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Healthcare Industry Commentary
Market Trends...
  • 2017 sees new business models through ongoing mergers & acquisitions of healthcare entities
  • Accelerated, web-based technology -especially in Mobile and Internet-Of-Things (IoT)
  • New contracting strategies based on reimbursement challenges and cost control measures
  • Ongoing healthcare reform policy developments in Washington require continual monitoring and interpretation



HEALTHCARE INDUSTRY COMMENTARY AND CURRENT EVENTS
Week Of 1/28/2018
6 Options To Improve Healthcare Content Marketing Performance

Quality Healthcare Content Can Be Invisible To Search Engines And Millions Of Viewers; sometimes even the best healthcare content can’t be found.  Quality healthcare content requires significant time, financial and technical investment to develop. Even with solid expertise and considerable resources, the highest quality material can be seemingly ineffective as search engines and audiences stream by it. Sometimes it’s understandable based on sheer volume of healthcare / non-healthcare content uploaded to the Internet each minute, the enormous number of venues where content is shared and even the most seemingly unique healthcare topics already having well-placed quality content published. It’s time to assess your options to give you and your content the attention and ROI it deserves.

Verify Technical Attributes Are In Place And Functioning Properly

Be certain the digital framework of your healthcare content is optimized; key considerations include:

· Get on Google’s good side and equip your website with HTTPS

· Stay on Google’s good side by making your site mobile-friendly

· Eliminate redirects

· Mend broken links

· Use social sharing buttons

· Assess and deploy reasonable ways to cultivate backlinks

· Submit an updated sitemap to key search engines

· Optimize site performance with better page speed

· Delete or revamp out-of-date or presently irrelevant content

No matter how good your healthcare content is, even the best needs to have a sound technical operating base and supporting cast to reach full effectiveness.

Revisit Keyword Selection

Keyword research, especially when it’s being revisited, can be tedious but well worth the effort. Seek out those keywords with high profile but low competition and repopulate your content accordingly. Be certain your content is appropriately worded and aligned with the specific healthcare audience (clinician, consumer, commercial, etc.) perspectives in mind. For some, this means rewriting the entire work but this is not always necessary and it will serve you and your ROI goals better if you learn to keyword-smith proficiently.

Fortify it with additional key supporting facts / current trend details to establish credibility and enrich your keyword volume. This may be sourced from KOLs / Influencers or medical references. The highly specialized rhetoric of healthcare offers unique combinations of vocabulary to effectively optimize content if you invest time, research and creativity.

Consult Your Repurposing Strategy

When you are creating content, always have alternate methods in mind to share it further apart from the original format / placement of it. Assess your repurposing options and strategically deploy your content in another format or venue. If you do not have a repurposing strategy, chances are you have quality content that’s languishing and capable of generating more ROI.

Paid Search

Some promotional funding can go a long way in helping languishing content get on its feet. Be sure you have adequate of finances available to do it. Before launching a campaign, be certain the content you are promoting is at it optimal best and designate KPIs and other goals to measure effectiveness and ROI. A great way to cultivate organic reach is to boost traffic streams via paid search strategies and facilitate audience notoriety / sharing to carry it forward.

Redefine Your Topic

This requires additional research, time, financial and other resources. Re-think the content and the healthcare audience you are seeking to reach. Narrowing the focus may make it appealing to fewer viewers but may reward you with better engagement. Hopefully it’s not a complete do-over but sometimes it’s necessary to effectively reach your original audience or a subset of it. One of the positive aspects of healthcare is its complexity and the multiple perspectives various stakeholders have in it. Realign your content with a niche strategy in mind to drill down to those personas and audience sectors it matters to most.

Strategically Utilize Social Media

Depending on the healthcare topic and audience, some mainstream social media options may provide your content with some lift. Unfortunately, quantity does not immediately result in quality ROI. Take it a step further; identify ways to share your carefully crafted content in the narrower social media venues preferred by your prime healthcare targeted audience for greater effect. Always be prepared with a strategy to take your content to the audience and once they have it, be certain they circle back via links or other channels and easily share it with peers.

Revenue-effective ROI is challenging to achieve for many healthcare marketing initiatives. Even the most established brands have to maintain constant vigilance and commit substantial resources to be certain the high ranking they enjoy continues to stay aloft. A combination of these options will increase the opportunities for you to improve your healthcare content marketing performance and meet those KPI / ROI goals you are driving towards.

WEEK OF 1/21/2018
8 Actions Improve Healthcare Email Marketing ROI

54% of marketers say building engagement is their top priority with email marketing according to Ascend2 …

While numerous digital communication and promotion options exist, email continues to be one of the most preferred channels to promote brands and generate sales. Despite the demise of email marketing forecast years ago, it continues to be an attractive and effective tool in engaging audiences. Its performance and utility intrigues marketers and at the same time challenges them and their audience based on sheer volume and content relevancy. These are 8 action items to gain critical advantages in your healthcare email marketing and sales initiatives.

Security / Privacy

All email marketing initiatives need to consider security and privacy — especially in healthcare. Be certain security updates in your systems and applications are up-to-date and installed as soon as possible when they become available. Take maximum precautions to ensure your audience and your organization are as protected as possible. Likewise, always be cognizant and fully compliant with any privacy standards which apply. Security and privacy issues are at the forefront of our Internet society and their significance is highly magnified in the healthcare sector.

Key Performance Indicators ( KPIs ) / Sales Goals Attainment

Sales goals and KPIs for healthcare email marketers are the equivalent to weather and crop reports for farmers. These should always be monitored closely and continually reassessed. Even if your lead generation, direct sales or other benchmark goals are being consistently surpassed, be certain they aren’t reaching a point of a “comfortable” plateau — the forerunner to potentially dropping. Always seek alternatives to further uptick performance. While some may consider these options to be “on reserve”, they can also be under-served leads which the competition captures before you do.

… Based on insights from MarketingProfs, 15% of marketers surveyed say their companies still do not regularly review email opens / click-through rates; only 23% say they have uniformly connected website / email for tracking what happens after a click …

Sharpen Segmentation

Continue to slice and dice your email marketing database to further define targeted healthcare audiences and subcategories within them. The respective customer personas in the subgroups offer prime opportunities to fine tune targeting, focus content and increase engagement. Reassess how you are segmenting your customer database resources to devise new engagement opportunities.

Deeply defined subgroups enable you to connect with new audience members or those in which you were not successful with through earlier attempts. You could end up sending less emails and be rewarded with better sales results and ROI based on efficient persona profile development and optimized database drill downs. It is important to be aware your company and its offerings, the subcategory members and / or the healthcare marketplace may have changed. New developments on either side always warrant updated considerations to revisit audience subcategory email database opportunities to maintain customer connections and generate sales.

Automation

Review what processes and tools you are using to develop and implement your email campaigns. Familiarity with a routine / email marketing tool may lead you to overlook better methods or platform technology to use. You may not be recognizing existing or new features your platform has which can make your life easier and email marketing efforts more effective.

There may be better platform options available to execute email marketing campaigns. New platform technical features enabling you to execute more options could deliver more for less. Carefully evaluate your current processes and setup; changes in procedures, utilization or technical resources can lead to significant operational, sales and ROI improvements.

Benefit From Opt-outs

Don’t abandon opt-outs as “lost causes” and leave it at that to move onto others. Use opt-outs to critique campaigns and deliverable details including targeting, frequency, content, touchpoint features, offerings, and other variables. Your targeted audiences are already receiving emails based on personal / professional communications; email marketing messages pile on top of those — no matter how earnest and legitimate your outreach is, it is still fighting for attention. Healthcare, among other characteristics, is a clinical, financial and technical marketplace; there are many stakeholders which share the same customers your email marketing and sales initiatives are targeting.

… Based on information from Yes Lifestyle Marketing, Click-to-Open rates are declining; average click-to-open rate (CTO) is 8.9 percent, a 13 percent drop YoY resulting in a 22 percent drop over the last two years …

Sizable audiences segments are opting out merely to reduce clutter. Opt-outs are a great way to objectively learn to re-focus your campaign strategy. They also cultivate the importance of offering other ways for the audience to stay engaged with your company through social media or website follows and other sign-up opportunities which may start with an email but continue on in other digital venues. Be certain your content features these touchpoint features and channels to provide your organization and the audience ways to continue to be connected outside of the email realm.

Double Up On Focusing Content And Offerings

The healthcare industry is continually changing. Develop and share content specifically relevant to your healthcare audience aligned with current events, new developments and your products / services. Use them to make the connection between the industry, the customer and your company; position your offerings as timely solutions to their needs.

Trending topic examples can be aligned to numerous healthcare industry sectors (health system, PBM, MCO, etc.), medical specialty (anesthesiology, cardiology, obstetrics / gynecology, etc.), condition (acid reflux, asthma, hypertension, etc.), payer (Medicaid, Medicare, DHA/ TRICARE, etc.), professional (health system CFO, CIO, CMO, etc.) or other defined interests. As healthcare assertively evolves; wide and narrow audience segments value timely updates enabling your company to be recognized as a front runner with answers to their challenges triggered by industry change.

Change Up Your Approach

A good healthcare email marketing strategy does not always include an offer, sale or other promotion. Informational content can be shared with your targeted audience and lead to sales without a “pitch”. The content can demonstrate your organization’s leadership / knowledge in a particular area; it is important to established positive notoriety, professional credibility in the healthcare sector.

Review the last 6–12 months of emails your organization has shared with a particular segment; if they are all “pitch-focused” with diminishing returns, it’s a good indicator you are fatiguing your audience and need to change up content to more effectively engage them. There is always a strong push for more sales and it’s easy to overlook redundant approaches which audiences will eventually associate with spam. Choosing a “non-pitch” approach to change things up is a good consideration. Personalize messaging whenever possible to reinforce audience engagement.

…The top email providers are Gmail, Yahoo, Outlook, GMX, Zoho, iCloud, AOL, Elude according to MUO…

Mobile

Mobile-friendly campaigns are part of successful healthcare email marketing strategy formulas which can also enhance non-mobile venue engagement. Content should be easily viewed / scrolled, quickly understood and acted upon through touchpoint features. Fortify your email / digital marketing with trigger email features pivoting on audience interactions is an example. Maximize quality design and content attributes to minimize steps and optimize messaging so processes are convenient for the audience to respond to favorably which increases direct sales, lead generation and other revenue-positive engagement opportunities.

Moving Forward

These 8 actions are only the beginning. Connect them with your present and future healthcare email marketing initiatives to build engagement, sales and ROI. The more effectively your email marketing is executed will not only strengthen your position but also provide more encouragement for your trusted audience to disregard those from competitors.

WEEK OF 1/14/2018
DNAnexus Investor Gene Pool Includes Google And Microsoft 

… High Tech Leaders Plunging Into Precision Medicine …Microsoft and Google are both investors in DNAnexus, a high profile precision medicine start-up …

DNAnexus is a cloud-based genome informatics & data management platform company and a leader in biomedical informatics. Its latest round of funding totaled approximately $58 million. They will apply the monies towards precision medicine and genomic data management solutions for clinical trials. Based in Mountain View, California, they have created a global network for genomics and other biomedical data with a presence in Africa, Asia-Pacific (including China), Europe, North America and South America.

Its scalable and secure platform supports thousands of researchers across an array of sectors including bioagriculture, biopharmaceutical, clinical diagnostics, government, research consortiums and sequencing services. Besides Google and Microsoft, other investors involved with DNAnexus include Claremont Creek Ventures, Foresite Capital, MidCap Financial, TPG Biotech and WuXi NextCODE. Claremont, Foresite and TPG specialize in healthcare venture capital; Midcap is a venture capital firm investing in and outside of healthcare while WuXi NextCODE is a China-based genomic information company.

… Precision medicine is a technically advanced, patient-centric approach to healthcare …

Precision medicine combines an assortment of variables such as genes, environment and lifestyle to align diagnosis and treatment of diseases — as well as prevention steps. Clinicians and payers are attracted to the focused metrics it provides by its sorting of enormously complex clusters of data and associated patient care details. Physicians are able to provide more accurate care to specific patient types based on its insights. Payers like the “dialed-in”, data-supported aspect of better diagnosis / treatment paths although precision medicine is not an inexpensive process.

… Google, Microsoft and other “non-healthcare” tech companies are increasingly attracted to the precision medicine sector …

Google and Microsoft have invested in start-up interests, developed innovative solutions and assembled partnerships centered on precision medicine and other data-demanding, health innovation ventures. The technical approaches and high end analytics are an ideal fit for the critical thinking data management resources each company has. The funding Google and Microsoft provide DNAnexus won’t crimp their checkbooks and the potential ROI is worth their investment in terms of long term sales potential.

… Healthcare is intrinsically awash in data and analytics; there exists an overwhelming need to assertively harness the data from the past, present and into the future to convert it from accumulated statistics into actionable knowledge …

Healthcare is a solid opportunity for Google and Microsoft to readily deploy their attributes and resources in such a way they apply their core expertise, diversify their business reach and generate ROI-effective sales without sacrificing focus. Google and its Verily unit are assertively pursuing a number of advanced healthcare endeavors as is Microsoft; for example both Google and Microsoft have oncology-related ventures underway.

… As for the worldwide precision medicine market, the clinical anticipation and investor runways are long …

Based on data from Market Research Future, it is expected to expand at a compound annual growth rate (CAGR) of 12%; the outlook is for it to reach $88.6 billion by 2022, originating from $38.9 billion in 2015. For DNAnexus and its leading competitors, including Bina Technologies, CLC Bio, Complete Genomics, Knome and SolveBio; there will be plenty of interest and funding from non-healthcare and healthcare investor interests alike in the upcoming years to accelerate and enhance precision medicine business opportunities.

WEEK OF JANUARY 7, 2018
Healthcare Becomes Largest Employer Sector 
In The United States

Based on an article in The Atlantic and GAO statistics, the healthcare industry is the nation’s largest employer –surpassing even retail. This represents challenges and opportunities for many stakeholders. Here are 7 considerations regarding the ever-evolving healthcare sector with consumer, commercial and clinical perspectives in mind:

1. Government is the primary payer in the United States; spanning Medicaid, Medicare, DHA / TRICARE and other programs / sources of reimbursement; less companies feature retiree health benefits for workers --increasing reliance on government funding support

2. The aging population in the United States is a key factor in the healthcare industry job boom

3. As a quarter of the workforce will be older than 55 by 2025, a significant number of persons, both caregivers and non-caregiver workers associated with healthcare, will be key elements in the employment sector 

4. Traditional healthcare roles largely centered on Nurses, Doctors, Pharmacists; new positions have evolved (typically referred to as “Care Extenders”) and they include Nursing Assistants, Physician Assistants, various Therapist and Aide specialties

5. Nurses, Doctors and Pharmacists can consider an expanding multitude of their own specialties / sub-specialties as additional academic credentials and certifications are available and required

6. For health insurers / payers, existing and new caregiver specialties each need their own billing / reimbursement assignments which create their own financial and data management growth requirements and challenges

7. Healthcare product and service marketers, healthcare management (hospital / health system, group practice administration, etc.) and other stakeholders need to account for the growing complexity / expansion of organizational staffing structures, specialties and roles associated with patient care

WEEK OF 12/31/2017
Hospital / Health System Mergers Of 2017

There were scores of hospital / health system mergers and acquisitions in 2017. Even smaller deals involving 2-4 hospitals will have huge importance within their immediate metropolitan areas whereas the larger deals will have metropolitan, regional and even national impact.  Non-Profit and For-Profit hospital / health system sectors had significant activity; Illinois, New Jersey, New York and Pennsylvania experienced the most transactions...

…UNC Health Care and Carolinas HealthCare seek merger to form 50+ hospital health system … Ascension acquiring Illinois-based Presence Health, a 12-hospital system … Catholic-sponsored SSM Health buys four hospitals from Congregation of Sisters of St. Agnes … Hackensack Meridian Health and JFK Health merge to create 16-hospital system in New Jersey … Dignity Health and Catholic Health Initiatives combine to form hospital chain spanning 28 states ... Advocate Health Care and Aurora Health Care deal will create $10.7 billion two-state health system … Ascension Health-Providence St. Joseph Health merger encompasses 191 hospitals / 27 states (annual revenue of $44.8 billion) … With acquisition of IASIS Health Care; Steward Health owns 36 hospitals across 10 states… Cooper University Health Care, Lourdes Health and St. Francis form 3-way health system merger … HCA Gulf Coast buys 4 hospitals from Tenet … Greenville Health System and Palmetto Health merge to form largest health system in South Carolina … Baptist Memorial Health and Mississippi Baptist Health System plan to merge ...

WEEK OF 12/25/17
Healthcare Product Manufacturer Mergers Of 2017

Look for these 2017 merger and acquisition deals to have even more impact in 2018 on the rest of the healthcare industry.  There will be competitive countermeasures in the form of additional mergers and acquisitions in the sector as well as new contracting arrangements impacting patients, clinicians, hospitals / health systems, payers, GPOs, PBMs and other stakeholders.  Seven of these deals were over $5 billion dollars...

… Johnson & Johnson’s $30 billion takeover of Swiss pharma firm Actelion … Gilead’s $12 billion acquisition of Kite Pharma … Abbott finalizes Alere deal for $5.3 billion … Reckitt Benckiser Group acquires Mead Johnson Nutrition for $17.9 billion … Sanofi picks up Protein Sciences with upfront payment of $650 million … Cardinal Health acquires Medtronic business unit for $6.1 billion … Teleflex buys Vascular Solutions for $1 billion … Hologic acquires Cynosure for $1.7 billion … Stryker purchases Novadaq for $700 million … Allergan completes deal to buy Zeltiq Aesthetics for $2.4 billion … Integra Lifesciences buys J&J’s Codman Neuro business unit for $1.05 billion … Gilead purchases Cell Design Labs for $567 million … Takeda acquires Ariad Pharmaceuticals for $5.2 billion … Stryker picks up Entellus Medical for $662 million … Boston Scientific snaps up Symetis for $435 million … Mallinckrodt buys Sucampo Pharmaceuticals for $840 million … Becton Dickinson buys C.R. Bard for $24 billion …

WEEK OF 12/18/2017
Ascension And Providence St. Joseph Health forming mega-merger…

In mid-December, 2017; two major hospital systems were in merger discussions which would create a new leader in U.S. hospital ownership totaling 191 hospitals. Non-profit Ascension, based in St. Louis, Missouri and non-profit Providence St. Joseph Health, headquartered in Renton, Washington, would create a new mega hospital entity comprised of 191 hospitals across 27 states.

Ascension already easily ranks as one of the largest health systems in the nation. Its staff includes 150,000 associates and 36,000 providers. They operate 2,500 points of care including 141 hospitals and over 30 senior living facilities spread across 22 states and the District of Columbia.

Providence St. Joseph Health is a sizable health system entity with 50 hospitals and over 825 clinics. Their facilities are located across 8 states. The organization employs about 111,000 staff members.

…According to hospital / healthcare consulting firm Kauffman-Hall, “Transactions among larger and like-sized organizations are rising as health systems across the country look to build scale and new capabilities for an uncertain healthcare environment”…

If the two entities combine, its annual revenue is estimated at $44.8 billion. The next largest competitor would be HCA. Presently, HCA owns 177 hospitals which generate roughly $41.5 billion in annual revenue. The new tandem would have considerable leverage in negotiating with insurers and medical / pharmaceutical product manufacturers as well as being a competitive force against other for-profit and non-profit healthcare provider organizations. It would also be able to establish a fortified healthcare marketing brand across multiple medical specialties and consumer / patient health services.

The proposed Ascension and Providence St. Joseph Health merger caps off a year of extraordinary large scale health system deals conducted by Steward Health Care, Advocate Health, Aurora Health Care, Dignity Health, Catholic Health Initiatives, UNC Health Care and Carolinas HealthCare System and others. They impact for-profit and non-profit health system organizations and span metropolitan as well multi-state regional geographic areas. As clinical, technical, financial and competitive changes continue across the United States, the wave of mergers and acquisitions across the healthcare provider organization sector (which includes hospitals, practice groups and specialty providers) will be an ongoing process representing challenges and opportunities.

WEEK OF 12/11/2017
Five Winning Healthcare Content Marketing Practices

…The most successful healthcare content marketing strategies embrace the concept of relentlessly jockeying for position when it comes to audience engagement, search ranking and ROI…

Healthcare And Technology Compete Against Themselves Everyday…

Healthcare content marketing is a never ending race. Healthcare and digital technology are two industries which literally outpace themselves with innovation. This tandem of change represents challenges and opportunities for healthcare marketers to consistently go the distance with their content marketing initiatives.

Commit Your Content To The Audience

The healthcare audience consists of a variety of stakeholders. There are significant differences between communicating with clinicians, healthcare administration, patients, consumers and other audience sectors. Don’t hesitate to develop two distinctly different communications regarding one healthcare topic to engage specific audience stakeholders effectively. Fine tune your messaging accordingly so it is appropriate for the persons you seek to engage. Furthermore, the wrong language may mislead your audience which is something to avoid at all costs when it comes to healthcare.

…Details from Pew Research shows 74% of internet users engage social media with 80% of those users focusing on specific health information -plus nearly half of them are searching for information about a specific physician or other type of clinician…

Help Google Help You

Healthcare content has an enormous global web presence. Be certain your content is strategically well-written and search friendly. Key words are good, long-tail key words are better. Views don’t matter unless they are from the persons you are targeting and hope to further engage. Take a little more time to craft your healthcare content so it can be found by those it matters to most.

…Spinning Out Of The Curve…

Practice Good Form

Be certain the format of your content / text is laid out cleanly and well organized. It is always courteous and digitally important for your content to be easily read; now more than ever mobile viewing needs to be accounted for. Carefully evaluate and confirm your healthcare content can be easily read whether it is displayed on a desktop, laptop, tablet or mobile phone. As time goes on, don’t forget Google will either reward or penalize your healthcare content ranking based on its mobile-friendly attributes.

….Based on research from Wolters Kluwer Health…

  • 72% of doctors access drug information from smartphones
  • 63% of doctors access medical research by tablet
  • 44% of physicians communicate with nurses and other associates from smartphones

Be Time Sensitive

Throughout history, healthcare has been an industry driven by change. Therapies, treatment guidelines, procedures medical technology and regulations are continually evolving at a rapid pace. As you develop your healthcare content’s conversational dialogue, factual details and other elements, be certain what you are communicating and how you are wording it is accurate and up-to-date.

…As you charge late in the stretch to the finish line…

Spur Your Content To Stay On The Move

The better the content is, the more audience members are likely to want to share it. It is important to reinforce its portability. Make sure your healthcare content can easily be sent on its way between audience members. By doing so, your audience will grow accordingly and so will your ROI.

…On average, healthcare marketers spend 23% of total marketing budget on content marketing initiatives, compared to 31% percent for all marketers according to the Content Marketing Institute…

There are numerous contenders in the healthcare content marketing digital space. To be successful, it is necessary to have a consistent and effective strategic stride to move ahead of the competition. These five concepts will bring your marketing goals, objectives and ROI across the finish line.

Week Of 12/04/17
CVS Health Proposes To Acquire Aetna: Eight Fast Facts

An innovative and competitive move if the debt load can be effectively managed.  The healthcare industry continues to evolve; business models within the sector are changing and propelled by large scale merger and acquisition initiatives…

The proposed CVS Health / Aetna deal combines two healthcare industry leaders with wide and deep reach across commercial and consumer business sectors nationwide. Both organizations are well-established and as a combined tandem, represent a significant competitive threat to Centene, Cigna, Express Scripts, Fred’s Pharmacy, Humana, Kaiser, Optum / UnitedHealth Group, Prime Therapeutics, Rite Aid, Walgreens-Boots Alliance, Walmart and select Blue Cross Blue Shield plans (CVS Health recently formed a strategic alliance, IngenioRx, with Anthem, the largest BCBS affiliate).

Eight Fast Facts…

  • CVS Health will pay about $69 billion for Aetna; Aetna stockholders will receive $207 per share, $145 in cash and $62 in stock
  • Aetna, based in Hartford, Connecticut, was founded in 1853; CVS Health, founded in 1963, is headquartered in Woonsocket, Rhode Island
  • Roundly calculated figures reveal CVS Health employs about 158,000 persons; Aetna has over 49,000 employees
  • Within the latest Fortune 500 rankings, CVS Health is listed at number 7; Aetna is placed at number 47
  • CVS Health produces over $146 billion in annual sales; Aetna’s annual sales exceed $63 billion
  • CVS Health operates more than 9,700 retail stores (including more than 600 pharmacies within Target stores) and is one of the leading pharmacy benefit management ( PBM ), home infusion and specialty pharmacy companies in the United States
  • Aetna is a global organization which includes Coventry Health Care and Continental Life Insurance; it offers conventional and consumer-directed health insurance comprised of medical, pharmacy, dental, behavioral health, long-term care and disability plans
  • The CVS Health and Aetna deal needs to be approved by regulators; either the U.S. Department of Justice ( https://www.justice.gov/ ) or the Federal Trade Commission ( https://www.ftc.gov/ ) will review their case

The CVS Health / Aetna deal is also viewed by some as a preemptive move in anticipation of Amazon’s still unfolding entry into the healthcare sector. Optum / UnitedHealth Group has already undertaken an assertive strategy to diversify its business model through strategic acquisitions of physician practice groups. These include buying Surgical Care Affiliates ($2.3 billion) and DaVita’s medical group ($4.9 billion).

Antitrust concerns are paramount for acquisitions in the healthcare provider and healthcare insurance sectors. Regulators will carefully assess the proposed arrangement from multiple perspectives. If approved, CVS Health and Aetna will be busy with executing integration initiatives to optimize the combined attributes of their new company.

To finance the deal, CVS Health reportedly plans to issue $44.8 billion in new debt plus $21 billion in new equity and deploy about $4.1 billion of cash on hand. Cost cutting and other financial belt-tightening measures will get underway quickly if regulators grant their approval; these will challenge the new company to effectively compete while equally meeting customer service and shareholder expectations.

Undoubtedly, CVS Health / Aetna competitors will be assessing their business models and strategically evaluating their merger & acquisition options moving forward.

Week Of 11/26/17
CVS Healthcare Reportedly In Advanced Discussions To Acquire Aetna

CVS Health, the retail, mail order, specialty pharmacy, home infusion and PBM healthcare services conglomerate is reportedly in acquisition talks with health insurer Aetna. Such a deal would reach or exceed $66 billion dollars.  

...CVS Health and Aetna executive leadership have not officially commented on any details regarding a potential merger – acquisition deal...

...Just months ago, Aetna's proposed deal to acquire rival health insurer Humana fell through due to regulatory / antitrust concerns...

CVS Health has been on a roll. It just recently entered into an agreement with Anthem, the nation’s largest Blue Cross Blue Shield affiliate comprised of 14 BCBS plans. CVS Health will be Anthem’s PBM partner. The deal is especially lucrative in that it allows for CVS Health to enhance the position of its Minute Clinics as a healthcare provider for Anthem members. A frequently overlooked detail is CVS Health owns / operates the retail pharmacy units within Target stores; these total over 600 locations. Anthem’s present PBM, Express Scripts, will no longer be Anthem’s PBM partner effective January, 2019.

...CVS Health ranks at number 7 in the Fortune 500, Aetna ranks at number 47...

An acquisition of Aetna by CVS Health would fortify CVS Health’s position as a provider and payer, a business model option currently being hotly cultivated by UnitedHealth Group and its Optum unit. It would also help CVS Health defend its business against potential incursions by Amazon as it seeks to widen its reach into the healthcare industry. It is reported the CVS Health / Aetna deal would be formally announced as soon as December, 2017.

Week Of 11/19/17
Amazon Web Services ( AWS / Cloud ) In Talks With Healthcare Data Giant Cerner


…Based on insights from management consulting leader PwC; “Amazon does have expertise that makes it a natural candidate to look for ideas that would reform the U.S. health care industry as it tries to control costs”…

It is no secret Amazon has been diligently expanding its presence in the healthcare sector. Their activities include obtaining pharmacy wholesaling licenses in at least 12 states and expanding the number of medical products well beyond those typically found in the medicine cabinets of consumers worldwide. Over the Thanksgiving week word was out that Amazon and Cerner were in latter phases of discussion regarding more advanced initiatives involving Cloud and healthcare technology applications.

Amazon and Cerner have worked together on other healthcare data management / storage deals in the past. This new arrangement may involve more access to advanced analytics related to population health with an emphasis on medical data insights to improve care and lower costs. For Amazon, a clinically strategic arrangement with Cerner would expand its presence in healthcare. It potentially would engage hospitals / health systems, health insurers / managed care organizations, medical researchers, pharmaceutical manufacturers and other healthcare entities where deep analytics, patient care, treatment costs, healthcare outcomes, healthcare records ( EHR / EMR ) and other big data management capabilities are highly valued.

…Based in North Kansas City, Missouri, Cerner is a global healthcare information technology company generating over $4.5 billion in annual sales with more than 20,000 employees…

…Amazon’s Web Services (AWS) unit is generating almost $5 billion in quarterly revenues…

Healthcare is a privacy, data-driven and precision-based industry. While Amazon has excellent data security and broad analytic capabilities, they do not have these attributes recognized and established in the healthcare community. They have made deliberate steps to change this including fortifying its AWS services to meet HIPAA requirements and secure protected health information ( PHI ). Collectively, Amazon API Gateway, Amazon SQS, AWS Direct Connect and AWS Database Migration Service are HIPAA compliant.
Cerner, founded in 1979, has a proven track record and positive reputation in the healthcare industry. Cerner’s HealtheIntent software platform is a heavy hitter in population health management. As a tandem, Amazon and Cerner have better potential to effectively compete against some of the other unique healthcare initiatives underway at Epic, Google, IBM / Watson, Meditech and Microsoft / Azure.
Looking ahead, there is an array of options and strategies for Amazon and Cerner to consider. Amazon’s master plan for the healthcare industry is difficult to decipher but clearly they are approaching the sector from multiple angles. Cerner can continue to amplify and enhance its present offerings and develop new ones with Amazon as a resource partner. There is a reasonable fit for each as they seek to grow taller and wider within the healthcare space. The innovation they can bring would undoubtedly benefit multiple stakeholders in the medical community and pose a serious threat to competitors.

Week Of 11/12/17 
Google: A Thinking Force In Healthcare 

Google’s analytic, deep thinking attributes make it ideally suited for the clinical, financial and technical challenges of the healthcare industry…

According to popular media and assorted speculators, Amazon is the most formidable giant about to disrupt the healthcare industry. Without question, Amazon has established more than a toehold in the healthcare sector which is easily confirmed by searching its ranks of offerings for over-the-counter medicines, medical supplies (bandages, disinfectants, gauze, gowns, linens, masks, gloves), medical devices (blood pressure cuffs, hand-held instruments, IV sets / disposables, otoscopes, stethoscopes) and basic office fixtures / supplies (stools, cabinets, paper goods, computer products) — even hospital beds. Their plan to scale up in the prescription drug sector is sending waves of positive and negative anticipation in multiple directions.

Meanwhile, many healthcare industry stakeholders have overlooked the enormous clinical, financial and technical attributes Google possesses and is assertively cultivating for widespread impact across an array of healthcare sectors.

…Google’s parent company is vacuuming up top talent in health care and biotech according to CNBC…

The super powers of Google have ample presence and growing potential in the healthcare industry. Their actions and progress don’t often make the front page news as many aren’t directly aligned with everyday consumer interests. Google is managing and manipulating complex volumes of big data for decision makers in clinician (nurses, doctors, pharmacists), healthcare administration, medical research, risk management, payers and other sectors. The choices these stakeholders make based on their use of Google managed data will have enormous impact across an array of healthcare industry stakeholders. Their internal and external healthcare ventures and partnerships demonstrate Google’s near and long term commitment to be a healthcare industry technology leader.

…Business Insider says, “The venture capital arm of Google’s parent company is betting its billions on life-enhancing healthcare startups”…

A sample of Google’s healthcare positions…

Google Healthcare

Heavily focused on artificial intelligence and machine learning applications to support clinicians across a variety of diseases, health conditions and patient types; it collaborates with various healthcare entities including University of Chicago Medicine, University of California San Francisco and Stanford University
https://research.google.com/teams/brain/healthcare/

Verily Life Sciences

A business unit of Alphabet (Google’s overarching corporate entity) dedicated to healthcare and the prevention, detection and management of disease
https://verily.com/

Calico (California Life Company)
Concentrates on challenges of aging and helping people lead longer and healthier lives while generating greater insights on biological factors and processes related to aging
https://www.calicolabs.com/

Google Fit
App development focused on healthcare aligning with consumer / patient care to monitor vital signs and exercise levels via Google Wear wearables, tablets and android devices
https://www.google.com/fit/

Google Cloud (four units with healthcare ties):

1) Apigee: Provides API management and predictive analytics software (acquired by Google for $625 million in 2016)
https://apigee.com/about/solutions/healthcare

2) G Suite for HIPAA compliant workloads

https://gsuite.google.com/industries/healthcare/

3) Google Cloud Platform for HIPAA compliant workloads

https://cloud.google.com/

4) Google Genomics: manages global genomic data for healthcare / life sciences organizations
https://cloud.google.com/genomics/

…Large tech companies committed as much as $30 billion into artificial intelligence in 2016 — plus another $9 billion going into artificial intelligence start-ups according to the McKinsey Global Institute…

Google Search: the search engine which put Google on the map upon which 1 of every 20 searches is related to healthcare
www.google.com

Augmedix: physician interaction / communication using GoogleGlass
www.augmedix.com

ByteFlies: wearable health technologies
https://www.byteflies.com/

CytoVale: biophysical marker technologies
http://cytovale.com/

Onduo: a diabetes management company developed by Verily (which has a collaboration with Blue Cross Blue Shield)
https://onduo.com/

…Based on Digital Journal’s insights, Google’s strong intentions towards healthcare artificial intelligence has been confirmed through its new accelerator program…

Depending on the application, device, partner, healthcare sector and other variables, there are other healthcare initiatives Google / Alphabet has underway. Internet of Things (IoT), telemedicine, mobile, medtech and other digital / IT-based interests are ideally suited for Google resources and vice versa. The variety of Google’s deployment in so many different aspects of healthcare demonstrates they are willing to invest in learning more about it and start something entirely new which will be unsettling to competitors and established healthcare entities that have not been innovative. Through organic development, acquisitions and partnerships, Google / Alphabet has numerous options to widen and deepen its healthcare presence moving forward.

Week Of 11/5/2017
Mobilize Your Mobile Healthcare Marketing

Mobilize Healthcare Marketing And Sales ROI…

With much of the globe accessing the Internet for information from mobile devices, mobile marketing is a critical element to consider in effectively engaging customers and driving sales. Clinicians (nurses, doctors, pharmacists, researchers, KOLs, etc.), healthcare administrators, risk management, purchasing professionals, patients and consumers rely on mobile devices to readily access information.

…According To Google…

  • 1 out of 20 searches is related to healthcare

  • More searches take place on mobile devices than on computers in 10 nations including the U.S. and Japan

  • 49% of B2B researchers using mobile devices for product research do so while at work

  • About 50% of B2B queries today are made on smartphones

Effective mobile marketing is never fixed in place, it is readily responsive to customer, marketplace and your company’s changes. It is a component of your overall brand, social media and healthcare digital marketing strategy. The world is more likely to have a mobile device immediately accessible to them instead of a computer; aligning and exploiting mobile venues can directly contribute to larger profits and brand stability. These are key elements in an effective mobile healthcare marketing strategy…

Start With Regulatory, Legal, IT…

During the initial phases of a mobile healthcare marketing initiative or with established, ongoing mobile marketing activities, consistently consult your medical / regulatory and legal units. Their input is critical. They can provide you with the guidance / boundaries needed and help you avoid developing / changing something they cannot approve. As new initiatives are being developed, they can be on the look out for recent clinical or legal changes impacting them.

IT is just as critical especially if you are partnering with outside vendors. Mobile marketing content and associated digital assets need to be assessed by IT to be certain they can be optimally supported and as secure as possible. Across the board, mobile marketing endeavors must conform to regulatory, legal and technical requirements.

KPIs, Goals / Objectives…

Define your KPIs, goals and objectives from the start, they need to be scaled and planned according to budget, staff and technology resources. If your organization is trying to break into wider scale mobile marketing initiatives and / or experiencing significant challenges with specific brands or market sectors, these sales gaps are a great place to focus. Consider addressing the gaps with specific mobile-friendly initiatives to sharply focus resources and strategically engage customers. For new or established offerings supported by mobile initiatives, be certain you have a duration point in mind to support them financially / technically for short or long term deployment based on the agreed upon your KPIs, goals and objectives.

Define, Target The Right Audience…

It is important to determine from the onset how to individualize and prioritize customer sectors so you can focus your resources accordingly. Determine which sectors best align with a mobile marketing initiative which your organization can solidly deliver for maximum ROI. There are numerous audience / customer stakeholders in healthcare; the most basic considerations include patients, consumers, nurses, doctors, pharmacists; then there are payers (MCOs, PBMs), hospitals / health systems, GPOs, distributors, wholesalers, etc. — which ones will deliver the greatest ROI via mobile marketing? Defining the target provides the focus through which to deploy resources. It will also help determine what social media venues and mobile technical features you may use to engage them effectively.

Critically Assess Your Website…

…Google has announced their mobile-first index will be active in 2018…

It sounds backwards in a mobile-focused strategy but it’s an important basic early first step. If your website isn’t aligned with mobile; your overall digital marketing will suffer in two ways. First, instead of engaging patients / consumers, your website via mobile will irritate them and perhaps steer them to your competitors with mobile-friendly sites. Second, it is assumed Google will favor websites with mobile-endearing attributes so if your website isn’t mobile loveable, Google will eventually get around to giving it a lower ranking in search results. Brands frequently change landing pages due to new product or service launches and improvements. Be certain the landing pages are identically effective for mobile web users and traditional web users.

Consult Customers…

….Based on research from Wolters Kluwer Health…

  • 72% of doctors access drug information from smartphones
  • 63% of doctors access medical research by tablet
  • 44% of physicians communicate with nurses and other associates from smartphones

…Research by Boston Consulting Group ( BCG ) reveals B2B customers are seeking the same digital experience they encounter as consumers and that mobile can accelerate time to purchase by 20%…


Consult your patient / B2C, HCP and B2B customers about their mobile engagement. Learn as much as you can from them whether you are building something new or evaluating how to make improvements to an existing mobile resource. Monitor their feedback to identify new trends and learn how their particular mobile engagement differs from others within and outside of their segment. They can tell you what was or is successful and what they deem to be valuable moving forward.

Use Competitor Mobile Marketing Initiatives As Part Of Your R&D…

Strategically assess what competitors are doing in mobile and determine if it is successful or not. Competitors are key elements of your mobile / digital marketing research and development program. If they have something successful, evaluate it and determine if you can develop something better. Be certain what they have is not only useful but has legs to go the distance. In mobile and other aspects of technology, there can be an upward, vertical trajectory quickly followed by a downward landslide of abandonment. Customer, technology, competitor, regulatory and other changes can propel engagement forward or backward quickly; be certain what you are investing in has a lifecycle long enough to meet your ROI goals.

Evaluate Mobile Marketing Initiatives In Other Industries…

While the healthcare sector has plenty of innovation underway in the mobile space, don’t confine your mobile approach to it. Look into multiple industry sectors and assess their mobile-driven marketing initiatives. Transfer their ideas, knowledge and approaches to the healthcare sector as appropriate. Commonplace strategies in one industry can be overlooked in another; transferring a proven utility customized for healthcare stakeholders can set your mobile initiatives part from the competition.

….Results Of An Indegene Physician Marketing Study Reveal…

  • In 2016, preferred channels were brand promotional emails, KOL webinars, HCP portals
  • By 2018, preferred channels will be social media, mobile apps and HCP portals
  • Life science digital marketing spend will exceed $14 billion by 2018

Interactive Calls-To-Action…

Take special advantage of the mobile platform and its touch screen attributes. Utilize these to develop and cultivate mobile-friendly calls-to-action. On a computer, these are not clickable; on a mobile device, the ability to click a phone number, engage an email or link is a great way to measure customer engagement and drive sales. Be certain your mobile marketing initiative pivots on these features rather than just one-way communications to cultivate more ROI-driven interactions.

To App Or Not To App…

…Based on an mHealth Economics 2017 study which surveyed over 2,000 mobile health stakeholders, there are about 84,000 health app publishers — with about 325,000 health apps available through the leading app stores…

…26% of consumers start mobile research with a branded app according to data from Smart Insights…


Be careful in what you invest in when it comes to app development. Be certain it not only works flawlessly but is also widely embraced and used by your customers. Dozens of healthcare mobile marketing initiatives pivot on apps without demonstrating meaningful or even traceable ROI performance.

The average person has 60–90 apps on their phone and regularly use up to ten. Avoid the embarrassment and waste of developing a wonderful app which your organization anticipates as the pivotal edge of digital marketing and then is panned by customers. If this happens, good luck in fighting for more digital marketing dollars in next year’s budget exercise. As for your customers, they will eventually delete your app and perhaps be less receptive to downloading another one from your company.
Apps must download quickly, have a high utility in their use and operate consistently at high speed. They require their own marketing campaign (be sure to plan this in your budget) to launch them and then ongoing promotional support to remind existing users of their presence and gain new subscribers. Apps need to be enhanced / updated periodically; be prepared technically and financially to execute this.

Mobile-Friendly Email Marketing…

Email marketing is one option to consider. Email marketing is a widely used strategy / tactic but has not become fully mobile friendly yet. Adaptations to traditional approaches like e-mail marketing must be made so customers have mobile-friendly versions with clickable links. These links should direct the customer mobile journey to access your website, converting emails into engagement / transaction pathways through the marketing / sales funnel. Maximize quality design to minimize clicks, optimize messaging so the process is convenient for the customer which will be reflected in sales and ROI.

SMS/MMS Text Subscription Options…

Texting can be touchy. Make sure in advance your targeted customers are receptive to it otherwise you may be spewing a lot of messages but still miss your ROI goals. While primary messaging is delivered very efficiently, it can be annoying. If you choose texting in your mobile strategy, do not be cryptic in the greeting / messaging; be certain your company, brand and nature of the communication is clear upfront. If your customer is interested, they will engage it; if not, they will delete it. What you want to avoid is leading the customer on and ultimately wasting their time in determining who sent the text and what the exact nature of it is.

Video Growing In Popularity…

Video has multiple communication attributes and can help effectively share more complex details, features and processes. With video, it is critically important that it is seamlessly functional and fast. If it takes too long to load or tends to have intermittent pauses on user devices, it will be abandoned by the user in short order.

…A study from Cisco predicts mobile video traffic will account for 75% of total mobile data traffic by 2020…

…Data from Blue Corona reveals more than half of all YouTube views are on mobile devices…

Video can augment the overall communication you are introducing to viewers; getting their attention and emphasizing key aspects to encourage them to further engage the content you have provided. As with the other features noted, be certain its use contributes to ROI performance.

Voice is coming on strong as well…

…Search Engine Land says 20% of search queries on Google’s mobile app and on Android devices are voice searches…
…43% of mobile voice search users do so because they say it is quicker than going on a website or using an app; ; 21% of mobile voice search users do so because they say they don’t like typing on their mobile based on information from Statista…

Technical Alignment…

Technology innovation is a friend and foe. Be certain what you develop takes full advantage of existing technology and is adaptable to future changes. If very significant technological changes are about to occur, pause your initiative and build it around the new standards for optimum performance while competitors scramble to develop re-worked upgrades on older apps. Be wary of seemingly innocuous mobile technical changes, they may impact speed, functionality and display attributes negatively which users will be quick to experience.

Be Certain You Deliver What You Promise…

Good content marketing strategy doesn’t just support customers with information and feel good reinforcement; it influences behavior and encourages customers to definitively take action in your favor. Strategic contenting marketing and mobile healthcare marketing initiative KPIs, goals and objectives are not built on the rhetoric of “back ordered”, “please hold”, “not available at this time”, “check back with us” or “maybe next month”. Be certain whatever is being promised can be provided to your customers. Customers engaging mobile prioritize and value immediacy; if your company is not prepared to provide them what they have requested based on the content you have shared with them, they will be disappointed and likely disregard content you share with them in the future. Depending on what your mobile marketing initiative involves; these considerations may include care, service and product deliverables:

  • account management
  • appointment times
  • clinicians / care providers
  • customer service
  • product inventory
  • proficient order processing
  • reliable data / reporting
  • technical support

Continually Evaluate And Refine…

Keep your healthcare mobile marketing initiatives on the move:

  • Be certain to develop quality content with a mobile perspective in mind
  • Leverage data insights platforms and analytics; simplify your reporting so you are consistently assessing progress according to your KPIs, goals and objectives
  • Whenever possible, fortify your mobile initiatives with two-way engagement attributes to embrace your audience / customers while collecting valuable data from their interactions
  • Collaborate unilaterally with your expanded teams (brand management, digital marketing, product management, marketing communications, IT, outside vendors, etc.) to prioritize aesthetic, technical and UX changes to improve mobile ranking, user experience and ROI
  • Both mobile and desktop are essential so do not abandon desktop; a great deal of mobile engagement leads to desktop in the buyer / user journey

Don’t Stand Still…

Just like the healthcare industry, mobile runs on perpetual innovation. It is important to continually assess mobile marketing effectiveness as change is always underway. Be certain your KPIs are still relevant and accurately measuring your progress towards meeting the goals and objectives you defined. Monitor managed care, clinical, technical, financial, legal, competitive and user factors in the effectiveness of your mobile marketing actions. By keeping your healthcare mobile marketing initiatives aligned and ahead of changes; it continually optimizes ROI and outdistances competitors in the long run.


Week of 10/29/17
Healthcare Digital Marketing / Social Media Marketing Course Correction Strategies

Healthcare digital marketing and social media marketing strategies are complex and inherently challenging to effectively manage.

They require close alignment of significant staff, financial and technical resources to achieve maximum ROI. Upon reaching prime level of performance, the new challenge is maintaining productive results, breaking through plateaus and cultivating further growth. By carefully accounting for close and distant key elements in your digital / social media marketing strategy and tactics, you can avoid running aground and keep your initiatives productively underway.
Amazingly, just one variance across the balance and execution of the resources and / or the marketplace can trigger efficiency leaks leading to a drag and downturn of performance:

  • Consumer / patient / professional social media preferences change
  • Competitors launch assertive, novel strategies temporarily or permanently disrupting established success
  • Provider, regulatory, payer positions pivot in another direction
  • New and established products in the market rise or descend as threats

These and other changes can always be expected to occur. Even the most well-planned and successful initiatives can flourish and then flame out. They can be impacted by a singular, seemingly small-scale development which turns into a series of consecutive unmet challenges. By identifying changes as they occur and assessing what their ripple effect can be, course correction strategies can be developed and executed to remedy issues and sustain momentum.

Check your bearings…

As changes occur in various sectors, this digital / social media marketing strategy cross reference can be a helpful compass. It is important to anticipate changes accordingly and respond quickly to unexpected ones to realign digital marketing strategies and tactics, along with the complete brand strategy, to maintain alignment with the marketplace and your customers:

  • Sustain and continue marketing / sales momentum
  • Unbalance competitors with quick and effective response to their threats
  • Maintain steerage of digital marketing / social media effectiveness to remain in constant contact with pivotal customer segments
  • Continue alignment, leadership position of responsiveness as marketplace changes continue to occur

Chart Your Course…

By cross-referencing key elements in your healthcare digital / social media strategy in a depth chart, you can move up and down the scale to determine which will need to be maintained, changed or monitored more closely as changes occur; depending on your healthcare enterprise, these elements can be used for pharmaceuticals, medical devices, clinical programs / health services and other offerings or you can develop your own matrix:

Digital / Social Media Marketing Elements

  • website
  • social media (Facebook, Instagram, LinkedIn, Pinterest, Snapchat, Tumblr, Twitter, Yahoo, YouTube, etc.)
  • dark social (especially link sharing pathways)
  • mobile marketing
  • email marketing
  • inbound / outbound marketing strategies
  • consumer / patient / advocacy group disease-focused venues
  • healthcare professional dedicated venues / medical specialty — focused associations
  • audience social media and app migration trends
  • SEO, SEM
  • technical developments (Google search algorithms, smartphone platform changes, new apps, etc.)

Brand Elements

  • indications / therapeutic area(s)
  • targeted patients / consumers
  • targeted clinicians (nurses, physicians, pharmacists)
  • medical specialties
  • brand / product life cycle phase (launch, 2–3 years old, established, mature, approaching generic)
  • competitive threats
  • primary, secondary, tertiary salesforces connected to product / service
  • non-digital / social media marketing initiatives (print, broadcast, etc.)
  • annual plan goals / objectives
  • budget

Marketplace Channel Elements

  • conventional primary care
  • hospital / health system
  • ancillary sectors (dialysis, home infusion, long term care, surgery centers, etc.)
  • pharmacy (retail, mail order, compounding, institutional, specialty)
  • distributors, wholesalers, medical suppliers

Managed Care / Market Access Elements

  • reimbursement
  • pharmacy benefit / medical benefit coverage
  • DHA / TRICARE
  • GPO
  • MCO (BCBS, health insurance plans, etc.)
  • Medicaid
  • Medicare
  • PBM
  • 340B
  • regulatory (Federal, State, FDA, FTC, etc.)

Depending upon which element(s) change, move up and down the depth chart to assess overlapping effect and determine what adjustments can be made strategically, technically, financially to correct your course.

Are the changes only in your Digital Marketing / Social Media Marketing Elements or in one of the lower tiers and rolling up into them?

Too often, corrective actions are taken within the scope of the immediate challenge and address only one element and not the others. Although it is not immediately perceived and it is presumed core strategies remain intact, effectiveness begins to erode:

  • Digital /social media marketing effectiveness is less effective as it has not been adjusted although key elements below it have been
  • Digital / social media marketing effectiveness is less effective as it has been adjusted but one or more of the contributing elements has not

Sailing Ahead…

Healthcare digital / social media strategies and tactics perform in a fluid environment. If they are not swimming in the currents customers are in, they will eventually be sailing away from them unless accurate and quick corrections are made. Using cross reference methods as a compass to maintain your healthcare digital / social media marketing initiatives helps them stay on course now and over the horizon. 

WEEK OF October 22nd, 2017
Centene Corporation:  Bucking The Trend

Over $40 billion in annual sales…

Centene is a unique managed care conglomerate based in St. Louis, Missouri which has quietly grown into an industry leader. Founded in 1984, Centene has over 30,000 employees and generates over $40 billion in annual sales. Their book of business is about 12 million members located in 28 states; a large number of them are covered via government-sponsored health plans. Centene’s many accreditations include NCQA, URAC and Phase III / CAHQ Core.

Specialized markets, services and plans…

Centene is well known in Medicaid and Medicare markets. Their Medicaid business unit supports TANF, CHIP, foster care, ABD and long term care markets. Centene’s Medicare business is centered on Medicare Advantage dual-eligible special needs and Medicare — Medicaid plans. Centene’s health insurance marketplace unit (HIM) offers benefits through which some members qualify for government subsidies; these benefit programs are marketed via their Ambetter plans. In addition to these areas, Centene operates in an array of other specialized markets; this is an overview of their key business units:

  • Casenet: population health and care management software
  • Celtic: commercial insurance for the uninsured
  • Centurion: correctional systems healthcare
  • Evolve: supplemental health benefits, administrative support
  • Health Net Federal Services: military and veteran communities
  • LifeShare: integrated long term care
  • U.S. Medical Management (USMM): integrated home health care

Business challenges…

Much of Centene’s business is considered to be more complex to administer with potentially lower revenues when compared to conventional health plans and market sectors. In many cases, other insurers have reduced focus in these segments to avoid the burden of complex benefit management tied to government funding. They equate this business equation with higher operating costs, lower premiums / margins resulting in less revenue / profit. Various insurers including Aetna, Anthem, Cigna, Humana, UHC and a number of others have business in these areas but limit the scope of their exposure. They prefer to allocate organizational resources to more traditional, profitable health insurance offerings and customer segments. Centene successfully engages government-sponsored healthcare and other non-mainstream markets as a routine, well-executed core strategy of their business model.

A growing organization...

Centene has been able to grow organically and through a series of strategic acquisitions. Their latest expansion purchase is sizable. In September, 2017, they announced their acquisition of Fidelis Care (New York State Catholic Health Plan) for $3.7 billion. In 2016 they completed their deal to buy Health Net for $6.8 billion.

Centene’s empire, based on servicing less traditional healthcare market sectors, continues to pursue business and grow where other companies failed to meet their goals. In 2018 the company projects to do business in 3 additional states (Kansas, Missouri and Nevada) by offering plans on those states’ health insurance exchanges. Centene seeks to expand its business in several states including Florida, Ohio, Texas and Washington next year. As other insurers reduce or entirely exit Obamacare markets, Centene sizes up those gaps as opportunities, strategically develops benefit plans to introduce to those areas and then has an effective go-to-market strategy to launch and promote their offerings to consumers and other stakeholders.

Moving ahead…

Centene’s ongoing growth is impressive and it appears to be well-positioned to continue the trend. It has built up considerable administrative, clinical, financial, marketing, operational and sales experience over the years with successful results. Risk management is something they take in stride. This enables it to accurately assess difficult markets and develop viable health insurance and other solutions for consumers plus additional customer stakeholders. Their tolerance for unconventional markets and higher risk is greater because that is their specialty; they assertively manage this business to their advantage.

New or established competitors find it challenging to perform at Centene’s level given the markets they have to play in. Centene is ranked 66th in the Fortune 500 and 27th in Fortune’s 100 fastest growing companies. As medical and pharmacy costs increase, marketplace needs change and healthcare insurance industry churn continues, Centene has a promising future ahead.


Week Of October 15th, 2017
IngenioRx: Anthem and CVS Health Join Forces

IngenioRx — A Business Climate Changer…

The recent announcement of a partnership between CVS Health and Anthem is a significant development. Anthem is one of the largest managed care organizations in the United States. CVS Health is a coast-to-coast healthcare conglomerate comprised of retail / mail order / specialty pharmacy, home infusion, PBM and other clinical, commercial healthcare units. The combination of these two entities provides them formidable competitive and organizational advantages. Scheduled to begin formal operations in 2020, their contract agreement is for 5 years.

Express Scripts Explores A Different Path…

Anthem’s present PBM is Express Scripts. Express Scripts and Anthem were not able to come to an agreement to extend their exisitng contract. Express Scripts recently acquired a medical benefits manager (EviCore Healthcare) for $3 billion to offset the loss of Anthem at the end of 2019 and to diversify their business model beyond pharmacy-centric healthcare industry sectors. There is also speculation Express Scripts may have also done this to avoid being acquired by Amazon who is expected to launch healthcare-focused business initiatives, including pharmacy services, in the near future.

Anthem is the largest Blue Cross Blue Shield affiliate; it operates plans in 14 states. The Anthem / CVS partnership will have its own business unit called IngenioRx. While CVS has its own PBM (Caremark), IngenioRx will be a separate unit and have its own management team and pursue business in other states beyond the 14 in which Anthem is established.

AllianceRx Walgreens Prime…

The IngenioRx partnership is similar to one already underway between Prime Therapeutics and Walgreens Boots Alliance (WBA) known as AllianceRx Walgreens Prime. It was introduced in 2016 and is a long-term strategic alliance comprised of a retail pharmacy network agreement and a combination of the companies’ central specialty pharmacy and mail service businesses. It is a collaboration of the nation’s fourth largest PBM owned by 14 leading Blue Cross and Blue Shield health plans (none are part of the Anthem organization) and one of the nation’s largest drugstore / pharmacy services providers.

United HealthCare / OptumRx And Catamaran…

In 2015, United HealthCare (UHC) acquired what was then the 4th largest PBM in the nation, Catamaran. Catamaran in many ways resembled Express Scripts including its penchant for driving growth through continually acquiring smaller PBMs and other specialized companies to fortify specific business units within it. UHC integrated Catamaran into its internal PBM unit OptumRx.

Each of these PBM arrangements is enormously significant. They impact a large portion of the population in the United States and have pivotal influence on pharmaceutical and other healthcare product manufacturer marketing, sales and market access strategies. Express Scripts is by far the largest independent PBM. It will be interesting to see how they align the existing pharmacy benefit and the new medical benefit capabilities to operate independently and individually moving forward.

Forging Ahead…

For now, the CVS / Anthem duo will be busy maintaining, growing their existing businesses and making extensive preparations to migrate the Anthem business from Express Scripts at the end of 2019. For other healthcare industry competitors in the marketplace with substantial interests in the pharmacy business like Aetna, Cigna, Costco, Humana, Rite Aid, Walmart; they will closely scrutinize their existing business models and marketing strategies to determine what they need to change to remain competitive and get maximum value from pharmaceutical and other healthcare product manufacturers.

Some of the larger health systems marketing their own medical / pharmacy plans may be impacted by these large collaborative agreements. If Amazon is indeed moving forward in the healthcare sector with pharmacy-related programs, they will need to strategically account for them as well. Healthcare industry business models continue to evolve; hybridization is an ongoing trend with wide reaching business to business, healthcare and consumer / patient impact.

Week Of October 8th, 2017
​California Regulations Drive Up Costs

On Monday 10/9, California Governor Jerry Brown signed into law legislation requiring pharmaceutical manufacturers to report certain price hikes for prescription medicines. In the United States during 2016, brand pharmaceutical prices rose almost 13 percent on average. Generic pharmaceutical product prices increased by an average of roughly 0.32 percent. Specialty pharmacy pharmaceutical products (injectable therapies, biologicals, etc.) increased by an average of about 8 percent.

The rules are being put in place to provide more visibility to drug manufacturer pricing practices. The legislation (known as “SB 17”)requires drug companies to provide a 60-day notice if their prices are raised over 16 percent during a two-year period. Added measures to the legislation include the requirement of health plans and insurers file annual reports outlining how pharmaceutical costs affect healthcare premiums in California.

A Wilderness Of Exhaustive Complexity

  • Brand and generic pricing models are not simple. Starting with the basics, drug makers have to account for R&D, manufacturing and commercial support costs plus competitive measures, marketplace trends and contracting strategies to devise wholesale acquistion cost (WAC) for a product -its published “list price”. Once the pharmaceutical company engages the actual marketplace to sell a product; original WAC pricing is significantly transformed through an array of discounts, rebates, chargebacks and other contract agreement features. WAC is a manufacturer’s list price of a drug when sold to a wholesaler; then typically a 20% mark-up is applied to the manufacturer’s price which results in the average wholesale price known as “AWP”. SB 17 focuses on WAC pricing, not AWP pricing.
  • WAC is at the top of the pharmaceutical pricing funnel but once product pricing winds its way down in a particular channel’s contracting process; it is drastically different by the time it is tied directly to provider, payer and / or patient product acquisition costs. Contracting strategies impacting the original AWP are aligned with specific healthcare sectors. These include group purchasing organizations (GPOs), managed care organizations (MCOs), pharmacy benefit managers (PBMs), retail / mail order / compounding / specialty pharmacies, Medicaid, Medicare, 340B, DHA / TRICARE and others. Drug wholesalers and distributors each have their own way of contracting with pharmaceutical manufacturers and then apply different pricing / margin management / incentive formulas to their respective customers. AWP is diced and sliced differently once it travels into various healthcare industry business channels.  A single contracting / pricing formula cannot be devised for use within a single or across business channels; each one operates differently to accommodate customers, align with class of trade and be in compliance with regulatory / reimbursement standards.
  • Whether it’s a direct sale from the pharmaceutical manufacturer to the point-of-care provider and / or through the wholesale / distribution supply chain, another series of variables comes into play including: national drug code (NDC) number, active ingredient, original or repackaged product, brand or generic status, formulation, route of administration and package size.
  • Digging down further in the details about package size alone represents its own pricing challenges. Depending on the unit volume of a container, the number of containers sold in one package and / or case, pricing is also differentiated. This can apply to pills, capsules, vials, pre-filled syringes, IV products and other formulations.
  • Procurement practices by purchasing / finance units along the way have an impact on final pricing. Depending upon how much of a particular product is distributed / administered / dispensed, pricing is impacted. Bulk quantities typically have better pricing and buyers may prefer them if their organization goes through a lot of the product or they may use less of the product but still choose to buy the bulk quantities to save money. Depending upon the organization, this can be a good practice (buying drugs at low prices) or a bad practice (outlaying funds and not converting the inventory back into cash fast enough).
  • Buyers also contend with the particular contract arrangement they are purchasing the drugs through as rebates, chargebacks and other incentives come into play. Other considerations include competitive measures between manufacturers, changes in formulary, brand / generic status, clinician preferences and product availability. These factors span all categories of pharmaceutical products and need to be accounted for in purchasing decisions. Based on these variables and AWP, the relevancy of WAC further erodes.

A Gold Rush Of Controversy

There is well found criticism of the legislation as it looks and sounds good to the media and consumers (i.e. voters) but falls short of accounting for the true complexities involved. While it puts a spotlight on pharmaceutical company pricing, it fails to address the pricing practices of wholesalers, distributors, health systems, pharmacies, PBMs and other stakeholders through which pharmaceutical products change hands. Another consideration is the premiums health insurers and MCOs levy on their memberships in relation to medical loss ratios (MLRs) and other risk management variables. To what extent are premium and copay increases attributed to rising drug costs versus the profits of health insurers and managed care organizations?

In the case of the California legislation, the requirement for health insurers and MCOs to file annual reports regarding the impact of drug costs adds to their operating costs. They will need to setup and manage ongoing streams of pricing data and other information to be compiled, analyzed and submitted to the state. Likewise, pharmaceutical manufacturers will need to account for these reporting requirements by developing tracking, analysis and compliance measures which will require data, staff and financial resources.

For state government, they will need to develop their own management processes requiring staff, IT and budget resources to manage the reports being submitted by dozens of pharmaceutical manufacturers, health insurers and MCOs. It is widely recognized administrative costs play a tremendous role in the spiraling expenses of healthcare; the requirements of SB 17 significantly contribute to the administrative burden for government, health insurers, managed care organizations and pharmaceutical manufacturers.

Pharmaceutical Manufacturers Stake Their Claim

The pharmaceutical industry delivers enormous value in minimizing the impact of acute and chronic health issues which can include the avoidance of costly medical procedures and constant professional care. While its profits are scrutinized, it is equally important to recognize the high cost of doing business in the healthcare product manufacturing sector. Complex research and development initiatives have staggering costs. Manufacturing, quality control, commercialization, legal fees and other factors all contribute to pricing considerations. It is also important to note pharmaceutical pricing and contracting practices are not essentially in the pure interest of profit. They are also in place so manufacturers can assertively compete against each other which helps to lower prices.

Pharmaceutical manufacturers have numerous options to choose from to minimize scrutiny of pricing practices beyond disclosing WAC. Pricing and margin advantages can be shrouded in contractual arrangements between GPOs, PBMs, MCOs and other business partners which are well within compliance and legal requirements. Other states have deployed or are in various stages of passing legislation similar to California’s so some drug manufacturers have already voluntarily committed to specific price increase limits on an annual basis. Price increases at the maximum level below the reporting requirements implemented across a series of calendar intervals are fair and reasonable options drug companies will consider regarding California and those states with similar requirements. Pharmaceutical companies still have the option to raise prices at their own discretion above the 16 percent over a two-year period threshold, routinely report it and be in compliance with the California laws. It may also encourage them to spike prices in a single year and revert to considerably smaller price increases in subsequent years.

Looking ahead, pharmaceutical companies may also choose to launch products with significantly higher WAC prices in the future. This will give them more room to maneuver with customers through various contracting arrangements. If the goal is to eventually limit pharmaceutical price increases through government price controls, WAC at launch will be a paramount starting point for pharmaceutical manufactures to introduce a new product. It may potentially trigger a trend in higher than normal drug prices for new and conceivably better pharmaceutical products moving forward as drug makers strategize they need to make more money out of the gate versus increasing profit gradually over the lifespan of a product. Pharmaceutical manufacturers may also be encouraged to acquire others to widen pipelines and portfolios of established products to make up for the loss of per product margin.

Will More Regulation Provide A Positive Payout?

Lawmakers, industry stakeholders, clinicians and patients / consumers are seeking a middle ground. Ultimately, it is higher care at lower cost. It is clear the State of California government and dozens of other state governing bodies want to do more to reign in healthcare costs. Political leaders want to be recognized and re-elected. Merely by introducing such legislation, politicians can claim they are taking action on behalf of their constituents. If states enact measures that are not well-conceived and administered, they generate bureaucratic waste, cultivate complexity and drive up costs for multiple stakeholders including government, health insurers, MCOs, pharmaceutical manufacturers, providers and ultimately patients / consumers / voters.


Week Of 10/1/17
Steward Health – A New Contender

Largest Private For Profit Health System In The United States…

At the close of September, 2017, Steward Health announced it had completed another hospital / health system acquisition and this one has particular significance. Its buyout of IASIS Healthcare now makes it the largest private for-profit health system in the United States. Steward Health, based in Boston, Massachusetts, picked up Franklin, Tennessee-based IASIS Healthcare for about $1.9 billion dollars. The deal was originally announced in May, 2017 and is now completed.

Expansive Organizational Reach…

Deals of this magnitude cumulatively impact the national healthcare provider landscape. Steward gains 18 hospitals primarily in the south / southwest; Arizona, Arkansas, Colorado, Louisiana and Texas. They are now the operator of 36 hospitals distributed across 10 states. It also gets ownership of a managed care business operating in Utah, Arizona and Massachusetts. The IASIS Healthcare acquisition immediately follows other Steward Health deals involving the purchased of 8 hospitals in Florida, Ohio and Pennsylvania.

Business Impact…

Steward Health will now be competing against a variety of new and established health systems across its marketplace coverage. The IASIS acquisition takes them further west than they have ever been. Their organizational size will provide them additional negotiating leverage against health insurers, group purchasing organizations and healthcare product manufacturers.  For healthcare product manufacturers like pharmaceutical and medical device companies, Steward has much greater prominence in their business and marketing plans.

​There is a great deal of M&A activity in the hospital / health system sector across the country. Tenant Health has been seeking to divest some of its hospitals and numerous organizations including Ascension, HCA, OCF Healthcare, Paladin, SSM Health, UPenn and UPMC have been seeking to expand their hospital / health system holdings.  Some other proposed deals have been scuttled due to regulatory 
limits but they have not been enough to blunt the overall trend​.

In addition to acquisition activities, a number of health systems have merged as well including Baptist Memorial and Baptist Mississippi, Geisinger Health System and Jersey Shore Hospital, Greenview Health and Palmetto Health plus a tri-combination merger of Cooper University Health Care, Lourdes Health and St. Francis Medical Center.  Based on the ongoing hospital / health system M&A activity that shows no sign of slowing down, it can be presumed Steward Health will maintain its M&A momentum as the wave of consolidation continues.

Week Of 9/24/2017
The Horsepower Behind Healthcare Mergers Acquisitions

Giddy Up For A Deal

The healthcare product manufacturing sector as always been a changing landscape of new and old firms impacted by mergers and acquisitions. Biotech, pharmaceutical, diagnostics, medical devices, supplies and other producers have travelled the M&A range. Over the last 3 years, a remarkable run has established itself in healthcare M&A activity. A combination of conditions, resources and triggers has proven to be a catalyst for healthcare product manufacturers to charge ahead with merger and acquisition strategies.

Margins

Continued pressure on margins by managed care, regulatory agencies and patient / consumer advocate groups are having an impact. They help to drive healthcare product manufacturers to widen product lines to add revenue streams. If per patient / per unit income is less, increasing sales volume gets more consideration. Having more products to sell increases sales and provides bargaining leverage which are a tandem to drive sales and increase revenues despite margin pressure.

Diminishing Returns / Damaging Effects Of Continual Cost Cutting

Detrimental effects of relentless cost-cutting measures are more apparent. There is only so much out-sourcing, budget slashing and other “optimizing” measures can achieve until they have a corrosive effect on organizational effectiveness and deliver less return on the bottom line. It becomes necessary for companies to bolt on assets (which they seek to make more profitable through reduction of redundancies once deals are completed) to acquire additional capabilities and lines to sell. As more companies demonstrate their ability to outdistance competition through innovation in an increasingly technology driven business world, cost-cutting in many ways is a lower-tier option; the favorable strategy being M&A and innovation as an optimum tandem.

Plug The Revenue Leak

Blockbuster products are harder to develop and technology reinvents higher standards and levels of performance across product sectors. To engage more difficult patient types / diseases, therapies are more complex and challenging to develop. High margin niche products deliver good income but treat fewer numbers of patients. Technology and material advances can quickly render existing medical devices obsolete. Pipeline candidates don’t make it to the approval stage or are outdated before they are launched. Meanwhile, established products reach the end of their patents or fall out of favor with clinicians and contemporary care standards. Acquiring another company’s products and their pipeline buys time, widens / refreshes lines and hopefully provides new products to introduce.

Growth By Acquisition Strategy

Some established and new healthcare product manufacturers are relying much more on buying other companies and investing less in traditional internal research and development. Their research and development initiatives literally center on finding embryonic and startup firms with novel product concepts. These companies can be invested in as satellite research and development units and funded as appropriate depending on progress and promise of product approvals.

Come Buy Me ( CBM )

A variation of the Growth by Acquisition Strategy is the “Come Buy Me” (CBM) business  model strategy. CBM organizations make a series of small acquisitions which are usually focused in select healthcare sectors for example dermatology, respiratory, lab diagnostics, etc. As a cluster, the company establishes a market presence within the particular medical sector. Collectively, the products produce more impactful revenue and with launches, the company further establishes itself as a proven entity within the specialty.

The CBM continues to ratchet up its growth through incremental product launches and additional deals. The strategy is to build up enough of a profitable portfolio of products and market presence that another company seeking to have a wider footprint in the sector for long term growth acquires them. The goal is not to build a dominant entity in the sector, the goal is to assemble a group of sector products under one organization which can be sold as a bundle to enable another company to quickly widen market presence.

Competitive Threats

Even established healthcare product companies historically adverse to mergers and acquisitions are engaging in them to blunt competitive threats. Other companies accelerate their market presence and product line heft through acquiring other companies and quickly scale up to become assertive challengers to sector incumbents. Conversely, to prevent challengers from penetrating a long-held sector or invading a new one that an established product company is just beginning to enter, they conduct an acquisition to firmly entrench themselves in the new sector, fortify their position and disadvantage competitors.

Private Equity

Healthcare has always been a popular playground for private equity (PE). They can take large and small companies private and with a variety of options available to them, either retain them as cash cows for other deals, sell them to other PE companies or re-launch them into the public sector again. They are strategically savvy perpetuators of M&A activity in the healthcare industry.

Favorable Financing

Strategically creative and assertive lenders, large cash reserves and solid stock performance build corporate confidence in exploring their M&A options. Investors are seeking more from their holdings and companies have to find ways to satisfy them. They can choose to build themselves up further through acquisition or have a “going out with a bang” sale to another company.

Technology

In pharmaceutical, medical device and healthcare supply manufacturing, technology can be a difference maker. Technology driven insights, processes, and production capabilities are critical contributors to competitive performance. Healthcare product producers can buy a competitor using these advances and apply them to their own commercial operations; they can also choose to acquire the companies developing these resources. There is always the option to develop these advantages internally but there is not always time or the appropriate mix of staff, finance and IT to generate productive ROI quickly from them.

Saddle Up

Depending on the company, any combination of these conditions, resources and triggers can result in the undertaking of a merger and acquisition strategy. They have a wide ranging effect on patients, consumers, providers, public / private investors and various commercial entities. Market conditions can change rapidly and reverse the trend; companies then choose to rein in their merger and acquisitions activities. Large or small, mergers and acquisitions in the healthcare sector are an ongoing and eventful ride.


Week Of 9/17/2017
A Deceptively Unique And Effective Healthcare Broadcast Ad / Digital Marketing Strategy
Two-Screening Strategy Scores Points During Super Bowl 51…

A new NFL season is underway but a quick look back is warranted at how last season ended with a Super Bowl upset and a deceptively unique and effective broadcast ad / digital marketing strategy was executed. A regional building material and supplies retailer and a Pittsburgh-based ad agency successfully deployed a two-screening strategy during Super Bowl 51. They effectively combined brand identity, a “customer journey” of sorts and broadcast advertising with digital marketing attributes and contemporary TV audience viewing habits. For healthcare industry and other marketers, it is an optimum model to revisit and compare against existing TV advertising and digital marketing activities to develop more impactful and measurable marketing initiatives with greater ROI.

Understand Two-Screening Behavior…

Two-Screening is the act of watching TV while also engaging another digital device; frequently a mobile phone, or tablet. Viewers tuned into TV programming are dividing their time between the TV screen and the screens they readily control in their hands. Two-screening is controversial and here to stay. While television ratings are based on the number of viewers and audience demographics associated with the featured programming shown, two-screening diminishes true rating performance. While the ad is shown at the ideal time coupled with the programming most closely aligned to the audience being targeted; audience members can make a choice of watching the ad or catching up with text messages, emails, their social media accounts or other options through their mobile phone or tablet. A report published by Accenture in 2015 estimated about 87% of consumers used a second screen while watching TV. 84 Lumber and Brunner, their ad agency, developed a two-screening strategy to work in their favor.

Understand Two-Screening Technical Enablement…

Displays in mobile and other devices are excellent. Batteries and wireless are constantly improving, devices don’t have to be constantly tethered to a cord to recharge; great wireless / wifi eliminates the need for them to be latched to a cable. Downloading and viewing is almost seamless, the speed / consistency of displayed content is virtually real time. To add fuel to the fire, some consumers are using their phones and tablets to control their TVs, making two-screening all the more an integral part of the TV viewing experience.

A Contributing Driver Of Two-Screening Behavior…

Advertisers and networks seek to cultivate more revenue by featuring multiple clusters of ads over the course of an hour. The clusters of multiple ads encourage viewers to look at something that specifically interests them until the featured programming content resumes. Commercial breaks trigger consumers to reach for their mobile phones and tablets where they control content they prefer that is accessed, scrolled, swiped in seconds. The longer the commercial break, the more deeply engaged the two-screening audience is with the content shared from the device in their hand. The customer has a choice of journeys, why not encourage them to choose the journey your brand offers? Based on these challenges, healthcare and other industry marketers with heavy TV ad spend need to be more innovative in how they can effectively span broadcast and digital venues and generate measurable ROI; a strategy that embraces two-screening may be a viable option.

Profile Of 84 Lumber And Their Ad Agency, Brunner…

Founded in 1958, 84 Lumber is a privately-held retail building material supply company. 84 Lumber is based in 84, Pennsylvania (near Pittsburgh). Brunner was founded in 1989 and is a privately-held, independent agency headquartered in Pittsburgh. Brunner has worked with a number of notable brands. For both firms, it was their first Super Bowl ad.

How 84 Lumber And Brunner Developed And Executed Their Two-Screening Strategy…

When the ad was reviewed by Fox, the network televising the Super Bowl, some of its content was deemed “controversial”. The content was then partitioned, some to be featured via broadcast and the remainder via digital. The broadcast portion began the journey / pitch and then guided the audience to go to their website to view the outcome. Based on the rumored “controversial” content, there was already a media buzz about the ad prior to the Super Bowl. The story content on the broadcast side was compelling enough, however; for a large number of viewers to follow through on their own via their mobile phones, tablets to experience the rest of the commercial.

Impact…

Once the ad aired, within one minute following its showing the 84 Lumber server experienced more than 300,000 hits; excess volume had to be routed via paid social to YouTube (the enormous surge of traffic was one thing 84 Lumber and Brunner had not fully accounted for in their technical preparation). Despite the other advertising candy the Super Bowl is known for and of course the game itself, a sizable viewing audience immediately opted to further engage the brand via digital. YouTube, featuring the broadcast ad and the digital extension, continued to experience high traffic navigating to the 84 Lumber content for days. 84 Lumber and Brunner masterfully executed a two-screening strategy to their advantage; bridging unique, story-based content from the broadcast space to the digital space where the audience could purposely engage the messaging further and also be measured accordingly by web analytics. What are some of the takeaways for healthcare and other industry marketers to consider?

Get More From Broadcast Television Advertising And Digital Marketing…

For healthcare and other marketers investing millions in television ad development, testing and deployment; two-screening is a growing part of the challenge when it could be part of the formula. Audiences migrating to non-TV network provided programming are challenging broadcast advertising strategies even further. A deliberate strategy to take advantage of the two- screening audience can enable marketers to get more ROI from their broadcast and digital marketing budgets along with collecting ongoing valuable data. With a structure of quality content, an effective segue and knowledge of audience viewing habits, they can convert the two-screening threat into a competitive edge.

There are significant details involved with direct-to-consumer advertising on TV. Scenarios, aesthetics, animation versus live action, written / voiceover messaging (including the required fair balance rhetoric) all have to be accounted for within a 30-second space –-60 seconds is a luxury but sometimes used if the budget is right, the product is at launch, under competitive siege or especially complex. Imagery and messaging must be powerful enough to steer the patient journey in the direction of the call to action, i.e. “Ask your doctor if __________ is right for you”.

Considerations…

  • Why should the patient journey with your brand end there when it maybe more impactful / measurable by continuing at the brand’s website?
  • How can the audience’s recall be more effectively reinforced to “ask their doctor”?
  • How many times and at what cost does it take for 30-second ads to have measurable impact?
  • How can the consumer / patient be technically enabled to share the ad’s information with family members or friends?

Know your audience…

An effective two-screening strategy purposely develops compelling content and deploys the broadcast ad with an integrally effective segue guiding the viewer to the website for the rest of the story. Based on Accenture’s data, there is a good chance overall audience members will have the second screen device within easy reach to do just that. Depending on the desired audience sector targeted, market research will need to assess what their viewing habits are and their propensity to be “two-screeners”. If the greatest portion of the desired audience is typically without a second device, the two-screening approach is not an effective strategy or the ad can be designed to effectively deliver the brand message via broadcast while somehow accounting for two- screeners as well to garner their engagement on the digital side.

Two-Screening Advantages…

  • Healthcare marketers can effectively span broadcast and digital venues

  • The TV portion of the ad is not over-burdened with encapsulating the brand experience from start to finish

  • By aligning TV ad times with website visits, the immediate response to ads can be assessed

  • Further audience insights on the extent of two-screening and their use of devices, locations, etc. can be cultivated

  • Website engagement will reveal further insights on the audience and their particular interests in the brand and the information provided in the digital realm

  • Web content, optimized with sharing features, can enable the audience which originated on the broadcast side to propel the digital content through social sharing to a secondary audience and so on without having to pay for more ad time and result in even greater overall ROI

  • If engagement is lower than expected despite being positioned with the intended audience, explore the reasons why; is the content not compelling, the segue not well communicated or is the ad already a two-screening casualty and not being viewed by as many audience members as anticipated?

Planning A Two-Screening Initiative…

  • Carefully interpret industry data on audience mobile, tablet usage and TV viewing patterns and conduct your own research initiatives as well; this knowledge is pivotal for a successful two-screening strategy

  • Develop detailed budgets in advance, initiating an effective two-screening initiatives may require more financial resources than originally anticipated

  • A two-screening strategy requires more preparation and resources to effectively execute plus its novel approach should be reserved for high priority use; examples include A) new product launch or new indications B) countering an assertively potent competitive threat C) new campaign for an established brand D) special televised event sponsorship

  • Establish goals and objectives on the broadcast side and digital side to individually and collectively measure effectiveness and ultimately ROI

  • Test story concepts, account for the patient journey, test content, test the segue from broadcast to digital, test effective continuity on the digital side

  • Pilot the two-screening approach with a miniature budget and targeted audience to fine tune and scale up

  • Account for all medical / regulatory requirements on the broadcast and digital side

  • Be certain website capacity is able to easily accommodate surges in traffic

  • Verify the broadcast and digital content is well assimilated and viewed via mobile and tablet screens

  • Maximize social sharing technical attributes; make it easy and encouraging for the broadcast audience who travelled to the digital realm to share the brand experience with others digitally

  • As audience groups continue to migrate to new digital / social / streaming venues, develop modified two-screening strategy options accordingly

  • Closely monitor ad fatigue; determine ways in advance to produce new digital experiences for the broadcast audience to segue to in the future

An Innovative Healthcare Broadcast And Digital Marketing Strategy…

A successful two-screening initiative is much more than a request to “visit our website”. It’s an integrated content and technical strategy to embrace a broadcast audience and comfortably transport them from their living space to the brand’s living space where they can spend longer, more meaningful time than just 30 or 60 seconds with your brand. They can explore the brand experience at their leisure; share it with family members and friends while determining what their next steps are.

Follow the customer / patient journey map…

In many ways the two-screening strategy can align well with today’s digital consumer and their respective patient journeys. It is imperative to know where and how you can align your brand strategy to it first before you invest in deploying it. As audience preferences change and technical innovation provides them with more routes and destinations to choose from, follow their map and modify two-screening strategy accordingly; stay ahead of the customer journey and your competitors.

Week Of September 10th, 2017
Healthcare Digital Marketing Organizational Effectiveness:
Put Five Ducks In A Row

Digital marketing initiatives are a mainstay action in healthcare industry commercial organizations. On the surface, they are aesthetically engaging and smoothly functional. Underneath, there is a wide array of organizational, financial and technical resources deployed to develop and deliver them. How these goals and assets are shared before digitalization of business concepts occurs can make a tremendous difference in the overall customer experience, a company's competitive advantage and ROI. By having their ducks in a row first, organizations can have the fundamental elements aligned to develop and launch deeply successful healthcare digital marketing initiatives despite ever-changing marketplace undercurrents.

Leadership Commitment

Consistent forward-thinking by present and future senior company executives to fund and optimize healthcare digital marketing initiatives as something as integral as managing payroll

Realization by upper management that digital marketing is never completed; changes in technology, regulations, information sharing practices, marketplace forces and social media fluidly impact each customer segment and respective customer journeys

"Be in it to win it"; outdated, under-funded approaches are quickly revealed to customers by who else but competitors seizing the opportunity to better align with customers with more strategic, assertive deployment of digital marketing assets

Customer Connection

In concept, the company understands the importance of reaching out to customers and with equal or greater importance; learns how customers reach the company and its products / services through their journey and make decisive buying decisions

Healthcare digital marketing is complex; to what degree can digital marketing initiatives / customer focus overlap before they are dilution occurs and separate initiatives to be developed?

Which digital marketing customer segment (consumer, patient, nurse, physician, pharmacist, payer, institution, trade partner and other entities) and respective initiatives provide the greater ROI?

Integrated Marketing / Brand And Digital

Brand and digital marketing units must share common goals and objectives otherwise they separate to serve their own agendas and become jointly dysfunctional; they should be equal stakeholders in how customers perceive, engage and choose the company's offering and the overall customer experience

Effective brand and digital marketing teams interoperate as a multidisciplinary business unit; they are an integral hub with direct conduits to sales, managed markets, market research, trade relations, regulatory, corporate communications, IT 

A primary, binding objective of the integrated marketing units is equal improvement of ROI and the customer experience 

Technical Resources

Technical resources will be continually assessed, upgraded, discontinued or changed out due to innovation, improved cost efficiencies and impact on the strength of maintaining the optimal customer experience and ROI

Internal (company stakeholders) and external (outside vendors) must be synchronized in technical approach otherwise a gap in resource ROI will emerge and widen -degrading focus, eroding customer experience and ultimately running up costs

Brand and digital marketing teams, along with multidisciplinary counterparts, take ongoing technology changes in stride; maintaining focus on customers and business goals while effectively rotating tires on a rolling carload of technology innovation 

Partnership With Sales

No matter the level of "feel good" factor, uniqueness of approach or messaging, level of detail or volume in content, digital marketing initiatives must be steered in the direction of the company's bottom line and ultimately sales

Sales is a beast, the "Transactionator", which must be well fed; if it goes hungry, it weakens and so does the company that surrounds it; digital marketing initiatives must contribute to feeding the Sales beast

Brand and digital marketing teams, with their multidisciplinary stakeholders, need to partner with Sales and be certain the content generated and delivered contributes to a positive customer experience resulting in actions taken to generate sales

Strategically developed and deployed healthcare digital marketing initiatives are a mainstay in cultivating revenue regardless of competitive, technological or marketplace change undercurrents. . Uncoordinated efforts clutter customer perception, deplete resources and dilute organizational focus. By collaboratively defining, aligning and supporting their ducks in advance; organizations avoid swimming in circles while maximizing customer experience and ROI.



Week Of September 3, 2017
Tenet Healthcare Is Selling Hospitals…And Maybe More…

Consolidation, Mergers, Acquisitions…Three popular key words applied to search engines regarding the healthcare industry and especially the hospital / health system sector. Numerous marketplace forces have driven this trend. These forces are driving Tenet Healthcare Corp. to offload some of its hospitals and possibly take more drastic measures.

Early in September ’17, Tenet Healthcare shared with the healthcare and investor communities its plans to sell off 8 hospitals in the United States plus an additional 9 hospitals and clinics in the United Kingdom. Tenet, based in Dallas, Texas is a healthcare provider / services conglomerate founded in 1967. It owns 77 hospitals, has 130,000+ employees and just under $20 billion in annual sales.  
Tenet operates hospitals, health systems, surgical centers and urgent care centers through a variety of business units and partnership arrangements. They also manage 6 health plans and more than 10 accountable care networks. It’s estimated they have approximately 20,000 licensed beds. Tenet also has a healthcare revenue management software business unit.

All of these entities and their respective revenues eventually are accounted for one by one at the bottom line. The 8 U.S. hospitals and 9 U.K. hospitals / clinics were low financial performers. Tenet is seeking to optimize its facility / service mix to address its debt which is substantial at $15 billion and respond to impatient flagship investors seeking better ROI.

Healthcare is a demanding and unforgiving business. Often perceived as a rewarding fat margin industry; it is rife with punishing challenges and change. Reimbursement pressures erode profitability.  Remarkable clinician knowledge, big data insights, bullseye diagnostics and advanced therapies enable more critical patient types to be successfully treated.  The promising breakthrough results are costly as innovation delivers better outcomes but requires providers to relinquish "old" technology before its full value is realized. The new and better options developed in quick succession benefit clinicians and patients but befuddles financials. Ongoing healthcare reform issues add to administrative costs and dilutes focus on the healthcare mission. Pivotal consideration applies to attracting and retaining well-educated, experienced clinicians to deliver optimum care. Tenet is not immune to these intrinsic healthcare industry factors. 

To offset lower reimbursement and maximize use of capital equipment / technology, facilities and top clinician teams, hospitals and health systems have been merging.  New, energy-efficient, low maintenance facilities centered on delivering optimal care are being constructed.  Some health systems have developed and marketed their own medical insurance plans.  The strategy behind larger, more diverse provider organizaitons is to service more patients under one operating entity, streamline continuity of care, reduce competition and gain greater leverage against health plans and healthcare product manufacturers. Tenet has assertively undertaken these measures to sustain its growth and fortify its competitive position -while assuming greater financial risk.

These changing business models impact the surrounding healthcare industry including pharmaceutical and medical device manufacturers, managed care organizations (MCOs), group purchasing organizations (GPOs), compounding pharmacies, distributors and wholesalers.  Contracting, marketing / sales strategies and tactics change accordingly depending on who the hospital / health system buyers or sellers are, what terms are in place  and what needs to be re-negotiated. The seller conceivably is relinquishing some leverage by off loading patient volume to the buyer; who in turn is gaining leverage by enlarging their organization.  The buyers and sellers have to strategically account for the impact all of these changes have on their patients.  Tenet is on both sides of these equations. 

While Tenet is in the process of selling facilities to Paladin Healthcare (based in El Segundo, California) and HCA ( based in Nashville, Tennessee); other buyers are likely to surface. There are voices in the investor community which want Tenet to explore its options to subdivide itself by spinning into several entities such as health system, health plan, surgical center / urgent care and financial software operating companies. In concept this has attractive investor attributes but it is not without complexity and associated costs.

The $15 billion debt burden versus $20 billion annual sales is an inescapable issue; it cannot be merely managed in perpetuity. Tenet Healthcare CEO Trevor Fettor has agreed to step down from his position. Tenet has its work cut out for itself to choose a new leader, deliver high levels of care, assertively address a corrosive debt load, maintain a competitive position and satisfy investors. As Tenet takes action to resolve its issues, it will undoubtedly influence it competitors (and their investors) who are in the same challenging financial position.

Week Of August 27th, 2017
Eruption:  Another Large Scale Health System Merger In The Chicago Marketplace

A market redefining health system merger was announced on August 22nd impacting one of the largest urban areas in the United States.  It will form a wide scale health system connected to the Chicago metropolitan marketplace, nearby suburbs and a sizable portion of northern Illinois. Presence Health (comprised of 12 hospitals) will combine with AMITA Health, a 9 hospital, Chicago-based partnership of Ascension’s Alexian Brothers Health System and Adventist Midwest Health. Adventist Midwest is part of Adventist Health System, a nine-state, 45 hospital health system headquartered in Florida; Ascension Health, based in St. Louis, is comprised of 141 hospitals in 22 states.

Presence Health is the largest Catholic health system in Illinois.   It was formed by combining Resurrection Health Care Corp. and Provena Health in 2011.  The merger was successful although integration costs, reimbursement reductions and a competitive health system marketplace has challenged the growth of Presence Health moving forward.

The new combined entity (which still requires financial due diligence plus regulatory and canonical approval) will have competitive heft against other leading health systems in the Chicago marketplace including Advocate Healthcare, Northwestern Memorial HealthCare and NorthShore University HealthSystem.  Another large healthcare provider organization, Centegra Health System, has merger plans underway with Northwestern Memorial.  Advocate Healthcare and NorthShore University were forced to abandon their plans to merge based on regulatory barriers earlier in 2017.  All of these health systems are well-fortified with clinics, specialty practices and other healthcare service facilties in addition to their hospitals.  

Besides these organizations, there are other healthcare heavy hitters in the Chicago marketplace which will be assessing their options. They include Edward-Elmhurst Health, Loyola University Health System, Rush University Medical Center, University of Chicago Medicine and University of Illinois Hospital & Health Science System.  All of them are vying for patients and the very best clinicians to treat them.  Large physician practice groups in the area, including DuPage Medical Group and Illinois Bone & Joint Institute, may be pivotal in their future alliance or outright acquisition plans.

Looking ahead, it will be interesting to see what further changes occur in the Chicago marketplace and how they influence health system merger plans in other metropolitan areas nationwide -both from a strategic organizational and regulatory policy/ approval perspective.  The larger the health systems become, the more leverage they have in negotiating with healthcare product manufacturers and health insurance plans.  They can also streamline administrative costs and accelerate improvements in patient care.  

Healthcare product manufacturers will be more closely dialing in marketing, sales and contracting strategies to land and maintain these large customers; health insurers will be even more deeply scrutinizing premiums, employer plans, Medicare arrangements and medical loss ratios. For consumers / patients, there are advantages in being treated within one health system in terms of the total continuum of care, however; this may be at the expense of having less provider organizations to choose from and less competition -potentially leading to higher out-of-pocket costs.

Week Of August 20th, 2017
$6.3 Billion Deal:  STADA Disappears Behind The Curtain Of Private Equity

Private equity (PE) continues to be a force in changing the face of the global healthcare industry. STADA, a prominent generic drug manufacturer based in Germany, was taken private last week (8/18/2017) in a $6.3 billion dollar deal. Bain Capital and Cinven were the buyers. Consolidation in the healthcare industry has been rampant and the generic drug producer sector is not immune to it.

There are two key considerations in this deal. First, it is the largest private equity deal to date for a German-based company. Second, it could be the stepping stone to another PE deal. French pharmaceutical manufacturer Sanofi has plans to sell its European generic drug unit in the near future. It may be a fitting asset to be combined with STADA. Bain and Cinven would have a formidable generic manufacturing organization in their portfolio which they could cultivate for income, spin off in a public offering or sell directly to a pharmaceutical manufacturer. While they could do this based on the STADA deal alone, bolstering it with Sanofi’s generic unit would make it larger and potentially that much more profitable in any of the three options. The tandem would allow for a larger product portfolio for competitive marketing purposes against other generic drug makers along the way.

Additional gains would be realized through the inevitable cost cutting measures applied to each organization. Conceivably, the STADA deal may drive the price higher for the Sanofi unit if it is a pivotal target in Bain Capital and Cinven’s strategy. Sanofi may be able to extract more payment from them or other drug manufacturers seeking to buy the Sanofi unit. Healthcare continues to be a sector ripe with mergers and acquisitions; both public and private monies are being strategically exercised to gain maximum short and long term advantages. Bain and Cinven’s STADA deal has the makings of a lucrative profit platform in the pharmaceutical industry.


Week Of August 13, 2017
Senosis Health ---Google Makes An Investment In Mobile Healthcare Strategy

Google is on the move in the healthcare industry. Earlier this week it acquired Senosis Health; a highly specialized app / smartphone technology company which focuses on healthcare-related uses. Financial terms of the buy are presently not known. Google is laying the groundwork to become a growing player in medical market sectors.

Senosis Health is based in Seattle. The company’s technology aligns with the processing and user capabilities of smartphones to conduct various types of diagnosis and monitoring. Some of the general areas Senosis patient care technology links to are pulmonary / respiratory, blood / hemoglobin and jaundice in newborns. Existing smartphone features such as camera and microphone are utilized and for some diagnosis / monitoring functions, add-on components are required.

The deal is significant for several reasons. More companies are finding ways to merge existing technology with new advances and getting maximum use of hardware and programming technology. The wearables market is hot and there is a continual stream of upgrades and new offerings being launched. Smartphone healthcare technology seeps into the wearable market sector.

Telehealth is becoming its own industry. The ability to diagnose and / or monitor patients remotely is not only convenient; it can fill in geographic gaps where caregivers and facilities are at a fair distance from patients. It also enables patients to be monitored closely without being admitted or making repeated visits for clinician assessment.  By maximizing reach through technical resources and widening access to care, conceivably better outcomes are achieved at lower cost.  Google may also be able to make further revenue via commercialization of data generated from its devices and apps.

Looking ahead, it is worth monitoring to learn how Google plans to integrate the Senosis Health products into their healthcare product development and marketing initiatives. While the Senosis deal may not be a multi-billion dollar arrangement at the start, it is clearly a building block for Google’s present and future strategic healthcare business plans.  It will be interesting to see if the technology they develop will be shared with other companies in the mobile space like Apple and Samsung or medical device firms centered around telehealth and diagnostics.  As consumer and clinician needs evolve and technology advances, Google is fortifying its position to be a competitive contender in the healthcare technology sector

Week Of August 6th, 2017
Strategically Quiet Disruption In Home Infusion / Specialty Pharmacy: PharMerica Taken Private By KKR And Walgreens Boots Alliance

Let’s Make A Deal

On Wednesday, 8/2/2017, PharMerica was acquired by private equity firm KKR (Kohlberg Kravis Roberts). KKR paid $1.4 billion for PharMerica. Headquartered in Louisville, Kentucky, PharMerica is a leader in pharmacy services for assisted living facilities (ALF), hospitals, long term care facilities (LTC), skilled nursing facilities (SNF) and other specialty pharmacy service sectors. Its Amerita business unit focuses on home infusion services, Onco360 focuses on oncology pharmacy services and Luker pharmacy management unit operates in hospital pharmacy management. Overall, PharMerica is comprised of approximately 99 institutional pharmacies, 19 specialty home infusion pharmacies and 4 specialty oncology pharmacies in 45 states. PharMerica was founded in 2006 through the merger of the institutional pharmacy business of Louisville-based Kindred Healthcare and a pharmacy services subsidiary of AmerisourceBergen Corp.

Healthcare Sector M & A 

The healthcare industry is rife with large scale mergers and acquisitions in the tens of billions of dollars. KKR’s PharMerica deal may not be considered all that meaningful in terms of a comparatively low transaction number of $1.4 billion ($909 million plus assumption of about $490 million of PharMerica debt). KKR has successfully conducted far larger, more complex purchases and sales; in healthcare is presently has a handful of healthcare industry companies in its portfolio and is adding more. In July, 2017 KKR took healthcare website WebMD private in a $2.8 billion dollar acquisition and just recently acquired Envision Healthcare’s ambulance service unit (American Medical Response) for $2.4 billion. The PharMerica acquisition is extraordinarily strategic in nature as a minority stakeholder in it will be Walgreens Boots Alliance (WBA).

Friends With Benefits

Well-known WBA provides an array of retail, mail order and specialty pharmacy services worldwide. It owns a large stake in OptionCare, one of the nation’s largest home infusion companies. The company also owns almost 25% of AmerisourceBergen (which happens to own all of PharMEDium, the nation’s largest compounding pharmacy). By staking a claim to part of PharMerica, WBA widens its reach and revenue stream in the non-retail pharmacy services sector. While it may not completely own AmerisourceBergen, OptionCare or PharMerica; it owns enough to have a degree of influence in each. Equally important, it has a cut of their profits. Through this arrangement, WBA benefits from owning a portion of businesses and profiting from them and being able to invest in other interests while avoiding prohibitive debt loads and antitrust issues.  

Outflanking Competitors

The PharMerica deal has another significant aspect to it. Its competitors are now prohibited from freely and directly acquiring it. Two examples are BioScrip and CVS Health; two well established competitors in the home infusion / specialty pharmacy services sector which may have benefitted by acquiring at least a portion of PharMerica in a similar arrangement. Another is United Healthcare’s Optum division; it has a home infusion / specialty pharmacy services business unit, BriovaRx, which operates more than 30 branches. Potentially, there may have been value for them to bolster these operations through acquiring PharMerica.

Market Sector Disruption And Future Opportunity

Looking ahead, KKR and WBA have quietly disrupted the home infusion / specialty pharmacy marketplace and added another source of revenue. They can re-organize and invest in PharMerica accordingly to make it a larger, more robustly competitive player. Meanwhile, pharmacy industry competitors and other sector stakeholders will have a new challenge in monitoring a well-supported contender assertively moving into a new chapter of development and growth under the cover of private ownership.


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