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In High Stakes, Strategic Positioning, Surveys

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.

In High Stakes, Issue Navigation, Quick Think, Surveys

Delta Survey Says: People Are Angry, Patients Are Nervous

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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.

In High Stakes, Issue Navigation, Quick Think

Death by Misinformation: Five Ways Providers Can Fight Back

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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.

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

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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:

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In High Stakes, Issue Navigation, Quick Think

Six Critical Ways to Address Falling Short on Community Spending

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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: 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.
In High Stakes, Issue Navigation, M&A, Quick Think, Strategic Positioning

Cartels or Safe Havens?

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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: 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:

  1. 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.
  2. 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.
  3. 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.

In High Stakes, Issue Navigation, Quick Think, Strategic Positioning

Blame and Balance

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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: 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.

In High Stakes, Issue Navigation, Quick Think

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.

Learn More
In High Stakes, Issue Navigation, Quick Think, Strategic Positioning

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.

In High Stakes, Issue Navigation, Quick Think, Strategic Positioning

Four-Letter Word or Healthcare Hero?

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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.

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In Change Management, High Stakes

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

Text that reads "High Stakes" on a navy background with a lightly shaded stallion horse icon

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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