Internet Marketing for Ambulatory Surgery Centers (ASC)

Vision is the Art of Seeing Things Invisible~Jonathan Swift

When I read this quote it reminds me of how I should view the world of healthcare and marketing in the new digital age.  Hospitals and physicians are moving more quickly into the social media scene but one area that seems to be lagging is ambulatory surgery centers (ASC).
Back in September I started to do some research on internet marketing and ASC's and did not find a lot of information out there.  After some thought, I developed some strategies for how an ASC could use online marketing to increase marketshare and wanted to share a couple of those.

Influence

I came across an interesting book called, Influencer: the power to change anything. The book really helps you define how to be successful when trying to change behavior.  If you are busy and want to watch a short video about the subject, check out this youtube video: Influencer

We all have a preconceived notion that its all about willpower.  When it is really having the right kind of influence around us. In the video we are told to use ourselves as a walking research subject, trying to find what works and doesn't work.  That its not about willpower, basically that is a myth.  This really made me think about how we traditionally try to change people's behaviors when it comes to their health.  Is it because they are lazy?  No...it is because they do not know how to get the right type of influence around them.

Engaging Patients Part 2

So yesterday I wrote a little about engaging patients to make behavior changes using a social media game.  Today I want to look at how using a social media platform can help hospitals engage patients with chronic disease.

The Mayo Clinic has recently improved their social media platform by building a hub for patients to communicate with each other.  It provides a place where their 500,000 annual patients can connect along with their 50,000 employees.  So how does this engage patients you ask.....Living with a chronic disease makes people more likely to contribute to the online conversation. The Patient Connect site from the Mayo Clinic reaches their target populations and gives them the opportunity to interact with not only their current and past patients but their future patients too. 
When patients get sick, one of the first things they do is look online for information.  Their are a lot of sites out there providing this information.  It only makes sense that a Hospital is the one providing this information to patients and also is giving them a built-in support system with their peers.  The Mayo Clinic provides discussion forums, news articles, blogs by Mayo employees, and a large array of videos. This format gives the patients their support system that helps them make changes and understand their disease. 
Information searches are the largest searches on the web.  Most people are looking for that second opinion or the the latest new alternative.  Hospitals can make sure their message is out there so when patients are looking for a second opinion, their name is the one that shows up.  When they do that, they should harness the instinct to share and tools to make it easy.  Make the social sites loaded with information they can use and make it mobile so patients can comment and participate using their phones.  Mobile access bumps up participation so use it and help patients to change and/or understand their disease.  Knowledge is power after all.
--The Catalyst

Patient Activation Part 1

I have thought a lot about how you could help engage patients to participate in their healthcare decisions.  The problem is that it is really behavior that needs to change and that is such a personal choice that no one but that person can choose to make.  So the question is how do we do that?

There are a lot of different methods out there that may work for some and not for others.    One that seems to work well is holding people accountable for behavior changes through their social network.  One such site is a game on Facebook called Health Seeker.  They also have a mobile app so people can play it on their phones as well. This uses your social network and challenges to help you stay accountable.  It makes people more engaging by feeling the value of progressing through the individual and actions. As they complete their missions, they work on completing lifestyle goals.

How to Get Your Dream Job

Moving forward in your career is one of those things that can be difficult.  I find that most people are either focusing on making more money or they are afraid of change.  The first one doesn't sound so bad does it? Making more money, how can you go wrong?  The problem is, when you focus on making more money you typically end up in a job you are not happy with.  Sure it's a good end goal but you have to focus on a career that brings out your passion.  Lead by your vision not by money or fear.

If you find yourself looking at job postings and nothing looks right, then keep looking or create your dream position. Ask yourself, what do I do well and how can I bring it to my organization.  An example is: if you are a good communicator, find out if your organization has a leadership program.  If they don't, do they need one?  If you work in the healthcare industry, Lean Six Sigma is being used more and more in hospital's for process improvement.  If you like process improvement, get Lean certified and bring it to your organization and start a process improvement department.

Social Media & Healthcare

Is social media the answer to engaging patients to take a more accountable role in their health care decisions?  Yes and no.  Some people really are good with using technology for everything they do.  Others not so much. 
The key really is knowing who you are trying to reach.  Focusing on your customer and not the newest and best gadget out there. Sometimes, less is more.
What we have to remember is that 73% of adults use the internet to do searches for health information.  If a site gets more technical, the percentage of engagement goes down to the around the 30% range. 
So keep it simple.  Put instructions on a video. It is easier for people to go to a website and hit play then it is for them to follow directions and then more directions.  Invest in apps for those who would rather download an app then go to the web.  Lastly, still keep it simple for those who do not use computers or apps by making sure you have your phone number on the first screen they see.
--The Catalyst

Can New Jersey Hospitals Really Take on More Cuts?

In an article on FierceHealthcare.com they talk about how New Jersey seeking a waiver for huge cuts in their Medicaid rolls.  By doing this, the article points out that this would cause hospitals to pick up more charity cases.  If  a parent working half-time for minimum wage would not even qualify, this means that the hospitals will be footing the $300 million they are looking to cut from Medicaid.  An article from NJ.com, reported that New Jersey's hospitals profit margins were 0.2 in 2008.  They saw a slight increase in 2009 to 1.7 but in order to do this, "half the hospitals had to eliminate jobs, one-third put off giving raises, and one-quarter cut back on programs and services for patients."
Now with the state trying to fix their budget, the cost are being shifted back to the hospitals that are already trying to keep their heads above water.

How do we reduce cost in Medicaid without hurting the hospitals that are serving patients?  New Jersey is not the only state looking at dropping Medicaid patients either. This means that our state or your state may be next.
The out of control spending can not be fixed by making cuts, the healthcare system as a whole has to be reevaluated.  We have to look at why the cost are so high.  To get a better picture we need to be asking hospitals and physicians their opinions because they are the people on the front lines.  I am sure if you ask any hospital, they can tell you where the cost are coming from.
A few years ago I was talking to someone that worked in the billing department of the hospital I was working at and she said that they see a lot of people coming into the ER for things like diaper rash or a cough.  "Why would anyone go to the ER for diaper rash?" I said. "Because they can't afford to pick up medicine at the local drug store and they know if they go into the ER they will at least get medication to help them get by".

Okay so that is just one piece of the puzzle, but it sure would be a lot cheaper if we had clinics open 24 hours a day that were staffed by NP's to see patients with minor problems.  The states could put in their own clinics and could save money on reimbursement because they are paying for the clinic.

Another problem with Medicaid is the patients do not know the impact of the cost when they choose to go to the ER for things like a diaper rash.  If they had a healthcare spending account with so much money in it, they would be more cautious about how they spend their healthcare benefits.  Of course you would need to have a plan for those that fall into a certain criteria that protect patients that need treatment for cancer or have a major accident....but for the regular everyday medical issues that patients are going to their physicians or hospitals for, put a limit on them!

My mom falls into this category of low income and has a multitude of health issues.  I know the burden it has put onto not only her but my family as well.  She only brings home $600 a month and has been denied Medicaid more times than I can count.  The point is, we have found other ways to help get her medication cheaper, find ways to save money with healthcare providers by "shopping" around, and are more aware of the impact the cost has on our pocketbooks.  Although we have been cautious to try to save money with her healthcare, there have been things out of our control, like when she had chest pain.  The hospital had to write off the cost of her bill because she did not have healthcare insurance.  So because Medicaid would not insure her, the thousands of dollars it cost for her to have care fell back onto the hospital.

I know the other argument is....if she were on Medicaid it would be the tax payers picking up the cost.  What some people don't understand is that we pick up the cost anyway.  When people do not have insurance, the hospital takes on the cost, then the hospital raises their rates, the private insurers then pick up the cost, then they raise their rates to those of us who do pay for health insurance and ultimately we pick up the cost in the end anyway because our premiums go up.

Really in the end, cutting Medicaid will not only hurt the hospitals but it will hurt the tax payers as well.  People with no health insurance going to the hospitals and the hospital footing the bill for care causes a chain reaction back to all of us and increases our health insurance rates.  Cutting care is not the answer.  It is an easy solution to a big problem.  I guess people who are not affected will not care until they are able to see the big picture and realize it IS and will affect all of us.
--The Catalyst

Distruptive Innovation

I just finished the book The Innovator's Prescription by Clayton Christensen, (co-authored by Jerome Grossman and Jason Hwang) last weekend and thought it was an interesting book for people to read that are in the healthcare field.  If you have never heard of disruptive innovation it is a must read for people who want to make changes in healthcare and hospitals.  My question is, how do we do that?  How do we make some disruptive changes in the healthcare field?
Christensen talks about healthcare providers and how he believes they can come up with a solution.  There are three ways, the value-added processes, solution shops, and facilitated networks.  Most hospitals have a model where there is both value-added and solution shops which Christensen finds to be very inefficient.  What I liked is Christensen gives us a couple of examples of hospitals that he thinks are doing a good job in providing healthcare in the models described above. I encourage people to check them out and see why.

The first one I wanted to talk about is Geisinger Health System (which from what I have read is really doing things right).  Geisinger focuses on integrating wellness with a fixed-fee provider system.  When you go to their website, you can see their focus right away.  The top four tabs say "For Patients, For Professionals, Research & Clinical Trials, Innovations"  They are one of the top 10 hospitals in the nation and there is a reason for that.  With a focus on Wellness they have been able to decrease cost.  Their healthcare model has a ripple effect as seen in their financial summary for 2010 where it stated "The economic benefit to Pennsylvania (from direct spending and an indirect ripple effect of spending) totaled $4.6 billion, as reported by The Hospital and Health System Association of Pennsylvania"  This is amazing since hospitals all over the nation are struggling to increase their profit margins in a time where reimbursement rates are declining and regulations are increasing.

Another Health system Christensen talks about is the National Jewish Health.  They are what Christensen calls a solution shop.  He gives the example of a friend who suffered from asthma and had large expenses in prescription costs every month but he was still having problems despite the large amount of money for scripts and the many doctors he saw.  When he went to the National Jewish Medical and Research Center, he was able to work with a team of specialist that were able to focus on the root cause of his asthma and solved his problem.  How did they do it?  As stated on their website, they are "known worldwide for treatment of patients with lung, heart, and immune diseases and for groundbreaking medical research.  Founded in 1899 as a nonprofit hospital, it remains the only facility in the world dedicated exclusively to these disorders."  They are ranked #1 in respiratory care in the nation according to their site.  They are able to do this because they only focus on particular diseases and therefore are able to have a set of test that can be performed and then the specialist come together, review the test, and have a straightforward therapy for the patient.  Since they are working together instead of separately this is more patient focused and the solutions are more effective both with time and money.  Their primary focus appears to be on research as seen in their strategic plan on their website.  The only time it talks about patients is in their "clinical" section where they say "increase patient care to support greater breadth and depth of services; improve quality and performance; and take a leadership role in individualized medicine and personalized healthcare."  The rest of the strategic plan talks about research, faculty, entrepreneurial ventures and philanthropy (which in their statement consist of increasing donor base and funding opportunities).

The two hospitals have very different models.  One is the fixed-fee integrated system with a focus on wellness and the other is a solution shop with a focus on certain disease process to more effectively diagnose the problem and then are reimbursed on a fee-for-service.  It seems to me that what Geisinger Health Systems has more of a patient-centered focus which in my opinion is a better way of disrupting innovation.  Although both hospitals have great concepts, in the big picture what is really going to change healthcare is the economic benefits that can be seen in the billions in the Geisinger Health System.  Both have a strong focus on research but Geisinger focuses on increasing value for the patient and National Jewish Health research focus is on integrates clinical and promotes innovation and collaboration.  Neither is right or wrong, but when companies loose sight of the customer (in their case the patients) in the big picture, they ultimately will not be as successful at disrupting. 

If you want to have a better understanding of how disruptive innovation works, I highly recommend the two 9 min videos that the co-author Jason Hwang

What are good books for Innovation and Healthcare?

I would love any suggestions if you have one you would like to share :)
But I will share with you a few over I like with the next few blog post that I have read recently and why I like them.

First on my list is The Open Innovation Marketplace written by Alpheus Bingham and Dwayne Spradlin.

First, this book is amazing in the describing what open innovation is.  Alph Bingham is a co-founder of InnoCentive and is said to be a pioneer in the field of open innovation. 
The question I know you are asking is how can the information be used to reform healthcare?  If we look at rising healthcare cost, we know that we need a change and we need one quickly.  In order to do this we have to come up with solutions to the problems we are facing, especially for hospitals.
Hospitals already have a small profit margin (if they are lucky, around 2%) and if the healthcare cost continue to rise at a staggering rate, then many hospitals will soon be out of business.
In order to change this, they have to use disruptive innovation in order to combat the rising cost and to come up with a patient-centered healthcare that speaks between systems and engages patients, physicians,and hospitals.  But Innovation and new ways of doing things better is not made public and shared easily.  This is due to fear that they may loose their competitive advantage if they share ideas on how to do things better.
In The Open Innovation Marketplace, Bingham talks about risk portfolio management and open innovation and refers to it similar to managing a stock portfolio.
In the book he stated "One important component of open innovation is that it creates an opportunity to share risks and expenses with external parties....error minimization, portfolio management, and open innovation need to be integrated into a total innovation management system that copes effectively with risk and probability, and that manages to a desirable economic outcome" 
When hospitals need to change or have the consequences of failing, they need to change with an innovative model that has a team that manages their business and innovation.  This team can use what Bingham refers to as the Long tail (using the people that are not in your organization but have the knowledge to solve your problem) and gain the insight from the untapped knowledge in the world that far surpasses the current organizations knowledge base.  To help come up with solutions and/or new processes for hospitals, they can use companies like InnoCentive to post their problem and use the "long tail" to come up with the solution quickly and efficiently (You know if NASA is using InnoCentive to help solve their problems, so can hospitals).  When hospitals get their solutions, the innovation center can assess the who would be the best person and/or team to implement these processes. Now instead of taking months or years and trial and error, hospitals will have a solution to their problem in months.
Bingham and Spradlin also talk a lot about culture change.  If you work in a hospital that is not yet making changes to prepare for the future of healthcare, then the last half of the book will be very useful.  This is the section that is the "playbook" of the open innovation model or as they call it the playbook for the CDE (Challenge Driven Enterprise).  This gives organizations information how to change from a closed system to an open one and deal with the culture at the same time.  As pointed out in the book, "culture eats strategy for lunch."  If you need to make changes in your organization then The Open Innovation Marketplace, helps you deal with culture so it does not eat your strategy for lunch.

I know it sounds easy enough...using a company like InnoCentive to help come up with solutions to the problems hospitals are facing, but you have to know how to integrate that with your organization.  That is why The Open Innovation Marketplace is #1 on my list for a must read for CEOs, COOs and managers in healthcare

Catalyst for Change

Healthcare is my passion.  I love it but also see a need for change.  Working as a nurse over the years has made me see all the problems that healthcare has.  The dysfunction of an non-integrated healthcare system that leads to huge failures to our patients.  While working as a clinical research coordinator, I was able to spend more time with my patients.  In research you have to follow up on every little detail and through doing this I began to see a problem.
When patients were released from the hospital there was no one following up on their care.  I saw patients that were released for heart failure that had no follow up on medications, labs, and/or x-rays.  By the time I would see them in my office, I would contact the doctor and get them the test or medications they were missing.  I began to ask...how many other patients were out there that didn't have someone advocating for their care?  Why is there no communication between the doctors taking care of these patients and the patients themselves?  The patients would see a specialist and they would expect the family doc to follow up with them and the family doc would think the specialist would be following up on the patient.  All the while the patient had no clue they even needed to follow up with anyone.  Is it the doctors fault or the patients?  Well, neither.  It was a breakdown of multiple systems of communication.

We need to see changes....I guess we are finally starting to with the healthcare reform.  The problem is, what is the best way to "fix" what has been broken for so long?  How can we as healthcare providers work together to decrease the cost and risk that is associated with changing a system?  Well that is what I would like to start exploring.  Solutions to the insurmountable problems we see in healthcare.