not harmed.’” The AHA and FAH weighed in with overviews and critiques shortly after.

Our Take

(2-minute read)

It’s a Catch-22: Scrutiny of hospital consolidation is increasing in direct proportion to the need for hospitals to find strong partners.

Biden’s executive order follows a cascade of criticism and Senate hearings directed at hospital consolidation – with one outlet going a step or three further and referring to it as “cartelization.”

Yes, the scale of deals is on the rise. A Kaufman Hall study found that the number of deals through Q2 of 2021 is down markedly from previous years, but the size of those deals is “the second highest in recent years.” And yes, some research shows such mergers can drive up prices.

What’s missing from the conversation is that consolidation is happening because the system is broken. It’s broken in myriad ways (seriously, it takes two presidents to let us buy hearing aids without a prescription!?), and we’re stuck until we create something new together.

The current version of the escalating-costs narrative critics are using pins the blame squarely on providers by suggesting – implicitly and sometimes explicitly – that mergers are driven by greed. The White House fact sheet laying the foundation for the order says that “Hospital consolidation has left many areas, especially rural communities, without good options for convenient and affordable healthcare service.”

It’s a compelling narrative. Our question: Where’s the counter? Who’s telling the story of the real reasons a hospital might want – that is, need – to join a larger system? Or of what might happen if they don’t partner up? There’s a taste of that in the AHA and FAH statements, but more is necessary.

It’s time for hospitals and those who care deeply about access to healthcare to build that narrative. To speak up.

Hospitals can and do pursue mergers, acquisitions and partnerships for a variety of reasons. First among them is so they can continue to fulfill their missions. Over and over, we’ve seen hospitals stay open because of a deal.

Which brings up a related reason for deals. Rural providers often have no other option because the math isn’t working in their favor. The government pays as little as 50 cents on the dollar through Medicare and Medicaid. Plus, there’s a downward push by payers to reimburse at lower rates. That means standalone hospitals – particularly smaller community hospitals where relatively little revenue comes from private reimbursement – often must choose between closing or becoming part of a larger system.

Again, you can’t care for your community if you don’t exist.

So instead of the chatter depicting health systems as predatory, let’s share the stories of community providers seeking a partner for true shelter. To be able to survive. Providers and advocates for access can start engaging in that conversation this way:

Articulate the actual value to consumers of a consolidation or merger. To be clear, this isn’t offering the same tired and vague messaging about “value,” “transformation” and “scale.” It’s a direct, honest story about what will happen if the deal goes forward…and the consequences if it doesn’t.
Prepare for state attorneys general, health insurance companies and others to use the administration’s activity to ramp up opposition to consolidation (which challenges their market share). In other words, your government relations work and relationships with opinion leaders matter more than ever.
Explain how you will deliver on promises made. And then do it.

This executive order appears to be a request for more action, not the action itself. That suggests there will be a waiting period, possibly even a comment period. Don’t let that time go to waste. The conversation has been underway for a while, and it’s being dominated by non-providers. Some are well-intentioned and want to improve the value and delivery of care. Others are market competitors (the self-proclaimed disruptors) and adversaries who view this as a zero-sum game and are campaigning to make providers the fall guy. Hospitals, health systems and others who are focused on access need to stand up. This is a new type of scrutiny. It’s time to respond in new ways.

How to do that? Coming soon.

Ian Petty In High Stakes, , Quick Think, Strategic Positioning

Blame and Balance

Pie chart displaying "who is primarily responsible for the cost of care?"

Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: Health insurers soak in pandemic-fueled Medicaid growth

As Americans lost jobs and suffered major financial hits last year, Medicaid rolls swelled. Insurance companies are reaping the benefits because they now manage roughly 70 percent of Medicaid enrollees.

Our Take

(2-minute read)

It’s a strange time. More than eight in 10 adults think healthcare is too expensive, but who to blame? Everyone’s trying to figure out where to point the finger, and everyone in our industry is jockeying to position themselves as THE patient advocate.

But what do patients think? You know, those people actually receiving the care being offered and funded by our $3 trillion industry.

We decided to ask them through a quick survey of 500 U.S. adults.

Easy stuff first: In a predictable landslide, 85 percent said that healthcare is too expensive.

Next question: Who is primarily responsible for the high cost of care? Almost twice as many respondents (30 percent) blamed insurance companies vs. the next biggest culprit, “the system as a whole” (16 percent). About 13 percent cited hospitals. Women – the primary healthcare decision makers – were more likely to blame insurance companies than were men. On the other hand, men distributed their ire a bit more evenly among the various options, though insurance companies still edged out the dubious win.

It’s an intriguing wrinkle in a moment where we’re hearing of mixed results in payer-provider negotiations – some talks are collaborative; others are gloves-off, with payers squeezing hospitals for lower reimbursements. Meanwhile, insurance companies are enjoying the profits they accuse hospitals of pursuing and growing their revenue through increased management of and enrollees in ACA plans, as noted in The Big Story.

All of these pieces – and there seem to be a lot of them lately – add to the imbalance between insurance companies and those who are actually, well, providing healthcare. (Of course, even that distinction is blurring as insurance companies pursue vertical integration).

So, let’s look at a few facts to help balance the conversation:

Rural hospitals across the country are at increasing risk for closure, potentially leaving wider and wider gaps in care.
Safety net hospitals are barely hanging on.
Payers managing the Medicaid population seem to be doing just fine.
The five biggest health insurance companies control 44 percent of the market.
Medicare Advantage and Managed Medicaid grew from 26.8 percent of payer revenues in 2007 to 51.6 percent 10 years later, per Axios. That means they’re making more money from managed care even as providers make less relative to private insurance due to lower reimbursement.
Seventeen percent of in-network claims in ACA marketplace plans were denied in 2019, and only a fraction of a percent are ever appealed, according to a Kaiser Family Foundation study. That means insurance companies managing those marketplace plans are putting consumers on the hook for the cost of care.
MACPAC reported that “There is no definitive conclusion as to whether managed care improves or worsens access to or quality of care for beneficiaries.” More on that story can be found in this article from NPR, also linked in the Axios piece above.

There’s a campaign taking shape against providers in the halls of Washington and the pages of the press.

In a sense, it’s an effort to change the survey results you see above. Will it take hold? Time will tell. For now, though, we see that people are more likely to point the finger at insurance than hospitals. Hospitals have a solid reserve of goodwill earned from their long history and pandemic heroism. That’s a reserve they must not squander.