Scott MacStravic, PhD
After 30 years of heading, teaching, consulting and writing about healthcare marketing, I am a firm believer in the power of labels. While I never thought that changing the name of a hospital to a “medical center” or “regional health center” would, by itself, guarantee the survival of the institution, it could end up meaning something to both the public and the institution, if it also came with a different strategy and pattern of actions.
The labeling issue is equally important in proactive health services, the generic label for any combination of health promotion, health risk behavior and health risk condition reform, and chronic disease management. When these are carried out to reduce the sickness care costs for insurance plans and employers, they typically carry the label of “population health management”.
This indicates the intent to deal with entire populations, such as employees or plan members. It emphasizes the intent to deal with those population’s health, rather than wait till they are sick. Even when it includes “disease management”, it aims to prevent crises, complications and worsening of targeted diseases, rather than treat such after they arise. And it intends to manage that health, to control, direct, and improve it to achieve the goals that management wishes to achieve.
Sometimes, the “P” in the “PHM” stands for “proactive,” or “preventive,” even “pre-emptive” to emphasize the fact that it differs from reactive health services focused on what could have been prevented. Increasingly, the “P” stands for “productivity”, as employers realize how much their workforce productivity can be improved, their labor costs reduced, and their profits increased through improving the health of their employee population.
In future, I expect the “P” to extend to “performance,” since the overall quality of workforce efforts, not just their costs, including technical as well as service quality, customer satisfaction, reputation, market share, etc. can be positively affected by health improvement, along with other management efforts such as internal pay-for-performance. The full benefits to HCOs and other employers of improved health on total performance is yet to be learned, but seems sure to be significant.
That takes the “P” about as far as it will go, at least with current technologies, and well past where current practice is focused. The “H” part will undoubtedly remain the same, since it is the health vs. sickness of populations that will remain the major differentiator of PHM from traditional sickness care, even though it is erroneously labeled “healthcare”. But that still leaves some questions about the “M”.
The term “management” is well-advised as a label when marketing the idea or any supplier’s particular approach to PHM to HCOs, insurers, and employers in general. It will resonate with the managers who are the targeted decision makers in such organizations, and promote confidence that the health of a population can really be controlled, in contrast to the uncontrolled costs of sickness care. But it may limit the methods employed to traditional management techniques, and thereby limit the success of PHM.
Managers are used to being able to direct and control employees’ behaviors within their organizations. Managers have authority to do so, can reward or punish employees based on their compliance with policies, procedures, and standards. But when dealing with their health behaviors, in contrast to their work behaviors, “management” may not have all the best techniques.
Health behaviors occur 24/7, not just while employees are at work. And PHM for employers often includes dependents at home, over whom management has little or no authority. Managers can use traditional incentives and rewards for good health behaviors, and even threats and punishments for bad behaviors, but only within limits, given laws and regulations, as well as people’s tolerance for others’ attempts to tell them what to do in private.
The marketing paradigm may have much to offer to managers and the suppliers they hire to carry out PHM initiatives. By treating employees and plan members like customers, to be “wooed and won” by pointing out the full array of benefits to their lives that PHM can deliver, managers may find greater impact than traditional management techniques and “payment” or “punishment” can achieve alone.
The Duke University Health System, for example, empowers all employees or dependents in its Prospective Health Program to choose their own prospective health goals, and co-design the action plan that will enable them to achieve such goals. It retains the right to choose what kinds and costs of support to give them in pursuing such goals, but gives the same basic support services to all. (www.dukeprospectivehealth.org)
It may be that the label used when seeking to market PHM programs to employees or plan members – both for managers when thinking about how best to do so, and when describing what they are marketing to prospective participants – should be different from either of the “Ms” in PHM. In order to promote making PHM attractive and satisfying to employees and plan members, a label such as “Personal Health Development” (PHD) may prove more effective.
It is at least doubtful whether people like to be “managed”, for example, or even “marketed” to, given consumers’ general annoyance with “marketers”. But when healthier behaviors are pursued as part of personal, or perhaps family health development, it is clear that the emphasis is on the individual or family involved, rather than just on management. And the more that employees or plan members see PHM or PHD/FHD as enabling them to pursue and achieve personal/family improvement, the more the idea should be attractive to them, not just managers.
It will always require a “balancing act” to ensure that managers as well as employees and families gain through PHM/PHD/FHD efforts, since managers will mainly be making the necessary cash investments. But the persons and family members involved will be making the major personal time, effort, self-discipline investments necessary, and often cash as well – e.g. in paying more for healthy foods, exercise equipment, etc. The more they see the effort as in their own interests, and satisfying their own emotional as well as rational needs and values, the more successful the efforts are likely to be.
It has long been recognized that one of the most powerful forces in human behavior is “conatus”, a combination of self-preservation and self-development described by the philosopher Spinoza four centuries ago. And the more that PHM can be thought of and marketed as PHD/FHD, the more likely it will become and be seen as something that employees, family and plan members can “buy into. [D. Wolfe “The Most Influential Force in Human Behavior” Ageless Marketing Nov 17, 2006 (http://agelessmarketing.typepad.com)]
