Sunday, January 16, 2011

“Branding” of Health Organizations and Health Reform

“Branding” of Health Organizations and Health Reform

What prompts these blogs?

In this case, the catalyst was three articles in this Sunday’s New York Times business section. These articles included pieces on the “brand” problems of Johnson & Johnson, the maker of dozens of drug store products (“Can Johnson & Johnson Get Its Act Together?”; the excessive spending image of President Obama (“What Obama Should Say About the Deficit”; and reasons behind declining reputations of doctors, lawyers, and business professionals (“The Spirit of the Mensch”), a book review of Practical Wisdom: The Right Way to Do the Right Thing.

In the marketing world, a “brand” refers to the identity of a product, service or business. A “concept brand” is a brand associated with an abstract concept rather than a specific product, service or business. Concept branding transcends the business world. In health reform, this brand identity might include a federal government philosophy, a state government’s health policies, an academic medical center’s management strategy, or a physician association’s mission. The brand is the recognizable personality of an organization and how its constituents and society perceive it.

Health Reform “Brand’ of the Federal Government

The health reform “brand” of the Obama administration is the image of covering for the health care of all citizens. This care will be available for all citizens, will be guided by uniform and standardized federal standards, will protect patients from unaffordable costs and medical bankruptcies, and will be provided by a hybrid of public and private organizations, each of which will be held accountable for their actions. This concept is embedded in the name of the health care law, The Patient Protection Affordable and Accountable Care Act.

The “brand” may be modified when voters react negatively, as they did in the November 2 Congressional elections. To avoid the image of a government “takeover” and to blunt the negative image of the health reform law, the Obama team is now “swinging to the center” to placate businesses and more conservative elements of our culture, who fear runaway health costs will bankrupt the nation and limit individual freedoms.

Health Reform “Brand” of Massachusetts

The state of Massachusetts desires to project its own “brand” of health care. This “brand” could be called “progressive liberalism,” compassion and affordable care for all. It is widely considered to be the model for the Obama administration’s national policy. Its hallmarks are an individual mandate, coverage for all Massachusetts citizens, subsidies for families with incomes of up to 300 percent of poverty ($64,000), tight standards created by policy “experts,” access to primary care physicians to decrease ER visits, and elimination of uncompensated care.

This “brand” has worked to the extent that more than 95% of Massachusetts citizens are now covered, and 75% of Massachusetts voters and 75% of Massachusetts physicians think it ought to be retained. It has been more expensive than planned, and it may be a “brand” that fits only Massachusetts, according to exit polls following the Scott Brown election as Senator. Brown opposed the national health reform law, and voters approved of his stance on the issue. A poll by the Massachusetts Medical Society of 1000 of its members indicated the only 14% of doctors think the Massachusetts model would work elsewhere the U.S.

Health Reform “Brand” of Duke University

The Duke University Medical Center, of which I am a graduate, seems to be adopting a “brand” strategy of expansion through regional centers bearing the Duke name and logo and staffed by Duke employed physicians. This “branding strategy” goes under the names of “community initiatives” and “health care equity.”
I recently received a copy of the DukeMed Magazine.

The magazine featured an 8 page spread of 105 new physicians welcomed to Duke. These included 7 anesthesiologists, 3 dermatologists, 11 primary care physicians, 14 hospitalists, 22 medical specialists, 3 obstetricians /gynecologists, 13 surgeons, 2 ophthalmologists, 1 orthopedist, 4 pathologists, 10 pediatricians, 6 psychiatrists, 3 radiation oncologists, and 5 radiologists. 48 of the newcomers were women. From the pictures, it was apparent that 26 of the new physicians were assigned to 10 Duke Community satellite outpatient clinics and a regional hospital. If one were to assume these new physicians were paid $150,000 to $200,000 that would come to roughly $16 million to $21 million in one year, an investment in building a “brand.”

I do not want to make too much of this as a Duke initiative for regional expansion. This expansion, this spreading of tentacles from large health care centers out into the community, is going on in most academic centers and large hospitals. It is a hub and spook strategy of treating uncomplicated patients at the community level, referring the tough cases to specialists at the medical center, and establishing a brand name image in a given region with the management of a large institution with the skills, specialists, and technologies needed to deal with bureaucratic demands of health care.

Health Reform Brand of the Physicians Foundation

As physician organizations go, the Physicians Foundation is the new kid on the block. It was created in 2003 as the result of a court settlement of a class action suit between 19 state medical societies and major health insurers. The settlement created a non-profit 501C3 organization that advances the work of practicing physicians and improves the quality of health care for all Americans.
The Foundation is unique in its commitment to working with physicians nationwide to create a more efficient and equitable healthcare system. It pursues its mission through such activities including grant making, research, and policy studies. Since 2005, The Foundation has awarded numerous multi-year grants.

The Foundation seeks to establish brand name recognition as a physician leadership organization that develops new leaders and explains and defends private physicians in particular and the American medical system in general. Private physicians in owned practices provide 70% to 80% of American medical care. Most of these practitioners are in groups of 6 or less. They exert a positive economic impact in their respective communities, staff most of the hospitals in the U.S., and deserve recognition for their contribution to the health and economic well-being of their communities.

The health system has shown steady job growth during the current recession. According to the Bureau of Labor Statistics, from the start of the recession in December 2007 until December 2010, the nation as a whole lost 7.2 million jobs, but the health care industry gained 800,000, mostly in hospitals, doctors’ offices, and outpatient facilities. Collectively, hospitals and doctors are often a region’s largest employers and greatest job creators.

Among its activities, the Foundation has funded a number of independent white papers on the U.S system compared to other nations, the positive economic effect of private medicine, state of mind and finances of private practice physicians, the growing physician shortage, and the impact of health reform, both societal and governmental, on physician private practices.


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