A panacea for care confusion

From simple-to-understand names to targeted messages, healthcare provider networks are focused on clarifying the Affordable Care Act's broad impact.

From simple-to-understand names to targeted messages, healthcare provider networks are focused on clarifying the Affordable Care Act's broad impact.

Uncertainty over the future of the Affordable Care Act isn't slowing down firms as they look to bolster communications around accountable care organizations (ACOs) and health insurance exchanges, which are two key provisions in the legislation.
The Supreme Court has set a March date to hear a group of related cases claiming Congress exceeded its constitutional powers by requiring individuals to carry health insurance or pay a penalty.
If the court were to find the individual mandate unconstitutional, it would then determine whether it may be separated from the rest of the law or whether it is a necessary part of the law whose other provisions cannot stand on their own. If the court determines that the mandate is not severable, it could strike down the entire law.
Reaching healthcare providers
Even though the future of the bill remains in doubt, communications strategies are already well under way for ACOs, which consist of networks of healthcare providers that are rewarded financially by insurance companies if they can slow the growth in their patients' healthcare spending while maintaining or improving the quality of the care they deliver.
Communications firms have split their focus in two big directions – those wishing to establish ACOs receiving reimbursement from Medicare and those pursuing ACO status through contracts with private insurance companies, which are not subject to the Medicare requirements.
In both cases, most communications efforts have been business to business with a goal of getting various healthcare providers on board with the concept. Campaigns that have delivered messages that are too technical have been the least successful.
“The biggest thing that gets neglected is not saying what the benefit of an ACO is to the various audiences,” says Brandon Edwards, founder and president of Revive Public Relations.
Revive has used direct mail, email, and online events to reach targeted audiences. Social media use has been limited as physician adoption of digital tools is still low.
“If you want to get doctors,” suggests Edwards, “send a single blast fax like it's still 1989.”
When communicating with physicians, it's imperative to keep their office managers in the loop as they are the ones doctors most frequently turn to for advice. Revive has found office managers responsive to communications posted on closed Facebook community pages. Reaching both parties means creating correspondences that are written for different education levels so as to not talk down to physicians, but not be too highbrow for office managers.
Revive has also been tasked by clients to come up with alternative names for ACOs because the term “accountable care organizations” has been linked to negative phrases such as “Obamacare.” The firm's suggestions have centered on the term “coordinated care,” which gets across what the groups do without getting into how, Edwards says.
Jarrard Phillips Cate & Hancock, a healthcare public affairs firm with offices in Nashville, TN, and Chicago, has also been working with clients to move away from using “ACO” in the title of their initiatives.
“We thought about it from the perspective that healthcare reform is going to come and go,” says Molly Cate, a partner at the firm. “We were looking for the broader message, which is what are we hoping to accomplish from a healthcare perspective?”
For instance, her firm's client Saint Thomas Health in Nashville, named its ACO MissionPoint Health Partners.
“We didn't want to be limited by a definition that we feel is still evolving,” says Rebecca Climer, CCO for Saint Thomas. “There are aspects of the MissionPoint model that are consistent with the definition of an ACO, but the philosophy behind this new foundation goes beyond a business model for accountable care.
“We did not include Saint Thomas in the name for reasons of both accuracy and clarity,” she adds. “While our five hospitals and extensive network of services is the core of MissionPoint in terms of services provided, we are partnering with a number of organizations to provide the entire spectrum of services.”
When Saint Thomas announced MissionPoint last August, it met with business leaders to effectively explain in person the fundamental concepts of MissionPoint.
“It was important for us and our partners to explain first-hand what we are going to achieve, how the experience is going to be different for all involved, and how we are similar to and different from other models,” says Climer.
For physicians being asked to work with MissionPoint, the communication has entailed group and individual meetings in order to create the same level of understanding. Saint Thomas followed up with targeted email messaging for specific groups to inform them of important milestones. Going forward, it will focus on communicating all of the “firsts” associated with the activation of MissionPoint, such as the first pediatric home visit.

Easing tough regulations

The American Medical Group Association had issues with proposed regulations on accountable care organizations (ACOs) the Centers for Medicare and Medicaid Services released last March.

The group found the regulations overly prescriptive and operationally burdensome, rendering the incentives too difficult for ACOs to achieve in order for the voluntary program to be attractive to potential participants. In fact, a membership survey found 93% would not participate in the ACO program unless requirements in the final rule reflect major modifications.

The association tapped Dodge Communications to create ongoing integrated PR, media relations, and social media programs. Goals were to encourage the medical and media community to rely on the American Medical Group Association as a qualified ACO resource, promote its members as real-life examples of organizations delivering accountable care, and to educate current and potential members about ACOs.

Through long-term relationships with healthcare editors at key industry, national, and online outlets, Dodge was able to assist the association in securing premium coverage to effectively position it as a leading information source. Facebook, Twitter, and LinkedIn accounts were created to boost exposure and allow the organization to en-gage in two-way conversations with followers.

Over the course of one year, Dodge secured 61 media placements. In addition to placing feature stories and bylined articles, the firm facilitated interviews with leading industry and national publications such as The Washington Post, The Wall Street Journal, and The New York Times.

“The increased media coverage furthered our organization's program by making us a force to be reckoned with,” says Tom Flatt, director of communications and publications at the American Medical Group Association.

When the final version of the regulations was released in October, many of the association's concerns were addressed.

Talking technology
Another critical aspect of the communications process is getting information across about technology. Elements such as electronic medical records play an important role in ACOs, says Jeff Smokler, an SVP in the healthcare practice of Powell Tate.
“Electronic medical records are a crucial element in the movement to develop ACOs, as they allow providers to monitor patient care throughout treatment of a condition,” he adds.
Going forward, Smokler advises all parties to keep in mind that patients will need to grasp the value of more coordinated care to become willing participants in the process.
“Increased reimbursement – that is, paying for outcomes rather than volume – means little to consumers,” he says. “What does matter is their health. Both physicians and payers need to collaborate on communications that tell the ACO patient-centric value story.”
Communication strategies for state-level health insurance exchanges established under the Affordable Care Act have been developing at a much slower rate as firms work to figure out what the important messages are and the best way to deliver them.
The exchanges are marketplaces to buy insurance and where insurers sell their plans. The bill mandates that these plans be established by January 1, 2013, so individuals and small employers will be able to purchase health insurance coverage by New Year's Day the following year. If a state doesn't have an exchange in place by that first deadline, the federal government will operate the exchange in that state. Many states are already moving forward to enact legislation that will create the exchanges.
Combating confusion
There is still a lot of uncertainty about what insurance exchanges will look like. “There was a vision for exchanges that would be like an Expedia or Travelocity for health insurance. It's less clear if that is what it's going to look like,” says Al Jackson, who heads up Chandler Chicco Companies' Washington, DC, office.
Based on his work on the introduction of Medicare Part D, communications strategies should focus more on family members or caregivers.
“At the end of the day, seniors relied less on advertisements or stuff that came in the mail and much more on trusted sources,” explains Jackson.
States have begun to have town-hall meetings and focus groups to hammer out the content of their communications strategies. Public Consulting Group, a consulting agency that serves health and human services programs, has helped to run the meetings. The gatherings have been beneficial in that they have provided opportunities to dispel inaccuracies, says Alicia Holmes, a consultant at the firm.
One major hurdle will be reaching people who live in border towns that don't get news or advertisements from their own state. “Not reaching these people can have a huge impact on a campaign,” she adds.
Communications about the provision also need to be delivered by people who are part of the communities the states are trying to reach.
“People are going to respond to those already trusted in the community,” suggests Holmes.

Since the exchanges are likely to be filled with dozens of insurance plans, states will need to be careful not to overwhelm consumers with too much information, advises Smokler. States should seek partnerships to help get out messages.

For instance, with Powell Tate's help, Massachusetts launched its Health Connector program following the passage of reform legislation in that state. It teamed up with the Boston Red Sox, who had just won the baseball World Series, to draw more attention to the program.
As states launch their communication strategies, they should focus on statistics that talk about how this and other healthcare reform provisions will cut down on healthcare costs.
Jeff Rosenberg, SVP in Levick Strategic Communications' government and nonprofit practice, cites a study conducted last year that found the Affordable Care Act could save states between $92 billion and $129 billion in healthcare costs between 2014 and 2019. The study was performed by the Robert Wood Johnson Foundation.
“The success or failure of the exchanges is directly tied to the ability to reach, engage, and mobilize large numbers of citizens to purchase health insurance through them,” says Rosenberg. “By influencing public opinion early in the planning and development process, states will increase the chances that consumers and other stakeholders will embrace their approach.”
Insurance companies reach out
States are not the only ones who still must come up with communication strategies. Insurance companies must find ways to stand out to state insurance commissioners as they seek entry to exchanges and with consumers as they look to differentiate themselves within the exchange.
Outreach to state officials is likely to be an easier process, as insurance firms have relationships with the appropriate people. The campaigns for this effort will be more lobbying-based and not take place in the public eye.
Nailing down the right message for consumers will lie in how well companies launch nuanced efforts geared toward specific audiences. This is especially vital since insurance plans won't be that different from one another.
“People want to feel their individual needs are being accounted for,” explains Smokler.
When insurance companies launched ad campaigns in Massachusetts, they relied on name recognition to set them apart, according to Public Consulting Group's Holmes. On top of this, they were sure to incorporate the Health Connector logo into their ads so people were aware of the context of the messages.
Similar tactics are used by insurance companies that are already part of private exchanges, says Shawn Nowicki, the director of health policy at HealthPass New York. “Because exchanges operate within a broader health insurance market, insurers can also leverage their general reputation and branding to help attract enrollees.”

Affordable Care Act Timeline

Encouraging integrated health systems
New law incentivizes doctors to join together to form accountable care organizations. These groups allow doctors to better coordinate and improve patient care. If organizations provide high-quality care and reduce costs to the healthcare system, they keep some money they help save.
Came into force January 1, 2012

Understanding and fighting health disparities
To reduce persistent health disparities, the law requires any ongoing or new federal health program to collect and report racial, ethnic, and language data. The Secretary of Health and Human Services will use this data to help identify disparities.
Effective March 2012

Improving preventive health coverage
To expand the number of Americans who receive preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost.
Effective January 1, 2013

Increasing Medicaid payments for primary care doctors
As Medicaid programs and providers prepare to cover more patients in 2014, the act requires states to pay primary care physicians 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government.
Effective January 1, 2013

Prohibiting discrimination due to pre-existing conditions
The Affordable Care Act puts in place powerful reforms that intend to prohibit insurance companies from refusing to sell coverage or renew policies because of any pre-existing conditions the person seeking insurance might have.
Effective January 1, 2014

Ensuring coverage for people participating in clinical trials
The new law will prohibit insurance companies from either dropping or limiting coverage to any individual because he or she chooses to take part in a clinical trial.
Effective January 1, 2014

Paying physicians based on value not volume
A new provision will tie physician payments to the quality of care they provide. Doctors will see their payments modified so that those who provide higher-value care will receive higher payments.
Effective January 1, 2015

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