Category Archives: health care

Health records and dying babies: Marketing against inertia

This CBS clip above shows how actor Dennis Quaid’s baby twins were almost killed by a nurse in 2007. A week after being born, his twins developed a common staph infection. Staph is easily cured with 10 units of heparin, but Quaid says a nurse grabbed the wrong bottles and gave each baby a massive overdose of 10,000 units. Quaid and his family recovered, but Quaid became an advocate of so-called Electronic Health Records — the use of computers, not paper, to track your body’s history.

Call it the tragedy of group inertia

Your local hospital or physician likely uses vast amounts of paper to track your health — paper with no backup, that cannot be searched, that cannot be quickly checked to avoid mistakes. About 100,000 U.S. citizens die each year as a result of hospital medical errors. The Certification Commission for Healthcare Information Technology notes that small medical practices, say with 20 physicians and assistants, can save $250,000 a year simply by replacing manual chart pulls with electronic records. It’s obvious computer systems could improve public health and reduce costs, so why aren’t hospitals jumping on such modernization?

Solutions that require consensus from group decision-makers, even those with obvious benefits, are difficult to sell.

When demand is disconnected from supply

President Obama has earmarked $46 billion to help U.S. hospitals invest in patient records, but those funds are reimbursements, and cash-strapped hospitals must grapple with the upfront investments, training, and installations. Unlike products that are marketed easily by single companies with profit motives, Electronic Health Records are a more complex sale — requiring decisions by hospital boards, service line executives, and chief medical officers. The dramatic benefits in cost reductions and improved patient care arrive years in the future, while costs must be budgeted today. Patients themselves, the actual real beneficiaries, have little incentive to get involved, because most people rarely use health care — until they get sick — so the issue has as much top-of-mind awareness as whether your local fire department has enough hoses.

Compare this tar-pit morass with the “normal” $400 billion global ad industry. In common marketing dynamics, suppliers profit quickly by stimulating obvious demand. Geoffrey Miller notes in Spent that when Coca-Cola bought GlacĂ©au in 2007 for more than $4 billion, it began running ads of a nearly naked Jennifer Aniston — pushing demand for a product that works out to $5.20 per gallon vs. $0.006-per-gallon tap water. Is bottled water really better? No matter. The customers gained desire. The company gained profits.

But what about services where desire and profit are not clearly connected — say, fixing aging bridges, keeping public water supplies clean, or using low-tech bar codes to save little babies’ lives? Like cleaning out your garage, such missions fall through the cracks when distant (but real) paybacks don’t stimulate demand to take action, and inertia takes over. Add the requirements that entire groups agree before action, and the issues stall further.

The way to market against inertia is finding pressure points that move groups to action. We’ve seen this recently in the antimarketing against public healthcare reform, where the labels “socialism” and “death-panels” fueled groups to push against a fuzzy, complex issue. There are people with power in bureaucracies who can be convinced to take the lead and incite others to action. Mr. Quaid alone can’t stimulate demand for the Electronic Health Record solution, but he gave it a nice push.

Via Susannah Fox and E-patients.net.

The sex appeal of health care, cavemen and Ronald Reagan

It’s hard to remember now but what put Ronald Reagan on the political map was his ardent fight against Medicare in the 1960s. Medicare, which was eventually passed into law in 1965 and enrolled former President Harry S. Truman as its first participant, faced many of the same arguments as health care reform today: people without insurance need help vs. government is not the best way to run insurance; compassion vs. socialism; left vs. right.

Whatever your view, this old tape of Reagan is worth a listen for its sheer persuasive power. Reagan exudes an authenticity that amplifies his message, creating a Steve Jobsish reality distortion field; after 60 seconds, no matter your old opinion, you begin to believe.

Persuasion is not about logic, it’s about survival

Scientists have dissected the root of charisma as the psychological frisson you get when someone projects both toughness and empathy. Reagan did it. Obama does it. The feeling that you’re about to get hit yet helped, an emotional at-sea response that puts your receptors slightly off center. Persuasion comes from belief that the person trying to lead you has an overpowering ability to assist, to the point of slight danger. Charisma is the Brad Pitt you want to be, but wouldn’t want left alone with your wife. It’s what you’d need if you were running a cave clan.

Today, health care is ringing our help-danger bells. Darwinian psychologist Geoffrey Miller explains in “Spent” that humans are trained by evolution to both project and receive signals for reproductive safety — vital to pass your genes to the next human generation. When you wear an expensive watch or necklace, you are projecting signals that you have fit genes for sex (even though you’re probably married, your DNA can’t help itself). When the sky grows gray at night and suddenly you feel like retreating to a warm restaurant or bed, you are receiving signals to seek shelter from genes that once might have been eaten in the dark. Because we need sex and shelter, we chase leaders who give off the same vibe.

You oog-ah. We like-ah.

Brands and causes can also project charisma, if they signal both strength and empathy. This is why nations rush to war when wronged (we’re hurt, heal us by fighting an enemy in a tough-guy stance) and why health care is now such a hot topic among conservatives (we’re hurt, heal us by fighting an enemy in a tough-guy stance). The message causes the same frisson of a danger avoided, an injustice righted. Get behind it, because in your heart you’re afraid and need help.

Health care evokes emotion because our great-great grandparents followed clan captains who would guide them from danger to safety, from famine to rich harvests, who exuded brawn that led to copious mating and future generations. It’s a good lesson for marketers as the U.S. ad industry contracts by $10 billion. To persuade a skittish audience feeling fear, you need tough-guy love.

Inspired by our frequent debates with Ken Wheaton.

Antimarketing: If it works for health care, why not you?


We’ve been watching the sordid healthcare debates in the U.S. with fascination. 46 million Americans still have no health insurance, medical costs are skyrocketing, total spending is on track to become one-fifth of the GDP by 2020, and the younger population does not have the numbers or tax inclination to support aging Boomers. But toss out one whiff that the government will hold death panels to kill old people, and hey, that sounds realistic, and suddenly people are mad.

We won’t say who is right or wrong (although we read pages 425-428 of the actual bill that described end of life counseling and have to say, it’s the basic job description of a social worker). The point we can all agree on is casting seeds of doubt works — as well as spitting in a salad dressing bottle.

Antimarketing works best in politics where you only have to tip a few percent of people in the middle of the spectrum to stop a cause. Political masses act like an inverted pendulum, a tipsy balancing pole with a hinge near the ground that can easily be pushed left or right. Antimarketing also appears in urban legends (remember the early one about not flashing your car lights to someone else at night cause a gang would then come and kill you? Or was that healthcare panels, we forget…). It plays upon our fears. It pushes us *away* from taking an action, and if enough people don’t act, your anti-cause has succeeded.

Warning: Our competitors’ products might kill you

The puzzle is, why don’t more advertisers try this same thing? We’ve seen whiffs of it — PETA ads protesting animal furs, anti-clean-coal ads showing nasty dust sprayed around a white house. Our favorite is the recent Australian skin-cancer rap, and not just for the swimsuits. But it is very difficult to push consumers away from buying objects, because the magnetic attraction of food/sex/shelter/status/signaling overrides any counter argument rather easily. We’d be fascinated to see more antimarketing in the real marketing world. Would it work? You fight so hard to attract customers to your product; what happens if you push them away from a competitor?

Image: We Made This

The brilliance and big problem of Google Health


Google Health launched yesterday to give patients a simple way to maintain a personal health record. It will probably fail, despite Google’s billions and drugstore partners, because physicians have no market incentive to share information.

To understand the problem, let’s first put a human face on it. The photo above is our mom, a cancer patient being admitted to Dartmouth-Hitchcock, one of the best hospitals in the United States. The procedure was about her 25th at this hospital, yet she was asked to fill out a form listing past surgeries and current prescriptions.

Mom is sharp, but she takes about 30 pills a day and her body has more scars than an Iwo Jima vet. If her surgical success depends on her personal memory, well, that’s not a great idea.

Now we won’t go off on the stupidity of this; Dartmouth is a fine hospital and is simply doing what physician groups do around the United States — using isolated information systems that don’t talk to anyone outside the walls. The problem is physicians have reason not to share.

You see, hospitals are just like the United States Postal Service. USPS makes a lot of money from some customers (businesses who ship packages) and loses a boatload of cash on others (Aunt Ginnie who needs letters delivered in rural Oklahoma). Physician groups have the same customer value issue. They make a huge profit from some patients (knee replacement, bariatrics) and lose money on other patients (inner city emergency care). Hospitals have to provide both levels of service, so it is vital that they attract lots of high-profit patients to offset the losses elsewhere.

Sharing information via a personal health record would disrupt that model. What happens to a surgeon who “owns” your personal records if suddenly those records are easily transported to any other expert in the country? Think how much the competing surgeon groups would love to have a quick, complete history of your health.

And this, dear patient, is why unified health records do not exist in the United States.

There is hope. Other industries, finance in particular, have built unified views of customers because they realize sharing information outweighs the costs. Your credit score is a perfect example of every lender and transaction being recorded instantly and shared, to help banks offset the risk of giving loans to deadbeats. But this system only works because the market benefit — avoiding risk — outweighs the market cost — giving away competitive information.

Pharmacies are the first to start building unified records; MedCo and RxAmerica have partnered with Google, because the unified view of a patient could make ordering pills a lot safer. But hospitals and physician groups still have little incentive to join. The only hope is that some hospital somewhere will realize giving patients control over their information may be a competitive advantage — a new way to help that sets them apart.

For now, Google Health invites consumers to upload and manage their own information. Good luck remembering that tonsillectomy, and downloading the file to your surgical team next time you’re bleeding in the emergency room. We love Google’s initiative and hope it succeeds. But the reality is for many years more, your docs will ask you to fill out a form.

Google CEO Eric Schmidt gives a brilliant view of the problem here:

Scrubbing with Verve: How the green movement motivates good design


Spring and green are in the air. Norway just made news by announcing it would be carbon neutral by 2050. The New York Auto Show this week, filled with depressed automakers who realize Americans are not buying high-margin gas-guzzling SUVs and may retrench from buying cars at all in our home equity hangover, had one bright spot — sexy designs of small, nimble, efficient cars like the Ford Verve. One glance and you think, finally, designers are getting green right.

Our favorite environmental push, though, comes from Deirdre Imus, who founded dienviro.com with Hackensack to educate the public about how to control environmental factors such as mercury, lead and tobacco that may trigger cancer. Imus launched a line of home cleaning products, called Greening the Cleaning, which scrub scum with plant-based enzymes and none of those toxic fumes that require a gas mask.


This is a brilliant move, because the shelf-space for green environmental cleaners is still pretty empty, and Imus could rapidly build momentum even as the big CPGs catch on. Proceeds support a 4,000-acre cattle ranch in New Mexico for kids with cancer.

All of which seems a bit logical. Producing products that are beautiful, efficient, non-toxic, and give something back to the world. Can you hear the marketing opportunity for your own brand?

This just in: Cell phone that runs on blood


OK, this is a bit icky, but you knew machines would eventually meld with people. Engineer Jim Mielke has designed a wireless keyboard display that slides under your skin and is powered by blood (which flows into and out of a coin-sized fuel cell). The display includes an on-off button, a touchscreen interface, and microscopic spheres that change color from clear to black — your iPhone meets the tattoo. The designer claims the device could actually have medical benefits, such as monitoring blood disorders and warning you of pending health trouble.

Imagine the future.

Hon, hold on one moment. I have another call on my other arm.

Please turn off all cell phones and body parts during the motion picture.

Son, have you been drinking? Let me see your wrist display!

The device was unveiled at the Greener Gadgets Design Competition, where you could also find degradable phones, camping umbrellas that produce solar energy, and, our favorite, the powerstrip with small foot ejector pedals (who wants to bend to get the cord?).

Of bariatric searchers and women’s knees


Have you heard of gender-specific knee replacement? It’s a marketing push by some in the orthopedics industry, and it provides a fascinating look at how direct-to-consumer marketing in health care is growing stronger every year — first with pills, then with screenings and treatments, and now implants.

Consumer healthcare communications have been around for more than a century (Coca-Cola started out as a pharma pitch with 5 ounces of coca leaf per gallon of syrup, the same root source of cocaine), but really took off in 1997 when the FDA began allowing pharma firms to broadcast specific drug names to the U.S. public. Pharma had always been aggressive; there are about 100,000 pharmaceutical sales reps in the United States calling on 830,000 healthcare professionals who make prescriptions. But advertising spending skyrocketed after the rule change from $700 million DTC in 1997 to $4.8 billion in 2007.

Some critics don’t like this, saying healthcare promotion drives up health costs, stimulates unnecessary demand, and disrupts physicians’ practices and expertise as consumers walk in demanding a purple pill. But these critics also miss two parallel trends that cannot be stopped — the rapid adoption of internet use to find solutions, and the rapidly aging Baby Boomer generation tipping into retirement.

Pew has reported that 80% of U.S. consumers with internet access search for health information online every year. We tested this in one hospital market recently, and ran Google ads for two days for search terms related to bariatrics. Hmm. Consumers searched on these terms 6,706 times within two days — only within the hospital’s catchment area — and the ads generated 55 visits to the test web site at a cost per click of $1.27.

Let’s see. If 8% of the consumers who reached the web site filled out a lead form, that would be $15.87 to identify a potential patient in the market for surgery. We’re not sure what the margin is on bariatrics operations, but it’s probably higher than $15.87.


Which brings us back to artificial joint replacement. Some ortho groups are promoting gender-specific knees, since men and women typically have different size knees and so the implants need to be tailored to fit exactly. Others might say the reality is knee replacements already come in a wide range of sizes, and it doesn’t matter if your leg is male or female — the orthopedics surgeon will get the exact size parts for your leg anyway.

Does it matter? Consumers with knee problems need help. Surgeons who offer this practice need to market their services. By using media to promote the surgery, and using a sexy offer — hey, parts that fit my gender! — surgeons are building patient volume while educating the public that help exists for joint pain.

Like it or not, healthcare marketing to consumers is a genie out of the bottle. The question for health providers is: Are you letting the millions of consumers searching for health solutions find you?

Add ‘microsite’ to your 2008 to-do list


One of our goals in 2008 is to encourage clients to rethink their web landing pages. As media planners, we focus on the front end of advertising — reaching specific demographic groups most likely to want your product, for example, men age 35-44 who are weekend warriors likely to blow out a knee and need orthopedics, or the women in their lives who guide the majority of healthcare decisions.

We don’t build web pages and so have no vested interest in saying this: But let’s face it. Your web site probably needs work.

The challenge with advertising, especially advertising online, is that you can lead a prospective patient or customer to your web site — but what happens when they get there? Many web sites are ill-structured to convert a visitor to a qualified “lead.” And web sites are not always easy to modify. Smaller businesses don’t revamp web sites often, and large bureaucracies often find changes mired in Steering Committee or IT meetings.

The quickest solution is to build a microsite, such as the bariatrics site above. This concept is simple — build a small, nimble subset of your brand, focus it around a specific customer or patient need, and launch quickly. Microsites have several benefits:

+ You can typically complete the entire project within 6-8 weeks
+ You avoid nasty internal debates over how to improve the current vast main site
+ It extends your reach on the internet, creating more “points of entry” for customers
+ You can rapidly add a visible lead form — to collect the visitor’s name, email, phone and ZIP — to build a prospect database
+ You can show your boss, hey, look, we actually did something this year (Admit it. That would feel good.)

Some marketing executives shy away from this concept, certain that their master web site is enough. This isn’t the case. If you pull a report of the first pages visitors hit within your web site, you’ll find the majority are landing deep inside — because most web users start at Google, and Google’s search engine throws them past your home page into the innards.

A microsite replicates what people want when using the internet — finding information rapidly about what they are searching for. Worth considering in 2008. Plus, it makes internet and media planners like us much happier when the leads we deliver to your web site find a simple way to give you information, so you can turn them into customers.

Glenn Beck to melt the brain of hospital CEO

Or something like that. Apparently CNN talk guy Glenn Beck had a botched surgery and posted a video on YouTube lashing out at a hospital in the Connecticut or New York region, dang, while he’s still in the bed. Beck says he’s debating “naming names” when he returns to the air Monday, and may tell stories that will “melt the brain of the CEO of this hospital.”

Thoughts:

1. Beck, we really liked you back when you were just a DJ in Hamden, Conn.
2. Sorry about your back.
3. Geez, we’re glad we’re not the CEO of the hospital you’re gonna name.
4. This whole democratization of video on the internet is getting really scary.
5. Somebody, get PR on the phone FAST.