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Society for Healthcare Strategy and Market Development November/December 2013


MedStar Health: Sports Sponsorships as Part of the Brand Strategy

Healthcare organizations can leverage sports sponsorships for philanthropic, employee engagement, and community relations opportunities. By Jean Hitchcock and Marc Bluestein

In 2013, it is projected that $13.8 billion

will be spent on sport sponsorships in North America, a 6 percent increase from 2012.1 In fact, the amount spent on sports sponsorships is more than the total amount spent on all other forms of sponsorship combined, including entertainment, cause-related, arts, festivals, and membership organizations. Why Is Sponsorship Growing? There are a number of reasons for the continued increase in sponsorship spending:

Decreasing efficiency of measured media: Costs for traditional advertising continue to increase, while ratings and readership decline. Increasing need for two-way communication: Organizations are looking for alternative methods to communicate, which allow them to deepen their relationships with customers through live interactions, including sponsorship and social media. Favorable viewing by consumers: Consumers view it as a form of marketing that gives something back, benefiting another party in addition to the

marketer. It implies a degree of altruism that is absent from more commercial types of marketing. Across the country, hospitals use sponsorships to:

Promote general health and wellness messaging Showcase medical expertise in action Demonstrate community involvement Recruit and retain quality employees

sponsorships with sports franchises. However, not all sponsorships are created equal, and the first step in your evaluation of any sponsorship is how it complements your brand marketing strategy. Here are some key points to consider when evaluating a sports team sponsorship:

What are your branding goals? Spon-

Where Do You Begin? Given the US sports culture, it can be difficult to understand the desire of some healthcare providers to enter into

sorships are tied into your brandand should not be focused on revenue. When you consider the number of games multiplied by the number of season ticket holders, you may find your target audience is greater than the TVviewing audience.

Advertising is about the number of eyes seeing your message. How can

(Continued on next page)

Society for Healthcare Strategy and Market Development

President Holli Salls Principal Salls Group Chicago, IL President-elect Mark Parrington Vice President, Strategic Transactions and Development Catholic Health Initiatives Englewood, CO

Brand Strategy (continued from page 1) you maximize your media buy? There is a reason the dasher boards in hockey and the rotating signs behind home plate are the highest priced: Television viewing is highest for both.

Are you doing this to drive business, brand, or both? It is difficult to deter-

mine how much business you garner from sponsorships, and we recommend evaluating ROI on other metrics, like consumer perception.

Relationship with Team Owners The relationship with the owners of a sports team is critical. You want a partner who will enhance your brandwhich is different from a strictly paid advertising relationship. If you are a not-for-profit organization, you want to align with others who have strong community reputations. Sports sponsorships relate to co-branding; therefore, you must be selective about your partners. Professional Versus Local Teams The difference between professional sports and local sports is cost. Most professional league sponsorships begin at the six-figure level and go up. However, with these sponsorships, there are more media opportunities and a higher visibility. All things considered, you are part of a national organization. On the other hand, local teams may be your only option. If so, then maximize your investment beyond signage. Additionally, consider the amount of fan or audience participation as it relates to your local market. For example, marathons provide many sponsorship opportunities, but popular, large-scale marathons have high participation from out-of-town runners and spectators. Maximizing the Sponsorship Healthcare organizations can maximize the sponsorship for a number of purposes: philanthropy, employee engagement, and community relations. Once you begin to negotiate a sponsorship, leverage it for your other business needs by:

Immediate Past President Maria Royce Senior Vice President, Planning and Community Development WellSpan Health York, PA Executive Director Diane Weber, RN Society for Healthcare Strategy and Market Development Chicago, IL Editor Mary P. Campbell Society for Healthcare Strategy and Market Development Chicago, IL Design and Layout

How else could such a partnership help you? Sports sponsorships can aid your

organization in community benefit, philanthropy, and recruitment efforts.

Who will negotiate the teams medical care and advertising contracts?

There should be no correlation between the teams medical contract and a sponsorship. The decision to select a medical provider should be made, based on physician experience and quality outcomes. The level of sponsorship should not factor into this decision. You need to avoid any perception by the players or the public, that the teams medical care is based on the value of the sponsorship. Once you have decided that a sports sponsorship fits within your business strategy, then you need to decide if you will negotiate directly with the team or bring in a sports marketing firm to evaluate the opportunity and negotiate the contract. If you are in a large sports market and negotiate with multiple leagues, we recommend bringing in a firm. It is too difficult to stay on top of all the rules regarding marketing assets, sports medicine, and the use of branding elements, like logos. Official Medical Provider to the Team Consider the following points when making your assessment of a sports sponsorship. The golden nugget in any sports sponsorship is the ability to use the designation Official Medical Partner of the ____________. If you are not, then it is difficult to justify sponsorship dollars when a competitor is making the claim. For MedStar Health, this is the go/no-go decision.

Spectrum is the bimonthly newsletter of and a membership benet for members of the Society for Healthcare Strategy and Market Development. SHSMD welcomes unsolicited manuscripts, which will be used on a content and space-available basis. Preferred article length is from 1,200 to 1,500 words, and graphics (gures, tables, photos) and suggestions for sidebars are welcome. Please e-mail articles to mcampbell@aha.org.
The editorial office is located at: 155 North Wacker, Suite 400 Chicago, IL 60606 Phone: 312-422-3888 Fax: 312-278-0883 E-mail: shsmd@aha.org Website: www.shsmd.org Opinions expressed in these articles are those of the authors and do not necessarily reect the opinions of SHSMD or the American Hospital Association. 2013, Society for Healthcare Strategy and Market Development. Reprinting or copying is prohibited without express consent from SHSMD.

Sponsoring free Baseball Basics clinics for 500 underserved kids to support community relations Promoting player appearances for patients, particularly children Having access to tickets and suites for donors or key recruits Ringing bases with cancer survivors to highlight breast and prostate cancer awareness Being part of the NFLs A Crucial Catch campaign on Monday Night Football for National Breast Cancer Awareness Month Offering a bank of tickets to hospital leadership for employee recognition Taking advantage of significant media relations opportunities

2 Spectrum | November-December 2013

Case Study: Professional Sports Sponsorships and MedStar Health MedStar Health has a strong sports medicine program that has provided team and venue medical coverage for years. On a professional level, MedStar physicians provide medical care to the Washington Nationals and the Baltimore Ravens, as well as national sports associations, area college sports teams, and high school teams. Seminal concussion research among high school athletes, conducted by MedStar Health Research Institute, helped ignite the national conversation on concussions.2 Community and media attention on this topic helped build MedStar Healths strong sports medicine reputation, which is partly why so many sports teams approach us for sponsorships. Market research in the Baltimore area consistently ranks MedStar as strong in orthopedics and sport medicine. This high level of awareness is a direct result of our longest sports sponsorship/relationship with the Baltimore Ravens. Through an exclusive relationship, MedStars sponsorship includes

television, radio, online, and print advertising, as well as the injury report and highprofile in-stadium signage. The team has also collaborated with us on a concussion prevention program that is part of the NFLs initiative in our market. MedStar also has contracts for Ravens medical care and venue coverage that are kept separately for ethical reasons. That said, MedStar would not enter into a sports-team sponsorship if it did not include the medical contract. In 2011, MedStar partnered with the Washington Nationals. MedStar physicians were already providing medical care for the team, and we wanted to expand our relationship and enhance our reputation in orthopedics and sports medicine in the DC market. This sponsorship focuses heavily on television-camera-visible signage and digital assets because of the 81-home game schedule. MedStar Health now has relationships with two professional teams, in two different

sports leagues that cover both our markets, year-round. All aspects of these sponsorships are integrated into orthopedic marketing initiatives throughout the year.
Jean Hitchcock
Vice President, Public Affairs and Marketing MedStar Health Columbia, MD 410-772-6557 Jean.hitchcock@medstar.net

Marc Bluestein
President Aquarius Sports and Entertainment Gaithersburg, MD 240-547-3498 mbluestein@aquarius-se.com
IEG. 2013 Sponsorship Outlook: Spending Increase Is Doubleedged Sword, IEG Sponsorship Report, January 7, 2013, http://www.sponsorship.com/iegsr/2013/01/07/2013-SponsorshipOutlook--Spending- Increase-Is-Dou.aspx.

Andrew E. Lincoln, ScD, et al., Trends in Concussion Incidence in High School Sports: A Prospective 11-Year Study, The American Journal of Sports Medicine 39 (May 2011): 958963.

November-December 2013 | Spectrum 


A Crisis Communicators Self-Assessment

Here are six questions to gauge your hospitals level of crisis communication preparedness. By Patrick Donohue and Christopher Lukach

communicators; others test the strength of our multidisciplinary response team.

1. Does your organization have a crisis communication plan? Thats step one,

We all have that dream. You know

the one: Youre back in high school, and you forgot to study for the big test. You wake up in a sweat with the sensation of a dumbbell in the pit of your stomach. It is, thankfully, a fleeting sensation, when you realize it was only a dream. Far less fleeting, but not entirely dissimilar, is the feeling communicators have when 4 Spectrum | November-December 2013

they are unprepared to navigate a crisis. We subscribe to a simple precept: While a crisis may be unexpected, it should never come as a surprise. At St. Mary Medical Center in Langhorne, PA, crisis communication has earned priority status among the communication and leadership teams. The success of our crisis communication program exists because of a top-level commitment to preparedness, regular updating, rigorous testing, and unrelenting energy. Moreover, we have high expectations. At St. Mary Medical Center, we periodically ask ourselves six fundamental crisis-preparedness questions. Some are tactical, and some are cultural. Some rest solely with the

and its a biggie. A strong scenario-based crisis communication plan based on probability and risk is the ultimate, versatile crisis communication resource. For guidance on constructing a strong, actionable crisis communication plan, see the sidebar Does Your Crisis Communication Plan Make the Grade?

2. Do you have reasonable approval processes that permit you to communicate quickly? In todays demand-

ing 24/7 media landscape, quickly is an understatement. Communication must be nearly instantaneous to be effective. And its the first response to a crisis that sets the tone. For many modern crises, living down the first

Does Your Crisis Communication Plan Make the Grade?

A crisis communication plan is an essential tool in the healthcare communicators toolbox. Unfortunately, not every organization that has a crisis communication plan has a useful crisis communication manual. With todays demanding media and social media landscapes, we do not have the luxury of hours or even minutes to formulate our rst response. And as myriad modern crises have demonstrated, if were not quick to ll the vacuum of information, someone else will do it for us. First, be clear about what is considered a crisis. A no brainer, right? Not necessarily. For your planning purposes, a crisis is any event that has the potential to negatively impact your reputation or ability to operate. So while your crisis communication plan needs to consider the conventional crises, such as natural disasters, terrorism, and on-site acts of violence, it must also include those lesser crises and issues that carry the potential for great impact: a mismanaged merger or acquisition; sudden change in leadership; OSHA or regulatory violations; poor performance in a quality and safety rating; an inadvertent release of patient-identiable information, etc. Any of these incidents has the potential to come on suddenly and to impact the organizations reputation and, therefore, its ability to operate. Second, make sure your crisis plan has actionable information. Too many crisis communication plans are policy repositories lled with complicated processes rather than actionable work plans. Our crisis communication plan philosophy is simple: if it doesnt offer the necessary information and communication framework to respond within 15 minutes, it isnt prepared to do its job. Remove speed bumps by getting the plans contents pre-approved by legal and administrative teams. Third, make sure it is accessible. A well-designed plan is worthless if you cant nd it precisely when you need it. Security and condentiality are important, but not if they undercut the plans accessibility. Following a recent, innocuous bomb threat to our hospital, our response was impacted because the administrative rst responders were not clear about location of the nearest plan. Now, at St.Mary, aside from a hard copy with each member of the leadership team, we keep multiple hard copies near the command center and key locations, and a copy with the hospitals switchboard operators. Modiable, interactive, intranet and thumb-drive versions are also available to the communication team. Fourth, train your crisis response team in using the plan, then offer periodic refresher trainings. Spotlight the resources within the plan: the roles and responsibilities of the crisis communication team and how the plan can be accessed. And, most important, regularly test the contents using complex and difcult scenarios. Bend them. Stretch them. Break them. In the end, your plan will be stronger, and your hospital best prepared to weather a storm.

statement lasts well beyond the events actual resolution. Communicators need to act quickly and without the delay of a lengthy approval process. The crisis communication plan helps this process by providing pre-approved, pre-vetted statements that reinforce your values without speculating. But communicators also need a certain amount of leeway. This leads us to the next step.
3. Do you have the authority and confidence to act in a crisis? Earning a

counseling on a myriad of issues, demonstrating your clear and reasoned thinking and your broad understanding of the healthcare business. Leaders also like to know that you have tested experience and have been through some battles.
4. Are your spokespersons trained and ready? In a crisis, it is ideal to have a

seat at the table status is a persistent cultural challenge for hospital and health-system communicators. But having the ear and respect for administration is a must for a successful program of crisis preparedness and response. The confidence of your leadership team can be a challenge to cultivate. You earn your seat routinely when you provide

single, primary spokesperson to keep the messaging consistent. But different situations require different backgrounds, skill sets, and levels of authority. At St. Mary Medical Center, we maintain a stable of spokespersons comprising executives (CEO, COO, CMO, and, of course, the marketing and communications director) and technical experts (director of security, director of quality and patient safety, CNO, CIO, HR director, foundation director, and vice president of mission). Each is trained to focus on

key messages in answering questions, and we provide periodic refresher training. Even those organizational leaders who may not be spokespersons in the microphone-and-camera sense are trained in the fundamentals, ensuring internal and external messages are consistent. We reinforce the process through practice.
5. Can you access key systems during an unusual event? As with many hospitals

and health systems along the Eastern seaboard, Superstorm Sandy impacted St. Mary. While stranded at home without power, much of our communication team was unable to access our network and, therefore, put into action our crisis communication plan. Ensure your team has back-up processes to access the major communication vehicles in the event of a (Continued on page 10)

November-December 2013 | Spectrum 


Aligning Strategic Vision to Consumer Education and Culture through Brand

Find out how one health system created a common identity that supported the sum of its many parts. By Erinne Kovi Dyer

In todays healthcare environ-

ment, there is a great deal of change. With change comes confusion, drastic shifts in priorities, and a general lack of clarity as to how to operate. For some, the unknown leaves them paralyzed. For others, it accelerates the pace of change. Yet, regardless of the pace, the destination remains unclear. So what do we still have within our control? The answer is our fundamentals, our core values, our operational models, and our people. With these elements, we can create our future and define what it is we want our consumers to understand about who we are and the value that we provide. Carolinas HealthCare System At Carolinas HealthCare System, we have a unique story to share. As one of the largest public, not-for-profit integrated healthcare delivery systems in the country, we are working every day to connect and transform care delivery in the Southeast. Our overarching goal is to provide seamless access to coordinated, high quality healthcareand to provide that care closer to where patients live. With 41 hospitals and 900-plus care locations in the Carolinas and Georgia, the depth and breadth of services we provide result in a full continuum of integrated care. It includes prevention and wellness, primary care at more than 180 locations, specialty care via several nationally recognized service lines, and one of the largest virtual programs in the nation. With more than 50 disease-specific certifications from The Joint Commission, we have one of the highest certification totals in the country among comparable systems. As a system, we have more than 7,800 licensed beds, and in 2012 had more than 6 Spectrum | November-December 2013

10.5 million patient encounters. We have more than 3,000 system-employed physicians, 14,000 nurses, and 60,000 employees. In 2012, we had more than $8 billion in annual revenue and generated $1.25 billion in community benefit. Despite our depth, breadth, and clinical excellence, Carolinas HealthCare System has remained one of the best kept secrets in healthcare. Consequently, our senior leaders have made a strong commitment to better educate consumers as to who we are and how we can provide value to them. To do this, we needed first to re-evaluate our corporate vision. At the same time, we knew that the organization needed a stronger sense of common identity, one that would have unifying power and enable us to move more quickly from good to great. A New Day We embarked on a journey and emerged with a new strategic vision: To be recognized nationally as a leader in the transformation of healthcare delivery and chosen for the quality and value of services we provide. We have taken this vision to heart and have committed to achieve it through the development of a single unified enterprise. In every area of our business, we have focused on developing enduring relationships with patients, based on superior personalized service and high quality outcomesat every location, with every encounter, every time. Seth Godin, author and entrepreneur, defines brand as the set of expectations, memories, stories and relationships that, taken together, account for a consumers decision to choose one product or service over another. In other words, brand = culture + experience. The culture of an organization and the experiences of its employees and patients drive and define the brand. There are several successful healthcare systems that have seen opportunity in unifying under one brand and one name as

Figure 1: Brand Manifesto

they restructured their business model to enhance customer value. Cleveland Clinic, Mayo Clinic, and Dignity Health are just a few of these. The successes of these brands lies in their ability to transcend the parts of their organizations and build a unified belief or impression of their system among everyone it touches. Carolinas HealthCare System is no different. Like many systems that have grown up over the past 30 years, we have been built on a foundation of growth and integration both in the acute and ambulatory spaces. Although this growth lends itself naturally to better coordination and integration, we had not focused enough on understanding how complex this house of brands appeared to our patients and communities, especially in a time of extreme industry change and public confusion. So we started with a new vision and began our brand journey.

Becoming One We created and evaluated several concepts, and Figure 2: Internal Portal Screenshot for the final campaign theme to introduce our master re-brand, we chose One. To initiate the campaign design, we had to create a unifying and conceptual manifesto that helped define and position us as an integrated, connected organization working to improve the care of every patient (Figure 1). We focused on four core principles: one syswith helping to re-define the culture of the tem, one team, one belief, and one mission. organization through a master re-branding One. Built for everyone, From the effort and an accompanying campaign knowledge of many, To bring health to all. rollout. We had to get to know the orgaWe then built a multi-channel strategy nization, and fast. to share this identity. Together with our agency of record, Campbell Ewald, we embarked on a commuMeasuring the Brand nications evaluation, while gaining buy-in The overall plan will roll out in many phases, and support from key internal stakeholders. and at this point we have only just begun. We performed interviews with more than 90 Nonetheless, through a strong initial launch leaders throughout the system, administrain outdoor, broadcast, radio, and collateral tive and clinical, to ensure we understood media, we have laid a strong foundation. the full scope of the organizations culture. To measure success, we were initially inThere was one major surprisethe many terested in awareness as a key indicator. shared beliefs about the state of the system And while awareness is important, we realand its goals. So unity of vision was actuized that in todays competitive healthcare ally the easy part. landscape, awareness alone is not enough. We then had to understand how the We knew we had to measure a deeper unexternal world understood and perceived derstanding of brand attributes. Carolinas HealthCare System. This was Taking a more innovative approach, we the hard part, but findings validated our analyze our brand health in identified original suspicion: There was a great deal geographies and measure additional items,

Defining the Brand: Getting to One There were several key differentiators that we knew we could take advantage of to meet our new vision. However, our most distinctive feature is our comprehensiveness and connectedness across a dense geography. Through a network of 900-plus care locations in three states, we knew we could provide access at every point of care across the continuum, with the highest level of quality, in a unique way. Our Corporate Communications, Marketing and Outreach department was tasked

of confusion about who we were and what defined us and our value to our patients and the greater community. What we uncovered was the widespread perception that Carolinas HealthCare System was everything but unified. We were seen as an amalgamation of many individual parts, many showcased with individual identities that had little connection to the master brand. To become a nationally-recognized healthcare system, we had to (re)define what integrated care at Carolinas HealthCare System looked like.

such as an understanding of connectedness and level of trust and belief in our ability to provide higher quality. Only six months in, we have seen incremental lifts in both un-aided and aided brand awareness, as well as some key brand health attributes. Internally, adoption has been nothing short of amazing. The message of One has clearly resonated through language, executive adoption of the concept, and its reiteration through all internal communications channels (Figure 2). Next Steps While we have been pleased with the initial launch of the campaign, we have yet to fully transition our enterprise assets to the brand name, color, and signage requirements. Healthcare is a complex industry, and there are many legal and regulatory requirements that directly impact the brand and its success. For example, many of our facilities are not currently licensed under our formal name, and this affects our transition to uniform signage throughout the system. So while we would like to use the brand name, we are unable to do so until we formally re-file under the new name. To summarize, the master re-branding and campaign launch provided an opportunity for a fresh startan opportunity to (re)define how our system provides care and to embed a new and important mindset into the corporate culture. The campaign has also allowed us the opportunity to educate consumers and our own employees regarding complex concepts in healthcare, particularly during a time of rapid and profound change in our industry. And we are far from done. Over the next 18 months, we are going to continue refining our messages, focusing on what we do differently as a system, and earning the trust of our consumers, patients, and communities. Our future depends on it.
Erinne Kovi Dyer
Corporate Vice President Corporate Communications, Marketing & Outreach Carolinas HealthCare System Charlotte, NC 704-631-0951 Erinne.Dyer@carolinashealthcare.org

November-December 2013 | Spectrum 


Creating a Winning Post-acute Care Continuum for the Future

Memorial Hermann Health System demonstrates that creating the most effective post-acute continuum requires a thoughtful process that is no different than creating an integrated service line for any clinical service. By Monica L. Carbajal and Daniel B. Walter

The Affordable Care Act,

accountable care organizations (ACOs), bundled payments, population health management, and all of the other major healthcare initiatives currently underway are clearly changing the way organizations provide service. While many health systems are evaluating their IT systems, clinical service lines, and physician alignment strategies, one critical component that is often over-looked is the post-acute care continuum. Unfortunately, this may be a costly mistake. Although post-acute care is not as high profile as many other service offerings, the fact remains that effective post-acute programs will be needed more than ever to manage the highest acuity patients in any of the emerging sharedrisk financial models. What Is Post-acute Care? By definition, post-acute programs are those that patients may need to access following their discharge from acute care. These are usually patients that no longer meet continuing stay criteria for acute care, but who are either not stable enough to return home or have ongoing clinical needs that are too great to be managed on an outpatient basis. Historically, Medicare has defined post-acute care as skilled nursing care (SNF), inpatient acute rehabilitation, long-term acute care (LTCH), and home health care. (Medicare does not include hospice in its traditional definition of post-acute care; however, many 8 Spectrum | November-December 2013

in the industry do include hospice in this definition because of the close link between home health and hospice.) Although post-acute programs admit many patient types, because older populations tend to recover more slowly and have more chronic conditions than younger populations, the most frequent users of all post-acute programs include Medicare and Medicare Advantage patients. In fact, Medicare and Medicare Advantage patient populations generally represent 60 to 65 percent of all post-acute admissions. The second largest group tends to be the high acuity (and high risk) catastrophic patients and/or patients with multiple systems failures. These patient populations generally incur long acute care lengths of stay and have multiple clinical or functional needs upon discharge that prevent them from achieving their desired level of independence. Market Size Many health systems consider post-acute care programs to be one off, since they are typically small compared to the marquee service lines of cardiology, orthopedics, or oncology. In fact, far more patients need to access post-acute programs than most health system executives realize. Figure 1 shows that about 40 percent of all Medicare acute care discharges will need to access some level of post-acute care upon discharge. Additionally, best practice referral patterns among those providers that have most effectively integrated their acute care and post-acute care continuums suggest that up to 50 percent of all Medicare acute care discharges will require post-acute care! This, of course, is in addition to patients from all other payer sources that may also require post-acute care. While the data in Figure 1 estimate the demand for post-acute care under current fee-for-service (FFS) models, recent analyses of several local markets with high penetrations of Medicare Advantage programs

suggest that, as providers assume more financial risk for patients, the utilization of postacute programs will remain at approximately the same levels as the current national data. In these markets, while the use of higher cost services, such as long-term care and acute rehabilitation are less than current FFS use rates in Figure 1, the utilization of lower cost services (home care in particular) are substantively higher. The total use of post-acute care in these markets is between 40 to 50 percent of all Medicare Advantage discharges, indicating that the demand for these programs will remain high, even as reimbursement models shift and providers assume greater risk. The Burning Platform for Post-acute Care Many health systems are beginning to evaluate their post-acute continuum today for several reasons. First, as previously discussed, the demand for post-acute care is high, and it is expected to remain high as the healthcare landscape evolves. Second, with an episode of care that extends 3090 or more days beyond the acute care stay, health systems are able to measurably improve patient clinical and functional outcomes over a longer period of time with post-acute services. Finally, there is recognition that as health systems assume more financial risk for clinical performance over a longer period of time, owning or having some control over these programs will be critical to the success of the organization. Figure 2 provides a summary of the most recent Medicare operating margins for each level of care. Pulling It Together Creating the most effective post-acute continuum requires a thoughtful process that is no different than creating an integrated service line for any clinical service. It requires the input and support of the medical staff, the executive leadership, case management, financial services, and multiple clinical and ancillary services. The key steps in this process should include the following.

Market assessment. Since most post-

acute patients originate from the acute care setting, it is important to know how many patients from the target health system require post-acute care today and what the demand is by diagnosis. Additionally, providers must understand how this demand will shift under shared-risk

Figure 1: Medicare National Post-acute Utilization Rates

Discharge Disposition
Inpatient Rehab SNF HHA LTCH Hospice

Figure 2: Estimated FY 2012 Medicare Post-acute Operating Margins1

Level of Care
Inpatient Rehab SNF HHA LTCH Hospice

All Medicare1
3.2% 17.3% 16.0% 1.0% 2.1%

Best Practices2 Low High

4.0% 12.0% 22.0% 1.5% 2.5% 6.0% 15.0% 24.0% 2.0% 3.0%

Payment Basis
CMG Per Discharge RUG Payment Per Diem HHRG 60-day Episode LTCH-DRG Per Discharge Per Diem

Est. Margin
8.0% 14.6%2 13.7% 4.8% 5.1%





MedPAC June 2008 Annual Date Book. 2 Walter Consulting.

MedPAC March 2013 Report to Congress. 2 Freestanding SNFs only; does not include HB-SNFs.

financial models, including population health management models.

Quality evaluation. A comprehensive

program managers, acute care case managers, and other staff, the risk of failure becomes far too great. Creating the Foundation for Success Memorial Hermann Health System (MHHS) is a large 12-hospital system in Houston, Texas, that discharges approximately 125,000 patients annually. In addition to its acute care services, MHHS includes two acute rehabilitation hospitals, four hospital-based rehabilitation units, skilled care, and home health and hospice services. In 2011, the leadership of MHHS decided to complete a post-acute strategic plan, to ensure that the organization was best positioned for the new healthcare landscape for all of its programs and services. The key goals of the process were to: Ensure through-put efficiencies for both acute care and post-acute care

assessment should consider the ability to improve the quality of patient care by implementing a plan of care that includes a potential referral to post-acute services. The impact on quality should then be measured through lower readmission rates, improved clinical and functional status, higher discharge rates to the community, and other similar benchmarks.

Financial analysis. The financial analysis

should assess both short-term and longterm financial impacts to the system. Providers should understand the economic benefit of establishing or growing certain programs today, including the impact of reduced acute care length-of-stay. Providers should also assess the opportunity cost of not having these programs in the future, including increased utilization of acute care services if post-acute care is not available.

Build or buy. While the bias for many sys-

Ensure patient placement in the most appropriate level of post-acute care Capture all potential referrals available under current systems Minimize outmigration Understand network adequacy for these programs

tems is to own their post-acute programs, for many systems, the best solution may be to partner with existing community providers. The correct approach will depend upon the critical mass of patients needing these services, the anticipated financial return, the capital cost required, potential Certificate-of-Need (CON) limitations, and other important factors.

be more intense than actually needed, these practice patterns would need to change as MHHS assumed greater financial risk under ACOs and other risk-sharing models. As a result of this planning effort, MHHS changed its organization structure to ensure appropriate accountabilities for program development, referral management, clinical outcomes, and financial performance. Metrics have been established to monitor actual performance compared to the plan, with reviews conducted on a quarterly basis. While the health system envisions even tighter integration in the future, the foundation has been put in place to strengthen the post-acute continuum as the environment continues to change. Like MHHS, many health systems are seeing a need to re-think their post-acute service offerings. While many systems will find significant opportunities in todays environment, the real opportunity is putting into place a post-acute continuum that can best serve the health system and its affiliates under any and all of the shared-risk financial models that will dominate the future healthcare landscape.
Monica L. Carbajal
Director Strategic Planning Memorial Hermann Health System Houston, TX 713-242-4791 monica.carbajal@memorialhermann.org

Organizational structure. Too many

organizations have failed in their implementation due to less than effective organizational structures. Although all parties may want the same outcome, without accountabilities for medical staff, post-acute

The planning team included representatives from senior leadership, planning, finance, case management, medical staff, and each of the post-acute programs. During the planning process, the team recognized that while today, under FFS reimbursement, the health system assumed little financial risk if patients did not stay within the system, or went to a post-acute program that might

Daniel B. Walter
Senior Principal Walter Consulting Atlanta, GA 404-636-9700 dan.walter@walterconsulting.com

November-December 2013 | Spectrum 

A Crisis Communicators Self-Assessment (continued from page 5) severe incident. This could mean anything from home generators, to mobile tethering software (to access the Internet from your mobile device), to a simple list of local libraries with internet access. Or, designate a representative to staff the hospital command center, where generator access to power should be uninterrupted. And, as if we needed it, heres another way social media changes the game your hospitals Facebook and Twitter presence may be all you are able to access with limited power and mobile access. Use them.

6. Do you have the plans and policies to monitor and respond to social media?

St. Mary and Anne Klein Communications Group developed a proprietary and focused Social Media Crisis Communication Plan to complement the hospitals broader crisis plan. Beyond assigning team responsibilities, the plan takes the guesswork out of social media activity, assigning an if-this-then-this workflow strategy to evaluate influence and risk. If you answered yes to these questions, you are ready. (Be sure you update your crisis preparedness plan at least yearly.) If you are in doubt regarding the answers to these questions, its time to take a hard look at your crisis preparedness strategy. And if you

answered, no, then its time to have a heart-to-heart talk with your CEO.
Patrick Donohue
Marketing & Communications Director St. Mary Medical Center Langhorne, PA 215-710-6908 PDonohue@StMaryHealthcare.org

Christopher Lukach, APR

Senior Vice President and COO Anne Klein Communications Group, LLC Mount Laurel, NJ 856-866-0411 ext. 15 Chris@annekleincg.com

The SHSMD Advantage

Continuing its commitment to providing members with practical, timely resources, SHSMD has just released the 2014 Calendar of Health Observances & Recognition Days. The easy-tonavigate online calendarback in PDF format gives you quick, convenient access to the dates and descriptions of more than 250 health-related observances. Its perfect for planning 2014 health fairs, community outreach programs, and employee recognition events. Member login is all thats required to access this great benet of your SHSMD membership. 2014 will be here before you know it, so visit www.shsmd.org/calendar, and start planning today. 10 Spectrum | November-December 2013

SHSMD Datebook
January 2014: Futurescan 2014 released October 1215, 2014: Connections 2014, SHSMDs Annual Educational Conference and Exhibits, San Diego, CA For more information on these and other professional development opportunities, go to www.shsmd.org.




Stranger than Fiction

By Rick Wade

solutely the goofiest thing I have ever read. If youre going to write these so-called case studies, at least come up with stuff slightly in the realm of reality! The voice on the phone was an old friend, a senior executive in marketing and communications for a major health system with a renowned academic medical center as its flagship. She was calling about one of the early Tightrope Walker columns a story about a pile-up of conflicts of interest in a mid-size, Midwestern medical center. But its a true story, I shot back before she could continue. I masked the names and some details that might give the hospital away, but it actually happened. No? Yes! The following month I got a call from the CEO of a rural hospital who accused me of having a mole inside his organization. It seems that a scenario about physician recruitment gone awry mirrored a mess he had to clean up several months earlier. The majority of Tightrope Walker columns over the past four years were rooted in events that I encountered during my 18years as AHAs senior communications officer. I was often directly involved as a counselor to the hospitals and health systems as they dealt with sticky situations in communications, patient privacy, community trust, mergers and acquisitions, screwy marketing, misleading advertising and, well, you name it. Some other column

Wade, that is ab-

cases came from professionals in the field who shared their experiences and the painful choices that often came with them. Spectrum will be changing over the next several months with new content and approaches to the issues and challenges you face. Its new editor, Mary Campbell, and I have agreed to retire the column. Good publications are like citiesthey are not meant to stay the same. They change and rebuild with the times. While I enjoyed writing the column, the real pleasure was the learning I gained from your responses, both directly and in the poll that accompanied each scenario. There never was unanimous agreement among the choices offered and respondents often checked the other box, indicating that another solution was possible even if they couldnt quite articulate it. AHA President Emeritus Dick Davidson often reminded staff and members that every failure of our society eventually ends up at the hospital door and every human trait, both good and bad, can be found inside. Hospitals are the places that receive and care for the victims of poverty, violence, substance abuse, and crime. They deal with our inability to care for our most vulnerable people, lack of basic health services in the community, and the illnesses and injuries that come with life itself. Hospitals also are where a communitys most skilled and compassionate women and men work long hours under emotionally and physically stressful conditions. Everything they do has an impact on the lives around them. And every hospital is a powerful economic and cultural influence on the area it serves. It generates jobs and supports dozens of businesses. What it says and how it behaves can make people deeply proud or ashamed. The blue and white H sign along Americas highways and streets holds out a host of promises

to everyone who sees itabout the compassion, mission, and ethic of the people and place behind it. Job Oneearning and keeping the publics trust and confidence is paramount. Throughout the years I have watched many hospital and health systems professionals in communications, marketing, strategic planning, and similar disciplines be the leaders in ensuring their organizations did the right thing when confronted with tough ethical and management decisions. Yes, they are part of the team, but their jobs compel them to probe, understand, and respect the hospitals singular role in the lives, hearts, and minds of its community in a way that others may not. They spoke as the conscience of the institution and a steward of its reputation. They made the difference. The pace and depth of change in healthcare today is breathtaking. I suspect the future will bring clinical and corporate moral and ethical issues that will make some of the things Ive written about seem simple. You can be on the tightrope if you want to be, influencing the future of one of your communitys most important cornerstonesand ensuring that it keeps the promise symbolized by the blue and white H. Stay on the tightrope and thank you. Editors note: On behalf of SHSMD, I thank Rick Wade for the wisdom, insight, and wit that he has shared with Spectrum readers over the last four years. Beginning with the January/February issue, Spectrum will feature select Q&As from the Societys online communities. Mary P. Campbell

November-December 2013 | Spectrum  11

Introducing Your 2014 SHSMD Board of Directors

President Mark Parrington, vice president of strategic transactions and development, Catholic Health Initiatives, Denver

The SHSMD Board of Directors is responsible for defining the Societys vision

President-elect Christine Gallery, vice president of planning and market development, Emerson Hospital, Concord, MA

and strategic direction. The 17 volunteer-leaders pictured on this page donate countless hours guiding the development of policies, programs, and services to make the SHSMD member experience the best it can be. Leading the Board as president in 2014 will be Mark Parrington, vice president of strategic transactions and development, Catholic Health Initiatives, Denver. Serving as 2014 president-elect is Christine Gallery, vice president of planning and market development at Emerson Hospital in Concord, MA. She leads the strategic planning and business development efforts of the organization, the physician recruitment and relations program, and the community benefits initiatives, including the Emerson Hospital Healthy Living Program. In 2012, the New England Society for Healthcare Strategy named her Healthcare Strategist of the Year. A member of SHSMD since 2006, Gallery has served on the Board of Directors since 2007.

The four Board members below were elected in September to three-year terms beginning January 1, 2014:
Ben Dillon, (reelection) vice president and eHealth evangelist, Geonetric, Cedar Rapids, IA Rose M. Glenn, APR, senior vice president, Henry Ford Health System, Detroit, MI Ryan S. Gish, senior vice president, Kaufman Hall, Skokie, IL

Continuing Board members include:

Holli Salls, principal, SALLSGROUP, Chicago; SHSMD immediate past president Kriss Barlow, principal, Barlow/McCarthy, Hudson, WI Larry Margolis, managing partner, SPM Marketing & Communications, LaGrange, IL Terri McNorton, assistant vice president, marketing, Ochsner Health System, Baton Rouge, LA Ruth Padilla, principal, Healthcare Strategy Partners, Inc., Nashville, TN Burl Stamp, principal, PYA/Stamp, St. Louis, MO

Nadine Bendycki, director of market research and decision support, University Hospitals, Cleveland, OH Jeffrey Kraut, senior vice president strategic planning, North ShoreLIJ Health System, Manhasset, NY Carol Koenecke-Grant, chief strategy ofcer, Childrens Hospitals and Clinics of Minnesota, Minneapolis, MN Susanna Krentz, president, Krentz Consulting LLC, Chicago

Holly Sullivan, senior vice president, Hammes Company, Grand Rapids, MI

Donna Teach, chief marketing and communication ofcer, Nationwide Childrens Hospital, Columbus, OH