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

The Big Story: Seesawing Perceptions on the Payer-Provider Playground

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

Our Take

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Questions about your managed care strategy? We can help.

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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

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

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

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

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

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

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

Taking Responsibility

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

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

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

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

Operating with Intention

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

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

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

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

Backed by Numbers

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

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

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

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

Launching the Program

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

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

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

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

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

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

Matching Tactics to Needs

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

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

The health system responded quickly with several primary tactics:

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

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

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In High Stakes, Issue Navigation

Prepping for the Inevitable: Handling a Healthcare Data Breach

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

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

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

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

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

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

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

Before a Breach Happens

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

When a Breach Happens

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

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

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

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

Don’t Duck. Fight.

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

The Big Story: The Healthcare Divide

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

Our Take

(3-minute read; 10-minute podcast)

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

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

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

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

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

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

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

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

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

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

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

Late Night Jabs

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

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

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

Our Take

(2.5-minute read)

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

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

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

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

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

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

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

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

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

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

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

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