Episode 45: New Battlegrounds, New Battle Plans

Well-known marketing consultant John Marzano describes the seismic shifts happening at the intersection of primary care, retail health, and COVID-19. In this episode, you’ll learn how consumers are going to be fickle when choosing primary care services, how those choices trickle down to specialty care in new ways, and how the need to ramp up communications with patients is greater than ever. All that, plus how it’s essential not to underestimate the difficulty of convincing patients that it’s safe to come back to the doctor.

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Full Transcript

Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone, and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans. And many of those humans have unbelievable stories to tell. Here, we leave the policy debates to the other guys and focus, instead, on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together and hear some amazing stories along the way. Ready for a breath of fresh air? It’s time for your “Paradigm Shift.”

Jared: Welcome to the “Paradigm Shift” of Healthcare. And thank you for listening. I’m Jared Johnson here today with my co-host, Scott Zeitzer. On today’s episode, we’re speaking with John Marzano, principal consultant with JAM3 Strategic Marketing & PR and former VP of marketing and public affairs for several major health systems across the country. Welcome, John, and thanks for coming on the show today.

John: Thanks, guys. Great to be here.

Jared: We’re delighted to have you because there are so many things going on in the world these days, but remind us first and foremost, where we are speaking to you from. What part of the country are you in?

John: I’m actually in Northeast Pennsylvania right now. Still in a yellow phase, technically, as the state has opened up in phases. We’re very close and in that quadrant that borders New Jersey, and about an hour from or about an hour west of New York City. So, we’re technically in one of those hot zones or was in one of those hot zones, but we’ve been easing up now. And, you know, the world is starting to awaken here again. So, which is a good sign.

Jared: It is. And one of the reasons I asked that is because depending on the area of the country we’re in, this is one thing we’ve been learning on the program is that it usually affects our perspective on the timetable for things on how quickly things will reopen. And what we’re gonna be talking about today has a lot to do with that.

It’s very much what’s coming in the near-term future, and those implications, long-term, on the business and financial viability for providers of all shapes and sizes, of all types of practices and health systems and hospitals, etc. And I think it comes into play a lot with some of the conversations we’ve had recently, because we’ve talked a lot on the podcast recently about the timing for reopening for elective procedures, for instance. And that could be one of many important business decisions that providers are facing that ultimately affect their financial viability. And we know these conversations aren’t just clinical in nature, they are very much financial in nature.

We understand that providers are trying to understand the different scenarios and the different options for where things may head. So, that’s where we can start our conversation with you today, John. You know, without us being totally doomsday, you know, that or anything like that, let’s have a reality check. You know, let’s talk about how practices can stay financially stable during these unstable times. What’s your take on that? Like, where’s even a good starting point for providers to start thinking about?

John: Well, you’ve read my mind. Primary care is one those areas, I think, that disruption started even before the pandemic started. And it’s one area, I think, where hospitals and health systems, as they look to re-engineer or reignite that business, they’re looking at different components already, right? Telehealth has grown exponentially. I think you have to look at this as primary care being the foundation of any health system. And a major referral source for that specialty care and for that tertiary care that goes on in major networks, I think you have to look at two areas right now.

One is a financing model and the other is, how do you respond and adjust or join this retail healthcare disruption that’s going on from the likes of Walmart, CVS, and others? You know, some interesting stats that go along with that, about 54% of all healthcare delivered is primary or routine care. Yet that component gets only about 7% of the healthcare spend in this country. So, immediately, you see there’s a real disconnect, right from the start. Many primary care networks that are part of hospital affiliations or employed physicians of hospital networks are loss leaders in those companies and those organizations.

And believe me, I’ve experienced that over the years in working at health systems. You’ve had a drop in office visits, obviously, through the pandemic. Telehealth has increased, but where is the reimbursement in that? We don’t know what the answer is to that question yet. Is a visit going to be a visit and reimbursed the same way either electronically or in person? I think the jury’s still out there. And as we all know from primary care, volume equals referrals and revenue, and right now it’s not happening. And I think organizations really have to take a serious look at that.

The second piece, of course, is the retail disruption. And you’ve got Walmart opening new health centers just yesterday, I believe, in Arkansas and planning to open more. CVS and their health hubs are ramping up that vertical. If you’re sitting there as a traditional healthcare provider, which depends on that primary care base as your foundation, what do you? Do you compete on operations or do you partner to secure those referrals? I think a lot of those questions are unanswered and we’re gonna see what’s going to happen, I think, in the coming weeks and months.

Jared: So, how do providers protect their turf in primary care? Let’s start with primary care providers, to start off with. We’ll get into specialty care because I think those answers are different in terms of what the relationship is and the implications are as primary care itself changes. How does the primary care provider even protect their own turf?

John: Well, I think there’s one area that jumps out at me and that’s ramping up talking to that patient base that they have. You know, most health organizations now have MyChart capability where you can keep your medical record with them. There’s a huge database in there of segments of different parts of the population. I think organizations have to take a look at that, be able to segment that population based on who they might think or who has a propensity to either need or want to re-engage quicker than others.

That’s been something that, you know, we haven’t really tapped into loyalty per se, but it’s a very loyal patient population, loyal to the organization, loyal to those physicians in that network. Use it, get out there and use it. Let’s try to re-engage in that way. And that’s just one way to perhaps go at this. There’s a lot of fear and anxiety out there, of course. And organizations have to be able to counter that by almost guaranteeing that it’s a safe environment now to do that.

Jared: And that’s not necessarily the easiest thing, is it? You can’t just tell people, “Hey, it’s safe.” Like, we just spent all these weeks and months showing and telling patients, “You can’t even come here.” Like, “It’s not safe. You’re not even allowed here.” And to expect anyone to turn right around and say, “Okay, now I trust you. Now I believe you. And now I can’t wait to come back,” when consumers were already leery, it’s the last place they wanted to be was at their doctor’s office, is the last place they wanted to be was in any type of visit at all.

They were coming…for the most part, you know, this is generalizing a lot, but these are very common consumer sentiments about healthcare in general. And while we may believe and feel like there are healthcare heroes now…I love seeing that hashtag still out there that we believe that the frontline clinicians are there to help us now. And I think that’s a positive change with consumer sentiment. What we are not seeing is this eagerness to come back to the doctor. And so, I think you’re dead-on in terms of ramping up how we keep in touch with our patient base. So, knowing that we can’t just tell them that it’s safe and expect everyone to come back, we put ourselves in a provider’s shoes. Like, what else can we be conscious of ramping that up? What else do we do to help a consumer understand that it actually is safe?

John: Well, I think you have to, again, as a marketer, you have to look at the channels that are available to you. How do you get in front of your populations? I mean, certainly, it’s done through social media. It’s done online. I see in this market, the hospital systems doing full-page ads, trying to reassure, convince people that it’s safe to come back. I think there are any number of channels that you have to use. You have to be willing to get out there and make sure you’re communicating to those specific needs. You know, how consumers are. They’re very fickle at times. And this is almost a situation where you’ve got to prove to them that it’s safe.

As the news cycles play out every day saying, “Gosh, there are hotspots that are increasing all over the country. Gee, maybe I don’t feel safe again.” I just noticed something today, again, that triggered that. Did some grocery shopping, and the shelves for paper towels are empty. And I hadn’t seen that in probably 30 days or so. So, okay, is the news media ramping up this fear again? That just sets people back a little bit. I don’t know. But again, you look at the consumer and the consumer is gonna be very fickle when it comes to that. You have to prove to them that you are…almost guarantee to them that nothing’s gonna happen and tell them how you’re gonna do that.

Scott: I agree with you, John. I think getting the word out and getting more specific about how you’re keeping your patient safe. It’s not enough to say, “I’m keeping you safe.” It’s gotta be very specific. I think that’s one component. And I also think that COVID and the COVID environment is bringing out a lot of cracks in the healthcare system that were always there. I mean, it’s not like people got into primary care because they were in it for the money. I always wanna hug a pediatrician because they get paid less money and have to deal with two patients, right? The mom as well as the kid. And that doesn’t matter what specialty it is.

So, I really do believe it’s kind of bringing that out. We’ve talked to a lot of different primary care providers and they’ve come up with a lot of different models, some of which involve paying for access to a particular primary care provider so that they don’t feel like, you know, they’re in a factory setting, so to speak. Because if you’re a hospital, you know, there’s two kind of parts to this conversation in terms of the battleground in primary care. One is from the primary care provider perspective, and one is from the hospital perspective, right, John?

John: Yeah, I think so. You know, the physicians, and I’ve talked with a number of primary care physicians, this goes back probably a month or so. And they were still having conversations about how urgent care was allowing scheduling of appointments now, which was directly competing with them. And I ask them, “Well, what are you doing as far as your availability online, whether it be texting or through telehealth?” And that was just starting to percolate a little bit. I think now obviously it’s going almost virtual because people expect that, and people aren’t afraid of it like they were before.

So, from the physician standpoint, it is a natural evolution for primary care to become part of these networks that offer telehealth services out there. And you can either localize it or in some organizations they use just a global primary care base to use. I think it’s always an advantage to use local physicians when you’re calling local. So, that’s one component. The hospital, the network itself, I really believe has to look at this very seriously. We can provide as much telehealth as possible, but you’ve got urgent care facilities, you’ve gotta compete now with the Walmarts and the CVSs of the world. How are you going to do that to protect your base? Because we didn’t get into this discussion yet about specialty care, but the natural segue to that is, if I can’t get business into primary care, it is gonna be that much more difficult to get it into this specialty care.

Scott: No doubt about that, that whole specialty care conversation. You know, pre-COVID, when I would talk to… Our primary customers are orthopedic surgeons, neurosurgeons, pain management, regenerative med, and they, of course, had very good or tried to have very good relationships with primary care providers, rheumatologists, etc. And if you go back 20 years ago, you talked about trust and about loyalty. I mean, the rheumatologists would always send most of their patients to a specific group of orthopods, say, if you’re talking about some type of arthritis situation.

And then the years go by and all of a sudden, hospitals are picking up different primary care providers, as well as rheumatologists, etc., insurance people are trying to find networks. And now here comes COVID, making it even worse, you know, so to speak. I kind of come back into that battleground. So, do you foresee, like, say, orthopedic surgeons, groups getting larger so they can actually hire their own rheumatologists and primary care providers, or do you see orthopods, neurosurgeons, etc., getting absorbed at a higher rate into hospitals or both?

John: I wanna say both right off the top of my head. Orthopods, it’s interesting you used orthopods as an example. Probably one of the two most challenging groups to ever work with in healthcare are orthopods, and cardiologists, always challenging. I can speak in this market and in other markets I’ve worked. The orthopods generally like to remain independent although more recently, I think you see them joining in partnership with either networks or other orthopedic groups to form larger orthopedic groups that basically control the market. So, I would say, to answer your question, the ladder component there of them if they’re big enough to be able to hire additional specialized care, you know, under their purview, if that’s a natural referral process. You know, the one piece that’s always been a challenge, I think, for specialties is their willingness and ability to go out and talk to their referral sources.

Scott: Absolutely.

John: As a hospital marketer and working with our physician networks, in the past, we would have to schedule events to get physicians together because it’s very difficult for them, not only on their time constraints, but difficult for them to go out individually and foster those referral sources. However, post-COVID, I think that’s going to be critically important, especially if primary care gets fragmented in a number of different areas.

Scott: Yeah. You know, you talk about, like, this layer of telehealth that’s coming in, and I do hope that the insurance companies start providing the same type of reimbursement for telehealth as they do a visit. And that may be government-mandated. I can’t see a lot of insurance commenting on, “Sure. No problem. Wonderful.” Can’t see that. That being said, that level of trust that is built up by being with, in-person, that doctor, no matter what the specialty is, will be a little bit less, vis-a-vis telehealth, it’s just the way we are as human beings.

I look at all this and you were talking about how hospitals work really hard to try to create get-togethers, you know, either dinners or informative education pieces, where essentially, say, a specialist, be that an orthopod, cardiologist, etc., would kind of talk to the general, either the general public or primary care providers to say, “Hey man, here’s the latest and greatest in what we’re doing and what we can do for you,” so to keep everybody in the loop. Do you think, like, med tech or, like, pharmaceutical companies and/or med tech can help with that? Hinder that? Like, how do you see that part of the relationship?

John: That’s a good question. I don’t know that I’m enough of an expert in that area to really get into the details. You know, I try to put my consumer perspective on, or the customer experience perspective. And you see it now as places, as Walmart and CVS are building their verticals, they’re trying to put as much of the routine care together, whether it be your scripts, whether it be your dental care, your eye care, your hearing care for older adults, I think wherever you can do that is gonna be a huge advantage.

Because if the consumer is afraid to go to healthcare organizations or hospitals right now, yet they feel safe, they’ve been going to the Walmart and they’ve been going to CVS all along during this pandemic, and they feel comfortable going in there, they’ll continue to do that because it’s accessible, it’s convenient in and out. “I know what I’m gonna pay when I go in there.” That’s the other piece of this, you know the pricing when you go in. When you into hospital, you don’t always know what the price is going to be. And that’s a whole other world to talk about, but, again…

Scott: We can have a podcast, a great podcast about price transparency, for sure.

John: Right. Exactly. So, I think wherever we can streamline the customer experience, I think it’s gonna be huge advantage.

Scott: Yeah. I consistently harp on all of my customers, “Stop calling your backline, you know, when you wanna talk to someone. Every once in a while, maybe once a week, call the main number.” That consumer of your own… You know, be that consumer because, you know, the orthopod does not get that there’s like eight buttons that someone has to press, or ortho, the cardio, whatever, whatever the specialist is. It’s like, “Wow. I never knew that. My goodness.” And so, you talk about patients going to Walmart or CVS, etc. It’s like, “Yeah, they’re used to treating their patients like customers, or they’ll go across the street.” I do think a lot of doctors, you know, which used to kind of think like, “No, I’m really good at what I do. They’ll just come see me.” I think that’s gonna change. And I think it’s making it happen faster.

John: I think you’re absolutely right. And, my gosh, I have hundreds of examples I could share with you about that very thing. A lot of times, it’s that frontline staff, the office intake, what’s your capacity in your practice to be able to get people in the door more efficiently, if we’re gonna market your service, your specialty care, well, you better be able to get patients in the door. And if you believe that your three-month backup is an advantage because people just will wait to see you, they won’t do that anymore. Consumers will not do that. If anything, they will go on a video visit or a video call to get their answers quicker. They’re not gonna wait four months to be seen, especially if quality is considered equal among competitors.

Scott: Yeah. I one hundred and fifty percent back that thought process. To all the providers out there, if you’re listening to this podcast, start thinking about how you can better take care of your patients. Number one, it’s gonna start with everybody. Please, get online and be specific on your websites out there and make sure that people are aware about how you’re taking care of them and your staff. And it’s gonna change. We’re gonna get waves of COVID where we are in Louisiana, I think we’re in phase two in New Orleans right now.

Hopefully, everything will be fine, but I think some people right now in Florida, Texas, Arizona, etc., they’re going through their waves right now, and the website can be very helpful and get that information up there. And then once you’ve kind of triaged that, and gotten that information up there, then you start reaching out to some of your partners and let them know, “Hey, I’m available. This is what I’m doing.” It’s not just for the patients. Let those people that you’re getting referrals from know that as well.

John: Absolutely.

Scott: Are there any other out-of-the-box ideas that providers should be paying attention to? I mean, we’ve talked about COVID being an issue. We’ve talked about Geiss [SP], CVS and Amazon. We’ve talked about them. Walmart, you know, they’re not going away. Is there anything else that if you a primary care provider…? I’ve got a son who right now is studying to be a DO. And I’m telling him like, “Man, you better be into this from the perspective of taking good care of your patients and into that because, my man, it’s gonna change. It’s gonna change a lot.”

John: Yeah. It depends which perspective you’re looking at. I think from a marketing standpoint, I believe organizations have to look at the science of the data and what’s out there in their populations to be able to effectively talk to them and get them back in the fold, so to speak. Patients are being bombarded from every angle right now. And I think if you can pull some science into it versus what has historically been done from a traditional marketing perspective, I think that provides some avenues to identify those patients who basically are in need of care, because there’s a lot of fear, they won’t get the care that they need. And they’re coming up with additional mortality because they haven’t been treated for their chronic disease or whatever it may be.

So, I think you have to pinpoint and find those patients in need. And that’s done through science. From a broader perspective, I think looking at merger and acquisition activity. I read something the other day where the next 6 to 18 months, there will be lots of jockeying going on because quite frankly, the number grows every day of health systems and the amount of money that they’re posting as losses over the last quarter and a half. That’s gonna continue until they can get business back in the door.

So, what does that mean for the physician, for primary care or specialty care that’s been associated with a network that may be up for being purchased or acquire other partners? I mean, I think that’s going to provide, again, some disruption to the normal course of business. So, I think those are all things that I think we’re waiting to see, and what’s going to happen in that process, but very interesting time for sure, but very uncertain time.

Scott: Yes. Look, we could go on for quite some time. We’re at our basically 25-minute mark and I wanna let everybody know like, hey, we’re gonna be talking a lot more about this. It really is a changing paradigm here. And if you’re a patient listening to all this, there’s a lot of stuff that you need to be thinking about. And I want everyone to stay safe, that’s for sure. And if you’re in the middle of all this, a physician or a hospital trying to figure it out, there’s a lot to think about. And we’ll be thinking about it for quite a bit. John, I really wanna thank you for your time.

Jared: Really appreciate it, John, likewise. The important part right now is just for us all to be thinking about what these scenarios could be, and not just sitting on the sidelines. By the time we do a typical healthcare thing of waiting for somebody else to figure it out, it’s gonna be too late, this time. It already has been too late, like, pre-COVID, but this time it really will be. Like, we can’t just sit on the sidelines anymore. And so, I appreciate you just giving us a few minutes today, John.

Scott: Definitely, stay safe, stay well, and good luck with everything you’re doing.

John: Thanks. Stay safe, everybody.

Announcer: Thanks again for tuning in to the Paradigm Shift of Healthcare. This program is brought to you by P3 Inbound, marketing for ortho, spine and neuro practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts.