Chapter 10. Marketing

Early on, coalitions need to develop a communication and marketing plan that presents a consistent image of the coalition and uses clear and appropriate communications. This plan serves two purposes:

1. Internally, it is essential for building and maintaining trust among stakeholders. Apparent unresponsiveness, muddled messages, and ill-defined goals can quickly damage the coalition's reputation.
2. Externally, it shapes how the media and the public understand the role of the coalition and how to use performance data.

Among Stakeholders

Define Your Terms

Misperceptions among participants can be an issue when forming a coalition. Confusion can occur on the scale of the project and in the way participants understand the terms being discussed. The Wisconsin Collaborative for Healthcare Quality stressed the importance of defining terms to ensure precise language among the participants. In its experience, confusion and tension were at times caused by the different ways participants understood the terms "provider," "cooperation," and "collaboration." In Wisconsin, physicians define themselves as clinicians, but health care systems define them as providers. Cooperation can denote a more informal relationship than collaboration, which requires a more durable, intentional agreement between two organizations to work together under a commonly defined mission and structure. It is crucial, therefore, to be clear in communicating objectives and defining terms with stakeholders.

Develop Communication Objectives for Each Stakeholder

The overall communication approach with stakeholders should be proactive, not reactive. It is important to develop particular messages for each core constituency and institute processes for regularly communicating with them.

Stakeholder audiences and key messages include:

• Employers, who look to provide employees information on where to get the best care. The also they want to purchase value—the best quality care at the lowest cost.
• Consumers, who look for information to make care decisions about a provider or practitioner who fits their care needs.

Methods for Communication

Minnesota Community Measurement publishes a newsletter five to six times a year for the provider community. At open enrollment time, the coalition routinely connects with large employers in its market to offer information for employees and refreshes data annually posted to the Minnesota coalition's Web site. Additionally, the Minnesota coalition has a regular news media release that communicates annual results through a live Web cast to the provider community and consumers and encourages them to visit the coalition's Web site.

It is also important to engage stakeholders, particularly those being reported on, in a collaborative process that allows for open debate and generates buy-in on how data will be reported and framed, what the cut points should be, what labels should be used, and so forth.

The Indiana Health Information Exchange follows an extensive internal review process that determines what larger messages are developed for the public. The process involves conducting Administrative Committee meetings, Measures Committee meetings, and Measure Subcommittee meetings monthly and Action Team meetings biweekly. The Administrative Committee involves high-level employer, hospital, and physicians groups and is weighted heavily toward payers and employers. Among other functions, it reviews program status, discusses directional issues, and reviews budget recommendations. The Action Team is a lower-level, smaller team that represents the types of organizations represented on the Administrative Committee. The Action Team reviews, studies, and formulates recommendations around issues before they go to the Administrative Committee. The Measures Committee consists primarily of physicians and medical directors and discusses clinical issues, measures, physician issues, and so forth. The subcommittees (Quality Health First, General Measures, Cardiology, and Orthopedics) study details concerning specifications, impacts, and so forth, before taking information to the larger committee. The Indiana coalition's public relations staff works with local news agencies to communicate high-level progress and initiatives derived from this process to the general public. Additionally, the Quality Health First subcommittee conducts monthly program overview presentations with any interested constituencies.

The California Cooperative Healthcare Reporting Initiative conducts regular Project Committee conference calls. The committee is composed of project stakeholders and is charged with making project-specific recommendations to the Executive Committee. In addition, the California coalition conducts a monthly "all participant" conference call to provide stakeholders updates on each project. Stakeholder-specific calls are scheduled as the need arises.

Facilitate Frank and Open Discussion Among Participants

As part of the startup process, provide regular forums where members can discuss and debate strategies and concerns. Regular meetings of coalition leaders and stakeholders are a good way to keep everyone on task, update one another on progress, and determine what needs to be done by whom.

To this end, Minnesota Community Measurement has set up two formal advisory groups. The Reporting Advisory Committee sets reporting policy, and the Data Planning Committee establishes the details around measurement. The Reporting Advisory Committee is composed of crucial stakeholders, including medical groups and health plans, and makes recommendations to the Minnesota coalition's board on what measures Minnesota Community Measurement will report and how it will display the quality information. The Data Planning Committee comprises all the health plans in Minnesota that submit data to the coalition and advises on data collection and aggregation.

Types of Communication

Internet/Intranet

Establishing an Internet presence is important for creating and promoting your coalition's public identity. The coalition's Web site often will be the first place people will go to learn about its mission and activities. Each Better Quality Information site has a Web site that includes an overview of the coalition, its partners, governance structure, and contact information. Some also include press releases of significant developments, guidelines, performance reports, tools, publications (for example, reports), and links. Links to the Web sites follow.

• Center for Health Information and Research-Arizona State University
  http://chir.asu.edu.
• California Cooperative Healthcare Reporting Initiative
  http://www.cchri.org.
• Massachusetts Health Quality Partners
  http://www.mhqp.org.
• Minnesota Community Measurement
  http://www.mnhealthcare.org.
• Indiana Health Information Exchange
  http://www.ihie.com.
• Wisconsin Collaborative for Healthcare Quality
  http://www.wchq.org.

Coalitions establishing an Internet presence should work with an information technology partner that is engaged with the coalition and sensitive to the needs of the health care community and a collaborative project.

Once the Web site is available, tracking traffic to the site is useful in understanding what constituencies are visiting and how often. Placing links to your site on stakeholder Web sites is an effective way to track visitors from that particular group.

A key tool for coalitions is a reliable and effective Intranet. The Wisconsin Collaborative for Healthcare Quality, for example, uses its Intranet for providers to review data before reporting it publicly on its Web site.

Newsletters and Presentations

An effective way to promote coalition activities is to publish an E-newsletter. For example, Minnesota Community Measurement's E-newsletter is The Measurement Minute.

It may be challenging to produce content and manage a subscriber list; however, additional cost-effective ways to promote the coalition exist. These include contributing articles about coalition activities to stakeholder newsletters and giving presentations at stakeholder conferences.

Create a "Genesis Story"

Develop a narrative that tells what your coalition is, what it does, how it began, and what its early processes and successes were. This method is excellent for introducing the coalition to the media, legislators, stakeholders, and the public.

Public Relations and News Media

Establishing a coalition entails marketing what the coalition does. Working with the media can be an effective avenue for promoting positive news about the coalition and attracting potential collaborators and partners. In the formative stages, many Better Quality Information sites deliberately chose to maintain low profiles because they did not want "the hype to get ahead of reality." They wanted all aspects of the coalition to be on solid ground before developing marketing and public relations strategies.

Still, developing an effective public relations approach early on is crucial to maintaining a regional coalition, particularly when dealing with the news media. One approach is to cultivate relationships with health writers and reporters in the local media and provide them with background on the data and what the data mean. This will ensure providers are not misrepresented in the press.

Potential negative outcomes can contribute to providers' reluctance to participating in public reporting. Coalitions need to be sensitive to the effect release of data will have on the public. If not framed correctly and understandably, data can damage public perception of providers, even if the physicians are doing a good job.

Positive Influence

Massachusetts Health Quality Partners has established relationships with local media to ensure accurate accounting of the complex issues behind public reporting of data. In one instance, a newspaper was going to publish an article about the Massachusetts coalition's patient experience reporting that misleadingly expanded cut points from three to seven. Because of the relationship between the newspaper and Massachusetts Health Quality Partners, the editor showed the coalition what it intended to print before publishing the article. The coalition explained why the established cut points were crucial for accuracy, and this was reflected in the published article.