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Expanding Access with NFP Dental Practices July 2015 Lieberman Scott WDSF

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A brand advocate isn’t passive. She doesn’t scroll through Facebook notifications looking for “Click ‘Like’ and enter to win an iPad.” She doesn’t accept every company’s friend invite so she can drive her numbers into the thousands. A brand advocate is engaged with your product and loves it. Loves it enough, in fact, to tell people about it—not just the public but friends or family. Loves it enough, that they want to be a “maven” and know all about your product. Brand advocate “mavens” want to both know and share.

You probably have brand advocates out there, perhaps you don’t know it. To find them, learn from them, and enable them to work even harder for your brand, you need to know who they are, how to reach them, what they need to be an even louder voice and cultivate them. (Your casual fans are great too – more later on the potential for fans to be customer advisory panels).

How can you get started with a brand advocate program? First, learn from great examples of successful, established advocate programs. The case studies below show how brands have successfully engaged advocates and enabled their voice. Each company took a different tack, ranging from cultivating technical expertise to rewarding passion to just spreading around some fun. Some of the efforts were more complex (and expensive) than others, but all of the case studies can teach valuable lessons.

Who are your advocates and how can you reach them? Once you’ve read the case studies, think about how you might identify your brand advocates. When you want to know what’s new, you don’t talk— you listen, right? So if you already have social media strategies in place, start there—surveying your existing Facebook fans (the ones who clicked “Like”) is a simple way to find people who are willing to champion your product or service. Don’t ever forget this is a relation-ship. These are friends. Treat them as friends.

Before you initiate contact, listen. Follow posts on Facebook, tweets on Twitter, blogs and comments, product reviews, shopping sites and so forth, taking note of who’s posting the most and what they’re saying. Read it all, positive and negative. Get a sense of what’s important or valuable to your fans, for your product and their lifestyle, what kinds of questions they’re asking, wishes they seem to be expressing. Social media is a treasure trove of information for any business that wants to understand a customer base and their brand advocates.

Develop a survey to understand your fans (who might become potential customer advisory panelists or advocates). Find out as much about what they think of your brand and product (and perhaps potential products), what they use in your category and about them. The feedback on what existing fans think about your product and category, how they use products, what they like and what they would change is invaluable. Find out about these fans: do they post online, create product reviews, rate products, recommend products (doesn’t have to be yours). You are seeking to find online talkers with large bases of fans or followers. Find out which fans read blogs, comment, forward, tweet and otherwise engage with others.

Ask them to become part of a customer advisory panel. From these responses, separate the fans from a potential customer advisory panel and from this panel, find your smaller “maven” advocate group. Listen a little more to these special fans (you’re getting the hang of this relationship thing now .) Customer Advisory Panels can advise you on products, packaging, competitors, pricing and more. These panels will talk to you, but they usually don’t talk (as much) to others, as your “maven” brand advocates. These panels are interested in your product, and can provide you with thoughtful advice, but don’t necessarily aspire to be a “maven” with special information.

From this panel, find your brand advocate “mavens” who want to advise you and share with others. From this customer advisory panel, separate out those who are information seekers and sharers. This is your “maven” advocate group and will likely be 5-10% of your advisory panel. Understand what is valuable to these “mavens”, what do they believe, and what do they want to know. Remember they usually value “being in the know”, being the first to know about a new product, first to see or critique a new campaign. They love to share, and usually want to give away samples to friends?

(Customer advisory panels will try a sample, but usually don’t share samples. Ask each group. Do your research on this; it might be different for your category or product.) Sometimes advisory panels make better product testers as you don’t want too much sharing about early ideas. Mavens are better with new information.

How can you make it easy for them to talk about it? Part II to this article.

Don’t ever forget this is a relationship. These are friends.
Treat them as friends.
Appreciate them. (Two words, lots of work, and worth all the effort).

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ABOUT MARY KATE

Mary Kate Scott is the Principal of Scott & Company, a management consulting firm that creates strategies and executes projects for healthcare organizations.

She can be reached at mks@MaryKateScott. com

Prepared for the California HealthCare Foundation, this report examines the technologies, regulatory trends, and market forces that are reshaping the way many types of health care are delivered, and the impact these shifts are having on consumers, clinicians, and the system.

Mary Kate Scott
May 2009

Recent decades have seen a remarkable change in the delivery of health care services. Nurse practitioners now have much greater prescribing authority, consumers can purchase more than 700 over-the-counter medications once available only by prescription, and numerous devices have become available that enable a nurse, technician, or consumer — rather than a physician or a laboratory — to diagnose or monitor a medical condition.

This report discusses the technologies, regulatory trends, and market forces that are reshaping the way health care is delivered, and what these trends means for stakeholders. It also presents key questions for further discussion and research.

The analysis finds that the shift in diagnostic, monitoring, and treatment technologies from physicians to mid-level clinicians and consumers could significantly increase the health care system’s capacity, improve access to and the quality of care, and reduce costs. However, comprehensive research and health payment reform are necessary to foster and direct this market, and some additional government regulation may be necessary.

The complete report is available for download here.

View this report at the www.CHCF.org website.

Lessons from the Pilot Project

These tools describe the SPeD model and outline the roles and responsibilities related to enabling small practices to adopt and make meaningful use of EHRs and data-driven improvements. Included are assessment tools, technical guides, checklists, and a playbook.

May 2012

The California HealthCare Foundation (CHCF), in conjunction with a team of advisors, developed the Small Practice eDesign (SPeD) model to help improve small medical practices and their patient outcomes. The model relies on local trusted organizations called “aggregators” to help small practices implement electronic health record (EHR) and revenue cycle management systems. This toolset is a collection of resources for aggregator organizations working with small practices to adopt and meaningfully use EHRs for data-driven improvement.

These tools include assessments to determine aggregator suitability, small practice interest and readiness for change, as well as, how-to guides, FAQs, technical manuals, checklists, and other documents for EHR and revenue management implementation.

These tools describe the SPeD model and outline the roles and responsibilities of participating aggregator organizations, including assessments to determine an organization’s suitability to be an aggregator, tools to assess local small practice interest and willingness to participate in SPeDesign, as well as FAQs, technical guides, checklists, and other documents.

The tools were developed and refined based on the experiences of CHCF and organizations participating in the SPeD pilot implementations.

CHCF is making the guide and toolset available to users who agree to use it only for noncommercial purposes. To request the toolset, please visit www.CHCF.org.

Shortage of physicians and nurses;  Medicare changes; New insurance products; Generation Y physicians and consumers; Consumers pay more out of pocket and adopt a DIY attitude to healthcare.

Born 1980-1995:

“A civic generation, inner driven within the information revolution, striving to get ahead, belief they can and will change the world.”

Agenda:

Technologies that shift care settings; Technologies that dramatically improve outcomes; Technologies that drive hospital system efficiencies…

DOWNLOAD THE FULL PRESENTATION HERE.

Fast review: A typical innovation workshop consists of:

Use a warm-up activity to get people relaxed and creative. Start by getting people relaxed and comfortable with each other using a quick creative
challenge or quirky introductions. This is vital—many studies demonstrate the importance of being in a relaxed state…

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Considering that they’re the smallest players in the healthcare arena, retail clinics get a lot of attention. In an industry that has seen dozens of hotly contested (and failed) approaches over the years to achieving “right care, right provider, right time, right cost,” retail clinics are a rare thing: a model that truly delivers these goals and resonates with consumers. Retail clinics have increased price transparency, quality and convenience, and everyone–including the media, regulators, the medical establishment, investors and major hospitals–is taking notice.

In the past year, the number of retail clinics grew from roughly 150 to 700 clinics, managed by more than 40 operators. To date, 15 percent of these clinics are owned and run by hospitals, and more than a third of the clinic operator companies are part of hospital systems. This, in and of itself, is surprising. Retail clinics typically generate a modest $1 million in revenues per location, compared with hundreds of millions (or billions) in revenues generated from a hospital.

So why are multi-billion dollar hospital systems interested in these relatively small-time operations? In short, it’s because there are strategic, operational, and learning opportunities for hospitals in the retail clinic space. Forward-thinking hospital managers are looking for ways to capture the upside of retail clinics and mitigate the potential future loss of patients and earnings they represent.

The retail clinic model is straightforward: The clinics offer a limited menu of medical services on a walk-in basis, are staffed with nurse practitioners who are lower cost than physicians, and are located in small, relatively inexpensive retail spaces. Consumers have responded very favorably to this approach to care, with 1.35 million clinic visits to date and 90 plus-percent reported satisfaction rates on quality of care, convenience and cost. While initially clinics appealed to the two ends of the economic spectrum (affluent consumers who didn’t care about out-of-pocket cost because they wanted convenience and people who didn’t have insurance and were looking for lower out-of- pocket costs), consumers from all socioeconomic groups are now using these clinics, reporting high levels of satisfaction and intent to return.

So what does this mean for hospitals? Consider the following value points of retail clinics:

1. Increase capacity and reduce costs in the ED by redirecting patients.

Hospitals that have overcrowded emergency departments are diverting non-urgent patients (e.g., a child with a mild middle ear infection who comes in on a Friday night) to their own branded clinics within their facilities or in nearby retail stores.

For example, Aurora Health Care System in Wisconsin, serves its non-urgent patients far more quickly and economically (for both patients and insurance carriers) in a clinic than would not have been possible in a busy emergency room. If the patient is insured, clinics reduce the consumer co- payment costs; if the patient is not insured, he or she will pay a much lower out of pocket cost in a retail clinic than an ER. For uncompensated care, the hospital saves by caring for the patient in the most cost effective manner.

Hospitals are implementing this strategy by either owning and operating clinics in retail stores (such as Aurora in drug stores); other hospitals are evaluating the use of a modular retail clinic facility situated next door to their ED–patients can self-select or are provided with the clinic option when they check in with a nurse.

2. Keep patients in network–a defensive move.

Establishing retail clinics as part of a hospital chain “saturates” the market, dissuading the competition from establishing a foothold in that marketplace. AtlantiCare in New Jersey is an example of this strategy.

“We were the first to open a retail clinic in New Jersey. Our intention was to get started and to create some barriers to entry. If we had retail clinic stores then we hoped that Minute Clinic wouldn’t come into our market,” says AtlantiCare Health Services President Don Parker. To date, this has worked–the AtlantiCare retail clinics are the only clinics in this market.

In a similar vein, Sutter Health wanted to keep patients in its network in the competitive California market. Sutter named its clinics Sutter Express, leveraging a strong brand name, differentiating itself from other clinics, emphasizing the clinics’ hospital roots, and highlighting the advantage of a common EMR.

3. Attract new patients into the network.

Retail clinics are an inexpensive way to bring your services and brand to new patient populations. This can be a way to pave the entry for a new or larger hospital facility, or a way to draw new populations to your existing facilities.

For example, Geisinger established its retail clinics 10-plus miles from its hospital locations in an explicit effort to bring new patients from a broader area into its network. Alegent Quick Care (part of Alegent Health of Omaha) opened a new clinic in Plattsmouth, 20 miles south of its hospital base, because it couldn’t yet justify a full service hospital in this small (but growing) bedroom community, but wanted to establish a foothold for its brand in a promising market.

4. Create new, lower-cost methods of customer acquisition and brand exposure.

Clearly, consumers visit their supermarket, drugstore and mass merchandiser more often than they visit hospitals. The average shopper goes to the grocery store 2.2 times per week, and may only visit a hospital once a year (if that). When hospitals compare the traditional cost of acquiring a new hospital customer with the cost of operating retail clinics, they find that clinics are relatively inexpensive for large systems to operate (even if at a small loss, or small profit). Clinics can simply be a lower-cost way to market expensive hospital services and build brand exposure. Strong brands are built through customer experience, rather than only through marketing communications, and a retail clinic can offer a positive, personal consumer experience.

5. Drive changes in public health (integrated payer/provider systems).

Wellness is a major priority for the payer-provider system, and food is an essential part of health and wellness. Organizations like AtlantiCare believe that by putting clinics into grocery stores, often along with nutrition programs, they can drive better public health while also bringing down total patient costs.

Hospitals recognize that there are “ancillary” benefits to their retail clinic operations. While these benefits alone don’t justify establishing clinics, they illuminate smart ways to leverage a retail clinic operation.

6. Create a channel for new business lines.

Durable Medical Equipment Distribution: AtlantiCare uses clinics to let people try DME items they sell (scooter, canes), while Aurora drives its overall pharmacy business by placing clinics inside retail pharmacies that it owns.

7. Pilot new technologies “skunkworks” with people who embrace change.

Hospital staff who choose to work in new retail operations are often agents for change, and relish the opportunity to create new approaches to patient care or system processes. Alegent in Omaha is using their clinics as the pilot for EMRs.

“People who work in our retail clinics enjoy change, and the opportunity to create new ways to serve our patients. they are well suited to trying out new technologies,” says Rocky Fredrickson, CEO of Alegent Health Clinic.

8. Understand the new Generation X patient.

Seventy percent of all clinic visits are by Gen-X (age 28-42) moms and their kids, compared with about 22 percent of all PCP visits. This generation has a different view of a medical home and medical relationships, and this is the age where medical relationships and habits are formed. Hospitals that are struggling to understand and address the changing needs of younger patients see retail clinics as a straightforward way to serve, learn about and develop relationships with this community.

Read Part II: Tools for Hospitals to assess the potential impact on their patient and physician populations, economics, and brand–a pragmatic guide for hospitals to assess the retail clinic opportunity and create a strategy for improved patient care, patient and provider satisfaction and maximum impact.

Mary Kate Scott, Principal of Scott & Company, is a nationally recognized authority on retail clinics. Her firm helps hospital systems evaluate the retail clinic opportunity, calculate the economic and brand impact, and predict local consumer and physician response to different clinic operations. She is the author of The California HealthCare Foundation reports: Health Care in the Express Lane: The Emergence of Retail Clinics, and Health Care in the Express Lane: The Retail Clinics Go Mainstream. She offers speeches, workshops and media commentary on the intersection of consumers, healthcare and technology.

Part I of this article discussed the retail clinic model, the increase in clinics, and the consumer interest in clinics, with particular emphasis on the surprising fact that more than a third of the clinic operator companies are part of hospital systems. Retail clinics typically generate a modest $1 million in revenues per location, compared with hundreds of millions (or billions) in revenues generated from a hospital. So why are multi-billion dollar hospital systems interested in these relatively small-time operations? In short, it’s because there are strategic, operational, and learning opportunities for hospitals in the retail clinic space. Forward-thinking hospital managers are looking for ways to capture the upside of retail clinics (new patients, brand building and financial gain) and mitigate the potential downside (loss of patients and earnings) they could represent.

Before moving forward with a retail clinic, hospitals need to be clear on their own goals and understand how a clinic might play out across their system and in their community. Only then can a hospital choose the right play: to “watch and wait” as retail clinics evolve in their markets, form a partnership with an existing clinic operator, or build and manage their own branded clinic.

1. Prioritize the hospital’s goals for a retail clinic.

Retail clinics can help hospitals achieve several goals, so it’s critical to ensure which are the highest priority needs. Some examples of high- priority goals are: cost reduction from uncompensated care, better quality of service, keeping patients in networks, and caseload reduction in other areas of the hospital network. Different strategic priorities lead to different clinic solutions. For example, if the goal is to keep patients in network, a high-traffic external location in the community (even next door to potential competitors) makes sense; whereas if the goal is to reduce uncompensated care and overcrowding in the ED, it makes more sense to extend the ED with a co-located modular facility where uninsured patients can be easily redirected.

2. Understand local consumer attitudes about health care options.

Consumer response to clinics has been positive and strong. Still, it’s critical to understand how local consumers respond to competitive health care offerings. It’s relatively easy to commission consumer research in your own market to determine patient response to a hospital affiliated clinic. One hospital in the Pacific Northwest tested several different retail clinics models, with different clinic names, prices, menus of services and different retail locations to predict consumer acceptance. This research can be tailored by Zip Code, by in or out of network patients, and by insured or uninsured populations. Consumer research can help a hospital reduce its risk by better understanding which patients might be attracted and the overall impact on hospital operations.

3. Develop a financial forecast based on the volume of patients who might shift from the ED to retail clinics.

Within your own hospital, how many ED patients would be candidates for retail clinics given the limited scope of service–that is, how many of your current ED visits are for diagnoses or treatments that could be provided in retail clinics? Beyond the basic numbers, you must also understand who these patients are and why they might opt to use retail clinics (for convenience or cost) or not (perceptions of quality of care, awareness of the options). What will be the economic impact of moving patients to a different facility? Reimbursement rates will be lower from insurance carriers for retail clinics, but if a hospital has significant uncompensated care, savings are substantial. It is not as simple as determining if a patient is insured or not– both groups of patients can have positive economic impact.

4. Anticipate the physician reaction and the hospital’s response and communication plan.

One unique challenge for hospital-affiliated clinic providers has been to secure their own physicians’ support. Clinic advocates have made two arguments to physicians: one, if the hospital didn’t offer a clinic then a competitor would; and two, that clinics are an opportunity to keep a patient in the network. Despite substantial investments in outreach to physicians to educate them on the rationale for the clinics, the majority of clinic operators experienced significant physician concern prior to opening. However, once the clinics were open, physicians were more positive, viewed the clinics as one of several points of delivery of care, and saw it as worthwhile to maintain the patient within the system with continuity of care. Hospital systems can test local physicians’ potential reactions using online research techniques. This research can enable a system to determine the fit with their own hospital goals, anticipate physician response, and formulate communication strategies for different constituents.

5. Decide who will operate the clinic–the hospital or an external provider.

Several hospitals are choosing to operate their own clinics (see above for examples) and others are working with existing clinic operators, providing their brand names, expertise, physician oversight, and access to nurse practitioners. Aurora- -the earliest hospital entrant to the retail clinic world–operates its own clinics, whereas Hermann Memorial in Houston, Texas, provides its brand and physician oversight to RediClinics, and has developed a deeper understanding of the potential of clinics and their patients as a result of this partnership. Several other hospitals work with external operators (such as Medcor and others) who operate the clinics under the name of the hospital system.

6. Determine where the clinic should be located–on hospital grounds or in a retail environment.

Most hospitals who are participating in this trend are using retail locations for their clinics, including drug, grocery and mass merchandiser formats. Aurora is in WalMart, Sutter is in drug stores, and Atlanticare is in grocery stores. Several hospitals are now considering establishing clinics on their own grounds–either outside the front door of an ED, near the ED, or in a modular facility. Hospitals need to make this decision based on their goals–and an understanding of which patients will use this new facility, for what conditions and when. Each location offers different economics and will need a higher or lower volume of patients to justify the economics of different venues.

7. Understand the non-economic commitment it takes for a hospital to be a retail clinic operator.

Launching a clinic business has required a paradigm shift for hospital providers, who are eager to innovate and extend their knowledge of new delivery models, but who often know little about executing consumer-driven health care.

“We’re learning every day about consumers and the retail world,” says Linda Khachadourian, VP of Strategy and Business Development at Sutter Health. “This is so consumer-centric, and we don’t have retail experience . We hired a program director, specifically recruiting someone with a retail background. We’ve also had to learn to be lean and simplify. As a large organization, making these changes has required a mindset shift.”

Every hospital-affiliated clinic operator has different business goals and economic models, and retail clinics may not necessarily be suitable for every hospital. However, every hospital should know how to assess the opportunity clinics present. Understanding the economics and business models of clinics is a start, but, in fact, hospitals have numerous cost-saving advantages over standalone clinics: They can leverage their existing infrastructure (technology, protocols, and electronic records), assets, physician referral networks, brands, and insurance carrier relationships. Hospitals should systematically evaluate their assets, their strategic goals, their patients’ needs, local consumer attitudes, and potential physician responses in order to realize the full potential economic and brand impact retail clinics can offer.

Mary Kate Scott, Principal of Scott & Company, is a nationally recognized authority on retail clinics. Her firm helps hospital systems evaluate the retail clinic opportunity, calculate the economic and brand impact, and predict local consumer and physician response to different clinic operations. She is the author of The California HealthCare Foundation reports: Health Care in the Express Lane: The Emergence of Retail Clinics, and Health Care in the Express Lane: The Retail Clinics Go Mainstream. She offers speeches, workshops and media commentary on the intersection of consumers, healthcare and technology.