Care Marketing Matters, Winter 1999
Make it easy to use
Talk to any
health care administrator about clinical initiatives--practice guidelines,
disease management, alternative medicine--and you're likely to hear familiar
complaints about physician resistance. Yet in a recent survey of 103
Massachusetts primary care physicians, Dr. Dennis Ross-Degnan and colleagues
from Harvard Medical School and Harvard Pilgrim Health Care found that
their probe of clinical practice guidelines (CPGs) attracted far more
positive comments than negative ones.
Ross-Degnan launched his study to understand why CPGs, implemented with such
high expectations, had so often failed to improve clinical practices. In addition
to the usual suspectsphysician
reliance on their own clinical experience, fear of lawsuits, distrust of the
CPGs' clinical depth amd quality, reluctance to embrace guidelines to which they
themselves hadn't contributedRoss-Degnan
had expected to find that conflict between competing guidelines from different
organizations might be part of the problem.
But most of these assumptionsmany of them shared by the administrators
who implement CPGsproved
to be dead wrong. In fact, over 50% of the responding physicians said that CPGs
provide useful day-to-day algorithms and are effective tools and teaching reminders.
Yet, despite their positive feelings about CPGs, Ross-Degnan discovered that
most physicians don't use the guidelines that he studied; and thus never notice
that competing guidelines often conflict.
The study showed that CPGs fail not because of physician resistance, but because
doctors cannot use the CPGs as they are presented to them. The failures fall
into three major categories:
Physicians told Ross-Degnan that guidelines need to be brief, organized and accessible;
they cannot be expected to dig through a mountain of paper to retrieve appropriate
CPGs. Some doctors recommended laminations or wall charts. One suggested using
Physicians need to trust the information handed to them, and look for source
citations to establish credibility. In general, they preferred guidelines from
professional associations to those issued by MCOs. They trusted the associations
to place greater emphasis on clinical judgment than cost considerations.
Perhaps most important, a full 65% favored CPGs that weren't text-heavy with
dense paragraphs. Physicians asked for bullets, outlines, and flow-sheet summaries.
As one doctor noted, "Graphs are better than paragraphs."
In sum, CPG programs were not as successful as they might have been because administrators
had not provided what physicians needed: guidelines that respect their time,
intelligence, and communication requirements. Had the administrators conducted
up-front market research with their physician targets, they would have learned
what Ross-Degnan learnedand
would have had a better chance of achieving greater physician acceptance.
Going Direct, Getting Past the Gatekeepers
One of our clients, a company that depends on physicians reading and using the
educational materials they publish, found that only 20% of their target audience
was consistently ordering these materials.
The marketing department attributed low order rates to lack of awarenessespecially
since surveys showed that users liked the products. The decision-makers were
open to using direct mail to gain visibility, but their first attempt at a renewal
self-mailer failed to attract responses.
After considerable review, they revamped their direct mail campaign, top to bottom,
with a special focus on getting past the gatekeepersoften
secretaries or administrators--who are expressly charged to throw out "junk mail." Here's
what they did:
they reached their audience by working with current
addresses. While all mailing lists are prone
to decay, physician lists are especially troublesome
because doctors change addresses so frequently.
The company minimized list problems by mailing
to physicians at the time they updated their
addresses. These fresh addresses lowered the
number of "nixies" or returned mail.
sent "dimensional" mailings, distinctive packages
that did not look like junk mail and were, therefore,
more likely to get past gatekeepers. · They hired
a graphic artist and copywriter with health care
experience who were able to create messages specifically
designed to appeal to physicians.
offered multiple ordering methods and multiple
means for receiving the educational material;
the doctors could "have it their way."
overcame hesitancy by including product samples
with the offers.
After months of flat response, orders increased
by 20%. By overcoming the underlying communications
obstacles, the company connected to more physicians.
Giving Them Information That Hits Home
All health plans encourage physicians to improve quality and reduce costs;
many have Web sites to communicate to physicians and other constituents. But
few have leveraged the Webor
stimulate physician action. Health Partners is one plan that has found a way.
Try this test: Visit the Web site of just about any plan to get information
that will help you select a physician. Then click on http://www.healthpartners.com
to see something distinctive.
Most health plans simply publish general advice on selecting a physician or
provide a directory with contact information. Health Partners goes much further,
allowing members to select providers by location, price, specialty, hours,
Better still, Health Partners actually encourages individual members to use
their own selection criteria to compare physicians' performance. Choices include
everything from "amount of time the doctor spends with you" to specific clinical
measures such as the "percentage of women between the ages of 21 and 64 who
were continuously enrolled for the last three years and who had a Pap test
during that period."
Then, drawing on recent patient satisfaction surveys, Health Partners presents
side-by-side, apples-to-apples comparisons of providers' performance in easy
to understand tables and graphs. After examining an introductory table, that
assigns one to three stars based on level of satisfaction (one being lowest,
three best), visitors can drill into the data with subsequent mouse-clicks
to review response rates to specific service and satisfaction issues.
Consequently, consumers and physicians can instantly see how provider groups
rate in their patients' eyes. Mary Brainerd, Executive Vice President of Care
Delivery at Health Partners, says, "Although we designed our web site for members,
physicians are among the greatest users. Our physicians want to demonstrate
excellence, not just avoid outlier status. We find that physicians use the
patient satisfaction data to evaluate how they can improve service and focus
their practices on patient needs."
While it's difficult to measure the web site's impact on physician behavior,
the site's appeal is clear: its public rankings affect patient volume, a direct
pitch to physicians' interests.
Conclusion: More Than a Better Mousetrap
From what we've seen with service initiatives, it's not sufficient to build
a better mousetrap--sometimes it's even more important to make that mousetrap
easy to find, understand, and acquire.
Most health care service programs, for example, won't work without physician
buy-in. To achieve physician acceptance, the means of distributing the message--marketing--should
be an integral part of the service itself.