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Data and The Upside Down

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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: CVS Health database leak left 1B user records exposed online

Another week, another huge stack of patient information left on a virtual desk for the unscrupulous to rummage through. FierceHealthcare reported that back in March, CVS – through a third-party vendor – left customer data exposed to the tune of one billion search records. As in, not password protected. That’s right, the database had no form of authentication in place to prevent unauthorized entry. The situation was quickly controlled, but it begs the question to healthcare leaders: “How safe is the data you’re entrusting to vendors?”

Our Take

You’re sitting on a gold mine of information, and companies are coming to you with great opportunities for partnerships or you need someone to help manage it all. You have the chance to advance healthcare AND differentiate the care you provide your patients.

What’s not to love?

Maybe nothing. Hopefully nothing. But maybe a lot. So be careful.

With all the growth and excitement taking place around healthcare’s digital front door, a dose of caution is warranted. Because there’s the other side – the Upside Down, for you Stranger Things fans: While more data creates more value for patients, providers and innovators, in the Upside Down, the value goes to the hackers and scammers.

How do healthcare providers run that risk-benefit analysis? You’re certainly not going to build these digital tools yourself, so, how do you pick the right partner and set appropriate expectations with them and your patients? And how do you explain you’re winding down a project if things don’t work out? Finally, do you play a role in educating patients about health tech and navigating the myriad consumer health tools available to them? (Because really, what is Dr. B doing with all that info it collected?)

Here’s our advice.

  1. Create a governance structure in your organization that provides protection from abuse for all stakeholders – including patients, clinicians and staff. Involve everyone in that process: compliance, legal, IT, communications, marketing, operations and clinical. These guardrails will be invaluable as you evaluate any given project.
  2. Ask why you’re considering adopting a technology. Answer the question, “What are we giving up or putting at risk for the sake of convenience?” Run the risk-benefit analysis and make sure there’s a compelling case for the benefits, no matter how shiny the object is.
  3. Consider whether you can achieve the stated goal. Can you do what the end user wants (most likely either your patients or doctors and nurses)? Is partial success possible and acceptable, or is this an all-or-nothing thing? Of course, you can’t really figure this out unless you…
  4. …Talk to the consumer. Find out the value to them and ask about their risk tolerance.
  5. Be open about your decision. If you do move forward, make very clear to the consumer what you’re doing when they sign up. Don’t give them the typical 17 pages of small print terms of service. This is their health, their life and their privacy at stake. Be clear.
  6. Understand from the get-go where the offramps are, whether you achieve success or it doesn’t work out. Have an exit strategy. And then, communicate that exit strategy upfront to all stakeholders. Don’t wait until the project ends – especially if it ends because it didn’t work. People will ask what you’re doing with their data. Answer those questions before you start, not when you decide to quit.

For more on how to prepare for a data breach, check out this recent post.

Questions about your digital footprint? We can help.

You Can’t Please Everyone

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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: 178 hospital workers suspended for not complying with coronavirus vaccination policy

Houston Methodist took a hard line on employee vaccinations for COVID-19 and is under fire for enforcing that rule. Neither the mandate nor the protest is a surprise – a big talking point all year has been, “Can and should healthcare organizations mandate COVID-19 vaccines?”

Our Take

(3-minute read)

The bad news: No matter what you do, someone isn’t going to be happy about it.

The good news: There’s a certain freedom and clarity in knowing that you can’t please everyone. When grounded in mission, it’s an opportunity to do the best you possibly can and then rest assured.

Advice: Mandates are a tough call for healthcare leaders. Whatever you choose be clear.

Now let’s get down to brass tacks. Most people want healthcare workers to be vaccinated. Our own poll from Spring found that 79 percent of Americans believe healthcare workers should be required to be vaccinated. Out of Houston Methodist’s roughly 26,000 staff members, 99 percent got their shot – just over 600 received an exemption or were allowed to defer and 178 refused. Pretty impressive.

Yet questions are swirling as to whether vaccine mandates are legal. Just check out the lawsuits making their way through the courts. One look at the protests at Houston Methodist and you can quickly discern that not all healthcare workers are keen to comply.

This isn’t an easy call. We spoke with David Pate, MD, JD, former CEO of St. Luke’s Health System and our resident expert on this dicey and consequential topic. From that conversation and what we’re hearing from our client network, we know that many leadership teams are making that call based on the following decision framework:

  1. What legitimate reasons do you have as a healthcare provider for mandating staff vaccination? For staff, patients and community.
  2. What other vaccinations are currently required?
  3. Who does the mandate cover – from physicians to vendors to volunteers?
  4. What exemptions are there?
  5. Will vaccinated employees be identified? How?
  6. What changes to current precautions will be permitted for the fully vaccinated?
  7. Who will be educating your workforce about the process for vaccination and answering questions about its safety and efficacy?
  8. Should you first seek voluntary compliance with incentives?
  9. What are the consequences for refusal to get vaccinated?
  10. Do state laws against vaccine passports apply to healthcare employers?

Once you’ve made a decision on your organization’s position, consider these seven communications practices before uttering a sentence or sending your first “Dear Colleagues” email. Above all, know that tension grows when communication is confusing. Inconsistency breaks trust.

  • Explain clearly and often the reasoning and logic behind your decision.
  • Connect your decision with your mission of care for patients and employees.
  • Provide venues for those who feel negatively impacted to voice concerns. Acknowledge their insight, it’s valuable, even if you are staying the course.
  • Define the terms to avoid: “Why does this apply to me and not to them?” Don’t let nuanced decisions appear to be arbitrary double-standards.
  • Prepare for pushback and special requests. Patients may ask to see clinicians who are vaccinated – or demand proof. Have procedures and messaging in place to respond.
  • Put the decision in context. Discuss what other measures you’re taking. If mandating the vaccine, explain who is exempt and any additional precautions they must take. If you’re not requiring vaccinations, lay out plans to keep patients and staff safe.
  • Give people steps they can take. Encourage actions that will promote public health. Reinforce existing guidelines and best practices, voluntary vaccination. Educate people on the benefits of doing so: getting back to “normal.”

Want this information in an easy-to-use resource? Download the one-page checklist here.

Four-Letter Word or Healthcare Hero?

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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: Seesawing Perceptions on the Payer-Provider Playground

This week Modern Healthcare cast providers as potential bullies, taking advantage of COVID-19 to pressure payers for higher rates and bigger margins. This followed on the heels of a tough review of hospital consolidation in The New York Times while America’s Health Insurance Plans rebranded themselves to just “AHIP” as they become providers, too. We’re noticing a thread here.

Our Take

2020 was a banner year for insurance companies, even with a costly Q4. So payers celebrated by rebranding. As the Good Guys. As the ones “guiding greater health.”

This week saw America’s Health Insurance Plans convert to the simple “AHIP.” Very hip to ditch an apparently unpopular word from the moniker. We note, as Modern Healthcare did, what the Edelman Trust Index says about the trust consumers have for “insurance” companies today.

With their reframe, AHIP smartly took a page right out of the provider playbook by using mission-oriented, self-descriptive language such as “champions of care,” and “advancing mental and physical health.”

This blurring of lines might work. Still, wasn’t it jarring to see the news sitting atop the flagship trade publication for, ahem, providers? A sign of the times…and of an opportunity not to be missed.

Each of our picks for The Big Story painted healthcare providers, in part, as bad guys using their size, clout, public goodwill and financial resources to wield power over smaller hospitals and/or insurance companies to boost profits and plump their margins.

This ink is the latest in an accumulating narrative that pins blame for healthcare’s myriad problems – cost, price, pick your poison – on providers. And then elevates payers as the patient-focused advocates for a healthy society.

But that’s not the whole story, of course.

To be clear: Hospitals and health systems are not blameless victims. There are plenty of head-scratching examples of bad practices by providers and, frankly, providers don’t always do the best job of telling their side of the story even when they do the right thing (ahem again).

But there’s another side of the story to tell. One that explores how major insurance companies are raising premiums while pushing for steady or even lower reimbursement to providers. And one pointing out that provider rates are increasing with single-digit speed, while premiums jump by double digits.

It’s an awkward, sometimes contentious moment for providers. We’re not looking to flip the script, but a conversation that will truly make healthcare better needs more balance. An all-around honest and self-reflective look at our healthcare system and how it’s paid for is needed. Because we can’t improve the system without fully diagnosing the problems – all of them.

It’s a big challenge for those covering our overheated industry.

It’s an opportunity and an obligation for providers, too.

So what’s our advice for providers who find their organizations in the middle of these stories? Or who are having to duke out tense negotiations with payers both behind closed doors and in the court of public opinion? Approach it this way:

Steel yourself. Be aware. The tactics and lines of argument used in mainstream media for national stories will make their way into your next local negotiation. One side of this equation (sad that we’re even positioning our healthcare system as having “sides”) has been building a clear narrative and telegraphing that they’ll use it. No provider should be caught off guard. Tune into news like the stories above for the playbook’s X’s and O’s.

Be honest. Engage in some serious self-reflection on how you’re providing care, supporting your teams and doing what you can to fulfill your mission. Don’t let the perception of unfair coverage distract from any real issues that may need to be addressed.

Keep going. If the insurance industry is jockeying for position as the patient advocate, that means it’s a provider’s space to lose. Let payers roll out their new branding. Hospitals and clinics and medical practices are where people go for care, not insurance offices. Nurses and doctors and techs and LPNs touch patients, not actuaries. That’s the story you need to tell.

Get Engaged. It’s a long story. The insurance industry won’t remake their image overnight and providers won’t balance the conversation overnight either. But providers must begin by speaking with a collective voice about their value and engaging in a real, ongoing conversation about the balance our industry must achieve to serve.

Questions about your managed care strategy? We can help.

Operations and Emotions: A Case Study from Penn Medicine’s Employee Engagement for the COVID-19 Vaccines

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When people do it right, it’s our duty to share.

The “doers,” in this case, were leaders at Penn Medicine. Their challenge was getting their workforce quickly vaccinated against COVID-19.

“Our flu vaccination each year isn’t an issue,” said PJ Brennan, MD, chief medical officer and senior vice president of the University of Pennsylvania Health System. “But for this, we had to be more persuasive. We needed an organized approach.”

In that statement, he spoke for virtually every healthcare leader across the country as they prepared for the COVID-19 vaccine rollout last fall and as studies starting last year revealed concerns about the vaccines among healthcare workers.

Penn Medicine’s approach to driving vaccine acceptance is worthy of a close look – especially for the way it connected with employees of color and groups with high levels of vaccine skepticism. And it offers lessons for other projects requiring employee buy-in that providers will always have to undertake.

How’d Penn Medicine do it? The short answer: It took a careful blend of operational nous and emotional intelligence. By May 2021, all of the health system’s employees and clinical staff had been offered the vaccine, and nearly 70 percent—more than 33,000 people—were fully vaccinated. That month, the health system was among the first, and the nation’s largest to date, to mandate COVID-19 vaccination for all its employees by Sept. 1 and for new hires effective July 1.

Taking Responsibility

Florencia Greer Polite, MD, felt the emotional weight of the pandemic from the beginning. An obstetrician, she was just settling into her role as chief of Penn Medicine’s Division of General Obstetrics and Gynecology when a close colleague got very sick from COVID-19. He was intubated for over 40 days, had a stroke and is now unable to operate on patients.

With that experience setting the tone for “the most stressful of my 20 years in medicine,” Polite considered the fall vaccine rollout. “I wasn’t sure when I was going to get the vaccine, although I knew I would eventually,” she said. “I’m not an early adopter by nature.”

But then she noted she was “a leader – and a Black leader – in this department and this institution. I considered what being at the beginning of the curve could mean for other people.” After hearing that vaccine would be arriving in mid-December, Polite ultimately leaned into her role over her natural tendency. “I said, ‘I’m getting it. I’m going to stand on the side of science and not fear.”

Not everyone in her personal circle supported her decision. Nonetheless, Polite joined a group of other Penn Medicine leaders who received the vaccine on December 16, the first day it was available.

Operating with Intention

While Polite was wrestling with her decision to get vaccinated, CMO Brennan was studying the dynamics within the Penn Medicine staff and considering the operational implications of a mass vaccination push.

What led to success was the one-two punch of an efficient operation that came to life mindful of issues of trust and emotion. So the rollout, for instance, ensured from day one that Penn Medicine staffers could see someone from their community who had opted to receive the shot.

The team recognized that no operational work could succeed without first addressing the concerns of the people involved. That concept is going to prove vital in future non-pandemic, non-crisis change management efforts. Whether getting employees vaccinated or getting them comfortable with a new strategic initiative, addressing the emotional weight of the situation must come early on. This is especially true for skeptical groups – in this case, people of color wary of vaccinations.

Here’s how it looked from Polite’s vantage point: “We’re asking you to not just trust science; we’re asking you to trust us. We did it. We’re not asking you to be blindly faithful. We’re letting you know that you can see us in action.” This idea of trust and honesty demonstrated through personal example was at the root of Polite’s ability to move the needle. She didn’t need to “convince” anyone so much as show them.

Backed by Numbers

Looking at the other side of the coin, no amount of emotional support can make up for a poorly executed plan. Weak operations can damage the most carefully cultivated trust. Feel-good stories open the door, but they don’t finish the job.

Brennan and his team turned to the numbers. They wanted to understand the nuances of vaccine acceptance across the Penn Medicine constellation with a particular eye toward job position and race. “In this context, occupation is a surrogate for zip code,” said Brennan, referencing the public health method of using residential zip code as an effective way to categorize peoples’ demographics like socioeconomic status and race/ethnicity.

“White employees had a higher vaccine acceptance rate from the get-go,” he said. Only about one in five Black employees scheduled a vaccine appointment in the first week, compared to more than half of white employees. Other groups fell somewhere in between.

Brennan and his team worked to close the gap. Polite saw her mission clearly. “I have the opportunity as the chief to make sure that we are an institution that practices what it preaches and takes care of our vulnerable neighbors in Philadelphia,” she said.

Launching the Program

Here, the emotional and operational stories of Polite and Brennan merge.

Their solution was Operation CAVEAT, a multimodal educational outreach approach about COVID-19 and the vaccine that Polite fully describes in a Los Angeles Times column she co-authored with Penn Medicine colleague Eugenia C. South, MD, MSPH.

“CAVEAT allowed us to say, ‘Here’s the organizational structure around which we can be in direct contact with the folks who need to see us,’” Polite recalled. She also connected with the CMO of the Hospital of the University of Pennsylvania (HUP) about the lower vaccine uptake in people of color.

That conversation led to an introduction to Aron Berman, who leads environmental services, food services, patient transport and materials management at HUP. “We talked very frankly about the racial dynamics of his team,” said Polite.

Berman said, “There was a very clear problem with high-stakes consequences. I was fortunate to be in a position to have this conversation” and to use his position of leadership to, “do the right thing for our Black and brown colleagues.”

Through that understanding of his team, Berman, like Polite, recognized and acknowledged that race was a significant factor in vaccine acceptance and confirmed that his team wanted to hear from Black physicians.

Matching Tactics to Needs

Having determined who employees wanted to hear from, the next step was how.

Many of the employees on the teams Berman led had limited access to Penn Medicine email. So, the system’s vaccine-related information wasn’t reaching them while false or negative information from external sources was.

The health system responded quickly with several primary tactics:

  • Individual paper “vaccine invitations” that hourly employees could take to the vaccine center and walk in – no appointment, no waiting, no worries about trying to stretch a lunch break long enough to get through the process.
  • A series of posters and one-pagers featuring Polite and other physicians with quotes about why they got vaccinated and facts from the CDC.
  • A set of vaccine-related screensavers featuring Black physicians initially located in break rooms and clock-in/out rooms but later deployed throughout the health system.
  • Inviting physicians – at least one of whom was Black – to join the daily group huddles environmental services, food services and similar teams were already having to listen and answer questions.
  • A town hall meeting, open to anyone in the University of Pennsylvania Health System, featuring a highly diverse group of speakers.

The result was a notable – though not immediate – increase in vaccine uptake among Black employees. While the 30 percent gap they initially had actually briefly widened to 40 percent as uptake among all groups grew, it then declined as the efforts among Black employees gained momentum. Moreover, it’s likely that the effort put forth by the leaders involved will have positive long-term ramifications thanks to trust gained during Operation CAVEAT and related initiatives.

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Prepping for the Inevitable: Handling a Healthcare Data Breach

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Did the Colonial Pipeline hack make you think about the vulnerability of your servers? Do you raise an eyebrow when you see headlines about yet another hospital cyberattack?

Good. Now, what do you do to ensure you’re as prepared as possible in the perpetually escalating game of cat and mouse that is data security?

Jarrard Inc. Vice President Justin Gibbs – our resident expert in data breach prep and crisis work – and Lynn Sessions, partner and leader of the Healthcare Privacy and Compliance team at national law firm BakerHostetler, recently offered their insight on dealing with these situations. Sessions is well-versed in the issue, having guided clients through over 700 incidents.

The issue is complex, of course, but her underlying recommendation is to get back to the basics. “What type of security do you have in place?” she asked. Are you doing security risk analysis? Do you have multifactor authentication in place? Are you educating your staff on the risks? It’s nearly the same advice we’ve been giving as long as I’ve been doing this.”

Beyond those basics, Gibbs and Sessions shared how hospitals and health systems should prepare and respond. Whether your organization has already fallen prey to hackers and scammers or is just waiting for the bad guys to attack, Sessions and Gibbs have legal and communications steps you can take today.

“Get prepared now,” said Gibbs. “you know that it’s going to happen. Get your ducks in a row so you can protect the reputation of your organization that you’ve worked so hard to build over the years.”

Note: This is a general conversation, not specific legal advice. For that, contact Sessions.

Before a Breach Happens

  • Know the territory. Recognize the likelihood of an incident.
  • Create an incident response plan. Gather an interdisciplinary group that will include legal, IT and comms, and may include finance and HR. Consider bringing in a legal or forensic firm to simulate a breach and practice your response.
  • Assign roles. Make sure that approvals for various actions are well-defined and clearly owned. If you do have to make a payment, who signs off? What if that payment is demanded in cryptocurrency? How do you work with your board, and what’s their role?
  • As you move forward in your compliance with transparency and interoperability and data blocking rules, talk about the security measures you have in place. Educate patients on how they can protect their PHI.
  • Train your team for the aftermath of a breach. These incidents can require a hospital’s network be shut down for a day or three. Are your clinicians ready to break out the paper charts while your IT team gets your system back online?

When a Breach Happens

It’s a fine line. Patients and employees need to know about a breach, but you don’t want to create panic. Go with responsible transparency. Sharing every detail likely isn’t necessary and could be harmful. What you should do, though, is:

  • Start with the legal requirements. There are specific rules for what needs to be reported. Talk to your legal team and get that out of the way.
  • Acknowledge that this is a very personal, scary event for patients. It’s their information in the hands of, well, someone. And that someone doesn’t have good intentions.
  • Be realistic about what the breach could mean. Don’t act like it’s no big deal.
  • Explain what you’re doing to preserve patient privacy and to continue operations across your organization.
  • Explain what you’ve learned from the incident and how it will inform future IT plans.
  • Stick to a single set of facts. Pull all the information into one place, update it as needed and ensure anyone speaking on the issue gets their talking points only from that central source. Otherwise, you risk conflicting messages and extending the news cycle.

Want to learn more about protecting your reputation during a data breach?

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Don’t Duck. Fight.

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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 or at the link below.

The Big Story: The Healthcare Divide

The healthcare industry was tossed out of the pandemic frying pan and into the media fire this week when NPR and “FRONTLINE” aired The Healthcare Divide, their joint investigation into the growing inequities in American healthcare exposed by COVID-19. More scrutiny came Wednesday when the Senate Judiciary Committee held a hearing on provider consolidation and antitrust issues. Then on Friday the New York Times ran a story about COVID-19 bills.

Our Take

(3-minute read; 10-minute podcast)

Healthcare providers, it’s time to think less like institutions and more like your detractors.

The halo your organization earned through the pandemic is dimming as the negative spotlight shifts back onto institutions providing care. Everyone’s in on the game. Unions are trying to drive a wedge between provider organizations and healthcare workers. The media is collecting hospital bills from readers. Lawmakers are considering how to wield their antitrust powers. Payers are claiming providers are responsible for the high cost of care. And when consumers truly get on board, winter won’t be coming, it’ll be here.

So why aren’t healthcare organizations consistently better at addressing these arguments? Why do responses often sound weak and platitude-rich – like bland, gray word salad? Like they’re ducking the debate?

Fact is, many still aren’t harnessing the power of communications to tell stories in a human way and are thereby yielding their positions as the owners of patient advocacy. Writ large, the provider side of the industry has traditionally operated from a stance of defense and risk management.

But the pandemic showed us a different way; to tell true-grit stories of how they were making the impossible work.

Let’s hold onto that “what works” and make it permanent.

Because all eyes are on provider behavior. Trotting out outdated studies or spreadsheets won’t cut it. That approach doesn’t hold a candle to the other groups bringing in patients harmed by alleged anti-competitive behavior, telling stories of healthcare workers living on food stamps and being sued by their own employer and painting private equity rollups as dirty, get-rich-quick schemes.

Each of those scenarios has taken place at a national level, but similar conversations are happening in local markets. Want to be prepared for when the spotlight turns to your organization? Consider the following.

  • Define the terms. It’s your story, so own it from the start. Use people. Back it with data. Be straightforward. Words like “integration” may help obscure some of the baggage carried by “merger” or “consolidation.” But people need to understand what you’re talking about. Hospital administrators must be masters at simplifying the complexity of business. Lack of clarity leads to frustration and confusion in the long run.
  • Learn the language. What motivates your hospital isn’t always what motivates the PE firm, payer or union who’s sitting across the table from you as you hammer out a partnership. Don’t talk past them. Understand what they’re trying to accomplish, how they think about the industry and the tools/tactics they like to use. Then address the actual issues they’re bringing to the conversation and articulate how you balance operating a company with providing for a critical need.
  • Be specific. Make it a practice to avoid vagaries. You’re better served calling out datasets and concerns specifically. That way, when it comes time for a rebuttal, you’re addressing a real idea rather than muddying the waters and leaving yourself open to interpretation.
  • Don’t keep using the same narratives. People today are responding to things right in front of them – an unexpected hospital bill, changes in the local labor market, mothballing of services at the community hospital. You need to do the same. Stop running with that same old consolidation study. Align yourself with your doctors, nurses and staff and show specifically what you’re doing businesswise to provide support. If you’re called out for negative effects, respond with responsible transparency and humility, not defensiveness.
  • Call out the bad actors. Yes, there are some in every industry niche who don’t have good motives. Don’t sweep that under the rug, because it’ll just mean you get lumped in with them. Some critics, like the Judiciary Committee, are questioning if the PE model is compatible with providing care. If you’re working to show that it is, you need to share the good stories, but be willing to acknowledge when your peers don’t live up to expectations.

Want more? Check out the 10-minute conversation featuring Jarrard Inc.’s David Jarrard and Isaac Squyres:

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Late Night Jabs

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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 or at the link below.

The Standout News: Brought to You By People Who Are Smarter Than We Are

Jimmy Kimmel, who’s used his talk show to speak on healthcare and politics numerous times, jumped in again last week with a pro-vaccine montage. It featured a handful of physicians who flashed their credentials (and student debt) and insulted people who haven’t gotten the shot. It was self-righteous, hilarious and very cathartic. But not helpful.

Our Take

(2.5-minute read)

We’re offering the white coats a little free communications advice: Skip Plan A – “A” for Aggression – when trying to change behavior. When we talk about using doctors and nurses to advocate and inform because they’re your most trusted voices…this isn’t what we’re recommending. Put simply: Don’t go all Kimmel on your patients. Leave the biting comedy to the pros.

Look, we get it. The absolutely legitimate frustration your caregivers feel having experienced firsthand the trauma COVID-19 can cause and continuing to hear people railing against the vaccines or still denying the virus is an issue.

Even so, wanna make someone dig in their heels? Insult them. Make fun of them. Piss them off.

Of course, Kimmel’s doing a bit, not offering an actual public health PSA (as far as we know). We haven’t seen any of you take his approach. But don’t let it rub off. Don’t let the frustration you feel about stagnant vaccination numbers cloud your pro-vaccine communications going forward. As much as you’d like to verbally throttle people who aren’t inclined to contribute to herd immunity, just…don’t.

Experts say the next 100 million doses will be harder to give than everything we’ve done up to this point. A recent STAT News article titled Vaccinations are plateauing. Don’t blame it on ‘resistance’ put it this way: “As daily vaccination rates settle and the country’s progress toward herd immunity slows down, let’s not rush to the same misguided conclusion that this is mostly about lack of vaccine confidence.” Labeling those who buy into falsehoods “as hesitant or resisters only hardens their viewpoints.”

So how do we make this easier? Well, the CDC’s lifting of the mask mandate is certainly a significant carrot (vs. stick) that ought to go a long way. Otherwise, here’s some advice from your favorite spin doctors – that’d be us – about how to get people to roll up their sleeves.

Listen to understand. You knew we’d include “listen” here. There’s a lot of research out there about what’s keeping people from getting vaccinated. Digest it. Consider what it means for the specific communities you serve. Go to those communities and ask about their experience with the vaccine – why they got it or why they didn’t. Check with influential leaders like clergy and teachers to get a sense of what their communities are thinking and feeling.

Recognize that data only goes so far. Numbers are good to back the position you’re advocating. Combine those with real-life anecdotes for a one-two punch that brings home understanding. Stories resonate far more than bar charts, which is something people who intentionally mislead know well. So as healthcare providers, tell stories about what the vaccine allows people to do, the peace of mind it brings – and back them up with good data. People aren’t asking, “What are the numbers?” They’re asking, “How will this affect me?” Paint the picture.

Set expectations with your clinicians. Doctors and nurses have a lot on them already, so arm them to inform, educate and advocate. Give them the tools they need to do so – whether it’s talking points, collateral, access to your organization’s channels or coaching on how to engage with people who have a contrarian view. Remind them that what they say about this issue reflects on the organization, even when speaking on their own time and channels. This isn’t to say you should take action against a physician who speaks out in a way you don’t approve of; instead, be proactive in reminding people about their role, their mission and the trust people have in them.

Remember that carrot. The CDC lifting mask mandates for those who have been vaccinated is an incentive for those who haven’t. The promise of returning to normalcy should be more effective than threats and insults for those who are still on the fence. Reinforce messages focused on the benefits of vaccination.

Stick with it. We know this is yet another frustration in a year full of them. Hang in there. We may not be able to convince all, but with persistence and calm patience we can convince many. A positive approach – and even a little good-natured humor – will go a long way toward getting more jabs in arms.

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CVS & Mental Health: Running the Gauntlet of Vice

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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 or at the link below.

The Basics:

CVS has joined Walmart by placing mental health professionals in a few of its HealthHUBs across the country, with plans to expand. Meanwhile, other major retailers are beefing up their offerings by adding digital mental health services.

Our Take:

(3-minute read or 9-minute conversation)

Somebody clearly had “transform the industry” on their 2021 to-do list.

Yep, CVS got a lot of ink this week.

First, for expanding its mental health offerings. You can get your Essie nail polish, ibuprofen softgels, four-pack of paper towels and chat with a therapist in one convenient spot. Now that’s called meeting people where they are.

Last week the retailer said it’s expanding the scope of its HealthHUBs to increase access in underserved areas. They’re starting with a dozen test sites in places where many have experienced “high instances of mental health symptoms and distress, leading to increases in emergency visits” thanks to the pandemic.

Very triple aim. Props to CVS for democratizing access. Major step in the de-stigmatization of mental health issues – addressing our mental health should be right up there with our physical health. CVS is taking that step, as are other major retailers like Walmart, Rite Aid and Walgreens – Walmart with in-house therapists and all three with digital services.

Second, CVS announced their new $100 million venture fund to invest in digital start-ups.

Together, these should be big Ws for healthcare consumerism.

For CVS, layering mental health services on top of pharmacy, urgent care, family care and wellness products is supremely logical. And it’s just what you thought might happen when they bonded with Aetna in a loving act of vertical integration. These mental health services will be in-network to Aetna members. If this test pans out and the program expands, CVS will be looking to slot into the care continuum – or redirect it. And those not affiliated with one of the several vertically integrated behemoths could be at a serious volume and reimbursement disadvantage.

Finally, with regard to both the digital innovation fund and embedding therapists in stores, convenience is king. The HealthHUB motto is “Where healthier meets easier.” Enough said.

So, say you’re a traditional provider. How do you react?

We see two options: Partnering up with one of the retailers or taking a page out of their consumerism book. On the first point, the future of healthcare rests on partnerships. Traditional providers will want to be connected with CVS and others making similar moves to tap into the stream of referrals.

Now, let’s unpack the latter option.

  • It’s a given that hospitals aren’t the only game in town anymore. Evaluate the landscape so you know which new players you need to take seriously.
  • Look at your “consumer-friendly” offerings. Are they as helpful as those tools provided by other industries? Are they at least headed in that direction? If not, be damn sure not to over-hype your offerings. Advertising a tool or service that became commonplace in retail a decade ago might elicit a mere “meh.”
  • If you are taking meaningful steps to consumer-friendliness, share how you’re making experiences with your organization easier and more convenient. Explain new initiatives that are in the works so that even if you’re not where people might want you to be, they can see how you’re getting there.
  • Reevaluate your stance on price transparency. We’ve been harping on this for a while. This is a significant issue going forward. Not allowing patients to see prices before receiving care isn’t the same level of consumer experience as that nail polish + therapy vibe you can get at CVS. But it does give people a much clearer look at what they’ll be getting when they come to you.
  • Operationally, think about opportunities to integrate disciplines to foster holistic care. Can you embed or better connect behavioral health with primary care with cardiology with…?

Of course, the onus isn’t just on hospitals. CVS, we have our eyes on you. Here’s what we’ll be watching for:

  • Will you focus on episodic care or do you see this as an access point for a real care continuum? (You say you’re offering referrals along with assessments and counseling. What does that really mean?)
  • How will you help patients navigate what our Jarrard colleague Dan Schlacter termed “the gauntlet of vice?” Walking into a CVS, you’re faced with chocolate, junk food, gossip magazines and, in some places, alcohol. What’s the plan for helping patients work through those potential triggers on their way to the therapist’s office? Triggers that, as a successful retailer, CVS has dialed in through years of applying behavioral analysis.
  • Which door do we use? Between those potential triggers and the desire for privacy, how will you lay out your stores and HealthHUBs to make the pursuit of mental health services not awkward?
  • Will you use paper charts? Just kidding. Maybe. But really, as you expand offerings, how will you manage EMRs? And will there be a firewall between medical records and consumer data? If not, how will you mix that data to the patient’s benefit (hopefully)? 

It’s anybody’s and everybody’s game. Let’s hope the victory goes to the American healthcare consumer.

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Oscars Night Ad Tugs On Heartstrings, Puts Hospitals Under Pressure

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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 or at the link below.

The Basics:

The CMS rule on price transparency went into effect on January 1 but hasn’t been enforced, yet. A new awareness campaign launched during the Oscars last week with the stated goal of combatting hidden prices in healthcare. The group hasn’t gained much traction but has significant (if obscure) financial backing and celebrity involvement.

Our Take:

(3-minute read)

A dash of celebrity can really bring an issue into the national spotlight.

Hollywood tried to do just that last week when they broadcast a $2 million, 30-second PSA on healthcare pricing during the Oscars. The goal was to raise visibility about consumers’ rights to see hospital prices before they receive care.

The commercial’s talent? Oscar-winner and activist Susan Sarandon herself along with fellow A-lister Cynthia Erivo. To rally the effort, the Power to the Patients campaign is encouraging people to display wall art and murals invoking the cause and designed by celebrity artist Shepard Fairey. Check out cool examples on their website.

So. Did it work?

TBD.

Nothing’s gone viral yet: As of Saturday, the ad had only generated a meager haul of followers with 869 on YouTube, 813 on Instagram, 320 on Facebook and 166 on Twitter.

But providers, dismiss this at your own peril – especially if you’re one of the many that aren’t compliant with the currently-unenforced price transparency rule.

For those hoping this will just go away, you’ve got a few things going for you.

  1. The problem is complex.
  2. It hasn’t generated much coverage (finding a good link for the top of this note wasn’t easy and we ended up using their own press release).
  3. While we haven’t done any man-on-the street interviews, we’re guessing a raised fist – as depicted in the Power to the Patients iconography – isn’t what most people will associate with easy-to-navigate chargemasters.
  4. The ad and the website merely point to a problem without really explaining it or offering solutions.

But – and it’s a big but – Power to the Patients’ star-studded roster could be just the catalyst to fire up Americans about their power to bring healthcare to the consumer-friendly levels virtually every other industry offers. Already, savvy pundits are talking, including healthcare economist and blogger Jane Sarasohn-Kahn (HealthPopuli) who gave the organization a shoutout this week. And President Biden has indicated that he’s not pulling the plug on price transparency.

Providers certainly are more accustomed to insurance companies, pharma and medical devices being grilled as secretive drivers of cost. That won’t last long if this issue isn’t reconciled.

While we’re not exactly Power to the Patient insiders, we figure they aim to: induce providers to be compliant with price transparency; expose those charging higher rates and pressure CMS to enforce its own rule.

Which brings us to the advice portion – after all, that’s what we do at Jarrard Inc. So here goes:

It’s doesn’t matter if the campaign is clunky. Or that it uses splashy but vague tactics like murals and posters. Or that it hasn’t created a firestorm – yet. What matters is that the mission of healthcare providers is to deliver better, more equitable and accessible care to the communities they serve. We understand the challenges and the reasons given to not comply today. But wherever you are right now…

  • Think about the experience you’re providing to your patients. Decide whether that experience matches up with your mission, including on the rev cycle side of things.
  • Meet with your team to determine how far away you are from posting your prices and what you need operationally to make that happen.
  • Ask your community. Check in with your patients to learn what they want and how they’d like to approach things like scheduling, payment and – of course – cost estimates.
  • Be ready to explain why you’re taking the approach to price transparency that you are. If you’re not complying and haven’t been asked about it, consider Power to the Patients as notice served that you will be. If you are compliant, be ready to talk about how the tools work and be willing to acknowledge any gaps that may exist between checking the regulatory boxes and giving patients a seamless experience.

It’s time to step up your game. Otherwise, it may be your organization’s name in lights.

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It’s Your Reputation

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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 or at the link below.

The Basics

Two major providers are making a move to help them and their patients by upping investment in online reputation management. They’re looking for more (and more positive) reviews, plus an easier pathway to respond to negative ones. Provider ratings on sites like Google and Yelp are a significant factor when people look for care.

Our Take

A two-minute read for the high points; a 10-minute video/podcast for more

Doctors, we’re talking about your reputation.

And so are a lot of others. While you used to think of marketing and reputation management as “dirty words,” many of you are catching on to the necessity for doing both.

Online reviews are definitely a big deal for patients seeking a provider. Resistance to addressing them is foolish, especially when you start seeing a wave of negative reviews or inaccurate information – like the ambulance that ended up in an empty field because the online listing for a new facility was wrong.

So, how do physicians – ahem, healthcare marketing departments – take care of their online hygiene and manage their reputations? Well, it takes energy and effort – there’s no silver bullet. Which means that before you go sign up with a software provider, you have to do a little of your own recon:

  1. Find your information. Where does your organization show up online? Google? Yelp? Facebook? Where are people finding your brick-and-mortar addresses?
  2. Review your information. Are your hours and basic contact info correct on all those listing sites?
  3. Collect your information. Create a spreadsheet that will serve as a single source of truth. Seem overwhelming? Start with one segment of your organization, say the clinics or just your physicians. This spreadsheet will be critical to tracking your presence online once you do sign up with a reputation management vendor.
  4. Correct your information. You don’t need us to explain this.
  5. Respond to reviews. Get back to people and express your appreciation for their feedback. Don’t avoid negative comments. Don’t do anything foolish, like ask for personal health information in a public forum. Questions? Check with your legal and compliance team – or call us, for that matter (but not for legal advice).
  6. Solicit reviews. Some platforms, like Yelp, don’t allow you to ask for reviews. So check first. Where you can, make reviews part of the post-visit follow up. Make it easy for people. One more time: Make it easy.

So, should you follow in Sharp’s footsteps and embrace reviews, actively soliciting them to help people find you and to look better when the do? If you’ve got your aforementioned ducks in a row, we say bring ‘em on.

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