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In High Stakes, Strategic Positioning

Inflation’s Rising Tide Sinks All Healthcare Boats

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The Big Story: Fed Fights Inflation With Another Big Rate Increase

And: GDP fell 0.9% in the second quarter, the second straight decline and a strong recession signal.

Says Moody’s Analytics chief economist: “The economy is close to stall speed, moving forward, but barely.”

What it Means for Healthcare Providers

Aggressive inflation and the bitter medicine of rising interest rates are the latest gut-punch for providers serving in an endless pandemic, holding together an exhausted workforce, assuring anxious patients and striving to stay relevant and in business.

You’ve seen the plot points for a while. Wage wars. Rising medical debt. Tense payer negotiations. Hesitant, cash-strapped customers. The lack of supply and the cost of, well, everything, from gloves to scrubs to the burgers served in your food court.

But taken as a whole, where does this story take us? Paul Keckley wrote this week that he sees the impact in at least three broad categories.

But how does this big picture affect our agenda for this week’s leadership team meetings? As leaders and communicators, what do we do now?

Good question. To help, we tapped into our Jarrard Inc. brain trust and asked colleagues who work alongside providers big and small this question: “What does ongoing inflation and uncertainty mean operationally, and how should communicators address it?”

Here are their takeaways.

Billing and Cost of Care

By Abby McNeil, vice president, National & Academic Health Systems Practice

Bad debt will rise. That holds true for institutions and patients. Focusing on patients, systems may consider offering greater flexibility on payment terms to help manage the burden and minimize people delaying care due to cost concerns.

Communications Imperatives:

Physician Compensation

By James Cervantes, vice president, National & Academic Health Systems Practice

Competition and expectations will increase. Though they earn more than the average American, like the average American, their home pay is not keeping up with inflation. After record rises in 2021, inflation is set to again outpace expected physician salary growth of two to four percent in 2022. So those three percent increases provider organizations consider doling out to docs don’t go so far in showing the love.

Add to that increasing physician burnout, shifting Medicare fee schedule rates and growing reluctance to pay out shared savings – due to uncertainty and lower hospital margins – and you’re likely to have more unhappy docs coming through hospital doors. It’s a great opportunity for private equity firms, who are investing in physician practices with renewed vigor. For them, the promise of streamlining operations, reducing management responsibilities and increasing compensation makes for an attractive package.

Communications Imperatives:

Labor

By Isaac Squyres, partner, Regional Practice; Teresa Hicks, associate vice president, National & Academic Health Systems Practice

Unions will be pushing. Persistent inflation in an already highly competitive job market could easily lead to continued pressure on labor costs for providers. This time around, it won’t be driven by the cost of travel labor as much as current employees looking for higher-than-customary cost of living and/or merit increases. Don’t be surprised to see unions using inflation during upcoming negotiations as leverage to push for wage increases.

Communications Imperatives:

M&A and Distressed Assets

By Isaac Squyres and Abby McNeil

More hospitals will be for sale, fewer buyers will be available. The eye-watering inflation figures keep triggering rate hikes, with another 75-point rise this week. That will continue to increase the cost of capital for systems evaluating potential deals from the buy-side and lead to pressure for those on the sell-side. With financing set to get harder and more expensive to access, highly leveraged organizations will feel the stress on their balance sheets. Large banks may already be pulling back credit availability to their big customers, potentially leaving organizations to go through other lenders or private funds to get through new projects or even to cover current needs.

Communications Imperatives:

Payer Relations

By Teresa Hicks

Everyone will look to cover shrinking margins. The jump in consumer prices is cranking up the heat in the pressure cooker that is payer/provider relations. Each side is bringing that extra stress to the negotiating table.

Communications Imperative:

Investing

By Sheila Biggs, associate vice president, Health Services Practice

Pressure to execute will increase. After a hot run of investment in 2021, economic uncertainty is starting to cool healthcare PE in 2022. That trend may continue as inflation points to a decent chance of recession. Valuations are now stabilizing after reaching significant heights over the past 12 to 18 months. The result? A greater focus on dialing in the operations and path to steady growth for existing portfolio companies. Resources and expertise will be deployed towards optimizing what’s already there, ensuring a pristine product-market fit and an emphasis on providing a great experience for patients and employees. In the end, that benefits everyone.

Communications Imperatives:

Social determinants of health

By Erika Matallana, associate vice president, Regional Practice

A perpetual problem will reach more people. Interest is growing in food-as-medicine. But with prices rising, the ability to use non-medical interventions to heal or prevent disease has become more difficult. Documented in countless reports over the years, many vulnerable populations have never had the option of food-as-medicine. Whether urban communities of color or the rural poor, purchasing healthy food has long been a financial stretch – if fresh vegetables are even available. What’s new now with inflation: The threshold for who can approach food-as-medicine has been raised, and even unhealthy food is becoming more expensive.

Communications Imperatives:

  • This is the time for empathetic and transparent conversations with employees. Check in on them. Find out what they need.
  • Share more with employees about the headwinds your system faces. Employees who believe in the work you do deserve to understand why you’re making the decisions you are, especially if they’re impacted.
  • Re-up your price transparency and cost-estimator efforts. Make it as easy as possible for people to understand what they’ll be paying and how they can do it.

Physician Compensation

By James Cervantes, vice president, National & Academic Health Systems Practice

Competition and expectations will increase. Though they earn more than the average American, like the average American, their home pay is not keeping up with inflation. After record rises in 2021, inflation is set to again outpace expected physician salary growth of two to four percent in 2022. So those three percent increases provider organizations consider doling out to docs don’t go so far in showing the love.

Add to that increasing physician burnout, shifting Medicare fee schedule rates and growing reluctance to pay out shared savings – due to uncertainty and lower hospital margins – and you’re likely to have more unhappy docs coming through hospital doors. It’s a great opportunity for private equity firms, who are investing in physician practices with renewed vigor. For them, the promise of streamlining operations, reducing management responsibilities and increasing compensation makes for an attractive package.

Communications Imperatives:

  • Hospitals and health systems seeking to keep physicians happy and honor their hard work from the pandemic years will probably need to go beyond three percent.
  • Employers need to focus on the mission of the organization, the role the organization plays in the local community and how employment or affiliation with that organization can provide physicians with the personal and professional satisfaction that they’re looking for. But again, that promise must be backed by delivery.

Labor

By Isaac Squyres, partner, Regional Practice; Teresa Hicks, associate vice president, National & Academic Health Systems Practice

Unions will be pushing. Persistent inflation in an already highly competitive job market could easily lead to continued pressure on labor costs for providers. This time around, it won’t be driven by the cost of travel labor as much as current employees looking for higher-than-customary cost of living and/or merit increases. Don’t be surprised to see unions using inflation during upcoming negotiations as leverage to push for wage increases.

Communications Imperatives:

  • Provider leadership needs to engage in and facilitate conversations now between nurses, unions and administration.
  • In addition, have conversations about what employees may be looking for outside of monetary compensation to help with engagement, job satisfaction and retention. Those things may not fully make up for hourly-wage expectations, but it can help take the edge off. Be clear about what your organization can and can’t do – and why.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

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In Change Management, DigitaLee, High Stakes, Strategic Positioning

DigitaLee 12: Poetry vs Prose

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DigitaLee 12: Poetry vs Prose

This week on DigitaLee, David Shifrin and Lee Aase talk about a potential reset in the startup economy, some of the digital apps and therapeutics that are making care more efficient regardless of the economic outlook, and then notes for healthcare provider organizations looking to implement or partner with those digital health tools.

Listen and subscribe to the podcast, or read the transcript below.

Read the Transcript

David Shifrin: Well, it’s no surprise to anybody that we are likely, or at least potentially, staring down the barrel of an economic downturn, possibly recession. And that has huge implications for everybody, of course, but also the investment community because when money is cheap, when interest rates are low, it’s easier to invest. And so there’s an interesting article in Fierce Healthcare titled “Here’s why some VC investors say an economic downturn can be good for digital health.” The general point of this article is that when it’s harder to build something, better things will get built. It’s the cheap and easy stuff isn’t as likely to be built. And so I think it’s exciting and also challenging because it means that innovators and entrepreneurs and startup founders and all the rest, people who are looking to make change, they’ve got to work harder and really find that product market fit, make sure it’s sustainable and all that. But talk a little bit about, you’ve got so much experience in the startup world as well as the digital world. What do you think about this idea that a downturn may be helpful in resetting the market?

Lee Aase: Yeah. Oh I think it’s, I think it’s right on because it really does impose a discipline on the startups to be having a product that people are willing to pay for that is meeting a real need that they’re eager to have. And it’s not just built on fluff and hope and hype, given what the project that I’m personally involved in right now, we’re focused on providing real value to patients. And as I look at it, we have concerns about a downturn, but we’re also saying, if you’re a low cost provider of a good service in a down economy, that actually creates big opportunity.

Because if you’re able to do that and then to scale, that’s meeting a real need, people will need healthcare, they will need health-related services. That’ll be something they’ll be likely to prioritize.

And what’s remaining to be spent after the doubling of gas prices and all is something that will be probably disproportionately skewed toward healthcare. But so then it makes the value delivery proposition really all that much more important.

You know, you don’t want a downturn, you’d rather, you’d prefer there not be. But given that’s a reality, and I think it’s everybody’s pretty much saying it’s a foregone conclusion that this is going to happen, so you might as well embrace that and understand what the new terrain’s going to be like.

And that really is putting constraints on an enterprise, causes it to need to be much more resourceful and need to make sure that everything you’re doing is contributing toward value for the customer. And it’s like in poetry versus just prose, okay? Poetry puts a limitation on it, and that’s why poetry and music, songs, can be much more meaningful is because it sets rules around you, that in terms of how you have to present your thoughts and your ideas versus rambling on a podcast like this.

David Shifrin: That’s so interesting because somebody I was talking to a couple weeks ago used a similar analogy. He was actually talking about a wedding toast that he had heard, and he made the point about the difference between being contained or having a container, rather than a cage. And those can seem very similar, but they’re not. And the guy I was talking to referenced it and said it’s like poetry and prose.

Lee Aase: Yeah I mean, I’m about to have the sixth of my children get married at the end of July. And what I’ve done for the others is that the father of the bride, father of the groom always, often, gives a toast or gives a speech. I’ve always done a poem, you know, it shows some thought going into it and a caring, actually, about – not to hammer on anybody who doesn’t do poetry in their wedding toast – but it’s just a way of showing that, yeah, I spent some time thinking about this and so I think it’s that same way with an enterprise that those kind of constraints, those rules and the rules of cash flow, as well as profitability, are things that impose a discipline that will, that can be very constructive.

David Shifrin: So let’s focus specifically then, Lee, on some areas where it does seem that there’s great value. And you’re talking about being able to deliver care more efficiently and cost effectively.

And so as you and I were prepping for this, bouncing some articles back and forth about the rising value of digital therapeutics and mental health apps, and then you also sent over a couple of ideas around digital diabetes treatments.

Lee Aase: Yeah. Well, when you’re talking about the things that affect the healthcare system, diabetes and diabetes related illnesses are just massive in terms of the impact on mortality, on morbidity, on just the finances of the healthcare system. And so Virta health is one of those startups based out of San Francisco.

And they’ve had about 50% of their patients be able to reduce or eliminate medications and get blood sugar normalization through dietary intervention, but it’s a real, it’s a high touch by high tech kind of approach. At Indiana University, Dr. Sarah Halberg led the research on this, where they did, it’s not a randomized control trial, but it was a targeted intervention where they were able to take patients who had type 2 diabetes give them this app-based interaction where they’re getting coaching and support from professionals who are able to help them in the behavior change, and to give them advice and help them to make these changes. And when you look at the amount of money that’s being spent on diabetes, medications and complications of diabetes, there’s a reason why I think the last I saw was that the market valuation for Virta health was $2 billion.

And so it’s all…the point is there’s a lot of opportunity there and that’s one in particular that I’ve seen. Levelshealth.com is another really interesting one. It’s more on the…the idea behind it is providing a way for people who are interested in blood sugar control, interested in their metabolic health, to be able to get a continuous glucose monitor, which ordinarily is only prescribed for people with diabetes as a way of monitoring their blood sugar day to day.

But a lot of people are becoming convinced type 2 diabetes doesn’t happen overnight. And by understanding better how our bodies react to different kinds of foods, we can maintain better blood sugar control for a lifetime and avoid the type 2 diabetes.

David Shifrin: So it becomes proactive rather than responsive.

Lee Aase: And there’s a, they’ve set up really an elegant platform.

A couple weeks ago that I went and signed up on their site, they have a waiting list. Okay, you sign up and you’re on a waiting list, which seems really weird for a company that’s selling the ability to have continuous glucose monitors, but then I think the point of that is that it’s membership based. So there’s a couple hundred dollars annual membership fee for this, then you go through a health questionnaire and then they do have a physician or medical licensed medical professional who’s able to prescribe a continuous glucose monitor. And anyway, I just got notification that my unit is shipped and I’m going to get to use it, but they did a really…I think there’s some interesting parts of this, by having the waiting list, it does create a scarcity sort of a feel. Also helps them monitor or make sure that they can manage a really good experience, that they’re not going to get overwhelmed with it.

David Shifrin: Just considering what we were talking about earlier, I mean, if you’re going to do this, you’ve got to do it, you can’t just pull in a bunch of money and then grow and then realize that you can’t sustain it. This has to be done well.

Lee Aase: Yeah. And then I think the other part of it is, by creating that scarcity, once you sign up, then you’re on their list and you get emails, and they get educated about it. Because I could see how some people might have misgivings at first when they say, oh, there’s a membership and that’s before I even get a CGM. And so giving people a little time for it to marinate a little bit is like a sales funnel, an extended sales funnel, for this that is creating an aware, a better understanding of the model and how their system works. So by the time, you know, it was like last week I got the email saying you have a chance to actually get into this, now you can get off the waiting list and get into it. And I was ready to do it, but I also wanted to experience what this platform was like.

So that I could have a better understanding of what’s happening in these in these startups and how they are. Really I think it’s a really interesting way, and we’ll have a really high impact on people being able to take charge of their own health.

David Shifrin: Yeah. And again, so much of this and so much of digital therapeutics and digital health in general is avoiding problems before they become problems. and that lowers costs down the road. That improves the economic balance in healthcare and society in general, so it makes a ton of sense.

So then Lee, as you think about a potential reset in the market and providers of all types are always looking to partner implement new software solutions, digital options, to improve care delivery all the rest, what does the process look like for that right now to make sure that you’re improving the patient experience and delivery of care, keeping costs down and frankly, picking a solution that’s not going to vaporize in two weeks because they ran out of money?

Lee Aase: Yeah. So I think it’s important for the clinical folks to be really bought in on “this is something that will be good for patients.” This really makes sense, from the patient care perspective or from the prevention perspective that this is something that they believe in.

And then being able to evaluate it in the context of so what are the costs of this? Is this going to add to us being able to provide this kind of care? Where can it save us money and some of the other things that we’re doing that will enable us to deliver a better value?

And then yeah, right, looking at the financial situation with the company itself and saying, does this model look like something that is not going to be gone tomorrow? That it’s something that if we’re going to go to market with it with our patients, that this is something that’ll stand the test of time, or at least make it as far as we can tell. Like stand the test of time sounds way…first of all, it’s a cliche story about that. But that it will stand the test of the current turbulence. And that this is a company that is likely to be able to sustain the value and sustain the services to our patient.

David Shifrin: Cool. Thanks, Lee.

Lee Aase: Thank you. I always love this.

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In High Stakes, M&A

Notes from Chicago: Talking Points at the 2022 AHLA Annual Meeting 

Text that reads "American Health Law Association" with their logo on the left over a city backdrop

In-person events continue to bring energy back to the healthcare conference circuit. Last week, a group from Jarrard attended the American Health Law Association 2022 annual meeting. We joined more than 800 other attendees, mostly healthcare attorneys representing both law firms and in-house council for provider organizations. The rooftop receptions and perfect weather were a great follow-on to the Miami conference we attended in May and made for an excellent backdrop to discuss the challenging topics of mergers, partnerships and crises.

Here are a few key themes we heard while reconnecting with friends: 

Lots of activity…but are the buyers there? 

Generally, healthcare deal attorneys indicated that they’re busy. There are a number of deals progressing towards milestones in both the acute and non-acute side of things. Financial pressure is expected to drive activity in the acute care space over the coming quarters. CARES funds have run out. Bond covenants loom on the horizon… The expectation is that more hospitals and health systems who are financially challenged or distressed will be looking for partners. On the private equity side, there’s still quite a bit of dry powder – though if, when and how it’s deployed remains to be seen. 

Looking more closely at activity among hospitals and health systems, sellers need buyers and there’s a question whether all of those seeking a partner or buyer will be able to find one. Potential hang-ups include the fact that financing gets more expensive by the day and that the FTC, DOJ and state AGs are training their powerful microscopes on consolidation – we’ve already seen several deals called off in recent months. 

A search for greener pastures 

Marriages weren’t the only thing that had attendees’ attention. Breakups, too, were a topic of conversation. Observers in the M&A world say organizations are evaluating their current partners to figure out whether they’re still the right relationships. And, whether there are more attractive prospects out there that would be a better fit for the organization going forward. It wouldn’t be a huge surprise to see an uptick in the number of partnerships that unwind. 

A parallel topic among AHLA attendees involved the fit between organizations coming together in out-of-market mergers, a few of which are sprinkled through the list of recent deals. Cultural fit, in particular, was top of mind. Organizations looking to partner across markets need to ensure a thoughtful integration process – an imperative that holds true in both the acute and non-acute space. 

An emphasis on equity 

Health equity was very much a topic of conversation, particularly at the plenary sessions. Erin Richardson, chief of staff in the Office of the CMS Administrator, emphasized the “Biden-Harris administration’s focus on equity” during her keynote address. Our takeaway? Anyone considering a deal must have a message and plan for how a potential partnership will impact health equity. 

With the meeting taking place days after the Supreme Court’s decision to overturn Roe v. Wade, there was an undercurrent running through the conference about possible effects of the decision. Questions centered on what the ruling will do for employee recruitment, particularly for younger workers. Will healthcare workers want to move to states with restrictive abortion laws? Will college, nursing, medical or graduate students want to attend school in one of those states? Speaking of health equity, how might this set us back? And, for companies considering employee benefits allowances that cover travel for services not available in certain states, will the laws even allow it? The potential ripple effects are extensive and inchoate. 

Historic uncertainty 

All told, throughout the conference lingered a feeling also evident during the AHLA Transactions Conference back in May. For the first time, given the competing market forces converging on healthcare, the outlook for the next few quarters is remarkably uncertain. 

The AHLA takeaways gibe neatly with what we’ve been hearing from our clients whom we’re advising on communications and political strategy for a range of partnership projects. With seemingly more sell-side projects in the offing, will the buyers be there to get deals done in an ever-complex and challenging environment? Our advice: Sellers need to explain what they have to offer potential buyers. And, of course, continue to expect a lot of scrutiny for any proposed deal. 

Above all, get out first and control your narrative. 

Questions about the role of communications before, during and after a deal? Give us a call or fill out the form below.

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In DigitaLee, High Stakes, Issue Navigation

DigitaLee 11: Crypto Scams on LinkedIn and Tracking Pixels on Hospital Websites

Orange text that reads "The Digital Future of Healthcare" with smaller text at the bottom saying "DigitaLee with Lee Aase" on a navy blue background

This week on DigitaLee, David Shifrin and Lee Aase talk about digital security in two forms. First, the general trend of hackers and scam artists constantly finding new ways to snag your info…and money. These days it’s a cryptocurrency scam on LinkedIn costing people tens of thousands of dollars. The second thing is the recent news that many hospitals have tracking pixels placed not just on their websites but on their patient portals. That’s bad news and a bad look when it comes to healthcare marketing and, most importantly, patient privacy.

Listen and subscribe to the podcast, or read the transcript below.

Read the Transcript

David Shifrin: All right. So a brand new topic today, Lee, something that nobody has ever talked about before, ever. We were digging under rocks and found this. No, it’s not true. I wish it was true, but it’s not. Conversation today about cybersecurity and protecting our own personal information, and this really started with an article that we found – I think it’s from CNBC – talking about a LinkedIn scam where people are creating fake profiles and then pulling people into cryptocurrency scams while they pose as financial advisors and bilking people out of a lot of money.

So that kind of raised the issue of you always have to be wary about what you’re dealing with online, and then led into sort of a wider conversation about just personal information online in general, which brought up this other new problem that has been revealed recently, where tracking pixels have been placed on not just hospital websites, but in some cases on patient portals. And that is allowing for the transfer, the sale of private health information and other personal information from patients to be sold.

Lee Aase: Yeah. the LinkedIn article – the article about using fraud on LinkedIn, people setting up fake accounts and enticing others into investing in cryptocurrency – and then the story the one person featured was that that they had been directed into Crypto.com, a reputable site, and then building that relationship and then over time having it being migrated or being encouraged to migrate into another site owned by the other, by the bad guy. So I think it’s just good for us to know that people who are wanting to do us ill are restless. Restless. They do not rest and they’re very eager to exploit opportunities.

I see it all the time with text messages that I get saying “an AT&T message: your bill has been paid and please accept your gift” with a link to click, there’s all sorts of just shady things like that are happening. And just I guess eternal vigilance is the price of liberty, as the old saying goes, or the price of yeah, economic liberty. Because the person in this particular case had lost $280,000, had been swindled out of that. And I guess what we’re seeing with these digital platforms is just a lot more opportunity for people to have a broader, for the bad guys to have a broader range, broader scope in terms of an audience that they can try to exploit.

DS: What’s interesting about that article too, I thought, was that it highlighted that LinkedIn is a good place to scam people because people look at LinkedIn as a relatively safe professional place to go. And I think your point is exactly right. They just have to be wary and can’t, frankly, can’t trust anything.

LA: Yeah. They also post that they work at a given institution or for a given company. And there isn’t any verification of that. That’s they’re alleging that. And I’ve had that back before, in my days working with Mayo Clinic, somebody would say they were a Mayo Clinic employee, and they were reaching out to me, and I’d look them up in the directory, in our online directory, employee directory to say, so is this even really a…I don’t recognize this person, is this a Mayo person? But it’s so easy to just say, oh this is somebody who works with me. Yeah, I’ll accept them, whatever.

DS: And then I don’t know if you want to talk about this here, Lee, but you had mentioned too that you had a recent experience with some bots and spammers that fits in with this.

LA: Yeah, it was just crazy. It was right along these lines. And speaking of AT&T, I got a call from AT&T that someone was trying to purchase a phone using my phone number and they had, they were calling to confirm that it wasn’t me, or to check that it wasn’t me. And I said, no, that’s not me.

And when I hung up, I opened my email and I had about 200 different email list subscription things that were coming in saying thank you for signing up for the Indiana Department of Labor list and for the US Agency for Economic Development. And so I did a Google search and said, so why am I getting all these emails for subscription lists?

And I guess this is a scam that’s happening now, where people do some kind of a hard, they were trying to get a free phone, and what they’ll do then is use your email address to subscribe to email newsletters that don’t have a captcha on them, you know, prove-that-you’re-human kind of thing, so then the idea is that when that, AT&T notification comes that it’s swamped by all these other emails that you’re getting as well, and you end up deleting it and not recognizing that it’s happening.

They’ve harvested the lists of all these places where they can push one button and put in your email address and subscribe you to all of them through a bot, and then it’s just a matter of creating chaff, creating counter measures that prevent you from seeing what’s going on. So yeah, that’s just one new wrinkle about the relentlessness and restlessness of the bad guys in terms of figuring out new ways to cover their tracks.

DS: Lee, let’s flip this then from sort of our responsibility – it’s always our responsibility to be vigilant – but to think about this in terms of what we actually give permission for and our expectations around privacy. Our information, as everybody knows, is out there everywhere; we sign up for Facebook, we sign up for Twitter, we sign up for anything, and with cookies we’ve just signed our whole lives away. And yet at the same time, there’s still an expectation, right, that certain elements of our life should be private, particularly when it comes to health.

And so that is a concern now with these, the exposure of tracking pixels being placed on provider websites and on patient portals. So talk a little bit about how social media is collecting information, how these pixels work and why it is possible.

LA: Yeah. When a pixel gets placed on a website and whether in this case that we’re talking about here, you’re talking about patient portals, I think that’s just amazing to me that someone would think that was an okay thing to do. It’s one thing when it’s a regular hospital website, when you’re into the patient portal, then you’re looking and you do events that trigger capture of information.

And they were talking about that; the name of the patient, the time of the appointment and the doctor…so if it’s a specialist in gynecology or in other, whatever specialist, whatever specialty it is, it can be pretty revealing of what kind of interest or condition that the patient might have.

I think hospitals and health providers that are dealing with pixels at all on their sites are really setting themselves up for pretty a big privacy concern blowback, that there will be some episodes like this that will come in the future where information gets disclosed, that somebody will raise a major issue and people and organizations that are using these within their sites are going to be not in a good spot. They’re going to have reputational risk. And I just don’t think…they have reputational risk now, they will suffer reputational damage and there will be concern about it that’ll be hard to erase.

So I would really recommend that hospitals and other providers be super reluctant to engage in that and maybe be very careful. And I don’t know, there was the old Ronald Reagan saying “trust but verify”, but I don’t know, you know, I don’t think you should trust. I think it’s just, it’s playing with fire to be messing with that.

DS: So it does put a little bit of a crimp on marketing plans, because if you just say, look, we’re not going to mess with this at all, we’re not going to mess with pixels, then that does – and talking on the main website, not talking about patient portals, that should just be a given – but if you say we’re not going to even go near the fire much less play with it, then yeah.

That could have potential implications for how you’re doing retargeting, how you’re setting up your advertising campaigns. But I think that the challenge then is, or the call then is just to find other ways to reach people, use other tools. But don’t put yourself in a situation where you’re unwittingly violating all kinds of patient confidentiality.

LA: If you’re the gateway for information getting out about your patients, and even your prospective patients, getting shared with others and sold to others, that’s just not…marketing is something that’s done in healthcare, obviously needs to be done, but that needs to be put in and it needs to be in a very circumscribed place so it’s not doing harm to the people that we’re trying to serve.

DS: So then Lee, for the tip, I think that kind of is it, but more specifically, what are a couple of things digital teams should, after listening to this, should go and check, or that an executive should ask their team to make sure everything’s okay?

LA: Yeah, they should just be definitely finding out what the organization is doing and has done with pixel placement and use of these, and if they’re going to go into it, going with eyes wide open and really understanding in what limited respect they might consider using something like this, but it is playing with fire and likely to get burned.

DS: Okay. And then the other piece of this, again flipping it back towards the patient then, is so often we’ll get emails from different service providers saying whatever, “Xfinity will never call you requesting your password or your social security number,” something like that. And I think that ends up in the material that we get from hospitals or doctors’ offices in that sheaf of papers that we always have to sign in the privacy practices. But I think it’s also important just to, it’s one more responsibility on the providers, but to take the time to explain to your patients how you collect information, how you ask for information, what you’re doing, and to really give them the resources that they need to protect themselves and their personal health information.

LA: And in a way it’s like the survey fatigue that we all have because you get this “American Express wants to know what your experience was like with your most recent person” or Delta airlines or whoever. And with all these disclosures of privacy practices as the consumer, it is bewildering.

It’s just, it’s a snowball. And so finding ways to, as healthcare providers, to be clear about that and eliminate the jargon and try to be plain English communication. But mainly don’t do bad things. Use the mom test: what would you want happening with your mom’s information? And golden rule: doing unto others is you’d have them do unto you, that if you wouldn’t want your information used in that way, you probably ought to not be doing it. Especially given that many of our, many if not most, of our healthcare providers are nonprofits, so you’re supposed to have a charitable public service orientation. I think that weighs very heavily on the level of caution that you should be exercising when engaging in any of this kind of stuff.

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In High Stakes, Issue Navigation

Communications Guidance on Roe v. Wade

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It’s here.

Today, the United States Supreme Court struck down Roe v. Wade.

The ruling is “one of the most consequential in modern memory.”

Across the country, healthcare providers are deeply involved in the private and very public conversations happening in light of the seismic decision.

The questions we’ve been asking since the leak have been answered. This is a moment of divisive and profound emotion. Celebration and relief on one side. Fear and anger on the other. Exhaustion by all as our country is further unsettled.

Hopefully, you’ve done the homework recommended several weeks ago. Either way, here’s immediate guidance.

Speak. To whom and how depends on your community, your culture and position. But the people important to you – your colleagues, nurses, allied physicians and, likely, your community – want to know how today’s decision affects them; how, as an organization, you’re thinking about it and acting on it; and what the longer-term consequences might be.

There are (too) many hot button cultural issues today, some of which healthcare leaders may have strong opinions on but little standing. Weighing in on the war in Ukraine is a local decision.

The redefining of women’s health services, however, is squarely in your lane. It is where your voice is uniquely trusted, needed, expected. Again, whether to have a message on this issue is not optional. Not addressing it – the choice of silence – is a powerful message, too. Choose words.

Here’s where to start:

  1. Align your team. This issue is divisive enough; your organization should speak now with one voice. Gather your leadership group as colleagues, listening to each other in a spirit of friendship, good faith and a shared commitment to the mission of care. Find that common message.
  2. Know your record on abortion services. You have an obligation to follow all laws and regulations. You also have a mission to care for those in need. How have you been operating and, now, how will you operate in the context of your state’s environment?
  3. Equip leaders. Send your managers into team huddles with the tools they need to listen effectively, guide conversations as appropriate, and allow people to express how the news is affecting them while keeping things civil and centered on the common mission.
  4. Check in with employees. Provide channels for team members at all levels to learn about the organization’s stance and how it affects operations, while leaving space to provide input.
  5. Support your clinicians. There’s deep concern about the legal risk faced by physicians who provide women’s health services in states with existing or soon-to-be-passed restrictive laws. Get your legal, clinical, financial and marcom teams together to discuss how you’re handling this and how quickly you can move. Then, meet with the clinicians who may be affected to discuss your plans and listen to their concerns.
  6. Check back with your GR team. Your state officials have been planning for this decision, and it’s a fair bet that your legislature’s and legislators’ plans have been all over the news. Even so, there may be nuance now that the decision is official. You’ll want to know.
  7. Anticipate “what now” questions. Be ready to speak directly to the questions that are asked, but don’t feel like you must have an answer to every question. This is new. Similarly, don’t get bogged down in discussion on scenarios that didn’t come to pass.

This is a hard moment. We know it demands the very best of each of us as we move through this fractious time, and as you take on this challenge for your organization. Mission, culture, zip code and politics all play a role in how you respond. Why so hard? Because it raises the questions, “Who are we as an organization?” and, “Who do we choose to be?”

We also know this is the latest in a relentless accumulation of hard moments. As you rise to the occasion – again – take care of yourself and your team. And know that we’re in it with you.

Photo by Claire Anderson on Unsplash

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In Change Management, High Stakes, Strategic Positioning

What Gets Measured Gets Managed: An Update on DEI in Healthcare

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Healthcare and society are now two years into a period of renewed focus on improving diversity, equity and inclusion for both those employed within healthcare and those served by it. The hope, after devastating inequity and bias were brought to light through the pandemic and George Floyd’s murder, is that this “period” will in fact be permanent. It’s well past time to finally solve the lack of diversity within the upper echelons of healthcare and the gaping chasms in access and health equity between white and Black (as well as brown) populations.

So, then, what progress been made in the past two years? Is momentum being maintained towards bringing more Black voices and experience into healthcare, not just in word but also in deed through investment of FTEs and financial resources?

With the second federally-recognized Juneteenth holiday just passed on Sunday, the Jarrard Inc. DEI team, which operates under the Kaleidoscope name, wanted to get a sense of what’s happening across healthcare.

To do that, we sent questions out to some of our expert friends from across the industry whose work centers on DEI in healthcare – and beyond.

Every contributor reminded us that representation matters – it’s table stakes. And several pointed out the importance of organizations and leaders meeting people where they are by developing initiatives that fit with how those affected already live. That, rather than trying to pull people in and putting the burden on them.

Here are six themes from our conversations. Full quotes from the interviewees can be found below.

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