Contemporary Advocacy Marketing in Healthcare
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"Effective, Contemporary Advocacy Communications in Healthcare,” 2017 Annual SHSMD Connections Conference, September 24 – 27, Orlando, FL. Presenters included Vanessa Stafford, Julie Henry, and Dan Dunlop.
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Contemporary Advocacy Marketing in Healthcare
- 1. The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA. © 2017 Society for Healthcare Strategy & Market Development Contemporary Advocacy Marketing Julie Henry, North Carolina Hospital Association Vanessa Stafford, New Hampshire Hospital Association Dan Dunlop, Jennings Health September 25, 2017
- 2. Twitter Handles • @nhhospitals & @vanessainnh • @nchospitals & @juliehenry • @dandunlop & @jenningshealth
- 3. Our Presenters • Former hospital marketers and communicators • There’s no accounting for taste • Both face the challenge of being under- resourced from a marketing perspective
- 4. A Study in Contrast • NH & NC Republican legislatures • NH expanded Medicaid • NC did not expand Medicaid • NH has 32 Hospitals • NC has 130+ Hospitals
- 5. Both face the challenge of pursuing their advocacy agenda and communicating in a compelling fashion with key constituents. Who are these constituents?
- 6. Our Connection to Advocacy Marketing • NCHA • Social media marketing plan • Social media content and unique hashtags around key issues: • Medicaid expansion, hospital tax exempt status, certificate of need, behavioral health • NHHA • Infographics and memes for social media • ACA repeal • Economic impact • Community benefits
- 7. Advocacy in healthcare has never been more important • Facing repeal of the ACA • Potential reversal of Medicaid expansion • Legislation and policies related to opioid addiction • What’s at stake?
- 8. The Challenge • Developing communication that is meaningful and relevant. • Doing so with limited resources. • Marketing with value. • Must be intentional and strategic. • Need to simplify complex issues. • Broker important political relationships. Can’t be dogmatic. • Take control of your story/message. • Using social and digital media for advocacy – to shape the message and assert the agenda. • Get members involved.
- 9. Learning Objectives • How to successfully package advocacy messages for the most impact. • Considerations to weigh when developing messaging to support your advocacy program. • How to integrate digital and social media into your advocacy efforts. • The keys to effective grassroots advocacy.
- 10. Who is Telling the Story? • Layoffs/turnover at major state newspapers – No dedicated health reporters – Experienced reporters are gone • 24-hour news cycle – Competing with ”breaking” news – No time for complicated stories • Agenda-driven media coverage – Buying time/space
- 12. NCHA’s simplified messages and how we got there
- 13. What Are We Up Against? Members • Industry advocacy efforts are the sole responsibility of the Association staff Legislators/Lobbyists/Other Healthcare Groups • “When people see the NCHA coming, the first thing that runs through their mind is often ‘what are the hospitals against now?’”
- 14. They Just Don’t Get Us “The expenditures by hospitals and other health-care facilities are social costs, plain and simple. The use of resources in society, labor and capital that they generate are the costs that society incurs because of illness.” Editorial 8/24/17
- 15. Simple Messages are Key • Hospitals/health systems strengthen the economy • Hospitals/health systems enhance quality of life • Hospitals/health systems respond to emergencies 24/7, 365 • Hospitals/health systems care for the sickest and most vulnerable
- 17. More than words is all you have to do to make it real
- 18. New Facebook Tactics Location targeted ads Facebook LIVE! Plus animated video posts (Ripl) and Soundcloud
- 20. Crisis Mode: Behavioral Health in New Hampshire New Hampshire facing an unprecedented behavioral health crisis that highlighted a broader systemic issue • Daily backlog of patients awaiting beds at state hospital averages 35-50, with 5-10 of those being children under the age of 18 • Insufficient Capacity = not enough DRF beds, treatment beds, qualified workforce, community health services & support upon discharge • In violation of state statute that requires an involuntary submission hearing within 72 hours
- 21. Behavioral Health in New Hampshire Obvious Allies • Hospitals • Community Mental Health Centers • Boards of Medicine, Nursing, Psychiatry • NH Behavioral Health Association • Congressional Delegation Other Partners • Department of Health & Human Services • State Legislature
- 22. Behavioral Health in New Hampshire Key Messages • Inadequate resources for those suffering acute psychiatric crisis • Highlighted the steps the State & Legislature had taken to address this situation • 40-50 patients a day in acute psychiatric crisis waiting for appropriate services • NH used to be a key model program for others
- 23. Behavioral Health in New Hampshire Key Messages • Hospital emergency departments were not the place for these patients to receive the treatment they need and deserve. • The state needs to ensure that these individuals can get the care they need when and where they need it. • Would never accept these kinds of waits for patients suffering any other illness.
- 24. Behavioral Health in New Hampshire Advocacy Efforts • Joined the fight by launching first statewide Campaign to Change Direction focused on the stigma associated and changing the culture around mental health
- 25. • Made the media work for us by organizing tour of the Yellow Pod at Concord Hospital Behavioral Health in New Hampshire
- 26. Behavioral Health in New Hampshire
- 27. Behavioral Health in New Hampshire • Made the Behavioral Health & Opioid Crisis a key priority during beginning of legislative session • Guided 16 hospital site visits with Congressional Delegates • Provided talking points, data and fact sheets on behavioral health to hospitals and other partners – one collective voice • Built media schedule that combined op-eds, press releases, statements
- 28. Behavioral Health in New Hampshire Outcomes: • State 1115 Medicaid Waiver - build capacity by integrating behavioral health with primary care through Integrated Delivery Networks (7) • Surveyed hospitals & community mental health centers to align services being provided • Daily ED Boarding Report • Hospital training for staff safety & aggressive behaviors
- 29. Behavioral Health in New Hampshire • 4 hospital pilot program providing on-site probable cause hearings for the involuntary committed to abide by 72 hour rule • Bipartisan approval of HB 400 – $20M investment in new mental health beds, mobile crisis teams, data management systems & evaluation of current mental health system
- 30. Behavioral Health in North Carolina • Priority is legislative reform –20-year old law –ED boarding crisis –Broken system • Opioid Crisis
- 35. New Hampshire & the ACA Legislative Makeup Governor Chris Sununu (R) GOP Senate (14-10) Senate President Chuck Morse (R) GOP House (226-173-1) House Speaker Shawn Jasper (R)
- 36. New Hampshire & the ACA Legislative Makeup Senator Jeanne Shaheen (D) Senator Maggie Hassan (D) Representative Carol Shea Porter (D) Representative Anne McLane Kuster (D)
- 37. New Hampshire & the ACA Key Legislative Priorities State Budget Medicaid Expansion MET / DSH Behavioral Health / Substance Use
- 38. New Hampshire & the ACA Medicaid Serves 185,000+ NH Residents • 90,000 children • 20,000 people living with disabilities • 11,300 adults with low incomes • 8,600 senior citizens • 2,100 pregnant women
- 39. New Hampshire & the ACA Medicaid Expansion • 1 of 31 Expansion States • New Hampshire Health Protection Plan reauthorized through 12/31/18 • Bipartisan Solution without state funding • State share of funding made up of voluntary donations from hospitals and insurers as well as premium taxes attributable to the NHHPP plans sold on the exchange • Serves 53,000 individuals previously uninsured
- 40. New Hampshire & the ACA Medicaid Expansion Impact on Uninsured 47% reduction in uninsured OP visits 41% reduction in uninsured ED visits 48% reduction in uninsured IP admission
- 41. New Hampshire & the ACA Affordable Care Act • Decreases in uninsured patients • Decreases in uncompensated care costs • Decreases in inappropriate ED use Simple Right?
- 42. New Hampshire & the ACA Our goal is often our challenge = EDUCATION
- 43. New Hampshire & the ACA Legislative Makeup New Hampshire Senate 24 Members 14 Republicans New Hampshire House 400 Members 226 Republicans
- 44. How Are We Using Social Media?
- 46. Ghosts of Communications Past…. Effective Grassroots Advocacy
- 50. FACEBOOK Audience Hospital Employees Engagement 218% increase in average monthly engagement since January 2016 Effective Grassroots Advocacy
- 51. TWITTER Audience Legislators, Media Engagement 139% increase in engagement since January 2016 Effective Grassroots Advocacy
- 52. Effective Grassroots Advocacy Identify Priority Goals Set Strategy Define Message Establish Editorial Calendar Integrate Digital Media Organize Champions Build Coalition of Partners Engage Your Legislators, Policymakers, Key Influencers
- 53. Direct Messaging
- 55. Challenge
- 57. Key Take-Aways 1. Advocacy is everyone’s job 2. The right message is often a simple message 3. Social media can play an important, cost- effective role in your advocacy marketing 4. Don’t forget about the power of video
- 58. The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA. © 2017 Society for Healthcare Strategy & Market Development Questions? jhenry@ncha.org vstafford@nhha.org ddunlop@jenningsco.com Please be sure to complete the session evaluation on the mobile app!
Editor's Notes
- For Dan’s part about traditional media and loss of control. We have seen major changes at the two largest newspapers in the state – 20 year veteran reporters leaving, business reporters are now assigned to “community wellness”, even investigative reporters that haven’t always been our friends are leaving. There is no one left to pitch the more indepth stories to. 24 hour news cycle means there is no time for indepth stories – so we are left with “fluff” or unhappy consumer stories. Our hospitals are responding in some markets by buying ad space for their news… and we as an association are purchasing time on talk radio, which has allowed us the relationship to get air time for more complex topics like behavioral health
- We have a statewide ad buy that has afforded us time on a capital-area talk show.
- As a trade association, we recognize that we are usually the offensive line for our members. But recent research among our members told us that sometimes they believe we should be out there on our own. Especially when we are fighting for something that is a hard sell, like CON, or when we have to take a position for political reasons that may not be popular among all our members, like nurse supervision. We also recognize that too many times, we are seen as being against things, rather than being for something. Ironic, as we are “for” health all the time.
- As a CON state, we also face regular criticism from free-market advocates, like a recent editorial in response to an economic impact study we did. While the research determined that every 1 hospital job means 2.4 jobs in the community, the column claimed that hospital jobs are a drain on the economy, rather than a positive. Tell that to your 1,000 employees and their families.
- So we decided to go positive. These statements are positive and undergird all of our advocacy messages –from protecting Certificate of Need, to lobbying against federal and state funding cuts, to responding to the mental health crisis. Not new ideas, so the idea is that it is easy to weave into existing health system communications. But they do counter some of the most prevalent misconceptions among elected officials and the business community – who are our primary audiences.
- Hashtags that we are encouraing members to use
- This year, we got a little more creative in our use of facebook – we found that facebook ads are a very successful way to reach legislators, so we have done geotargeting of the legislative building the past. This year, we took that a step further and targeted thanlk you ads in their home districts during the break after session. We also experimented with Facebook live – though not as much as we’d like – and discovered the challenges of having a concrete block built legislative building that also prohibits streaming on its wifi. And we used some new tools – new to us – for highlighting video and audio clips on social media.
- ACLU - holding patients in emergency rooms for weeks while they wait to be involuntarily committed to the state psychiatric hospital violates the law or patients’ constitutional rights state law governing involuntary commitments – doctors have deemed patient is a danger to themselves or others. Once an involuntary determination has been made in the emergency room, the patient can’t be released until a bed opens at New Hampshire Hospital. State law requires any involuntary psychiatric patient get a probable cause hearing within three days of admission. In practice, the 72-hour clock starts once a patient has been admitted to New Hampshire Hospital, not the emergency room. It means patients can be held in hospital rooms for days or weeks without seeing a judge.
- Hospitals include both those classified as designated receiving facilities and those who don’t have DRF beds but who are currently treating patients Every partner was an audience with a different message and a different “ask” – tailored campaigns
- Challenges: THE ED is NOT the place to provide these services. The environment is too chaotic and the volume and acuity of medical patients is too high. Furthermore most ED providers and nurses are not psychiatric specialists nor should they be expected to be. group therapy sessions, counselling sessions during the hold time would move the patient along their path to stabilization. This is not what they receive currently. They wait in a holding pattern. High volume, running 10-12 daily; wait times are longer 10-20 days, inappropriate setting (hallway) lack of safe rooms (only 6), lack of workforce needed to hire travel RNs, still understaffed. Unable to recruit qualified RNs due to rate of pay with NHH rate of pay so much higher Our hospital does not have any psychiatric providers. no psychiatrist, etc. No available psychiatrists limitations of the ED functionality, it's not designed to support lengthy, resource intensive care or case management. existing contracts
- Armed hospitals with social media campaign & digital elements to share their own stories Traditional Media – op eds, article in H&HN Magazine
- Speak more to the specifics of HB 400, the RFPS, additional funds, etc. that will accomplish the above
- BH is an issue that we took on this year in a big way, with legislation to overhaul legislation regarding involuntary commitment. This was our approach to the crisis all hospitals are experiencing with long wait times in the ED and the lack of community based programs to keep people out of crisis. As we were developing our strategy, the opioid crisis was becoming a higher and higher priority on the state and national stage and we worried about whether it would eclipse our legislative push. The positive thing is that the opioid crisis has pushed behavioral health into the mainstream media conversation and is beginning to reduce the stigma around mental health issues overall.
- We generated our own caregiver and provider stories – mom, physician and care manager – made compelling videos and talked about the issues from their perspective.
- Again used our thank you ad approach to credit those lawmakers that got behind the legislation.
- hashtag
- Senator Maggie Hassan only won by 1,000 votes, defeating Republican incumbent Kelly Ayotte which could have changed the entire outcome of the ACA Repeal and Replace efforts
- Identify what we were doing, and then what we changed / added. New way of thinking, incorporating channels we weren’t using, connecting the dots between opportunity and story
- 9 page documents meant to educate our key influencers, with supporting documents for our hospitals – no instructions or guidance, and no real thought behind other effective channels of communication that would achieve ultimate goal of education
- We also used the opportunity to reinforce our thank you messaging with state lawmakers for their support on issues like CON and behavioral health with location targeted facebook ads like this one, thanking them for protecting the healthcare safety net. We used similar themes in our ongoing radio advertising campaign as well as in a small number of newspaper ads and billboards.
- Samples of how we are trying to model incorporating messages into what our members are already doing
- As we approach health insurance enrollment period, it is a great time to talk about the impact of increasing bad debt on your hospitals’ ability to care for all. Engaging in conversations about the behavioral health crisis is a way to put a personal face on this issue – because the people who care for those in crisis are being impacted in a big way. And as you prepare for big changes in health care, you have to think about going beyond talking only about new services and new year’s babies and laying the groundwork for tough conversations. How do we start talking about access to healthcare and not just about protecting rural hospitals – because healthcare in many small and rural communities will not look the same in a few years – maybe it already doesn’t.