by Davis D. Fansler

In the days when health plans more or less directed patients to the care they received, providers were concerned more with being in the plan's participating provider network and less with building distinctions and competitive advantages among their patient base. Those days are coming to an end.

As the market continues to shift toward greater patient involvement in selecting health care providers and paying for their services, it will become increasingly important for medical groups, whether independent or health-system sponsored, to distinguish themselves from their competition.

As with other efforts in which health care finds itself lagging when compared to other major industries – automation is a very visible example – most medical groups find themselves in uncharted waters when it comes to brand creation, or how they wish to be perceived by their community and their patients. Health care providers should keep in mind that consumers are attracted to quality, value, access, scope of services, and safety, so it's around these attributes that they should focus their brand-building efforts. Let's take a closer look.

Quality

Defining quality in the delivery of care should not be confused with the notion of delivering the highest quality, but rather consistently delivering quality care. Reducing the variation of care and outcomes among providers within an organization is what best serves that organization's increased visibility and desired reputation in its market.

The key element in reducing overall variation is reducing any “conflicts” within the group about how to treat presenting complaints. If all presenting complaints are treated similarly, variation of overall care is reduced dramatically. The “word” can be spread in a number of ways – reporting data via a group's website or via organizations such as the Institute for Clinical System Improvement; signing up with consumer-driven health plans where such data is used by consumers/enrollees in the selection process; and identification of the cost of providers, for example. And if the data isn't worth reporting, the group will be well served to restructure its strategic objectives toward making it so.

Value

One can define value in health care as the quality and/or outcome of medical services divided by the cost of those services. It can also be defined by determining the extent to which patients received the outcome they expected. This should include not only the clinical outcome but also the mechanics of the visit itself, e.g., little wait time, no administrative hassle, dealings with a courteous staff, etc. Accordingly, how efficiently and effectively a practice performs greatly impacts the value it can deliver to its patients.

During the age of managed care, patients were largely insulated from the expense side of the equation given the traditional funding structure of health care. However, with the emergence of consumerism, there is an increasing awareness of the cost of providing medical services, evidence-based support for treatment recommendations, and an emphasis on cost effective medical decisions.

In short, demand (the patient/consumer) is being more directly connected to supply (the provider), requiring value to be delivered or the customer will go elsewhere. The health plan’s role as the “insulator” or “middleman” is declining rapidly. Consumers want direct access and are demanding accountability from their providers, which leads us to the next issue: access.

Access

No longer can or should it be a veritable “badge of honor,” particularly among specialists, to have a six-month waiting list for an appointment. Even absent this mentality, physicians can no longer view a long waiting list as a source of security for the future of their practice.

To create more open access, practices must evaluate the tools they have in place that most impact provider availability. These include their practice management software, telephone system, medical records management policies and procedures, day-to-day operating efficiencies, and even e-mail and Internet capabilities. Providers must also be willing to eliminate delays, improve cycle time, reduce the backlog of clinic appointments, and support better matching of patients to providers.

With these elements successfully in place, a truly “open access” model can be established and improved customer service achieved. It’s important to keep in mind that this ultimately means that patients see the provider they want to see when they want to be seen and not when the provider wishes to see them.

Scope of services

Patients don't want to travel from their physician's office to another location for an X-ray, lab test, or other routine ancillary service. Whenever possible, medical practices should pursue expansion of their service lines to capture more of the services they already control within the four walls of their practice.

Such a strategy allows the practice to improve its bottom line without increasing pressure on its providers to be more productive. More important, patients will acknowledge and appreciate the added convenience.

This is not to say that developing or expanding a clinic’s service line should be at the expense of the local hospital or lead to increased duplication of service. Great opportunities exist to joint venture service lines with the local hospital or other local providers. By doing so, mechanisms can be used to improve overall reimbursement (e.g., by securing provider-based reimbursement for the entire revenue stream, including the clinic’s) and delivering a more efficient community-wide delivery system. In this context, everyone can win.

Safety

Around the time that an Institute of Medicine report, “To Err is Human: Building a Safer Health System,” raised consumer concerns about patient safety, The Leapfrog Group – a coalition of business giants – was formed “to alert the health care industry that big leaps in patient safety and customer value would be recognized and rewarded.” Since then, the group has steered hundreds of thousands of its employees to health care providers that meet its standards.

Clearly, recognition by groups such as this can help physicians and medical groups solidify and build stronger customer relationships.

Four keys to building a brand

So how does an organization build a brand? In one of the MGMA's publications, AdvisoryPlus, Bill Howe, President and CEO of the Strategic Marketing Group, writes an interesting and concise piece on creating a strong brand¹. In the article, he identifies several key principles for doing so, which I have taken the liberty to expand upon:

1. Identify target members. The trick is to identify the right targets. In this regard, many physicians and health care executives lose sight of the fact that it's more important to reach the people who count than to count the people you reach. The next challenge is to know them better than anyone else. Building customer loyalty is the cornerstone to a brand's success.
   
   
2. Commit to superior service. Commit all of your practice's resources to offering patients/customers the best possible services. Once you have determined your focus, you must create an organizational structure and nurture a culture that enables you to serve your patients better than anyone else. Great marketing can build great brands but only if they're based on a superior delivery of health care services. As Peter Drucker said, “the goal of marketing is to make selling superfluous.” In other words, in the delivery of health care, if you deliver on your “promise” (i.e., access, safety, consistency, quality care) time and again, the need to sell (i.e., prove yourself) diminishes.
   
   
3. Focus on customer perception. The only reality that matters is the perception of your customers (i.e., patients). It is imperative to escape the confines of how you think and instead use an outside-in approach that starts with the marketplace.
   
   
4. Listen deeply. It is essential to listen continuously to your patients. Deep listening is one of the least practiced but most valuable exercises that physicians and management can engage in—and it costs nothing. Physicians and management must maintain a constant state of discovery to stay abreast of evolving needs and wants. These insights become the means to continually refresh the brand by improving service and enhancing existing products.

Brand building is a marathon, not a sprint. In today's world of evolving changes in which health care is delivered and paid for, one can argue that the only constant is not just change itself but brand identification. The Mayo Clinic is the quintessential example. It has created indispensability for itself and its patients. People want dependability – a known quantity or value that differentiates itself from the pack of also-rans.

Conclusion

In sum, a strong brand answers the question: What do we need to do to get people to buy our services instead of someone else's? It identifies the group's unique characteristics to trigger a more immediate recognition and positive image. It's an organization's “personality.”

However, it also requires delivering the goods. For a brand to be sustainable, the consumers' (i.e., the patients’) experiences must be positive and consistent, which, as described above, include delivering easy and convenient access, an adequately broad scope of services, and clinical excellence visit after visit. The “promise” must be kept time and again. A strong brand is trustworthy; it makes a pact by delivering a consistent “give/get” between the provider and the patient.

An effective brand provides more benefits, value, and performance than competing services. In the end, the goal must be to secure each patient’s loyalty at which time your organization has begun the journey to indispensability.

¹MGMA AdvisoryPlus. Information provided by American Society of Association Executives, Marketing Fast Facts, 2001, written by Bill Howe, President and CEO, Strategic Marketing Group, McLean, VA.

Davis D. Fansler is a director in Partners Healthcare Consulting, a service of Wipfli LLP. He can be reached at 952.548.3402 or dfansler@wipfli.com.