Episode 11: The Intersection of Population Health and Marketing

For population health management to succeed, hospital teams have to step into new roles and responsibilities. Dan Dunlop, principal at Jennings, shares the new role of marketing teams in this effort. Who better to connect the hospital’s business objectives with the health needs of consumers than those who know both sides best? As population health initiatives evolve, expect to see more hands involved in the efforts.

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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 here are some amazing stories along the way. Ready for a breath of fresh air? It’s time for your paradigm shift.

Michael: Welcome to the “Paradigm Shift of Healthcare,” and thank you for listening. I’m Michael Roberts here today with co-hosts Jared Johnson and Scott Zeitzer.

On today’s episode, we’re talking to Dan Dunlop, principal at Jennings, a healthcare marketing and audience engagement firm based in North Carolina and Boston. Hi Dan, thank you for coming on the show.

Dan: Oh, it’s great to be here. Thank you, guys, for having me.

Scott: It’s our pleasure.

Jared: Dan, I think one of the very interesting things about Jennings itself, and not paid to say this at all, I just find it’s interesting even the way you guys have described yourself as an audience engagement firm and marketing, and we’re just speaking before the show, even as a starting point, that there are some pieces of healthcare that I’d really consider paradigm shifts, a lot of ways that healthcare is being done differently.

The marketing hadn’t traditionally been involved in and that’s what we wanna discuss today. A couple of those, one of those being population health management, which, like you said, that doesn’t typically come from marketing, but it sounds like there is a larger and larger role that marketers can play with that. So maybe we have a good starting point there somewhere in terms of what your experience has been with population health and we can see where it goes from there.

Dan: Sure. You want me to just dive in?

Jared: We can back up a little a before that too and just let listeners a little bit more about yourself and Jennings. I guess I do, I assume everyone knows because Dan’s a pretty big deal, listeners, so I assume pretty much people know who he is, but yeah, let’s do that. We’ll back up a little bit, you know, tell us a little about yourself and Jennings and who you are, what you’re all about and that kind of stuff.

Dan: Sure. I mean, we’re a firm, Jennings has been around for 40 years actually. This is our 40th anniversary. And you know, in marketing, I don’t know if longevity’s a good thing or a bad thing. It’s a good thing if you change with the time. But I’m always telling people that in healthcare marketing, if you don’t like change, you’re in the wrong business. And we’ve certainly changed. You know, we’re not the same agency we were 10 years ago.

We’re not the same agency we were five years ago. A lot of what we’re doing now is content development and content deployment, that, as you said, to engage different audiences, whether it’s physicians, whether it’s business people and influential or consumers, and often, it’s employees of the health system. You know, our job is to come in and figure out where’s the problem, where’s the challenge and opportunity, and then we develop a strategy and the tool to address whatever it is that the health system is facing.

Jared: Cool. So a couple of those things recently have involved, it sounds like, nontraditional types of content that you have been involved with and I’m sure that depends on what the objectives are of the hospital that you’re working for and that has involved population health itself.

Population Health Management

Jared:We probably would find it useful to even hear what…how you describe or define population health management to begin with. Maybe that’s a good starting point.

Dan: Yeah, it’s a really good point, Jared. I wish I had written down a definition just for this call because people do talk about population health and they mean different things. There’s not one collective, clear understanding of what population health is. A lot of people use it interchangeably with community health, and I totally understand that.

A lot of hospitals and health systems that are dealing with that transition from fee for service to more value-based and risk-based contracts and compensation think about population health in terms of, “Okay, we now have a population that we have to manage and we have this pot of money to manage the health of that population, and we have certain performance metrics that we’ve been given by the insurers that we have to meet, and those then impact our compensation.” So they see these populations that they’re managing within that, kind of, group of patients and they see that as population health management often.

When I talk about population health management, I like to think about how are we looking at people in a given community and addressing some of the key health issues that they’re facing, whether it’s diabetes, hypertension, some of those ailments, and how are we taking those on as a health system, for example? And so I can see, you know, given that, I can see how people could confuse population health management with community health management.

Jared: So there’s some financial incentives involved there. Can you dive into that at all a little bit in terms of like where…whose responsibility is it, who owns it, or which different types of groups within a hospital or health system own different pieces of population health management?

Dan: Yeah, it’s fascinating working, especially working with clinicians, working with the physicians and talking to them about the populations that they’re responsible for and the metrics that they’re trying to meet.

One of the great challenges from their perspective when they’re doing this and it does impact their compensation and the health systems compensation, one of their great challenges is how do we get the patient engaged in their own health? Because to meet these metrics, to meet these performance standards, the patient has to take certain steps. And the health system can call, you know, they can have navigators calling or reminding people to come in for their checkup or to check their blood pressure or do…or get their prescription filled, whatever it happens to be that they need to do to meet those standards, but if the patient doesn’t comply or the bigger issue probably is unable to comply, then we’ve got a serious challenge.

And I think sometimes the health system forgets that it isn’t just a choice by the patient to comply or not to comply. It’s often a factor of, kind of, the social determinants of health. It’s their economic situation. It’s where they live is. It’s part of their environment. So for instance, I might not get to my follow-up appointment because I don’t have transportation. Or I might not fill that prescription that I got when I was leaving the hospital or leaving the doctor’s office because I don’t have the funds to do it. So those are the kinds of issues that we’re having to deal with today as this whole compensation model changes and as the focus changes to population health management.

Scott: Yeah. It’s interesting you bring that up. I have a friend of mine who’s a pediatrician up in Columbia/Presbyterian Medical Center and she was telling me that…this was a while ago, maybe about a decade ago. They had just this horrible recurring deal with the South Bronx and surrounding neighborhoods where the kids kept coming in with asthma-related health issues. And the patients, the kids were…had tremendous issues with asthma. They were giving out all the medications and they just weren’t getting better.

And to you point about there’s a compliance part to it, like how quickly can they get their kids back, they’ve got two jobs that they’re working, how do they get them back? But this had an interesting root cause to it that a couple of people up there figured out, which was wow, where they were living is infected with pests causing these allergic reactions.

And so they went out, there happened to be a pediatrician there, a resident who was married to a young a lawyer. And they said, “You know, why don’t we go after the landlords and tell them like, ‘You know, you’ve got a responsibility to clean up and to bring some pest control in.’” And he did. They started using these lawyers who work pro bono to see what would happen. They had to work for a large group. And that actually had a better health outcome than just frankly handing out meds over and over and over.

Dan: Yeah. And you nailed one of the really important themes in population health management, which is, you know, in that case, we have all these children showing up with asthma. You can’t fix that problem through just one-on-one transactional-type medicine, you know, where you’re treating one patient at a time. There was a kind of a…almost a systemic problem with housing and there’s a direct correlation between the prevalence of cockroaches and asthma in children within these housing communities.

And so the best way to take on that challenge is not through that one-on-one interaction between the physician and the patient or the physician and the family, but by addressing the housing challenge, which is exactly what they did in that case. And that’s what needs to be done. These people so often are living in food deserts, they don’t have access to healthy foods, they don’t have safe places to exercise, or in the case of children, play. There are just all these social issues and environmental issues that impact health.

And so what they’re finding and what my clients are finding is that the best way to begin taking on these issues and to address population health is not through that one-on-one interaction. Yeah, they’re still going to have that transactional kind of medicine that’s always been around. But it’s really through community partnerships. It’s by taking the health system beyond the walls of the hospital and partnering with community organizations, whether that’s a church with some kind of food pantry organization, a housing organization. I know of medical centers that have helped to build housing for homeless people in their community, because that was the most direct way to address some of the health issues that people were facing in their community.

Getting Involved in Population Health

Michael: How does a hospital group decide that they’re going to do this and actually move towards this kind of action? Because it sounds incredible and it’s one of those things that I think a lot of us would like to see our healthcare systems do. But who’s owning that decision to make that change and who are the people that are actually able to implement that?

Dan: Yeah. In the hospitals I work with, there’s usually a CEO who’s a visionary at the top who understands that we’re in a different age. The solutions that we had in the past are not going to address the population health issues of the future.

So Renown Health, you have Dr. Tony Slonim who’s the CEO. He’s a visionary. He’s taking this on himself. He becomes the standard bearer for the organization and anoints his people, you know, empowers them to go out and form these partnerships within the community and he recognizes the value. I mean, there truly is. If you do a cost-benefit analysis, it will eventually save the health system money if they initiate these partnerships and make substantial donations to these organizations or at least partner with them in the investments that they’re making to help prevent health issues down the road for the people they’re trying to serve. So Tony Slonim in that Renown Health is a great example of that. Kim Hollon at Signature Healthcare in the Boston market is another example.

When I see this happening, it’s because there are CEOs in place who are not just staring at the bottom line, but they’re thinking broader and they’re thinking long term and they’re embracing the fact that this fee-for-service reality isn’t going to go on forever, even though it seems to keep going on forever. I mean, I remember 10 years ago, talking to people and saying, you know, this is going to be gone any day now and it’s still there. So I understand what people are doubters. But there these visionary leaders within these organizations who do become the standard bearers, who then allow their people or encourage their people to go out and form these partnerships.

How Marketing Can Get Involved

Dan: And one of the things I’m excited about, and I’ve written about for some of the trade publications, is, you know, marketers have always been on the frontline for these organizations. You know, we’ve always been the one, the marketing and communication folks, we’ve always been the ones who go out and build these relationships with community organizations. Hey, you know, we have health fairs and partnership with them, all those kinds of traditional functions that marketers did. And when I see this new age where we need to form these partnerships to address population health, man, the marketers can be…can play a key component in making those relationships happen and in facilitating action that’s going to improve the health of their communities.

So to me, it’s a really exciting opportunity, not just for the hospitals and the hospital administration, but for the marketing team to get involved in population health management.

Jared: Dan, do you have any examples of that? You know, where you’ve seen that work successfully where the marketing or communications team has really driven that type of initiative to help population health management succeed?

Dan: Yeah, yeah, there’s bunches of them. There’s an organization, if anybody wants to go online and do some research, called BUILD Health. It’s a program that was developed by the de Beaumont Foundation. De Beaumont is a foundation that funds a lot of public health initiatives or public-health related initiatives. And the BUILD Health initiative was a grant program where if a hospital and a community and a community organization all came together and sent in a grant application for some population health projects that they were interested in, they were eligible for these grants. And I can’t remember how many organizations they gave grants out to. I think they’re on their second round of these grants now.

But there are dozens of case studies from BUILD Health where these…exactly the kind of partnerships I’m talking about between hospitals, community, and community organizations have happened. They’ve been funded and they give measurable impact as a result of these partnerships.

A couple that I’ve seen through our work at Jennings, one I’ve talked to you about the past year was Copley Hospital in little Morrisville, Vermont. You know, it’s a very rural hospital and that’s, I think, it’s under 20 beds. But they knew that they needed to take action to address population health within their community. And they also knew that there are lots of little community organizations out there already taking action on their own. But there was no concerted effort. No one in the Morrisville area, in that Lamoille County, Vermont, had had taken all of this and put it under one umbrella and said, “How are we going to address population in our community?” And the hospital said, “You know, we can play that role.”

So the marketing team, of their own volition, came up with the concept of launching a community blog, a population health blog. And the beautiful thing about this idea was they invited representatives from each of these community organizations. There were anywhere between 10 and 15 community organizations represented and they were invited to submit a blogger who would contribute posts to this blog on a regular basis.

And I was there when we had our initial meeting, when we first got together with all of these representatives from these community organizations. Everyone was excited because we’re starting this new initiative to communicate more about how to stay healthy within this community, addressing health and wellness topics, and pointing people towards resources within their community. So we’re all around this table. It was really exciting.

But for me, it was really poignant because these people had never stopped and sat around a table together. But the marketing team at Copley Hospital had this idea and made it happen. And because of that, now for, I think, it’s three years running, they’ve been producing this blog and working towards improved population health. It’s an amazing story for a little tiny hospital with very few resources, but what it was able to do collaborating with these community organizations.

Jared: So Dan, I kinda hear…I’m hearing a couple of different things. I mean that really for population health management to be successful, that it really depends on who picks that ball up and starts running with it, that it can come from a few different areas of the hospital. What in your mind are the keys to doing this successfully, for population health to work?

Dan: Because collaboration is so important, I think developing trusting relationships is vital. And a lot of community organizations don’t trust the big health system, or they don’t feel like they have a seat at the table, or they don’t feel like they’re equals. So for the people on the health system side, which is where I’m normally working, it’s really important to go into those relationships with almost a humble attitude, really open to hearing what these community organizations have to say, being very gracious, you know. I’m a big fan, I think anytime you’re gracious and kind, you get farther in life.

As we entered these relationships and as these relationships become more and more important toward addressing population health, going in with the right attitude and just not being a bull in a China shop, but being a little bit more nimble and a little bit…just a little softer when you enter these relationships and make sure that you do as much listening as you do talking. And I don’t know that’s what you’re getting at with your question, but I do think that’s huge because there are… You know, forever, for decades and decades, there have been public health organizations and communities, and then the academic medical centers and then other hospitals and health systems, and the two haven’t talked to each other. It’s time for them to come together and communicate. But that takes some savvy to make that happen.

Scott: Yeah, I agree with you, Dan. I kind of grew up, I worked my way through college as an EMT at Charity Hospital down in New Orleans and kind of witnessed transactional medicine at its best and worst, quite frankly, and then worked with a lot of medical providers over the years. And you’re right in that because the model’s changing, you know, it’s not transactional medicine. It’s not just come in and I’m going to solve everything. I’m the doctor. I think that humility and the need to build trust, it seems like step one is, “Hey, you need a chief, a CEO,” I don’t want to use the term “thinking out of the box,” I’ll say “think out of the hospital first,” right?

Scott: Right, there’s step one. Step two, empower some people who normally don’t think about this. And I do think your thought about coaching everybody to say, “Guys, it’s time for you to listen a little bit more than direct,” because it’s usually the other way around. Like, “Hey, I gotta put out this fire. I’ll think about it next.” And this is really a lot to do with listening to the issues out there.

We looked up BUILD Health a while ago and they do have it down in New Orleans and a lot of it…about it is just getting patients to and from their care. And so they ally with the Regional Transportation Authority and other transportation services to help out with that. And I’m sure there’s a deeper story there. But to your point, if you can’t get to your appointment, there’s not much that we can really do. So how do we all work together to get people where they need to go and give them the information that they need?

Dan: In my firm, we’ve been really lucky in that we’ve been working with an organization called the Practical Playbook for the last five years. And Practical Playbook was an organization started by the CDC, Duke Medicine, and the de Beaumont Foundation. And its reason for being is to teach public health and hospital healthcare-type organizations how to collaborate, which is really cool. And part of what they’ve done over the last five years is work to get this kind of collaboration learning into the curriculum of med schools and public health programs.

So because, you know, in med school, you’re not taught how to collaborate with community organizations and you’re certainly not taught how to be humble when dealing with community health organizations. So it’s really important that this becomes part of the curriculum within med schools and public health institutions, so that those professionals, when they’re coming out of school, have at least a baseline understanding of what it takes to move a relationship forward.

Scott: Yeah, it’s a big part of the change that has been happening that we’ve seen in a lot of different people that we’ve been speaking with, this whole collaborative conversation that’s occurring. One of the shifts that we’re seeing in healthcare is it’s no longer the days of saying, “Take two of these and call me in the morning. Go see this guy. Just do what I told you to do.” There’s a lot of conversation occurring between different people, not just patient and doctor.

Dan: And I will add, you know, not everybody is on board with this. You know, when I talked about having visionary CEOs, you know, not every CEO is a visionary CEO. I was talking to a marketing director at a hospital several months ago and talking about some ideas I had for population health-related initiatives that the marketing team could embrace. And that marketing director told me point blank that, “You know, we’re not in population health business. You know, that doesn’t pay our bill.” And there’s still lots and lots of hospitals out there that think that way. So we’ve got our work to do, without a doubt.

Michael: You know, it’s interesting, Dan, I come from a nonprofit background before I got into marketing. And one of the things we would do, this is going all the way back to, you know, when I was in college, being a part of different student groups that would go out and just find ways to, you know, feed the homeless, gather with people that had nobody else really meeting their needs in an ongoing fashion, knowing that it’s possible for those kinds of groups to start engaging with hospitals and to move beyond just, “Hey, this is something we do because we care about it. It’s part our faith system or whatever that thing is,” but to see that there’s an ongoing continuum there to move people into like a better situation.

Because so many of the nonprofit organizations I’ve been a part of, we’re very good at solving one aspect of that problem and it was just kind of this hopeless thing of, “I hope that they get better after this.” You know, maybe things will work out for them or not.

So it’s really encouraging to hear that other groups are actually finding the ways to connect the dots there because these are very complicated problems. People aren’t deficit in just one area of their lives. Generally, it’s something that’s multiplied many times over.

Dan: Yeah, that’s a great observation.

Scott: Hey, Dan, you know, that’s interesting, the marketer that you spoke to and said, “Hey, I’m not in the population health business, I’m in the hospital business.” What’s the comeback to that? Because I think there is a comeback to that and I want people listening in to that conversation to kind of hear that, what your response was.

Dan: It’s tricky, you know, because I…especially when it’s a client-agency relationship, you have to tread lightly on what the comeback is. But as I get older, I get less delicate in how I deal with those situations. I think the comeback is you start talking about, “Okay, what are you trying to achieve?” And ultimately, he was coming at it from a very bottom-line perspective. You know, “It’s not in the interest of our bottom line.” And so where I went with that conversation with to-… I took it to a bottom and I said, “Well, here’s how a population health strategy is going to impact your bottom line.” I spoke to him in the terms that he was using, you know, I responded in kind.

But unfortunately, I think that decision is out of this individual’s hands, this particular marketer. He was just sharing what he’s heard from his leadership. So it’s a case where the leadership at that organization need to be educated about how various population health initiatives are going to help that hospital ultimately achieve its financial objectives. That’s where they’re focused.

Scott: Yeah, I couldn’t agree more. Look, they’ve got a lot of constraints. They’ve got a lot of money issues. I’m talking about larger hospital systems, especially ones that take care of… Well, actually, all hospital systems, but even the ones I’m thinking of, like, where the demographics are poor. I think the more proactive you can be, just from my own gut thought, would be a very positive thing. Getting the patient to buy in, getting the community to buy in, and getting healthier people coming in certainly seems to make a strong case for making it easier on everybody, including everybody’s bottom line.

Dan: Absolutely. I mean, there was no question in my mind that population health strategies were going to have a real positive impact for this rural hospital. It’s just a matter of time. They’ll come around sooner or later too. But again, like everyone else in the healthcare business in the United States, you know, they’ve been hearing this for 10 years and they’re still really in a fee-for-service business and haven’t been forced to deal with the realities of managing populations and/or manage the health of populations. But their time will come.

Scott: Yeah, they will. You know, whether they like it or not, it’s gonna.

Dan: Yeah, no doubt about it.

Michael: Dan, thank you so much for your time today. I know we just barely touched on all the things that we could talk to you about, so I really appreciate it and maybe we can have you back some time. But again, thank you so much.

Dan: Oh, my pleasure. Thank you very much for having me.

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