Branding

Walgreens: Purveyor or Provider?

Walgreens-store

An intriguing question emerged from last week’s merger announcement from Walgreens Boots Alliance and Rite Aid.  Led by CEO Stefano Pessina and his largely European executive team, will Walgreens be purveyor focused on retail sales or provider engaged with a transforming U.S. health care system?

The signals are mixed.  A tea-leaf reading of last week’s investor call suggests Walgreens is destined to be a purveyor, focused on selling products and services.  Today, however, Walgreens announced a big technology move that points to a provider future, closely integrated with payers and providers.

Purveyor or provider?  Read on.

Tobacco:  To Sell or not to Sell

“Are you considering eliminating tobacco,” Barclays Capital analyst Meredith Adler asked Walgreens president Alex Gourley during the investor call as the company fielded questions about earnings and the merger.

Gourley had just praised RiteAid for its new, sales-increasing wellness format, saying it was an opportunity for Walgreens, which also is seeing success with its new health, wellness and beauty positioning.

“It seems pretty clear,” said Adler, explaining her question, “that providers and payers feel uncomfortable working with a retail pharmacy that still sells tobacco.”  In the background was the 2014 tobacco sales halt of CVS Health, which boasts 49 clinical affiliations, including Cleveland Clinic.

Gourley’s answer:  No.

Walgreens would instead continue investing in smoking cessation.  Anyway, he noted, only about three percent of all tobacco sales occur in a drugstore.  He did not pivot to emphasize how Walgreens is working with providers and payers, notwithstanding tobacco sales.

A tea-leaf saying “purveyor”? Perhaps.

Outposts in Seattle

Gourley could easily have drawn the analyst’s attention to a Walgreens announcement just two months previously.  In August, Walgreens and Seattle-based Providence Health & Services launched a new “strategic clinical collaboration.”

Providence will own and operate clinics in 25 Washington and Oregon Walgreens stores under its Providence and Swedish brand names.  The first three will open in early 2016, with the remainder following in two years.

Rite Aid made a similar move in the Seattle market in May when it announced a joint venture between its RediClinic subsidiary and MultiCare Health System.   The joint venture will operate clinics in 11 stores staffed by board certified MultiCare Nurse Practitioners in collaboration with MultiCare affiliated physicians.

Seattle, home to only three CVS stores, will provide a sheltered environment for Walgreens and Rite Aid to test the strategy of developing “deeper and more strategic relationships” with health systems.  In particular, Providence is quite a catch, having directly contracted with Boeing to provide health care for the aircraft maker’s employees.

The EpicCare Connection

However, the nation’s 1,000 CVS MinuteClinics dwarf both Walgreens 400 Healthcare Clinics and Rite Aid’s small number of in-store RediClinics.  Surpassing 25 million patient visits since the opening of its first clinic, CVS says it is opening three new MinuteClinics a week.   Aiming for 1,500 clinics by 2017, CVS is acquiring all of Target’s 1,660 pharmacies and 80 clinics.

CVS is converting all of its MinuteClinics to the market leading EpicCare electronic medical records (EMR) system.  Used broadly across health care, Epic also has strong interoperability with other EMR systems.   This will provide seamless data exchange with most American hospitals.

“EpicCare will help us work more closely with physician practices as part of the medical home team, facilitate co-management of patients, and advance our mission to make health care more accessible, convenient and affordable for Americans,” said MinuteClinic chief medical officer Nancy Gagliano, M.D.

Dr. Patrick Carroll agrees.  Today, the chief medical officer for Walgreens Healthcare Clinics announced the clinics would begin moving to EpicCare early next year.  “As our clinics play an increasingly important role in health care, supporting the health care system, provider practices and patients’ medical homes, care coordination can be critical,” he echoed.

So, a provider future for Walgreens?  It certainly looks like it.  “This will benefit our patients, clinic providers and partners, and serves as an instrumental part of our strategic growth plan [emphasis added],” explained Carroll.

Confusing Signals

However, as recently as May, Walgreens quietly shuttered 35 clinics, a move two former employees described to Crains Chicago Business as signaling “uncertainty whether Walgreens really wants to spend more on primary care and in particular upgrading the clinics’ electronic medical record systems.”   Today’s announcement erases some of that uncertainty, at least with respect to the EMR system.

In Seattle, Walgreens will provide in-store space, overseeing any needed build out.  Providence will be using its own Epic system.  “Patients will experience a seamless patient experience through our existing electronic health record system, providing direct connectivity to the clinics and billing systems, which will ensure better continuity of patient care and collaboration among providers,” said Providence senior vice president of physician services Mike Waters.   Now, Walgreens will be able to connect directly.

Convincing Collaborations

In Seattle, a provider land lord; in Tampa, still a provider.  There, Walgreens partners with a multi-specialty practice, assuming risk in an accountable care organization (ACO), Diagnostic Clinic Walgreens Well Network.  Serving 7,500 patients, the ACO saved $1.5 million or 2% in costs.  However, Walgreens has exited ACO partnerships with Baylor Scott & White in the Dallas-Fort Worth area and New Jersey’s Advocare.  The company continues a clinical affiliation with Baylor Scott & White.

Meanwhile, Walgreens has launched additional collaborations with CHE Trinity Health, a 30-hospital, Michigan-based system, Arizona Priority Care, a unit of California’s Heritage Provider Network, and Mercy Health – Cincinnati.  Leading Trinity Health is former Medicare official Dr. Richard Gilfillan, chair of the Health Care Transformation Task Force; Mercy Health is part of the nation’s largest not for profit health system, Ascension Health; and Arizona Priority Care specializes in accountable care.

In Baltimore, Walgreens has a long-standing relationship with Johns Hopkins Medicine (JHM).  The company provides grants for population health research overseen by a joint committee.  Two years ago, it opened a store, including a Healthcare Clinic, adjacent to the JHM campus.  In this case, Walgreens’ board certified nurse practitioners staff the clinic, although they and company pharmacists can work with JHM faculty.

Rite Aid’s Health Alliance program should dovetail nicely with Walgreens provider collaboration initiatives.  The program brings together physicians, pharmacists and special care coaches to provide care and support to individuals with chronic and poly-chronic health conditions, helping them achieve health improvement goals established by their physicians.

Eight provider organizations currently are participating in Health Alliance, which leverages Rite Aid’s population health subsidiary, HealthDialog.  Another 11 reportedly are be interested.  On average, patients participating in the Rite Aid Health Alliance are 36% more adherent to their medications; they have lost an average of 7.7 pounds; they have a 39% reduction in blood pressure; and they have lowered their blood sugar by 36%, reports Drug Store News.

Big Bet on Consumer Technology

Rite Aid is also bringing Cleveland Clinic physicians into some of its Ohio stores via telehealth start up HealthSpot.  Installed in the stores is a kiosk, enclosed for privacy, which includes a video connection with a physician and the capability to take and transmit vital signs to the physician.

Opting for mobile, Walgreens is using the Pager platform, designed by an early Uber architect, to connect customers with physicians.  It also is relying on the MDLive platform for telemedicine, and working with WebMD on a wellness app, and with PatientsLikeMe enabling people to share medication experiences with each other.

Walgreens has been a leader in using technology to engage its customers.  Its app is the third most downloaded retail app in the U.S. and the number one brick and mortar pharmacy app, reports mobihealthnews.  Fourteen million people visit a Walgreens app or website each week and Walgreens fills more than one mobile prescription every second.

Walgreens’ Epic Catch-Up

However, until the EpicCare announcement today, Walgreens lagged in using technology to engage providers.  Its electronic record system could not easily communicate with other systems, forcing stores to use secure fax and email to communicate with physicians and other providers.   That raised serious questions about the future of its provider collaborations and role as a provider.

Now, EpicCare means Walgreens can be more than a purveyor.  It can also be a provider, fully integrated into the new health care.

Boeing, Going, Gone: The End of Group Health Insurance

Boeing Headquarters

Come the fall, when benefit enrollment is in full swing, Boeing employees in St. Louis and South Carolina will have a new option – one of their local health systems, in addition to current coverage alternatives from Blue Cross and Blue Shield (BCBS) plans.

Boeing announced last week that it has directly contracted with Mercy Health Alliance, an accountable care organization (ACO) in the St. Louis bi-state region, and the Roper St. Francis Health Alliance ACO in South Carolina’s coastal low country.  Express Scripts is managing the pharmacy benefit and the Health Care Service Corporation of BCBS Illinois will help with administration and paper work.

Greater Savings, Improved Health, Better Experience

By working directly with the ACOs, Boeing hopes to save money for itself and employees, improving employee health and enhancing service for a more positive employee experience.  Boeing South Carolina executive Beverly Wyse told WSCC-TV the company is applying the same logic to healthcare as it does in building Dreamliners, with a commitment to more quality, reliability and lower costs.

Boeing estimates employees will save $350 to $1,000 per person per year on monthly payments, deductibles, copays and prescription costs.  Mercy executive Donn Sorenson told the St. Louis Business Journal Mercy could cut per family health care costs by more than half to $6,000 from the large-employer average of $15,849.  He plans to do it with greater attention to preventative and maintenance care.

In negotiating Preferred Partner ACO contracts, Boeing puts a high priority on access and convenience.  Primary care appointments are available for acute conditions same day and within 72 hours for any condition.  The wait for a specialist appointment can be no longer than 10 days.  In addition, each Preferred Partner provides extended hours, a dedicated phone line with care navigators, a member website and phone apps.

Competition in Seattle

Additional Preferred Partner arrangements are in the works, understandably because Boeing’s formula appears to be working.   A year ago, Boeing contracted with two ACOs in the Seattle area – Providence Swedish Health Alliance and the UW Medicine Accountable Care Network.  Of the 27,000 eligible employees and 3,000 retirees, about 18,000 signed up for one of the ACOs in roughly equal numbers.

In Seattle Boeing has pitted two prominent health systems against each other, creating a retail, consumer market within its large employee population, much like a private exchange.  Through their ACOs, both systems have assumed upside and downside risk, absorbing an insurer’s traditional role.

Instead, BCBS Illinois collects and provides data, in addition to performing administrative services as in St. Louis and South Carolina.   Boeing’s relationship with BCBS Illinois could be a plus, if the manufacturer decides to implement a private exchange.  BCBS Illinois has its own, Blue Dimensions, private exchange platform, which offers “many of the same features of online shopping.”

Boeing’s Health Care Endgame

In fact, the Seattle competition may foreshadow Boeing’s endgame, according to Tory Wolff of Recon Strategy.  Boeing “is setting up its market to transition to a provider-consumer type market.  We do not expect it to be too long before Boeing starts transitioning its employees to defined contribution.”  The impact would be substantial.  The company spends $2.5 billion on health care for 480,000 employees, dependents and retirees in 48 states.

Assuming Wolff is right, look for Virginia Mason to become a third option for Boeing’s Seattle employees.  In St. Louis, SSM and its newly acquired Saint Louis University Hospital could become a second option.  In time, BJC Healthcare/Washington University Physicians will conclude their shared brand – without an insurer intermediary — can attract more Boeing patients.   In South Carolina and other major Boeing locations, expect the same.

Private Exchanges – Small but Growing Rapidly

While Boeing approaches a private exchange, where employees get a broad range of coverage options and a defined company contribution, other large employers have already made the plunge. These include Walgreen Co., CVS Health Corp. and IBM, at least for retiree benefits.

Admittedly, private exchange utilization is still extremely small.  There are six million participants this year, up from three million in 2014.  However, by 2018, 40 million people likely will choose coverage on a private exchange, according to an Accenture study.

Aon Hewitt attributes the projected surge to a number of factors, including lower cost.  The average annual cost increase to employers completing a second year renewal 2.6%.  Large employers with similar benefit structures saw increases of 6.5% to 8% this year.

However, the most significant driver is a 40% excise tax on “Cadillac” health benefit plans scheduled for 2018 implementation under the Accountable Care Act.  Imposed on family and individual plans respectively costing $27,500 and $10,200, the tax could impact as many as 48% of employers in its first year, according to the benefits consulting firm Towers.

According to Accenture, private exchanges are a “compelling alternative” for employers who want to accomplish two goals simultaneously – control cost and administrative burdens, while still providing health coverage.  They are very aware that 76 percent of consumers see health insurance as the primary or an important factor for continuing to work at their current employer.  In fact, employer involvement in facilitating health benefits matters as much if not more than the employer’s financial contribution.

Sam’s Club Now, Amazon Soon?

Typical operators of private exchanges include health insurance companies and benefit consulting firms.  However, small employers may rely on an unlikely source to provide their employees with coverage options, Sam’s Club, which has collaborated with Aetna to offer the Aetna Marketplace for Sam’s Club.  Employers can offer a defined contribution plan or make a flat, pre-tax contribution an employee can apply to his or her plan choice.  (Recently proposed IRS rules could negatively affect the latter option.)

Can Amazon be far behind?  Perhaps not.  Both Wal-Mart and Amazon are engaged in a fierce battle for consumer loyalty.   There is no public evidence suggesting an Amazon move toward offering a private exchange.  However, Amazon Web Services has been touting its deep association with Oscar Health, a technology-driven, health insurance start-up, which could be serving as a learning platform for Amazon.

What is surely not far behind is the end of group health insurance, supplanted by a rapidly growing retail market for health coverage.  As blogger Joe Markland has observed, “a single 10,000 person employer will become a firm with 10,000 retail buyers.”    In addition to the 40 million in private exchanges by 2018, Accenture predicts there will be 31 million participants in public exchanges, up from 15 this year, for an overall 71 million consumers.

Retail Market Driving Insurance Mergers

This burgeoning retail market is the primary driving force behind the mergers of Anthem and Cigna, and Aetna and Humana, respectively.  Yes, greater size will provide negotiating advantage, but within a model that is quickly becoming obsolete.  In fact, insurance industry critic Wendell Potter observed last year, “If the Boeing strategy flies, health insurers as middlemen will be history.”

Agreeing, Leavitt Partners notes that employers want benefit options that will drive a world-class, healthy, productive workforce.”  However, it concludes, “the current composition of intermediaries cannot meet these demands on yesterday’s technology and workflows.”

Instead, health insurers are racing to avoid commoditization.  They have to reposition to add value differently in the new retail paradigm.   Instead of pounding out reimbursement deals with providers, they will need to collaborate, creating differentiated coverage alternatives for retail marketplaces.

More important than added scale, success for these insurer mergers will depend on the integration and expansion of initiatives such as:

Ultimately, successful health insurers will be collaborators instead of intermediaries, creating value with, not at the expense of, providers in a retail marketplace.

For more on this topic, see Employers Chasing Health Care Rainbows and Branded Narrow Networks:  Gold Value at Bronze Prices.

As Insurers Merge, What’s Next for Healthcare? Watch Gretzky!

Gretzky

Remember that quote from hockey great Wayne Gretzky, “I skate to where the puck is going to be, not where it has been.”  To see where healthcare is going, watch Gretzky.  Watch the successful organizations that always seem to be in the right place at the right time. Watch Ascension Health.

The nation’s largest not-for-profit health system, Ascension popped up in a recent New York Times story on health insurer consolidation.  It had become an insurer, too, when it acquired Michigan-based U.S. Health and Life Insurance in February.

Ascension Health as Insurer

Ascension plans to continue the small insurer’s focus on serving small, self-insured employers, according to a filing with Michigan regulators.  Although 20 states have licensed the insurer, Ascension plans to concentrate on Michigan, where the health system’s footprint is biggest, as well as in Illinois, Indiana and Wisconsin.

Longer range, the system has the much more ambitious vision of coupling its new insurance asset with a newly formed Ascension Care Management subsidiary to provide employers with population health services. Ascension then can take provider direct contracting with employers to a new level.

Generally, organizations like the Mayo Clinic and the Cleveland Clinic have contracted with national employers for single-price orthopedic and cardiac surgeries.  Ascension, on the other hand, is ready to provide capitated care arrangements directly to employers for all their employees, not just surgical patients. Modern Healthcare reports that risk based contracts, including capitated arrangements with payers, already cover about 1.9 million Ascension patients.

Being a Healthcare Gretzky

To be a Gretzky, a healthcare provider must be able to assume risk. However, not every provider capable of assuming risk will be as good as Gretzky.  There is more to being a Gretzky, including focused scale, powerful information technology and clinical leadership.

Focused Scale

Surely, Ascension’s size is its most striking characteristic.  However, size alone does not make Ascension a Gretzky.  Instead, Ascension brings a distinguishing focus to its size, one that recognizes healthcare in the U.S. as a confederation of 50 state markets plus the District of Columbia.

For example, in Michigan, Ascension has allied with CHE Trinity Health Michigan to form Together Health Network for joint managed care contracting and, potentially, offering narrow network coverage products on the state’s public insurance exchange.

The network, which does not involve an asset merger, covers nearly all of the state, with 75% of the population no more than 20 minutes from a participating hospital or physician practice. Reinforcing that coverage, Ascension has also agreed to acquire Crittenton Hospital Medical Center in Southeast Michigan.

On the other hand, Ascension has scaled back in Arizona, where it has entered into a joint venture with Tenet and Dignity Health, resulting in Tenet operating Ascension’s Carondelet Health Network.  Ascension had not been a major presence in the market.

Ascension is also configuring horizontally for the nation’s diverse healthcare payment models.  In a recent article, CEO Tony Tersigni observed that Medicare resembles Canada, our under-65 model is closer to France, Germany or Japan, veterans, military and Native American healthcare is a lot like the British National Health Service and, for the uninsured, rural India or Cambodia provide the best comparison.

Consistent with this mental map, Ascension last year announced establishment of Ascension Health Senior Care, now the nation’s second largest not-for-profit long-term care provider in the nation.  Consisting of 34 facilities serving more than 5,500 patients, the unit shares best practices and establishes consistent standards.

Once again, like Gretzky, Ascension has positioned itself well. At this week’s White House Conference on Aging, the Obama Administration announced a proposed rule updating, for the first time in nearly 25 years, the quality and safety requirements for nursing homes and skilled nursing facilities.

Powerful Information Technology

Ascension is not waiting for national data to achieve “drastically reduced hospital readmissions.”  Instead, in almost real time, it spots patterns in 30-day readmissions using admission, discharge and transfer (ADT) data across the care continuum. The immediacy enables Ascension to evaluate and adjust interventions on a local level.

“We are highly engaged with supporting the technology that would enable rapid identification and management of those conditions, so we are working very hand-in-glove with our clinical leaders,” Ascension Information Services (AIS) vice president Mary Paul recently explained to HealthITAnalytics.

The system has identified three key risk factors for readmissions – medication management, access to primary care and socio-economic factors.  ““We can predict fairly well which patient is likely to get in trouble from their clinical situation, but their social determinants are just as important,” Chief Quality and Nursing Officer Ann Hendrich told the publication.

Meanwhile, 2,500 AIS employees are also working to standardize and consolidate across 1,900 sites of care in 23 states, according to CIO Mark Barner.  They are shrinking more than 4,000 software applications to a much smaller number and consolidating 37 disparate interface engines into one.  Ascension is using the Athenahealth ambulatory electronic health record application and cloud based applications for ambulatory physician practice management.

Clinical Leadership

Ascension Health has been at the forefront of the patient safety movement for more than 20 years.  In connection with a 2002 commitment to 100% access to safe, effective care, Ascension adopted a goal of clinically excellent care with no preventable injuries or deaths by July 2008.  The Joint Commission Journal on Quality and Patient Safety published a series of articles charting the system’s journey toward clinical transformation.

Ascension continues its leadership through its Hospital Engagement Network (HEN).  Selected by and with funding from CMS, Ascension’s HEN is developing advances in ten areas, including sepsis, hospital acquired infections, patient safety culture, home healthcare models, hospital acquired kidney failure, and safe patient handling.  Ascension will share the advances with hospitals throughout the nation.

The Ascension HEN has already identified, documented, refined and shared best practices in ten additional areas, including urinary tract infections, adverse drug events, pressure ulcers, fall injuries and central line associated blood stream infections. For example, Ascension developed a protocol for reducing catheter induced urinary tract infections, which account for 30% of hospital-acquired infections, by limiting catheter use.

In another example, Ascension has dramatically reduced induced or C-section deliveries before 36 weeks, which often result in higher complications for babies and mothers.  In February 2012, Ascension’s early-elective delivery rate was about 3.5%, already substantially lower than the national average of 10% to 15%.  Now, it is even lower, at 0.6% after shared data with physicians and stepped up patient education efforts.  (For additional advances in obstetrical care, see three Ascension-authored articles in the January 2014 edition of Health Affairs.)

Last month, Ascension told the White House Forum on Antibiotic Stewardship that it wants to “set the pace for the nation in antimicrobial stewardship.” It has pledged to establish facility-based antimicrobial stewardship programs in all Ascension hospitals that will include both a pharmacist and a physician with antimicrobial expertise.  The system also said it would reduce the use of three broad-spectrum or niche antimicrobials by at least 10% reduction during the first 12-18 months.

What’s Next for Ascension?

One of the best ways to project where a Gretzky organization will be next is to watch the Gretzky’s within it.  In Ascension’s case, that would include Chief Quality and Nursing Officer Ann Hendrich, who joined Ascension in 2003, after leading the development of an innovative coronary care unit at Methodist Hospital in Indianapolis.

That she would be a Gretzky to watch at Ascension was clear from an observation she made in her application to be a Robert Wood Johnson Executive Nurse Fellow in 1998.  Hendrich wrote, “The opportunity to take shell space and not replicate the present and familiar but integrate environmental design, technology and a new care delivery model is imperative.”

In her dozen years at Ascension, Hendrich has played a key role in cementing Ascension’s clinical leadership.  Given the system’s accomplishments, especially in clinical quality and patient safety, Ascension merits the recognition usually afforded the great healthcare brand names like Mayo, Cleveland Clinic, MD Anderson and Kaiser.

Establishing a strong national brand is “what’s next” for Ascension.  The need and the opportunity are clear and, to track how Ascension intends to build its brand, look to the recent arrival of another Ascension Gretzky, Nick Ragone.  A lawyer and author, Ragone most recently led the Washington office of Ketchum, a global public relations agency.

As Ascension’s chief communications officer, he will “enhance the strategic identity of Ascension,” according to the 2014 announcement of his arrival. His initial focus has been internal, engaging 153,000 employees, as it should be for any brand-building exercise.  Ragone is supporting an enterprise-wide “One Ascension” initiative, which is integrating and establishing best practices throughout the once highly decentralized system.

Meanwhile, Ragone is preparing to take his branding initiative on the road:  He is looking for a brand strategy director to “lead work around the definition and development of the Ascension brand, both internally and externally.  The Director will be responsible for developing the value of the Ascension brand and driving strategies to build brand equity for Ascension, its Subsidiaries and Health Ministries.”

Epilogue as Prologue

Earlier this month, Modern Healthcare editor Merrill Goozner interviewed Ascension CEO Anthony Tersigni.  He asked Tersigni about Aetna buying Humana and Anthem pursuing Cigna.  Tersigni shrugged off the big deals, saying, “Ascension is preparing to take on risk itself for self-insured employers as the system strives to manage population health while encountering an increasing number of patients in high-deductible plans.”

Spoken like a true healthcare Gretzky.

King v. Burwell: 12 Keys to Effective Communications

Supreme Court - King v. BurwellIn King v. Burwell, if the Supreme Court rules for King, as many as 11.7 million Americans will wonder how the decision affects them.  That’s right – not just the 6.4 million directly affected, but everyone who gets coverage through an exchange, state or federal, subsidized or not.

They will be looking to their insurers, physicians and hospitals for answers.   In fact, even some of the 169 million Americans getting coverage at work may also wonder, so their employers should brace for questions, too.  For most Americans, there will likely be more confusion than clarity.

Yes, policy wonks, political operatives and health care insiders already know the justices could eliminate subsidies in the 34 states using the federal exchange, hitting southern states the hardest.  They also know that the subsidies, averaging $268 per month, reduce premiums by an average of 72% to about $105 per month.

However, the entire issue will be news to most Americans when the decision comes down, especially if it is for King.  In fact, as many as 37 percent of voters do not know or have no opinion on the case’s core issue of subsidies, according to a Morning Consult national survey released last week.

The justices could hand down a decision any day.  So, if you are a physician, hospital, insurer, or employer, or engaged with patients and health consumers, prepare to communicate.

Here are 12 keys to effective King v. Burwell communications for your organization:

1.  Convene a high-level, cross-functional response team to assess the decision’s impact, identify affected stakeholders and their concerns and develop a response strategy.

2.  Establish a set of guiding principles to align actions and communications with your organization’s mission, values and brand promise.

3.  Develop key messages based on your guiding principles to help all stakeholders clearly understand your organization’s approach.

4.  Decide as soon as possible whether your organization will support state or federal policy solutions that will restore subsidies.

5.  Create a communications map illustrating how internal and external stakeholders will present or receive questions to ensure all gaps are closed.

6.  Provide general explanations to patients, members, employees and consumers regarding how the decision does or does not affect them, based on their state, insurance type and any subsidies.

7.  Address, one-on-one, individual patient concerns regarding continuation of care and ability to pay. (If you are a provider, see HFMA for guidance.)

8.  Help patients and consumers develop personal response plans, utilizing available community, government and private sector resources.

9.  Encourage patients to maintain care until they speak with their physicians and develop a personal response plan.

10.  Ensure employees and partners have a ready answer to initial questions based on the key messages, plus guidance to refer patients, members, friends and neighbors to your website for more.

11.  Meet immediate patient and consumer needs for information with a quick response and ongoing follow up, internally and externally, via statement, spokesperson and website.

12. Adopt a transparent attitude, responding as completely and forthrightly to questions and requests for information.

A free planning tool is available at Planning Effective Communications on Climbthecurve.com.

Voting with your Tweet: The Brandification of Democracy

state and corporate logo brand mapThere was a time, a little over 50 years ago, when the original “open for business” state closed for the day.  Instead of a “Welcome to Delaware” sign, drivers found a barrier.   Try again later, advised a guard.  When one motorist — unable to enter Delaware — asked, “Is New Jersey open?” the officer replied, “Yes” and then “Smile, you’re on Candid Camera!”

Indiana Embroiled

Now, every state brands itself as “open for business.”  It was no joke when many felt a new law sanctioning LGBT discrimination had closed Indiana.  Twitter exploded, corporate sponsors withdrew from conferences, and dismayed businesses froze expansion plans.  The demand: Change or repeal the law.

Adding urgency was the impending arrival of college basketball’s Final Four.  Indianapolis has spent more than 35 years and millions of dollars building its brand as the amateur sports capital of the world. It landed the NCAA headquarters in 1999, but the law prompted the NCAA to think of leaving.

Within days, Indiana rapidly changed the law, removing the discriminatory provisions just in time for the Final Four.  “The message is clear today,” announced Indiana House speaker Brian Bosma. “It’s coming from Republicans, Democrats, corporate leaders, the community leaders of all stripes, that Indiana is open for business.”

Explanations Vary

Many explanations for the both the controversy and rapid reversal focus on the uniqueness of the situation.  They note changing public opinion on LGBT issues, the preponderance of LGBT support among younger Americans and the broad cross-section of families with members who are LGBT or LGBT supporters.

Others cite intense pressure coming from big brands like Apple, Emily’s List, Lilly and others.  Indiana and Indianapolis have brands to protect, too.  “We’ve worked decades to build a brand that is Hoosier hospitality and this bill has really questioned that,” said a spokesman for Visit Indy, the Indianapolis tourism bureau.

Brand Convergence

However, this is not the last time, nor the only issue, where brands will play a critical role in the making – and unmaking – of public policy.  In fact, what occurred in Indiana – and concurrently in Arkansas – reveals a convergence in corporate and state branding freighted with considerable implications for our democracy and those seeking results from it.

The new, common denominator for both corporate and state brands is people.   No longer do attractive logos and clever taglines define a successful corporate brand.  Now, the people who follow a brand define the brand, attracted by a point of view.  Meanwhile, states are fundamentally rethinking their brands as jobs increasingly follow people, instead of the other way around.

Traditional State Branding

In their branding, states have historically targeted CFOs or operations chiefs.  Take Delaware, where its business friendly brand originated with the 1792 establishment of its Court of Chancery, business lawyers’ venue of choice.   Home to more corporate incorporations than people, Delaware became especially popular with financial companies when it eliminated usury limits in 1978.

Now, states jockey for high positions on site selection surveys in a battle to attract jobs.  “The fight for the attention of site consultants and CFOs is more pitched than ever,” observed Area Development in a recent ranking based largely on costs, infrastructure and logistics.  Indiana appears to have shared that mindset.

“Our brand includes collective thoughts about the cost of doing business in Indiana, the pro-business tax structure and the track record of how the state and local groups help companies find a suitable location and put together a mutually beneficial winning deal for relocation, wrote the economic development director of Shelby County just outside of Indianapolis in 2010.

Business is Changing

Business priorities are changing, though.   People concerns and companies’ employment brands count for as much, if not more.  The Indiana-based Salesforce Marketing Cloud division threatened to halt investment plans because of the law.  CEO Scott McCorkle warned Gov. Mike Pence:  “Our success is fundamentally based on our ability to attract and retain the best and most diverse pool of highly skilled employees, regardless of gender, religious affiliation, ethnicity or sexual orientation.”

For talent-dependent companies, “attract and retain” quickly becomes “attracted by” highly skilled people.  In fact, companies are increasingly locating where large numbers of young, college-educated people live, according Joe Cortright of the urban think tank, CityObservatory.   Pittsburgh’s Carnegie Mellon has a highly rated computer-engineering program, and the city is more affordable for recent graduates than Silicon Valley.  So, what does Google do?  It located in Pittsburgh.

Jobs Follow People

Turned upside down is the traditional paradigm of dishing out tax credits and other financial incentives to attract jobs.  In addition to and increasingly before the CFO, a company’s human resources chief needs to be satisfied the talent pool is ample and sustainable.  Indiana’s legislators got the message the hard way:  Jobs follow people, especially young, talented college graduates, and legislating with them in mind makes more sense for a state’s brand.   They might have noticed that the percentage of workers with advanced degrees in Indianapolis had increased from 11.6% to 17.1% between 2005 and 2013.

Evolving Corporate Brands

Meanwhile, corporate brands have also evolved.  Historically encompassing products, corporate brands now engage people through the brand’s role in their lives.  For example, 50 years ago, DuPont’s tagline was “Better things for better living, through chemistry.”  Now, DuPont says “We drive progress,” explaining that, “at DuPont, progress means creating a better, safer, and healthier life for people everywhere.”

Note the contrast between things, i.e. products, and a clear point of view – in effect a policy statement – about what it accomplishes for society.  Indiana’s Eli Lilly says it “unites caring with discovery to make life better for people around the world.”  “Join Apple,” the iconic tech company encourages prospective employees, “and help us leave the world better than we found it.”  Even Wal-Mart’s brand has evolved from “Everyday Low Prices” to “Walmart helps people around the world save money and live better.”

The promise of better lives.  Global corporations now make it, just as elected officials and those seeking election have done so for more than two centuries in our democracy.    For corporations, the power to deliver on such promises traditionally has come from commercial and financial success.  Increasingly, that power now comes from people as employees and brand evangelists, representing yet another convergence with government.  Both have constituencies.

Brands are Us

We are beginning to see the realization of a prediction made several years ago by Toronto social media observer, Josip Petrusa, who was among the earliest to coin the term brandification.  “Brands, he said, “will no longer come to represent the products that encompass them but the user who empowers them.”   This is particularly true when the preponderance of users are millennials, the same millennials companies seek as employees.  Petrusa explained:

“Millennials are considerably brand-centric. They love the brand. They love brands. They share brands. They talk brands. They live brands. They speak brands. And they have invested considerable ideological value into them. They have come to represent who they are.”  He called this the brandification of social presence.

Still, brand love can be fickle and swiftly withdrawn in the daily brand referendum relentlessly conducted on social media.  Having won followers with a point of view, a brand must stay true to that point of view or risk abandonment by followers voting with their tweets.

One of the biggest risks to a carefully curated brand is association with another brand featuring an inconsistent or, even worse, contradictory ideology or point of view.  When this other brand is a state, and the contradiction comes via legislation, spotlighted by social media, the collision can be quite combustible as we saw in Indiana.

Brand Alignment

However, the more significant outcome of Indiana’s brand collision was the quick, legislative reversal, ensuring alignment between corporate and state brands.  Going forward, with Indiana’s experience a compelling lesson, a state will be more careful to align with the corporate brands powerful enough to affect the state’s economy or its own brand.

The more such alignment between corporate and state brands occurs, the closer we will be to the brandification of American democracy.   It could be a good thing for those seeking greater tolerance and less discrimination in our laws, especially in the face voter suppression, gerrymandered districts, low voter turnout and the dark side of corporate political involvement – vast amounts of unreported spending.

More Corporate Activism

The question is whether brand evangelists will demand more social activism from corporations, especially those promising better lives.  Will North Dakota then have a better chance of filling 23,000 job openings by ultimately passing LGBT anti-discrimination legislation?  Will Arizona then see the lifting of a business boycott by rolling back a discriminatory immigration law? Will the 17% of Greater Cleveland’s college educated workforce – up from 11.7% in 2005 – engage corporations in reforming the city’s deficient police department?  Will St. Louis then recover from Ferguson with help from Millennial Activists United and others?

Perhaps American’s corporate brands will need no further prodding.  Maybe the like-minded among them will come together in common cause with states and cities to make lives better.

Candidly, I hope so.