Population Health Needs A Brand Positioning Strategy

Population Health (PH) is a term that has become ingrained in the Healthcare Reform lexicon over the past decade. It’s one of those politically gravitational conveniences that allow candidates from different parties to embrace a common goal with little risk of being criticized for holding beliefs different than their opponent. And that is precisely because it is difficult, if not impossible, to prove someone believes in something that does not have a consistent and agreed upon definition.

Just What is Population Health?
What PH enjoys in broad political support it lacks in definitional credibility. A good treatise on variations of contemporary definitions can be found in Academy Health’s Population Health in the Affordable Care Act Era by Michael Stoto, Ph.D. Without wanting to deliberately adulterate that work, Stoto highlights conceptual commonalities and differences in definitions from several sources that I will try and very briefly summarize below.

A focus on health outcomes – the subjectivity of which notwithstanding – and the distribution of outcomes (i.e., how do outcomes vary across comparative stratifications, such as geographic residence, ethnicity, age, etc.)

The impetus of achieving healthier outcomes is through encouraging healthier lifestyles, better nutrition, preventative care, avoiding behavioral risks, etc.

Measurement of health status indicators as well as the factors that are correlated with those indicators (e.g., socioeconomic conditions, physical environments, childhood development, etc.)

Utilization of data and analytics to develop a conceptual framework for understanding and explaining differences in population health indicators – and how that knowledge impacts research agendas, resource allocations and public policy.

Often discussed (or confused, depends on your perspective) with public health, though the latter also typically connotes a governmental influence of some type (e.g., a municipal health department).

Policy Perspectives
From a policy perspective, there are two ways to look at PH: altruistic and pragmatic. From an altruistic perspective policies that promise to improve population health are most often framed in cost—benefit analyses: the benefits, if achievable, are easy to agree upon (who doesn’t want to be healthier?). The ROI is the challenge and most often the subject of political contention.

From a pragmatic perspective – particularly as PH has been manifested in the Affordable Care Act – what we are really talking about is cost control. Healthier people demand less healthcare services. Individuals with chronic conditions that more effectively manage those conditions need less healthcare. Economics 101: if we can reduce demand while maintaining or increasing supply, costs should decrease.

Parallel to this latter perspective is the growing base of knowledge that indicates improving the quality of care can achieve both lower costs AND better care. So if population health is a vehicle through which quality can be improved, it benefits from that additional policy advocacy.

Population Health Perceptions
Population Health means different things to different people. A good part of that difference can be explained in the inherent subjectivity of the concept of health outcomes. Some other portion can be explained by academic exercises seeking to cut the Gordian Knot. Still another by political extrapolations that seek to gain favor by equating improved population health with an appreciative electorate.

Whatever the feasible explanation(s) may be, Population Health suffers from an identity crisis. Beyond just a definitional problem, however, it fundamentally lacks in having been able to achieve a shared understanding of its meaning and purpose at a level that resonates with the very “population” whose health is of concern. In short, PH could use a brand positioning strategy.

Perceptual Positioning of Population Health
One of my favorite books on branding is Brand: It Ain’t the Logo: It’s what people think of  you™ by Ted Matthews. Matthews argues that,

“a brand is the sum total impression and memory of every remarkable, every so-so and every negative experience with any and all pieces of an organization. A brand is the personality of [that organization] . . . and is judged and assessed a value by everyone it touches, whether inside the [organization] or outside. These perceptions of value may, or may not, be what you want them to be. Which suggests a fact that may surprise you: your brand isn’t really yours (emphasis added). You don’t own it – all the people thinking about you do.”

It’s not a leap to borrow or migrate these concepts of perceptual brand positioning to PH. Many proponents of PH take an interventional approach as a means to advocacy. Their focus is on modifying individual behaviors, inducing health screening, creating artificial employment incentives and imposing restrictions and/or impositions on environmental elements. This is not a sustainable approach to PH brand positioning simply because it fails to recognize that the perception of PH is owned by the individual – and not the advocate.

What to do Differently
When I was giving presentations across the country a few years back on the newly passed Affordable Care Act, I made it a point to say that I believed if we were somehow successful in increasing access to healthcare services, in improving quality, in lowering costs, in enhancing efficiency and productivity – that none of that would matter long-term because the forecasted demand from an aging demographic would atomize those gains.  The only escape from a tragic gap between demand for quality healthcare and the ability to meet that demand will come from lowering innate demand.

Population health, however one wants to define it, is therefore a critical component of any strategy that seeks to address the looming care gap. But the underlying concepts of what make improving population health mutually beneficial cannot be thrust upon individuals for their own good. Nobody ever bought a Macintosh computer because Steve Jobs told them they should. If you are an advocate of PH, then it’s time to start looking at how to perceptually position its brand benefits differently.

Look at the most valuable brands in the world, and look at how they were built: such as Apple, Microsoft, Coca-Cola, IBM, Google, Disney. Marketing and advertising played important roles, but it has ultimately been each organization’s ability to offer something of value to individuals that drove sustainable perceptions. What can be learned from the branding strategies of organizations like these that can turn the perceptual positioning of Population Health on its head to achieve the long-term benefits that we believe can be achieved?


“The Doctor Will Skype You Now . . .”

healthcare-marketing2-300x199In this month’s edition of the McKinsey Quarterly is an insightful article: Six social-media skills every leader needs.  If you are either currently – or aspiring to be – in a position of managerial leadership at any level of your organization and plan to work for more than a few more years, this is an article you need to read.

And if you are working in healthcare, I think you will find the personal and organizational ramifications of the Six Dimensions of Social-Media-Literate Leadership model presented in the article to be particularly exciting – and troubling.  Because of the inherent nature of the industry’s product (i.e., human health), the potential benefits and threats presented by social media are accordingly heightened.  When messaging distribution spins out of control and goes viral at a manufacturing concern someone could lose face.  When messaging gets convoluted in a hospital someone could lose their life.

The opportunities for creating organizational value through social media are vast and still largely untapped.  For example, the ability to engage and capture a broad spectrum of individual thinking; the ability to facilitate collaboration and engagement across social and cultural barriers; the ability to build brand loyalty through direct communication; the ability to accelerate innovation.

The other side of the social media sword is just a sharp – and even more so in healthcare.  Risks of individual privacy are at the forefront.  But there are also tremendous risks associated with distribution of disinformation, as well as the misuse and/or misunderstanding of credible information.

As the article points out, “the leader’s task is to marry vertical accountability with networked horizontal collaboration in a way that is not mutually destructive.”  How is this done? I have highlighted below the key points I took out of the article.

Accept Reality
Whether appreciated or not, social-media is a transformative disruption that is changing the way organizations operate (their structure, their strategic positioning, their business models).  The article describes McKinsey’s work with General Electric’s leadership in their social-media-transformation.  It is not a fad of the entertainment-minded pre-Baby Boomer generations.  Ignore its implications on the future at your own peril.

Learn to Let Go
The days of being able to carefully plan, construct and deliver your message via traditional forms of media (i.e., whether through print, e-mail or video) are quickly waning.  Today’s distribution network has been turned upside down: the message often starts with social communication and then gets crafted, molded and morphed into new meaning as it cascades upward through organizational hierarchies.  Recognize sooner rather than later what this means for your ability to control messaging.

Embrace – and Learn – Media Technology
In social-media risk mitigation, the best offense is a good defense.  The sheer volume of information bits from e-mail distribution, networking and news aggregation is overwhelming for most of us.  Being able to use tools that help navigate and focus your attention on highest priorities is essential.  Also being able to understand when, how and in what context your messaging will be received should help guide your communication style.  There are some wonderful software applications to increase your abilities in this area.

Stay Tuned In
Part of GE’s Leadership Explorations program includes reverse mentoring, where senior leadership is able to engage with media-savvy millennials to accelerate their knowledge and understanding of emerging social-media technology and applications.  Staying on top of the social-media evolution takes precious time that has to be diverted from more meaningful endeavors.  In other words, time has to be made to stay on top of it.

Be Cognizant and Be Careful
If you are familiar with the old adage, Some things are better left unsaid, then internalize that phrase and broaden its application to any potential means of sharing a thought via social media.  I have been personally mindful of the line from Kipling’s poem, If: “If you can bear to hear the truth you’ve spoken twisted by knaves to make a trap for fools . . .”  Unfortunately, that
is an inherent risk that comes with raw and transparent communication. 

Healthcare organizations – and their leadership teams – that “get” the socially and culturally transformative implications of social-media will note in the model presented by McKinsey aspects that reflect their own evolution.  They will be able to recognize and identify with the opportunities and challenges presented because they have already begun to experience both firsthand.

For those who don’t get social-media, well as was written in a Western Union internal memo in 1876, “this ‘telephone’ has too many shortcomings to be seriously considered as a means of communication.  The device is inherently of no value to us.”


Big Data and Brand Management

Big Data: big opportunities or big problems?  While most of what I have read seeks to position this question in the context of anticipated investments in human resources and IT infrastructure, I have a different take.  I think the most critical and salient difference in determining whether Big Data has positive or negative implications for healthcare providers will depend primarily on whether and how effectively it is utilized and managed in organizational branding.

Part I ~ Implications of Big Data
In explaining this, let’s start with a look at just a few examples of where and how Big Data will impact healthcare organizations. 

Clinical and Epidemiological Research
Healthcare providers have long been cognizant of the important role that cutting edge clinical and epidemiological research plays in helping educate and prepare them to provide evidence-based care.  They are also aware of the tremendous burden that misguided and/or shoddy research creates on both their time and talents.

At a clinical level, Big Data means being able to utilize previously prohibitive quantities of biomolecular data to test relational hypotheses much faster, while at the epidemiological level it means being aware of social cause and effect relationships much sooner.  In either instance, the impact and expectations of what to do with more information at an accelerated rate will have a significant impact on healthcare providers, as well as patient-consumers.

Consumer Empowerment
There are already literally thousands of smart phone/tablet app’s available to help individuals manage there own care.  A quite natural focus among these has been to design applications targeting chronic disease management.  As the Boomer age wave grows, so too will that portion of the patient population that is not only adept but very conversant in using electronic data and information to be highly informed and highly motivated self-care advocates.

Though Big Data is by far not the only force driving greater transparency of financial and operational performance metrics from healthcare providers, it will be the catalyst that transforms those metrics from merely data to usable information – and unfortunately, probably a good deal of misinformation as well.  Providers will have to be both cognizant and vigilant in assessing how this emerging trend will impact their market positioning.

The common thread of these three examples is what I call the Acceleration of Digital Chaos©.  More data is always beneficial to the extent that it creates greater awareness, enhances education, expands knowledge – and most importantly, creates wisdom.  But as we know, more data does not always lead to such hopeful results.  It also often leads to more confusion, more frustration – and worst, more risk of making critical decisions based upon faulty analysis.

Part II ~ The Importance of Brand Management
Wherever there is chaos and confusion that grows out of attempts to address a basic human need like healthcare, so too exists the double-edged sword of opportunity and risk: the opportunity to bring clarity amidst the chaos in the form of high-value solutions, as well as the ever present risk of making things worse.  And there too lies the associated challenge of branding: opportunities to leverage Big Data in ways that can greatly enhance the value of your brand – or facilitate its disintegration into a pile ashes.

To make sure Big Data serves your brand rather than destroys it will require an active awareness and understanding of where and how Big Data will intersect with Brand Management.  Several examples of these intersections are offered for your consideration.

Social Media
Social Media continues to grow in importance and relevancy to the healthcare industry.  Enter Big Data and now you have a tremendously powerful vehicle for gaining valuable information and insights on patterns and behaviors – of both consumers and competitors.  

To the extent a knowledge advantage can be gained through use of Big Data, that information can be used to help position your organizational brand in concert with consumer demands and expectations – and before competitors achieve that positioning.  I cannot think of a more important market-oriented investment that healthcare providers can make at this time than exploring and understanding how Big Data will transform the way data collected through Social Media can be used to competitive advantage.

Quality and Integrity
Examples in Part I above highlight the likely potential where Big Data will generate tremendous personal anxiety, confusion and frustration.  Take the average consumer-patient looking at knee-replacement surgery in the year 2015.  Armed with 30 published research papers on the advantages and disadvantages of different techniques; over 50 web site addresses stored in the web browser with pages and pages of performance data on surgeons;  15 different self-help iPad applications downloaded to determine the most effective means of post-survey rehabilitation.  You get the idea.

So the ability of healthcare providers to be perceptually positioned as a trusted resource to cut through all of the confusion and frustration will create substantial market advantages.  But, importantly, those healthcare providers that are able to achieve a sustainable advantage will not only facilitate a more efficient and helpful pathway through the confusion – but they will do so while backing it up with consistently higher quality care than competitors.  The two must go hand in hand.

Data Security and Corporate Compliance
I saved the most important for last.  This is a hugely tremendous risk to brand value that will be attendant to using Big Data.  We read of examples every day where patient data has landed in the wrong hands.  The consequences of being at fault – whether real or perceived – for a breach of data privacy and protection could erase years of investment in building your brand overnight.

Yet it is reasonable and plausible that a breach could happen despite the most advanced and diligent efforts of prevention.  In such instance, the organizational fallback position must be a strict adherence to corporate compliance policies that clearly make the protection of personal data the highest priority – not only in theory but in practice.

Please note this post is not by a stretch intended to be an exhaustive survey and consideration of either the ways in which Big Data will impact healthcare, nor the numerous ways in which it has the potential to impact healthcare providers’ brands.  It is intended primarily to help leadership teams of such organizations begin to perform their own assessment of how and where Big Data can have a Big Impact on their future branding efforts.


Coming to a State House Near You: Medicaid Wars

Did the June 28th Supreme Court decision disallowing the federal government to coerce state participation in the Affordable Care Act’s Medicaid expansion kick a hornet’s nest or just lay it bare for more to see? Currently at issue is whether individual states will now “opt out” of participation in providing Medicaid coverage to an estimated 15 million individuals across the country by 2019 under Section 2001 of the ACA.

This past week one of the most vocal opponents of the ACA, Florida Governor Rick Scott, was out and visible at numerous media outlets willing to give him a bully pulpit to reinforce his position – that not only will Florida opt out of Medicaid expansion, but will also refuse to implement Health Insurance Exchanges as well.  Whether he follows through (he is not up for reelection until 2014) will be another matter.

In fact, the political challenge for him and the 28 other Republican governors who have to mull over that decision is a choice between increasing already tapped out Medicaid budgets or foregoing billions of dollars of federal funding available to the states that do not choose to opt out.  Since the cost sharing is initially 100% federal funding, stepping down to 93% by 2019, opting out might be economically prudent but very difficult to sell politically.  There are only three Republican governors running for reelection this fall: Jack Dalrymple (North Dakota), Gary Herbert (Utah)  and Luis Fortuño (Puerto Rico).  So expect more chest thumping bravado before some very difficult choices have to be made going into the fall of next year.

Complicating matters, the SCOTUS decision has caused an unforeseen wrinkle, or  donut hole as it were – a new potential coverage gap in the decades’ long protraction to bring this country politically kicking and screaming into the 20th Century by providing universal healthcare coverage to its citizens.  The math (actually the overlapping regulations) gets very tricky, so I won’t begin to try and explain what I haven’t been able to completely understand myself.

The up shoot is that individuals living in states that opt out of the expansion with incomes above those states’ Medicaid income eligibility but below 100% FPL will neither receive coverage under the ACA Medicaid expansion, nor be eligible for subsidies to help purchase health insurance in the new exchanges.  It should be noted this does represent a reduction in current benefits to this population – but the assistance that had planned to be available under the ACA now would not in states that opt out.  In any event, it would seem to have the makings of a political sword that could be used quite effectively in the future against any of the Republican governors choosing the opt out.

Underlying this whole discussion, of course, are even more challenging issues – issues that Pub patrons should be very interested in monitoring.  In states that really do end up opting out of the expansion, will that leave additional state budget dollars for long-term care coverage? <insert your favorite political sarcasm here>  In states that don’t opt out (which I expect will eventually be just about all) how will future efforts to negotiate FMAP rates for cost sharing of long-term care be impacted by the new coverage benefit (i.e., will federal lawmakers be pressured to reduce their share in lieu of Medicaid expansion)?

What we have shaping up – and has been in the making for the past twenty years – is a fierce generational conflict: as the aging demographics demand a greater share of public assistance for needs of the elderly it will become more and more difficult to maintain assistance for the non-elderly indigent and disabled.  Lack of a cohesive and widely accepted policy on immigration will serve as a catalyst to intensify that conflict, and the battleground will be state capitals.

At a practical level what this means for providers of senior housing, aging services and post-acute/long-term care is being caught between the lines: a labor force sympathetic to the economic struggles of their generation providing care to a powerful demographic that will, in the aggregate, carry dominating influence in how public funds are allocated.  My immediate reaction to this is to recognize now how incredibly valuable brand positioning and brand awareness will be in the future – and how critically important brand management must become for those providers wishing to survive this coming policy maelstrom.

   ~ Sparky

Branding in An Era of Healthcare Reform

Larry Minnix, President & CEO of LeadingAge, recently began a video series entitled, a few minutes with Larry Minnix (I am guessing they didn’t hire Porter Novelli to help with the naming – or, maybe they did).  If you haven’t already, I encourage you to take the time to watch these.  Larry does a wonderful job sharing timely and highly relevant messages in his famously comfortable speakeasy style.

In the current episode that I’ve embedded below Larry discusses LeadingAge’s 2011 Annual Report. 

In referring to LeadingAge member organizations, Larry noted that, “we’ve had reinforced the fact that the most valuable, priceless thing that you own is your not-for-profit brand and heritage.”

I agree with Larry – today. Tomorrow – as in the next five to ten years – is a different story. The looming reality facing nonprofit senior housing and care organizations is that to remain economically viable in the future I believe their brand will have to become more synonymous with value than being nonprofit.

For those nonprofit organizations desiring to survive (and thrive) under Healthcare Reform, future brand identity and perception may need to change significantly. Consumer preferences of the Baby Boomer generation, the need to participate in integrated care delivery systems, learning to financially manage through new payment models (e.g., ACOs, managed care, payment bundling) – these are factors, which will have a greater impact on successful brand strategy than a nonprofit identity.

This is why I found that part of Larry’s message so timely and well placed. Tomorrow is not too soon to begin proactively managing your brand in lieu of Healthcare Reform. To be sure, managing a brand is a bit like herding cats: there are things you can control, things you cannot control and things you foolishly believe you can control.

I am reminded of a passage I like to quote from the book, Brand: It Ain’t the Logo: It’s what people think of you™  by Ted Matthews.

“A Brand is the sum total impression and memory of every remarkable, every so-so and every negative experience with any and all pieces of an organization. A Brand is the personality of a company, product or service and is judged and assessed a value by everyone it touches, whether inside the company (your employees) or outside (your customers, suppliers, shareholders and other stakeholders). These perceptions of value may, or may not, be what you want them to be. Which suggests a fact that may surprise you: your Brand isn’t really yours. You don’t own it – all the people thinking about you do.”

Perception is reality, isn’t it. Being able to monetize the perceptual advantage of being a nonprofit will continue to be critically important to brand awareness and positioning. I am not suggesting otherwise. But – it will not be sufficient for survival in the face of the tremendous challenges ahead, and it will be secondary to perceptually positioning your brand based upon the ability to deliver value under Healthcare Reform.

What do you think?

  ~ Sparky