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Using the Web to Get Up Close and Personal Consumer-Driven Healthcare Marketing: Using the Web to Get Up Close and In this paper we will examine the emergence of consumer-driven healthcare marketing including its operational definition, how it has been used in the past and how it has evolved. We will inspect other industries to understand the efforts that have contributed to their marketing successes as well as determine the relevance of these efforts for incorporation into the healthcare marketing model. We will consider the advantages of new technology-enabled marketing opportunities such as stealth ads, blogging, podcasts, and corporate participation in social networks. The implications and work-around strategies of regulation on websites offered by healthcare entities will be analyzed and we will end with a checklist of recommendations for the healthcare executive to consider when implementing a consumer-driven health marketing plan. Consumer-Driven Healthcare Marketing: Using the Web to Get Up Close and “Blue skies, shining on me. Nothing but blue skies do I see.” The amiable words, enveloped in the distinctive voice of Cole Porter, lofted from television speakers across America. The invigorating imagery of a hot air balloon drifting across a backdrop of cloudless blue sky illuminated the nation’s television screens. A gentle voice encouraged the viewer to “see your doctor about Claritin” because a “clear With this vague yet revolutionary commercial that aired in 1996, Claritin set the precedent for an era of consumer-driven healthcare. It was not the first pharmaceutical commercial to emerge on prime time television, but it was unparalleled in its ability to capitalize on the consumer’s desire for control. At the very least, this groundbreaking Claritin commercial transformed the pharmaceutical industry into a multibillion dollar enterprise that spends twice the amount of capital on promotion compared to research and THE EMERGENCE OF CONSUMER-DRIVEN HEALTHCARE MARKETING ‘Marketing,’ according to the American Marketing Association, is defined by the activities and processes for creating, communicating, delivering, and exchanging offerings that have value for customers, clients, partners, and society at large. Marketing is not embodied by any one technique; it is a broad endeavor that involves a wide range of relationship-building methods that rapidly multiply as technology evolves. Marketing is also not just limited to promotional techniques, but extends into product conception, pricing structure, distribution channels, customer service orientation, public relations and The term ‘healthcare marketing’ builds upon this definition by relating the activities and processes to the healthcare field. This seemingly simple transition dramatically affects the functional characterization of the term. Healthcare marketers promote a service that is complicated, expensive, and frightening (Shaw 2008). Most people refuse to envision utilizing the services of a hospital and adamantly oppose advertising that recognizes the statistical chances of their future-based medical need. Therefore, the more traditional activities of targeting products and services to specific audiences and communicating brand images to the community are often ineffective in the Toward the end of the twentieth century, challenges in profitability, customer loyalty, quality of care, and market dominance drove hospitals emulate other industries by incorporating formal marketing functions. However, the dilemma of brand promotion versus identifying and meeting customer needs muddied the water to the point that by 1991, only 20 percent of hospitals demonstrated a high degree of marketing orientation The pervasive challenges of healthcare marketing have plagued more than just hospitals; nearly every sector of healthcare has struggled to determine an effective means of marketing. Even for the nursing home sector “marketing practices have remained focused on traditional and relatively constrained practices” (Calhoun et al. 2006). In 1995, Newt Gingrich boldly announced that the approaching information age would mean more decentralization, more market orientation, more freedom for individuals and more opportunity for choice (pg92). Shortly thereafter, by early 1996, the public introduction of the Internet promptly connected more than 25 million computers in The Internet pioneered a new mentality in the acquisition of information. Suddenly, a wealth of data was available to the general public that could be exchanged and archived in real time from the comforts of home. For marketing, that presented new challenges in developing ‘face time’ with consumers through new media as well as losing control over consistency in their messages: Advertised claims could easily be verified and electronic sources provided a sounding board for disgruntled consumers to voice their The change in mindset of consumers greatly impacted the healthcare industry as well. Many hospitals elected to take a proactive approach to Internet marketing by instituting websites that were ‘online business cards’ in nature. These early websites provided straightforward information pertaining to the services and products offered, the equipment utilized and the locations available. These sites offered very little interaction with visitors and failed to understand the multi-user advantages offered by online While healthcare’s online presence remained relatively stagnant, other industries devised innovative ways to use their websites to engage consumers – sites were designed to harvest information about their visitors for future marketing efforts and interactive abilities allowed consumers to customize online tools and features to fit their preferences. For example, Southwest Airlines was the first major airline to launch a website that is today considered the largest airline website and ranks as one of the largest e-commerce sites with more than 57 percent of its annual revenues generated through online bookings For healthcare, the monumental influence of the Internet has begun to tip the scales on the deficiencies of conventional marketing. As consumers have become more sophisticated with the Information Superhighway, the locus of control in healthcare has shifted from the provider to the consumer. The new focus on customer wants, needs and expectations have fueled the rise of consumer-driven healthcare marketing. This fresh approach to marketing recognizes the participant’s role in the delivery of care and the promotion of health education and wellness (Calhoun et al. 2006). The buzz of opportunity in consumer-driven healthcare has attracted the likes of several big name companies such as J.D. Power and Nielsen. That interest could prove to be pivotal for healthcare marketers; most patients don’t understand hospital ratings by the Joint Commission, but even general consumers understand what the J.D. trophy means (Robeznieks 2007). These recognizable merits could change the way healthcare stimulates relationships with its online consumers. In 2004, the Society for Healthcare Strategy and Market Development of the American Hospital Association published a report on marketing effectiveness that revealed a chasm between what chief executives want and what most hospital marketers are delivering (Sturm 2005). The study further reveals that many healthcare executives believe that growth is a function of patient acquisition almost exclusively as compared to CEOs from other industries that expect revenue growth to come from existing customers. Since many healthcare markets have limited options for growth through acquisition, healthcare marketing plans must reformulate to address retention strategies and measure how marketing influences patient satisfaction. To do so may require an evaluation of how other industries have grappled with the challenge. Seeking inspiration beyond the constraints of the healthcare industry is far from a novel approach. Patient safety and quality in healthcare have both been improved by borrowing best practices from other industries (Shaw 2008). For example, factory principles have contributed to streamlining hospital operations, the airline industry has provided models to improve communication and enhance safety, and even Disney has had a profound effect on the way healthcare organizations engage consumers (Lee 2004). The precedents established from learning by imitation can easily extend into the In many ways the evolution of healthcare parallels that of banking. Both industries face a highly regulated environment, offer relatively universal services, and have worked to combat stereotypes of impersonal service and self-serving agendas. As of recent years, both hospitals and banks have attempted to reinvent their image by renovating their campuses into sophisticated spaces designed with a markedly retail flair, more comparable to coffee houses and elite hotels. The difference, however, lies in the banks’ ability to transform the mechanics of burdensome regulation into a selling point of the marketing plan. Similar to the Joint Commission, the majority of the banking industry is regulated by the Office of the Comptroller of the Currency (OCC). One of the criteria used to monitor the performance of banks is the degree of compliance with the Community Reinvestment Act (CRA) that was originally passed in 1977. The CRA mandates that all banking institutions that receive FDIC insurance be evaluated to determine if the institution has met the credit needs of its entire community in a manner consistent with safe and sound operations. The three main evaluation aspects of CRA include community investments, community service, and loans to community based non-profit organizations. Rather than produce the minimum amount of effort required to receive a satisfactory rating, innovative banks learned to capitalize on the mandate. Armed with the information that 84% of Americans say they are likely to switch brands to support a worthy cause when price and quality are equal, marketers for these banks took their CRA activities to the press (Retail Merchandiser 2005). Gradually, the negative connotation of banking has given way to the well-intentioned actions and media images of their directors and officers volunteering within the community. Healthcare has the same opportunity to capitalize on data for marketing gain. Measures regarding quality accreditation, pay-for-performance, operational efficiency, effective outcomes, and community impact are readily available to healthcare organizations by way of regulatory statistical necessity. Healthcare marketing should infuse these measures into their messages of mission, goodwill, and community service to engage healthcare marketing imperatives that advertising is believable, evidence-based, and valuable to the consumer (Wanless 2005). Consumer-driven healthcare marketers should begin with a rich understanding of their organization’s quality ratings through detailed analyses of their organization’s performance. Measures where the greatest differentiation exists should serve as a starting point for marketing development (Wanless 2005). From there, a story will evolve that gives direction to advertising efforts and provides credible evidence to back it up. The modern consumer wishes to know how an organization’s products or services will directly benefit him. How quickly will he receive care when he visits an organization? How advanced is an organization’s body of knowledge and how does that translate into his chances for a full recovery? How does an organization contribute to the community in which he lives? These are the pertinent questions being asked by a population accustomed to getting answers through the abundance of online resources. Southwest Airlines provides yet another stellar example of how an organization has utilized online marketing to foster relationships with its consumers. In addition to the economic advantages of online ticket sales through its groundbreaking website discussed earlier in this paper (it costs the airline $10 to book a ticket through a brick-and-mortar travel agent, but booking a ticket on the website costs the company just $1), Southwest has exploited the Internet with a variety of relationship-building campaigns that include weekly electronic newsletters and special offer emails (Levison 2001). Furthermore, the online booking process is simple for consumers by foregoing data-mining efforts that require visitors to log in or register to purchase tickets. The design of southwest.com has provided travelers the convenience of one-stop shopping with airfare purchasing, rental car reservations and hotel room booking all on the same website. Strategically, Southwest doesn’t partner with other travel sites because it cannot control the service a Southwest customer gets from the online agent nor can it guarantee the ease of buying a ticket online Southwest’s preoccupation with ensuring consumer satisfaction through online interfaces serves as an influential model for the future of consumer-driven healthcare marketing. Healthcare organizations could economize appointment setting through sophisticated online software applications and advertise the time-saving and convenience advantages to consumers. In regards to the one-stop shop aspect, healthcare provider websites could automatically set up recurring appointments that are structured by input of consumer preferences and referral appointments could be prepared instantly through the main portal so that patients wouldn’t have to arrange for their own fragmented care. In addition, maps to office locations, supplemental education material, patient paperwork, and reminders for fasting and/or a list of medications could be produced consecutively with appointment booking to enhance the patient experience. There is limited evidence to suggest that consumer-driven healthcare marketing is beginning to gain steam in the current market. However, in addition to the highly publicized successes of a handful of healthcare companies, the industry is beginning to recognize that the failure to engage in innovative marketing could lead to a probable Take for instance HealthAllies, a consumer-focused healthcare company that aggregated purchases of medical services not typically covered by insurance (orthodontia, in vitro fertilization, plastic surgery) and negotiated discount rates with providers. While the company arguably cornered the insurance market in terms of innovation, the main obstacle to its success was the health care industry's absence of marketing and distribution channels for individual consumers (Herzlinger 2006). HealthAllies was bought out by UnitedHealth Group in 2003, a company whose established marketing and distribution channels reduced the costs of customer acquisition NEW TECHNOLOGY-ENABLED MARKETING OPPORTUNITIES From the perspective of the modern consumer a dynamic, interactive web presence is a prevailing component of an organization’s perceived legitimacy. For the marketing professional, the public-preferred dependence on electronic sources to disseminate information and engage in company marketing efforts represents a markedly more economical approach to consumer campaigning. In addition, the traditional restraints of paper-based advertising are lifted, leaving behind only limitations of the For example, the enormous impact of web-based business such as online auctioning through Ebay and online matchmaker services like eHarmony propose an interesting concept to the toolkit of health care marketing. Imagine a situation where the physicians are “sellers” of service, where they can be rated on various measures by feedback left by past and current patients, while the patients are “buyers” who shop for doctors based upon their specific medical condition or individual preferences. Or perhaps it could resemble more of a two-way matching process where the patient provides information about themselves and their physician preferences and the physicians can provide information pertaining to their practice such as fees, specialties, and treatment preferences. Even the most honorable regulatory attempts at establishing a scorecard system for evaluating healthcare providers would likely fail to trump the familiar system established by peer grading through Ebay and eHarmony. Online videos are the key for converting online browsers into engaged viewers. The popularity of YouTube and other similar online video forums pay tribute to another American desire - to be entertained. To combat the inoculation of professional video advertising, companies have repositioned their efforts into creating ‘stealth ads’ – videos that appear to be homemade yet are created by big business. Corporate giant Nike commissioned basketball player Kobe Bryant to appear in one of their premiere stealth ads. The ad looks like home video of Kobe performing a daring stunt to jump over a car as it drives toward him. The Nike brand is never flashed and no credits are ever presented. Only several weeks after the viral video flourished throughout the web and received more than a million views did Nike release that it had indeed sponsored the ad. With the inherent nature of humans putting themselves into an array of circumstances that often require the subsequent use of health care services, a variety of pioneering stealth ads could serve the purposes of healthcare marketers. Take the nation’s preoccupation with television programs like Grey’s Anatomy, ER, and most recently, the docu-drama Hopkins. What better way to allow potential patients to peer into the core of your organization than by doing so through publicized video? Bonus: Considering the expense of traditional print advertising, the costs associated with recording ‘amateur’ style video and electronic means of distribution are minimal. Simply stated, healthcare is a service industry that places great value in the ability to foster relationships with its consumers. Often overlooked is a hospital’s engagement in online social networks to serve as an extension to this agenda. Blogging, an individually maintained chronicle of commentary and other materials such as images or videos, is yet another online phenomenon that enhances company websites in a number of ways. First, the frequency of updates and viewer traffic by websites that are home to active blogs are often viewed favorably by search engines. Perhaps more importantly, however, blogs by members of the health care team function to soften the antiseptic feel common to many corporate websites and the health care industry in general. The encouragement to employ blogs on healthcare websites is often regarded as an operational nightmare. The organization must seek to portray a professional image yet appear warm and personable; maintain control but allow input as a normal function of a relationship; and be current enough to stimulate interest without consuming an inordinate amount of time. Kaiser Permanente, an integrated managed care organization in California, responded to these challenges in a notably unique approach. As opposed to topics that would create legal exposure, they focused on themes that were inherently non- controversial such as promoting proactive wellness and self-care. For the first blog published by Kaiser Permanente, they selected Preston Maring, MD to be the contributing author. Maring was the local guru on sustainable farming and wrote colorful blog entries relaying farming stories and delicious recipes and cooking tips (Weber 2008). The weekly entries became a productive public relations tool that was well recognized beyond the boundaries of the organization’s geographic location. Logistically, visitors were able to submit comments that were moderated by Maring at his discretion and Kaiser Permanente retained authority over the boundaries of conversation. Most recently, the consumer-driven healthcare marketing pioneer, Mayo Clinic, enabled patient communication by developing a Facebook page, the most popular Web 2.0 venue for online social networking (Rollyson 2008). Facebook members utilize the page to share stories about Mayo Clinic and depict the care they or their friends and family received. The technology-enhanced word of mouth advertising creates the impression of peer-determined credibility and achieves an economy of scale that is elusive to traditional marketing: Mayo’s director of marketing claims one word of mouth recommendation is worth 600 media impressions (Johnson 2008). Many organizations have confused using the web to ‘get up close and personal’ with the regurgitation of patient information to a targeted group of end users. With this mindset, it is easy to understand how HIPAA represents a tangible barrier in the implementation of healthcare marketing plans. However, HIPAA is only a set of consumer protection standards implemented in response to the abuse and discrimination of unethical information exchange that thrived prior to its inception - reaching consumers in meaningful ways without the exchange of patient identifying data eliminates HIPAA Interestingly, a divide exists in the definition of a relationship. For healthcare providers, healthcare relationships place emphasis on collecting and applying data effectively through new database techniques that aim to improve health outcomes as well as marketer’s overall return on investment (Levins 1998). This format of relationship building is highly dependent on abiding by the regulations imposed by HIPAA. From a patient’s perspective, healthcare relationships are forged in the exchange of information. They want knowledge of, access to, and the power to participate in, health services that can help and heal them. This style of relationship allows for a level anonymity that bypasses HIPAA constraints, and yet satisfies consumer needs. Contrary to conventional wisdom, the general public is not adverse to divulging personal information for the benefit of health improvement. The most influential talk show hosts on prime time television, including Oprah Winfrey and Dr. Phil McGraw, have recently tackled taboo topics on health in response to consumer demand. A market has evolved where consumers are hungry for detailed information pertaining to wellness and disease management, yet their primary physicians are unable to devote the amount of time they perceive as necessary to satisfy these needs. Instead, consumers have turned to physicians in mainstream media to serve as alliances in healthcare matters. The best product of this social movement is Columbia University cardiothoracic surgeon Dr. Mehmet Oz, whose rise to fame is due in part to frequent appearances on the Oprah Winfrey Show, hosting a satellite radio program and authoring more than 350 publications. Dr. Oz’s dynamic personality and extraordinary compassion has encouraged audiences to become partners with their doctors in the delivery of care and learn to Dr. Oz’s model of marketing has innovatively addressed issues of personalized information that facilitate HIPAA compliance and warrant review by progressive healthcare organizations. The magnitude and depth of resources available on the Dr. Oz website is remarkable. Every imaginable aspect of diseases, ailments, mental health, physical fitness, diet and healthy living is uniquely identified and analyzed in a catch-all approach for meeting individual consumer needs. Another advantage to technology enabled relationships modeled by Oz is that consumers have unrestricted access to the physician by way of online videos, blogs, podcasts, and more that continually reinforce healthcare messages, as opposed to the transitory nature of a traditional doctor appointment. It is important to appreciate that a patient’s relationship with their physician often extends beyond the office in a realm that As this paper has demonstrated, the fundamentals of healthcare marketing have changed. The emergence of consumer-driven healthcare marketing has already had a profound impact on the organizations that have dared to experiment with its implementation. In reality, the financial risks of investing in new technology-enabled marketing opportunities often costs less than traditional methods of mass advertising delivered by costly print media. The Internet has created a new landscape in the relationship between companies and consumers through a variety of means that encourage recurrent interaction as well as immediate satisfaction of need. The marketing successes of prominent healthcare organizations and companies in other industries highlighted in this essay provide a compelling case for the proliferation of consumer- RECOMMENDATIONS FOR THE HEALTHCARE EXECUTIVE • Do not be afraid to introduce new technology-enabled marketing strategies. In many cases, contemporary marketing methods are less expensive per impression • Learn from leaders in other industries; companies like Coca-Cola, Toyota and Starbucks have helped some healthcare organizations develop new metrics, create exceptional experiences and promote themselves with new technologies. • Do not become too engrossed in the quantitative and qualitative results of marketing efforts – even the Mayo Clinic recognizes the inherent value of certain marketing practices that are impossible to measure. • Promote the safety of consumer-driven, personalized online applications by investing in the most current technology available in the field of website security. Most websites lose consumers when they fail to implement safety and Table 1 Comparison of Conventional Marketing versus Consumer-Driven Marketing Table 2 Web-based Marketing Tools, Definitions, and Usability Features distributed over the Internet by portable, targeted, and syndicated download. Berry, L. L., and K. D. Seltman. 2007. “Building a Strong Services Brand: Lessons from Mayo Clinic. Business Horizons 50: 199-209. Calhoun, J. G., J. Banaszak-Holl, and L. R. Hearld. 2006. “Current Marketing Practices in the Nursing Home Sector.” Journal of Healthcare Management 51 (3): 185-202. Chung, T., and R. Law. 2003. “Developing a Performance Indicator for Hotel Websites.” International Journal of Hospitality Management 22(1): 119-125. Herzlinger, R. 2006. “Why Innovation in Health Care is So Hard. Harvard Business Gingrich, N. 1995. “Newt’s Brave World.” Forbes. New York: Feb 27, 1995 pg. 92. Johnson, R. 2008. “Image Makeover.” [Online article on HealthLeaders Media website; http://www.healthleadersmedia.com/content/87816/topic/WS_HLM2_MAG/Image- Lee, F. 2004. If Disney Ran Your Hospital: 9 ½ Things You Would Do Differently. Bozeman, MT: Second River Healthcare Press. Levins, I. 1998. “One-on-one Relationship Marketing Comes of age.” Medical Marketing Levison, M. 2001. “Southwest Airlines Does Web Business Right.” [Online article on The International Data Group Network website; retrieved 11/23/08] [Online article on HealthLeaders Media website; retrieved 11/23/08] Mills, J. E., and R. Law. 2005 Handbook of Consumer Behavior, Tourism and the Internet. Binghamton, NY: Haworth Hospitality Press. Pines, W. L. 1999. “A History and Perspective on Direct-to-Consumer Promotion.” Food Retail Merchandiser. 2005. “Study: Cause-Related Marketing Initiatives Distinguish Company Brand.” [Online article AllBusiness.com website; retrieved 10/7/08] http://www.allbusiness.com/retail-trade/4300078-1.html Robeznieks, A. 2007. “Competing for More Attention.” Modern Healthcare 37(34): 24. Rollyson, C. S. 2008. :The Mayo Clinic Case Study.” New Strategy for Enterprise Competitiveness. [Online article on Christopher S. Rollyson and Associates website; retrieved 11/23/08] http://rollyson.net/download/GHCJ/hc_case_MayoClinic.pdf Shaw, G. (2008). “Department Focus: Marketing – Lessons from the Field.” [Online article on HealthLeaders Media website; retrieved 11/23/08] http://www.healthleadersmedia.com/content/215014/topic/WS_HLM2_MAG/Depart ment-Focus-MarketingLessons-from-the-Field.html Sturm, A. C. 2004. “Misplaced Expectations Make For Marketing Missteps: Is Healthcare Like Other U.S. Businesses That Seem To Be Long on Marketing Expectations and Short on Patience for Marketing Results? A New Report Suggests That It Could Be True.” Healthcare Financial Management 59(1): 88, 90, 92. Suano, E. 2004. “Southwest Airlines Spanish-Speaking Customers Can Now Make their Online Flight Reservations in Spanish.” [Online article on IonGlobal website; retrieved 11/23/08] http://www.ionglobal.com/news_2004_04.asp White, K. R., J. M. Thompson, and U. B. Patel. 2001 “Hospital Marketing Orientation and Managed Care Processes: Are They Coordinated?” Journal of Healthcare York University. 2008. “Big Pharma Spends More On Advertising Than Research and Development, Study Finds.” [Online article on ScienceDaily website; retrieved 11/23/08] http://www.sciencedaily.com/releases/2008/01/080105140107.htm Wanless, S. 2005. “Using Business Intelligence to Enhance Healthcare Marketing.” [Online article on Business Intelligence Network website; retrieved 11/23/08] Weber, H. 2008. Blog and Healthcare: “A Recipe for Success.” [Online article on Strategic Health Care Communications website; retrieved 10/7/08] http://www.strategichealthcare.com/pubs/ehealth/f2_BlogsandHealthcare.php

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Colloque “coordination et subordination”26-28 mai 2005Isabelle Bril et Georges RebuschiColette CortèsC.I.E.L. (Centre Interlangue d'études en lexicologie)Université Paris 7 Denis DiderotJuin 2005 Une analyse fonctionnelle, distributionnelle et cognitive des subordonnées de l'allemand moderne. Plan de l'article 1 Étude fonctionnelle des subordonnées de l'allemand 1.1. Tests de Ducr

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