The new Rx for healthcare PR is totally tied up with the radical redesign of the industry. A number of factors are influencing this trend: great achievements of biomedicine; the waxing of alternative remedies; the rise and falter of managed care; the towering presence of international drug companies; and the loose rein of the regulators that control them.
Each of these developments have made healthcare an increasingly formidable slice of the nation's economy. Spending on healthcare topped a trillion dollars in 1997, and is expected to double by the year 2007, according to the Health Care Financing Administration. By then it will make up 16.6% of the nation's Gross Domestic Product, up 3% from last year.
The lure of such big money is strong, and competition will be bloody.
Healthcare companies that rely on message will have an even greater demand for PR professionals to build their market share.
But it won't be business as usual. To keep pace, experts say, PR pros will have to develop a whole new set of skills. Gone are the salad days when crisp press releases and glossy media kits would score hits with clients.
Success in this dynamic new world demands not only clean sentences but a firm grip on finance. You'll also need to grasp your company's business cold, from the technology they make to the diseases they hope to treat.
And if you can't speak to different publics, from doctors and patients to government regulators and members of the board, don't let the door hit you on the way out.
The rules of the game changed about two years ago, says Roger Rollman, director of communications at United HealthCare of North Carolina. That's when the first salvo in the media's feeding frenzy on health maintenance organizations (HMOs) began. Few institutions, with the possible exception of the Nixon White House, have incurred as much black-ink wrath as the HMO.
At the time, a spate of stories were playing up the controversial 'gag clause', a cost-cutting tactic some HMOs were using to keep doctors in their stables from recommending buffets of expensive treatments to their patients. Congress stepped in to stop the practice, but not before a spate of local papers ran their share of horror stories about patients not offered the best possible treatment in an attempt to preserve an HMO's bottom line.
The trouble, Rollman recalls, was that the papers were running the stories with a national angle, citing example after example of people in other states. The local media didn't bother to bring the articles closer to home. 'Those stories would come into North Carolina on the wires and they would be run as if they were happening down the street.' But United HealthCare, North Carolina's fastest growing HMO, didn't have a gag clause, he says.
In fact, no HMO in the state did. 'When (such stories are) on the national agenda, they have a life of their own. Things go on as if they're on auto pilot with regard to managed care.'
From Rollman's perspective, the problem is a good case study for how the PR needs of managed care groups are like none other. Mark Merritt is inclined to agree. He's vice president for strategic planning and public affairs for the American Association of Health Plans, the country's largest trade association for the managed care industry. Merritt has what must be one of the country's most difficult jobs: trying to convince a nation of skeptics that managed care is in their best interest. He says he has grafted skills from his last post - spokesman for the Republican National Convention in San Diego - to help him deal with what is at root a political debate. 'The attacks that come against our industry are fundamentally political in nature,'he says. 'They require a response that engages on that terrain.'
So Merritt has devised an 'air game and a ground game.' The passing attack is all image, promoting the message that yes, Virginia, you really can get better care at a lower cost under the managed care regime.
'On the ground,' he says, 'we've been finding and identifying literally thousands of people to talk with media and elected officials' about their sunny experiences with their HMO, Merritt says. 'We've only had a bulls-eye on our back for the last two or three years. We've had to ramp up to get our story out.'
In this case, ramping up means spending in the ballpark of $10 million dollars a year. Merritt has field operatives and a high-tech web site to distribute the good news and mount a quick defense in the face of hostile news stories. But the capper, he says, is a multimillion-name database that can be cross-referenced by state, district, and legislator. It's the ultimate lobbying machine, capable of applying pressure where needed when Congress considers a significant bill.
Still, the best strategies won't always overcome southbound momentum.
Nicole Reilly has been Oxford Health Care's spokeswoman for about a year, taking over shortly after October 27, 1997, the day the company's stock tanked by more than 60%. By the end of the market massacre, Oxford had lost nearly $3.5 billion in market share, leaving everyone, from investors to subscribers, wondering whether the next chapter in the company's story would be Chapter 11. Everyone, that is, but the firm itself.
'Here you have a company that's under incredible scrutiny,' says Reilly, senior managing director at Hill & Knowlton. 'Its stock dropped. It has a computer conversion issue. People assumed that a stock drop reflected its position in the marketplace. The good news is, we had a good story to tell. The fundamental premise of the company is sound. But just because we're in the HMO industry made it doubly hard.'
One pro, who did not want to be identified, admits that bearing the standard for a managed care company is a Sisyphean task. Even a strong firm is still 'the cream of the crap', the executive says.
Part of overcoming negative impressions is to release floods of positive spin - 'countermeasures', in military parlance. The Internet, more than any other recent tool, has made an impact in this regard, says Bill Pierce.
Pierce captains the public affairs effort for the Blue Cross and Blue Shield Association who provide health insurance to around 70 million Americans.
Firms that aren't Internet savvy are at a significant disadvantage, he says, not because they lose clients, but because they miss out on a major communications device. 'You can't fax your press release to everyone under the sun, but you can put it on your web site, and you can get it out there fast,' he says.
Broadening the repertoire
Of course, the more things change, the more the old standbys get recycled.
To push the agenda of the Coalition for Affordable Quality Health Care, a subset of insurers that want to stress the benefits of managed care, Pierce has orchestrated a media and grassroots campaign aimed 'at the decision maker' - that is, basically everyone from the plan enrollee to the President's advisors on healthcare policy. The coalition spent $6 million on focus groups, surveys and major network TV spots this fall, and Pierce expects that number to double next year. 'The old tools do work,' he says. 'You have to engage in all fronts in all ways.'
John Taylor, vice president for public relations and advertising at Intermountain Health Care in Salt Lake City, says the dynamics of the healthcare market call for corporate PR professionals to bulk up a few 'core competencies.' These include employee communications, keeping workers in touch with the reality of the company as it gets buffeted by unflattering press. Taylor likes newsletters, but cascading meetings - provided they're useful - help, too. 'You've got to have them on board in our industry,' he explains, or customer service and morale issues could start to creep in.
Another key constituency are physicians. Taylor says 'face time' with doctors is critical to keeping them on board. Training docs to communicate with patients is also imperative, he adds.
Even so, Rhoda Weiss of Santa Monica-based Rhoda Weiss and Associates believes that with the fortunes to be made in the healthcare industry, PR professionals need to broaden their resumes.
'As everyone says (the industry's) gone from being purely tactical to strategic,' says Weiss, who runs an eight-person shop catering chiefly to healthcare clients. 'In healthcare, we really need to look at the needs of the organization. We need to be perceived as the chief communications officer. It isn't a matter any more of sitting at your desk and pounding out a publication. That's not going to get you market share.'
That attitude might sound mercenary, but Weiss argues that without it a PR executive is selling herself short. 'As soon as you use the word executive and have the knowledge of an executive, then you will be an executive,' says Weiss, who recently won PRSA's lifetime achievement award.
'I want to know everything about my company and the business of healthcare. I love doing media and I love writing, but the fact of the matter is, it's not going to cut it today, and it's not going to cut it tomorrow.'
Weiss, who teaches her craft at UCLA and lectures regularly to her colleagues around the country, says the new expanded job description has some very specific demands. People entering the field need to be steeped in finance and administration, and familiar with the clinical and technological, she says. Good writing and a degree in journalism are no longer enough.
A short mention in a major media outlet is nice, she says, but its legs are woefully short.
'PR to me is the sum total of impressions, experiences and relationships people have with an organization,' says Weiss. 'It's not about pretty brochures or being the logo police. We need to get over that. It's about market share. If you put on an event and 800 people come, what's success?
Unless you convert them, so what? PR is not measured by how many inches you get in the media or how many are at an event. It's measured by market share.'
Just as times have changed for corporate reps, PR on the non-profit side of healthcare is different, too. As Richard Hebert, communications director for the Center for the Advancement of Health points out, no one can afford to wait until someone discovers their story. Hebert has spent the last few years teaching doctors how to communicate their research findings to the public. 'My role is to encourage the researchers in the field to not be afraid to talk about what they're doing. Most of (their work) sat on library shelves collecting dust, not getting into the public vision.'
Hebert speaks for a consortium of some three dozen behavioral health associations, psychologists, biofeedback experts and hypnotists, to name a few. 'More and more they're talking about behaviors, and the importance of managing behavior. (Quitting) smoking, exercise, nutrition - all of those are things that we can do to improve our health, and the media has come around to recognize that.'
That Hebert's press releases, newsletters and other communiques get noticed, he says, is no accident. Their relevance to the public is the wash of a formidable tide in medical science. After nearly a century of unimpeded primacy, biomedicine has been caught - even, some would argue, superseded - by alternative medicine. A recent study in The New England Journal of Medicine, for example, found that more Americans visit 'natural' remedy specialists than go to primary care physicians.
Not surprisingly, the biomedical community has responded to the challenge of the alternative medicine regime. In October 1997, after strong lobbying from advertisers and drug companies, the Food and Drug Administration implemented what must surely rank among the agency's most influential decisions. Over the concerns of patient advocates and some medical organizations, the FDA eased its grip on direct advertising of medication to consumers.
The advertising world hailed the move as giving 'pharmaceutical companies more discretion' in how they marketed drugs on TV. Once burdened with fine print, ads could substitute much in the way of side effects and other information with a toll-free number for consumers to call.
The decision has had an explosive effect on drug marketing. Pharmaceutical companies spent more than $900 million dollars on ads to consumers in the year the policy took effect - a rise of almost 50% from the previous year, according to IMH America, a healthcare information firm. That's still less than a quarter of what those same companies spent pitching to doctors, whose imprint is needed for a drug to sell. But it's almost certain to be a low watermark, as the increasing competition for market share, and the high cost of developing a new drug, cut chance out of the sales equation.
For Kathleen Lewton, senior vice president and co-director of the US Health Care Practice of Porter Novelli, the rise in drug ads to consumers is just another example of how the demand side of the healthcare economy is becoming increasingly well optioned and informed.
'Consumers today have lots and lots of choices,' says Lewton. 'To execute that choice they've had to do a lot of homework,' she says. 'Simultaneously, along comes the net, which, at their fingertips, gives them access to more health information - both good and bad - than they've ever had before.'
A decade ago healthcare customers were more or less passive about the way their care was delivered, and took for granted the quality of that care. Those days, says Lewton, are over. 'Today you can't get them to stop talking,' says Lewton, who recently finished series of focus groups on the West Coast. 'They've got the jargon. They talk about 'my primary,' 'my co-pay'. They have learned a lot about the coverage of healthcare.'
But the Information Age has its winners and losers, and one group feeling the squeeze of the better-informed-consumer, says Lewton, are physicians.
'Physicians are also being bombarded by information,' she says. 'Every six months (there are) major changes in diagnosis, at a time when the one thing they don't have is time. Some physicians say the patient has more information.'
That's certainly a significant problem for agencies whose mission is to help promote products - drugs and HMOs, for example - to doctors. Yet it's also an intriguing one. 'The issue of how to get information to physicians in ways they can immediately use it is extremely challenging to people in the field,' Lewton says.
The old and new tools - journal articles, drug reps, the Internet - all help, but none will be sufficient. 'Whether you're working for a pharmaceutical company, an HMO or a hospital, getting information to physicians in a way they can use it would be one of the number one or two challenges.'
Lewton has written a book, Public Relations and Health Care, A Guide for Professionals, in which she attempts to flesh out the admittedly nebulous vocation. 'It's a hot field,' she says. In fact, in the mid-90s, she says, it was a little too hot, with antagonism and mistrust rampant - leaving PR reps in the middle of a firefight. Nowadays, the combatants - patients, advocates, doctors, insurers - seem to be softening their stances and working toward mutually acceptable middle ground, says Lewton.
Some physicians and HMOs appear to be reaching a truce of sorts, establishing treatment guidelines that give doctors a sense of control they felt they'd lost in the early days of the managed care revolution. And patient advocacy groups are springing up to help consumers navigate the numbing bureaucracies of insurance companies. 'I'm optimistic,' says Lewton. 'It used to seem like a war, but I really see that lessening a lot. It's a marvelous time to work in this field.'
New skills for a new market
Good writing and a degree in journalism are no longer the only tools needed to succeed in healthcare public relations. Here is a list of five important skills a healthcare PR professional needs to master in order to truly compete in today's changing market.
1 Be well steeped in both finance and administration. Grasp your company's business cold - from the technology they make to the diseases they hope to treat.
2 Be able to speak to and work with different publics - from doctors and patients to government regulators and members of the board. Doctors are one of your key constituencies. It's imperative to train them to communicate with their patients. All parties - patients, advocates, doctors and insurers - should work together.
3 Use the Internet to circulate press releases. Putting it on a web site gets it out to a larger public faster.
4 Recognize that alternative medicine is a factor in patient care. A recent survey by The New England Journal of Medicine found that more patients go to 'natural' care specialists than primary care physicians.
5 Realize that healthcare customers are better informed today than they were a decade ago.