With healthcare reform dominating headlines and activity in Washington, companies from various parts of the industry are employing different tactics to solidify their position in the debate.
When Pfizer announced in May that it would offer 70 of its prescription drugs for free to US consumers who had lost their jobs, the pharmaceutical company was lauded in the media for its outreach to loyal patients in a challenging economic climate.
Follow-up news stories looked at the program, Medicines Assistance for Those Who Are In Need (MAINTAIN), as not only a successful PR initiative for Pfizer itself, but also as an achievement for an industry facing the uncertainty of the escalating healthcare reform debate.
It illustrates a shift in how a company like Pfizer, the biggest pharmaceutical company in the world, views an issue like access.
When a manager stood up at a meeting to suggest that the company offer free medicines to people who have lost their jobs, the program was developed and announced to the public within five weeks, says Ray Kerins, VP of worldwide communications for New York-based Pfizer.
“In years past, that kind of conversation would be blown over and we'd go on to the next thing,” he says. “But the focus of Pfizer and what we're looking at now – that's the exact conversation we do want to have.”
What's propelling this conversation is the industry understanding that healthcare in the US will change. How it will change, when it will change, and how it will affect the pharmaceutical companies, health insurers, health product and technology companies, managed care providers, and hospital systems that make up the US healthcare system is still unknown.
The uncertainly has created an unpredictable climate for both agency and corporate communications pros aiming to communicate a position and prepare for the future.
“This is a situation where, clearly, because of the volatility of it, we have to be smart in how we're going out and communicating our positions,” says Kerins. “Identifying the best place for the dialogue to take place is sometimes one of the hardest things we do.”
The issue of healthcare reform, first a whisper during the election, has gathered steam slowly but surely since President Barack Obama's inauguration in January 2009. He made it clear both during the election and in the early days of his presidency that healthcare reform would be one of his top domestic priorities, not only for his term, but also for his first year in office.
“What President Obama had done is tie healthcare reform to the health of the economy,” says Peter Carson, EVP at Powell Tate.
The confluence of an influential and popular president, empowered consumers, the ongoing online dialogue, the economic downturn, rising healthcare costs, the relationship between a trade group and its industry, and the changing media landscape have offered both opportunities and challenges for companies and organizations seeking a seat at the table.
“This is the first time in the discussion of healthcare reform where you have overall consensus from all the major industries that reform is needed,” notes Kerins. “That's a major step forward in the process.”
The insurance question
Health insurers are at the center of the healthcare debate. As topics narrowed and legislation was written, much of the discussion turned to the feasibility of a government-mandated plan, and later to the idea of a health co-op.
Since February, Cigna, one of the four largest health insurers, has focused on a message of support for President Obama's goal for expanding access, controlling healthcare costs, and improving quality of care, despite the fact that it does not support a government-sponsored plan, says Chris Curran, VP of corporate communications for Cigna.
That is the main message that the company is trying to get across, specifically by noting the industry promise to guarantee coverage.
Curran notes that the communications team has concentrated its strategy around media relations, reaching out to the mainstream print and TV media, as well as wire services, to educate the public about its position.
“Media relations has more credibility on this issue than maybe advertising might have,” he says. “Media relations is really driving awareness about healthcare reform in the US among individuals and small businesses. It's one of the most important aspects of communicating in this climate.”
The Philadelphia-based insurer has also worked closely with America's Health Insurance Plans (AHIP), a trade group that represents health insurance companies. It has also tapped into its social media presence on Twitter to provide educational information about the healthcare debate to both its customers and the public.
With its media program – which includes reactive and proactive media relations, blogger outreach, and Op-Eds – well underway, Cigna plans to maintain its program as it aims to raise awareness about its concerns with a government-sponsored plan.
Obama pushed for legislation before the Congressional recess in August, but the extended timeline allows trade groups like AHIP and insurers like Cigna to reinforce their messages with Congressional districts, small businesses, and the general American public through the recess and extending through the fall.
“We'll continue to try to raise awareness around this issue, because now we'll have additional time in which to educate people,” says Curran. “Media relations is obviously a very valuable tool when it comes to educating the public at large.”
Big Pharma's role
While pharma companies don't face the exact same pressures as health insurers, concerns about how changes to access, pricing, and the overall issue of comparative effectiveness play a role in how these companies communicate.
As with Cigna, talking to the media has been the most credible way for a pharmaceutical company to position itself as a thought leader in the healthcare reform debate, discuss its expertise in a given field, or show its support or opposition to President Obama's plan.
“Groups want to be talking as much about what they're for as what they're against,” says Kathleen Siedlecki, SVP for Fleishman-Hillard. “There's a need to talk more constructively about what they're for and I think they are more strategic in terms of [how] they are reading the climate.”
Unlike during the healthcare reform process of the 1990s, most organizations in the healthcare space have spoken publicly in support of change and many companies issued their own principles of healthcare in 2008 and early 2009 as they prepared for the upcoming debate on reform.
Now, many drug companies, eager for the seat at the legislative table, have used the healthcare debate as a platform to establish themselves as thought leaders in the healthcare field, says Chris Foster, chair of the US healthcare practice at Burson-Marsteller.
“I think some of the leading companies are using this to demonstrate leadership by talking about the importance of prevention, the importance of managing chronic diseases, the value of medicine, and by also highlighting the individual programs, the centers of excellence that they may have been involved in,” he says.
Along with the creation of the drug program for the uninsured, Pfizer's CEO, Jeff Kindler, has maintained a presence in the media, talking about his opinions on meaningful healthcare reform.
The company supports reform through expanding coverage, improving quality, and enhancing efficiency of care and delivery. Kindler has spoken broadly about the industry's need for innovation.
Foster notes that where CEOs are trying to weigh in is as industry thought leadership – by trying to publish Op-Eds regularly and by participating at the coalition level, as opposed to solely on a company's behalf.
“There was reluctance among our clients to take a strong position on this for quite some time,” he says. “And I think it's only recently that we've seen some companies put toes in the water to get their C-suite folks out front.”
For example, David Brennan, CEO of AstraZeneca, has been outspoken – especially in his new role as the chair of PhRMA, the trade association for pharmaceutical and biotechnology companies – about his stance and the company's stance on reform, says Lisa Davis, VP of corporate communications for AstraZeneca.
Its messages have focused on the importance of market competition, enhancing patient safety, expanding coverage for the uninsured, rewarding innovation, and protecting intellectual property.
“We want to make sure we are a credible voice in this space, by being honest and by being open to all of the various sides that we're hearing,” she says.
Davis adds that the Wilmington, DE-based company has been successful with its communications about healthcare reform because the issue was identified as critical for both patients and business early on.
“Long before the healthcare reform debate in Congress hit, we had been having business strategy conversations, communications conversations, policy conversations,” she says. “Our outreach with media and key stakeholders increased a while ago.”
In the nearly two years that the AstraZeneca communications team has worked on healthcare reform, it narrowed down several key opportunities for the company to offer its messaging.
Key components include Brennan's appointment to PhRMA, a partnership with The Hill magazine, attendance at both the Democratic and Republican conventions, a prescription assistance program, a sponsorship of The Aspen Institute's Aspen Health Forum, and an online presence.
“We felt that we really needed to be at the table across the spectrum, before people even started discussions,” says Davis. “We are making sure we are a credible voice in the debate, that our views are heard, and that we come to outcomes that are good for patients and that are good for AstraZeneca.”
Changing the discussion
By offering prescription assistance programs or creating a presence at health events, companies can create a positive image of a healthcare service, as opposed to an image of marketing and selling.
“[It was] about moving away from being viewed as a drug marketer to a healthcare company, and then came healthcare reform, and that really just accelerated that aspect of the conversation,” says Peter Pitts, director of global healthcare for Porter Novelli. “To survive in a year of healthcare reform, whatever that means, can be crucial for pharmaceutical companies of all sizes.”
In recent years, pharmaceutical companies have sought to be viewed, not as drugmakers, but as healthcare companies that address issues like cost and prevention, he adds.
According to Kevin Colgan, VP of external communications for GlaxoSmithKline (GSK), 75% of healthcare spending is driven by chronic disease. By increasing prevention and targeting the triggers for chronic disease, people can reduce overall healthcare costs, especially in the long term.
“I think that in the ever-smaller world of healthcare – driven by the economy, by changes in reimbursement and access discussions – healthcare reform is now forcing companies to have more holistic messages,” says Pitts.
Last fall, GSK launched a program called the “Triple Solution” that was spearheaded by the policy, corporate communications, and government relations divisions.
The program addresses prevention, intervention, and innovation and support projects that demonstrate these ideas. Through the Triple Solution, GSK worked with the American Pharmacists Association Foundation to create a program where employers waive co-pays for prescriptions related to an individual's Type 2 diabetes, in order to help him or her better manage the disease.
“What we're trying to do is point out that fact that, if we can effectively deal with chronic disease, we can make a significant difference in improving the quality of health and the cost of healthcare,” says Colgan. “For us, focusing on the Triple Solution is aligned with not only our mission as a company, but also with where the Administration and Congress want to go with healthcare reform.”
While the Philadelphia-based company is looking to the national media to further its message about healthcare reform, the company is also looking to state, regional, and community programs and media to communicate.
“It's not something we would move away from once healthcare reform legislation is enacted,” says Colgan. “It will continue to be a good platform for us to talk about.”
Carson notes that it's important for clients – especially in such a volatile environment – to focus on the messages and issues where the company has the greatest credibility.
“That's when it's appropriate for [clients] to be out there in a very positive way,” he says. “They're watching the debate; they think they have an alternative; they as a company go and articulate that.”
The Cleveland Clinic has used its position as one of the top medical centers in the US to promote its model of medicine, as the topic has received more attention in the media.
The coverage and subsequent interest in how the Clinic operates caught the attention of President Obama, who visited July 23, as well as other policymakers, healthcare experts, and community leaders, says Eileen Sheil, executive director of corporate communications for the Clinic.
“We should contribute to the conversation about what works in healthcare, in the delivery of healthcare,” says Sheil. “I think that having that voice and talking about what we do well is something that we want to continue.”
The Clinic's message focuses on three areas, which include decreasing the burden of chronic diseases, integrating medical records, and reducing preventable causes of death.
“We're continuing to be careful not to get deeply entrenched in the specific discussions of healthcare reform,” Sheil adds. “We want to maintain our focus on the delivery of care because that's our area of expertise.”
Companies with a vested interest in healthcare reform have been increasing spend, either with their PR firms or with the public affairs agencies they work with in Washington.
For firms with heavy client representation in healthcare, reform has also pushed practice leaders and agency heads to tailor their expertise in the overall reform debate.
“We do believe that communications helps drive policy and I think our clients appreciate this as well,” says Foster, who says that he has noticed an increase in client spending at Burson for communications, grassroots efforts, outreach to key opinion leaders, and public affairs for clients involved in the healthcare debate.
As clients seek to find ways to establish credible, constructive messages regarding healthcare reform, many have turned to their agencies for guidance and education, especially when legislation became available to read.
Gil Bashe, EVP and leader of the health practice at Makovsky & Company, says the firm has also seen an increase in client spending around the issue. In addition, it has invested in the development of the health practice team to encourage expertise on the various topics that make up the healthcare reform debate.
“What we have done is to really become subject matter experts on key components embedded within healthcare reform,” says Bashe.
The focus of the client work around issues of reform has evolved, as well, starting with presidential candidate Sen. John McCain's (R-AZ) and Obama's first discussions in the fall about their principles of healthcare.
“We had some sense where they wanted to go and we began working towards that,” says Foster. “A lot of the heavy lifting happened this year, starting in January.”
That was when organizations began to strategize, develop messaging, and build coalitions as the national dialogue about healthcare reform began to gather steam.
“Government relations, corporate comms, products comms people, all of a sudden find themselves having to talk much more regularly, especially with the dynamic of change and how quickly the healthcare reform debate has progressed,” says Gail Cohen, chair of the global healthcare practice for Burson-Marsteller.
The same dynamic applies to PR firms, where a unified Washington and New York practice is essential to providing a strong client program.
Pitts notes that when he came to Porter Novelli this past March, his job was to bring the agency's New York and Washington offices together. For Washington practices and agencies, the proximity of the debate pushed communications leaders to prepare for what many see as a years-long fight.
Powell Tate established a health policy media room nearly a year ago for its Washington office, providing a place for staffers to gather and analyze news for clients, says Carson.
“In an age where a client can set their own Google News alerts, the differentiator for an agency is providing the analysis,” he says, “a window into the trends of where the debate is headed.”
A look ahead
As the healthcare debate has evolved from an election platform to an emotional, news-consuming topic, communications professionals have been forced to adjust their strategy.
Healthcare organizations – notably pharmaceutical companies facing pipeline issues and changes in consumer habits – have been preparing for a change of some sort.
However, a piece of legislation may not only change a company's or an industry's business model or cause layoffs or staff reductions, it may change the long-term strategy. Providing guidance on these issues is something firms will “probably be more involved with,” says Foster.
“I think that everyone agrees there's going to be fairly significant change in our healthcare delivery system and our payment system,” he adds. “What that looks like and what that will mean for hospitals, for insurers, it's a little early to tell. But, we do know that change is coming.”
The debate itself is very different than what was predicted. In the spring and early summer, those with seats at the table and a say in the dialogue include Big Pharma companies and insurers, says Cohen.
By July, large employers like Wal-Mart weighed in on the debate with their own messages, platforms, and strategy for how healthcare reform would affect the company, its employees, and even its competitors in the long term.
As the debate evolved more into the practicalities of the legislation, Pfizer deemed it prudent to step away.
“While we've been talking about it in the press, we've also been smart enough to say: ‘Let the folks who are involved in the conversations have their dialogue,'” says Kerins. “Sometimes, it may not make sense for us to have the dialogue in the press.”
As the national debate on healthcare reform continues, communicators will keep shaping and evaluating the messages and platforms as it relates to reform. And with so much uncertainty still on the line, the communications challenges will provide opportunities for companies to establish themselves as thought leaders, both in the eyes of policymakers, as well as the general public.
“Companies need to look at healthcare reform and understand that, intrinsically, it's going to change the way that they do business,” explains Pitts. “They may not see a change in their business in one, two, or three years. But, once you look at three years and out, the premise of the delivery of healthcare in this country and consumer empowerment is going to significantly change the marketing and communications of healthcare companies.”
America's Health Insurance Plans
America's Health Insurance Plans (AHIP), the trade group that represents health insurers, publicly came out in support of healthcare reform as early as 2006.
Although it does not support a government-sponsored plan, the group believes every American should be covered, quality should be improved, and costs reduced. Keeping AHIP's message positive in the debate is important this time around, as well.
“Our industry has taken a drastically different approach than it had 15 years ago,” says Robert Zirkelbach, director of strategic communications for AHIP.
In the 1990s, the group's predecessor organization, Health Insurance Association of America created the “Harry and Louise” ads that some say were responsible for the demise of the Clinton healthcare plan.
Now, the group supports a mandate to require healthcare coverage and has promised to guarantee coverage for those with pre-existing conditions and forego a rating based on health or gender.
It launched its first national TV advertising campaign since the “Harry and Louise” ads in July, says Zirkelbach, promoting the industry's support for bipartisan healthcare reform.
“The ad campaign is making sure Americans know that our industry strongly supports reform,” he adds, “and that we've stepped up to offer proposals to address their healthcare concerns.”
American Medical Association
The American Medical Association (AMA) has been at the center of the national dialogue about healthcare reform this year, given the fact that it represents physicians in the US.
Although the AMA has long opposed government-sponsored healthcare, it has spoken out in support of meaningful healthcare reform. The five issues it has focused on include protecting the doctor-patient relationship; providing affordable health insurance and stopping insurance denials for those with pre-existing conditions; promoting quality, prevention, and wellness; repealing the Medicare physician payment system; and cutting the role of medical liability and insurance company bureaucracy, according to the AMA Web site.
It has publicly come out in support of President Obama's plan, including House legislation proposed by the Democrats, mainly through the media, advertising, interviews with its president Dr. J. James Rohack, and the Web.
On the AMA Web site, the organization advocates for physicians and asks members of the public to follow it on Twitter, subscribe to its newsletter, Health System Reform Bulletin, or join either the Physicians' Grassroots Network or the Patients' Action Network.
National Federation of Independent Business
Although the National Federation of Independent Business (NFIB) opposed President Clinton's healthcare plan in the '90s, it came out in 2008 with a campaign about why small business needs healthcare reform.
“We're supportive of reform that makes things better,” says Stephanie Cathcart, senior media manager. “We opposed it because there was a burdensome employer mandate.”
Since the “Solutions Start Here” campaign began, the NFIB has developed messaging based on its members' needs, as well as outreach to policymakers and the media about why small business needs to be a focus in the national healthcare reform debate.
“It's about communicating what works and what doesn't work for small business owners,” she says. The campaign includes a Web site with the group's 10 principles of reform, a place to share a personal story, news updates, and an online petition aimed at President Obama and Congress.
Since its launch, NFIB president Dan Danner has participated in a healthcare summit at the White House. “We were pretty instrumental in ensuring that small business is a huge focus when we talk about healthcare reform,” notes Cathcart.
*This story appears in print as "Delicate procedures."