Healthcare Roundtable: Careful diagnosis

Transparency and the need to educate varied audiences are among the challenges healthcare PR pros face. PRWeek was in Boston for this Waggener Edstrom Worldwide-sponsored roundtable.

Transparency and the need to educate varied audiences are among the challenges healthcare PR pros face. PRWeek was in Boston for this Waggener Edstrom Worldwide-sponsored roundtable. 

The Participants

Lisa Adler, VP of corporate communications, Millennium: The Takeda Oncology Company

Colleen Beauregard, SVP, healthcare practice; GM, Boston, Waggener Edstrom Worldwide


Judy Glasser, SVP of communications, Beth Israel Deaconess Medical Center


Jennifer Gottlieb, biopharma practice leader, WCG


John Hallock, global corporate communications director, Athenahealth


Beth Martino, associate commissioner of external affairs, Food & Drug Administration


Jeanine O'Kane, director of healthcare, North America, MSLGroup


Daryl Richard, national VP of PR, UnitedHealthcare

The rise of transparency

Erica Iacono (PRWeek): What are the challenges and opportunities overall in healthcare?

Lisa Adler (Millennium: The Takeda Oncology Company): The [Physician Payments] Sunshine Act is something we can all relate to. Starting this past July in Massachusetts, we are required to disclose every single payment to any healthcare provider. We've had to put a lot of systems in place to make that happen. We're also finding the physicians and academic institutions we work with are very leery, nervous, and reluctant because it's on an easily identifiable database.

From a reporter's standpoint, it's quite interesting because you can see who's doing what. My concern is that it will be misinterpreted in a way that will disincentivize folks to participate in research and that it's really going to put a damper on innovation.

Iacono (PRWeek): How much information is too much to share with patients?

Adler (Millennium): Transparency is king, but I think people need to understand the context in which the information is being given. If you see a name on a list and it says $100, you can't automatically jump to a conclusion. That's the risk we have. While the intent of a law can be wonderful, the execution can sometimes go in the opposite way and have a negative effect.

Judy Glasser (Beth Israel Deaconess Medical Center): We share that same issue, being in a major teaching hospital. We have a lot of faculty members who have participated in lots of research programs. All of that is now being disclosed and listed on public websites. Very well-intentioned, smart, innovative, thoughtful researchers who are working with pharmaceuticals are now being publicly listed as receiving payment for work. You see that on a list and you jump to conclusions.

Every pharmaceutical company has a different way of listing it. We're tripping over each other with transparency. Transparency is good and the research support is good, but we've got to find a way as a society to allow it without vilifying these really smart scientists.

Jeanine O'Kane (MSLGROUP): There's an important point about context. The economy is moving 24/7. People want information. The consumer is engaged in a way we've probably never seen before.

There's transparency, but the demand of the consumer to have information has forced the transparency and that context: “Let me frame this for you. Let me give you the tools to take all this information that we're providing and frame it in the right way, use it, and digest it.” That's the part that's missing.

We're in an industry that wants to support and promote innovation and it's heartbreaking to think that there could be a potential negative effect.

Beth Martino (Food & Drug Administration): Government has been dealing with that for a long time, whether it's just salary data that's being put into databases over the last couple years. To me, it helps justify our existence in public affairs and PR.

This type of situation really dictates the need for an overall communications because one of the basics of communications is that you have to think about your audiences and your channels. People can easily rip something apart in 140 characters. It can be a much more challenging task to explain that and you can't always do that with a couple of tweets.

Colleen Beauregard (Waggener Edstrom Worldwide): When we're struggling both through a time when policy has been set and with what the implications of the policy are, this is a really good example. You've got biotech and pharma funding early-stage research and the researchers aren't allowed to talk about what they're doing. Someone calls them from the media to ask them what they're working on and they say, “We can't really talk about it.” It's going to force a dialogue. If we're doing our job, we're thinking about that before it happens so there's some agreed-upon explanation or context that can be provided.

John Hallock (Athenahealth): A couple of years ago, we had the Stark Act. Hospitals couldn't give kickbacks or things of that nature to doctors. What they wanted to do was promote adoption of electronic health records (EHR) so Beth Israel, or [other hospitals], could subsidize an EHR update of 5%. That's not a bad thing. We found that communities that have subsidized Athena, it's worked out to their benefit because there is more transparency in terms of clinical workflow, redundancy, and getting rid of waste.

We had this campaign we thought was so stellar where Athena ranked every single health insurer in the nation on how well or poorly they were paying doctors. We only used financial and administrative metrics. What we didn't do – because we wanted to shock them – was go out to our payer partners. We didn't tell them that this thing was coming. They suddenly started getting calls from Milt Freudenheim at The New York Times. We loved it because at the time we were a private company and we wanted to shock everyone, but we didn't realize that transparency for transparency's sake, without that context which we've since corrected, didn't work.

Educating broad audiences

Iacono (PRWeek): As communicators, has teaching your audience what to do with the information become almost your primary function?

Jennifer Gottlieb (WCG): It's not only educating the consumer or the patient. It's educating the physician, the media, and the consumer because there's information overload. When something comes out, whether it's a company, trade association, or the FDA, it's a big task to educate the whole country or world about what to do. It's more about us as a society and us as communicators looking at what the implications are when we put that out there. Who are our audiences, whether it's physicians, the media, or patients? And what should we telling them about how to absorb this information?

Beauregard (WE): We have so much data, but really no rich information. The companies that can figure that out – the ones trying to automate and integrate these silos of data and make sense of it for a lay consumer – those are the big bets. Those are the stocks you want to buy today.

Daryl Richard (UnitedHealthcare): Health literacy among consumers is still so low for all of our respective industries, so no matter what we decide to do with the data, we still have to figure out how to put it out at a level they can understand.

We just did a survey for open enrollment season. We found that the average consumer spends about 10 hours researching a new car purchase, but an hour or less researching their health benefits.  

Information around the quality and cost of healthcare is still sought after by so many folks. How do I know what doctor to go to? How do I know what hospital to go to? How can I take the time to research the best person for knee surgeries? Is there actual information I can tap into that shows readmission rates and ratings from external specialty societies by which the surgeon is accredited? It's trying to take that information and put it in a usable format. We're starting to build websites and tools to do exactly that.

Beauregard (WE): It's not accessible. There are many movements to make it more accessible, but you can compare healthcare and the insurance industry to where financial services was 15 years ago. They found a way to make it more accessible. It will come for healthcare.

Hallock (Athenahealth): Will it? The big issue two years ago when the stimulus act happened, it was the best and worst thing for our corporation. Suddenly there was this influx of $20 billion for a CIO at a hospital system to use. There are dozens of CIOs and CMIOs [chief medical informatics officer] who have absolutely no incentive to do away with a $125 million IT system that he or she bought 20 years ago.

Beauregard (WE):
What if patients starting choosing their doctors based on the kind of relationship they can have with them? I want a doctor I can reach on e-mail. I want a doctor who will send my kids' vaccines files on an electronic record. Some consumers make that decision. The doctors who aren't willing to adopt that kind of technology will have fewer patients.

Hallock (Athenahealth): When our CEO and sales guys go out to meet with hospital systems, they say, “We're just buying up docs again.” We're going to give them an EMR [electronic medical record] because patients want the data and moms and dads want to go into a HealthVault and see this information. Is that good? I don't know if that's good for utilization costs or for a hospital to have that much market share. Is it good for pricing? The Hi-Tech [Health Information Technology for Economic and Clinical Health] Act is pretty clear on when they want this to go down and it's taken 15 months to get “meaningful use” defined.

Upcoming challenges
Iacono (PRWeek): What changes or challenges do you see on the horizon for 2011?

Glasser (Beth Israel):
From the hospital world, I'm not sure that we would agree with the assessment that things are back and it's going to be a good year. From the provider world, predictions are for a very tough couple years because of real reductions in Medicare, consolidations, reductions from private insurers. On the reimbursement side, there's no growth, but our costs and labor costs keep going up. It's a real challenge.

There was a big infusion of research dollars, which was also a good thing from a research point of view, but that will go away after next year. The path is very unclear. I'd defy anyone to define what an accountable care organization is. It's going to be a really difficult year in the actual delivery of healthcare, in the business of doing healthcare, because of the squeeze on reimbursements and the new structures that nobody quite understands.

Iacono (PRWeek): What about investment in communications?

Richard (UnitedHealthcare): I see a lot more investment for how we communicate to consumers than we've done before. It's going to be needed, whether we like it or not. People are talking about healthcare – what works and what doesn't – a whole lot more than they used to. People were perfectly content with a $10 co-pay. They didn't want to know how much it cost. They didn't want to know how a claim got processed. They didn't want to know the difference between a doctor or a hospital. All of that is changing.

People want to consume more information and it's probably indicative of our society today. We're such an information-rich society. It's going to be knee-jerk in another 15 to 20 years that everyone expects us to be on their smartphones. It's more than just PR.

Iacono (PRWeek):
How do you educate consumers and make sure that messages are really getting through?

Adler (Millennium):
That's the challenge – to make sure those messages are really going through. Like any communications, you have to do it on multiple channels and you have to do it again and again to all the different audiences.

We were meeting with prostate cancer advocacy groups and each one had a different niche as far as whom they communicated with and how they did so. Working with those groups, we can fund programs to get those organizations to get to their folks to ask questions. We're certainly not going to do overt drug promotion, nor do we want to because it's much more credible, not to mention it's the right thing to do [when] working through those channels.

Social media is another opportunity. What we've done is put together this cross-functional team throughout the company, coming up with digital guidelines and policies. It's trying new things. For us, tweeting is a new thing although I don't know what comes after tweeting.

Iacono (PRWeek): How do you understand where it ends?

Gottlieb (WCG):
It's about knowing how your audience ticks. It's not that media is dead, it's just the medium is changing. It comes back to simple customer understanding and behavior.  

O'Kane (MSL):
More than ever, agencies have to be strategic advisers to their clients. If you're not up to that rigor, you're not going to make the match. You have to communicate about innovation. You have to break through tremendous clutter. You have consumers who are searching all sorts of places. The really important part is weeding through all the places where that consumer is and wants to engage. You must figure out the places where he or she is receptive, as well as the communities where they go. Sometimes, it's social media. Sometimes, it's print.

Leading social media efforts

Iacono (PRWeek):
Who is handling social media and mobile? Is it PR? Is it cross-functional?

Hallock (Athenahealth):
Doctors don't tweet. We shifted our entire budget – no more New York Times, no more big-time blitzes – to trades.  It's finding different advocacy groups where we can reach doctors or, better yet, the administrators in hospital systems. It's partnering with hospital administrators and their communications people to go out and talk about EMRs and why we benefit them. It has nothing to do with Twitter and Facebook. How do you get the doctor whose nose is down for 10 hours a day to pay attention?

Iacono (PRWeek):
Healthcare did jump over social media and into mobile. It seems healthcare, specifically, is using mobile in the best way.

Hallock (Athenahealth):
There's a fine line between when a doctor is online to check out drug information and they don't want to see a banner ad from Athenahealth. What about [online physician community] Sermo? We partnered and did a research study with them this year. We wanted to find out how many doctors knew about the Hi-Tech Act. Eighty-five percent of physicians in America had thought they heard of it, but they certainly didn't know the parameters of it. This is $44,000 over four or five years. The whole point is that they didn't even know. I don't know if Twitter is going to do that.

O'Kane (MSL):
Mobile applications are successful because of their utility. They encourage compliance. The mobile thing, to me, is so interesting because not everyone needs to have a Facebook page. The effective social media campaigns are so because of utility.

In the healthcare space, when mobile is used for compliance, adherence, or reminders, that all works and it makes sense. People are still struggling with the Facebook page, the adverse events, and concerns about somebody going off-label. [They ask,] “Suppose I post something and they cut the balance?”

Martino (FDA):
Social media is the “it” thing. It's what everyone wants to talk about. The mistake is jumping into it. It doesn't matter where you are, if you're a healthcare communicator or in financial services.

Beauregard (WE):
People are looking to replace the role of traditional media with something else, but in the world where we're living, there is no one size fits all. There will be people who opt in because the only way they get their news feed now is on their smartphone. Some people do not read the paper anymore. Some people only watch broadcast news. When we develop these communications campaigns, we call them very integrated.

Adler (Millennium):
How do you handle an adverse event? We've been approaching it is slowly, but we also look at it as: new tools, old rules. We keep looking to the FDA and to other folks to give us guidance, but the guidance hasn't changed, the rules of communication haven't changed, but the vehicles have changed. It is not fit for us to do anything from where I sit.

Iacono (PRWeek): It's also about demographics. Just look at mobile health service Text4Baby as an example.

O'Kane (MSL): It's the right campaign for the right people.

Iacono (PRWeek):
What about the cases of [people] who don't use Twitter or Facebook. Can you use mobile campaigns?

Jaimy Lee (PRWeek):
With mobile, you can reach these demographics that communicators might have trouble reaching. It becomes much more of a public health service than a social media page could.

Martino (FDA):
We've been working on partnering with other agencies and through the White House Office of Science and Technology Policy and the Office of Management and Budget on a recalls project [for mobile]. To me, you should be able to take your smartphone to a product, scan it, and determine if it's a recalled product. You should not have to go and scan through a spreadsheet of 30 different things and check a bunch of bar codes.

What would be ideal – and you can see the possibilities – is for all of us to have these store cards, the loyalty cards. You should be able to take the data from loyalty cards and pair that up with our recalls information.

Gottlieb (WCG):
You used to just say, “I want my information by e-mail.” Now it's text and all these other options.

CEO involvement

Iacono (PRWeek): Information overload is a challenge. How do you break through the clutter? How much of a priority is it for your different organizations to have all your different arms online?

Hallock (Athenahealth):
All we're looking for now are the secret societies. You can do SEO and send press releases and keywords, but that's basic blocking and tackling.

Iacono (PRWeek):
Your CEO gets it. That gets back to point of who values communications. It's hard to link PR to sales, although it's getting easier with integration and modeling.

Hallock (Athenahealth):
My CEO went on TV 29 times last year. He does not want to go on TV one bit unless we can find these guys. We'd rather spend $50,000 to get [an influencer] to come to our user conference, thinking that will attract doctors, rather than do anything on CNBC or Bloomberg. It's not hard to get 27 sell-side analysts to cover you. It's not hard to get the attention of Wall Street media. It is hard is to get doctors to say, “Alright, these guys are legit and I'll check them out.”

When you look at our marketing spend and overall marcomms spend versus awareness numbers as it relates to leads, or meetings, or clips, that is the whole lifeblood. That has nothing to do with how many cool stories you get in The Wall Street Journal.

Iacono (PRWeek): There are those CEOs who still want that A1 story in the Times, which is very valuable. But is that as valuable as reaching CardioSource? Do you struggle with convincing your CEOs that having a YouTube channel that reaches people, or Text4Baby, is more valuable?

Richard (UnitedHealthcare):
It's going to vary by industry and by company. For us, it's much more a public affairs model, the work we do, because we're one of the most highly regulated in the country. It's not just about the ad-equivalency model. It's being able to go our CEO and say, whether it's The Wall Street Journal or the cover of The Tampa Tribune, “We got a story in this paper or in this market, where not only are we trying to increase sales in this market by 10%, but we've got an extremely important regulator relationship in this market.”

There are all these other angles that come into the importance of what we do far beyond “great piece in The Wall Street Journal.” There's a general baseline with health insurers of reputational recovery that's needed for several years to come.

Martino (FDA): Coming from the Midwest, it's interesting because everyone invests so much time in the East Coast media – The Washington Post, The New York Times, and The Wall Street Journal. We invest a good deal of time in it at the FDA, but I wanted a copy of The New York Times one morning in Topeka and I had to drive 20 minutes.

Beauregard (WE):
We have to change the mindset from reporting about outputs to outcomes. It's great you can get a story in The Wall Street Journal, but if it doesn't increase prescriptions, if people didn't change their behavior or opinion about your company, product, or service, it gets you nothing. We're really focused on the outcome we're trying to drive and how are you going to measure it. If you cannot measure it in a way that passes the giggle test, you probably shouldn't be doing it.

Iacono (PRWeek): Sometimes we can say that to our boss or our CEO, but in the PR industry, we'll say “But we got 40 million impressions.”

Beauregard (WE):
With Text4Baby, the thing I get stuck with – and I know it's a brilliant campaign – is that they talked about improved outcomes. I thought: “How?” It's brilliant and I'm sure a lot of people opted in, but I have no idea how you measure that.

Adler (Millennium):
There are ways to measure but it's at a very, very grassroots level. As far as your question about CEOs, I'm fortunate that my CEO really gets it. Not everyone else in the company gets it, but she does. What we do is build relationships. You want to build relationships with your customers, with the patient communities.

One thing we're doing is peer-to-peer. We have folks who have had cancer or who have a loved one with cancer go out and talk to other support groups of people with cancer. The basic message there is: “Go ask a lot of questions, get all the help you need, read, and here are the organizations and nonprofits where you can get information.” So, we ask them in advance, “What is your baseline knowledge of resources and what kind of dialogue do you have with your physician?” Then we're going to question them on the way out of this seminar. Then we're going to follow up with them in three months and find out: “Did you have a conversation? Did you feel like you were better prepared? Were you able to ask the right questions?” While we may not have 400 million impressions, we might have 1,000.

Beauregard (WE):
You'll have some great data for which to tailor your program.

Hallock (Athenahealth): If you have an executive team that understands, that's one thing. For agencies, there was always that line, at least when I was there. You'd say, “Well, this was a great hit and I think it's in line with their business objectives.” They do see the competition or, eventually, some giant hit and they want it.

O'Kane (MSL): Part of our job is you have to challenge. A smart campaign maybe doesn't go to the traditional heavy hitters in terms of print media but there are online patient groups with more return.

Our role now is to be more of a strategic partner and adviser than ever before. Part of that is standing up to the challenge and saying, “These don't make sense.” You might get the splash that you need, but let me tell you places where you're going to have a meaningful engagement with a consumer. Have the meaningful engagement and we know that consumer will want to continue engaging you and the brand. It has to be meaningful and relevant. The brand and the company have to be up for that challenge.

With the economy, the fact there are so many places you can get news, and consumers being so much more informed, that's the hard part. You have to challenge that. We can't perpetuate campaigns that aren't meaningful, that fail to change indicators, and aren't measurable.

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