Fearing that politicians might focus their election-year campaigns on rising healthcare costs, the American Hospital Association is taking the offensive by crafting an image that shows its members are providing essential services despite a hefty price tag.
Since the beginning of the year, the AHA has unveiled a newly designed logo and created campaign cards for political candidates that outline principles for providing affordable healthcare. Last week, the AHA added another cog to its image machine by releasing a study that said the U.S. healthcare system earns at least a double return on investment for every $1 spent.
"Most organizations that are progressive and in a dynamic industry are periodically going to revisit the brand and their positioning in the marketplace," said Daniel Fell, a healthcare marketing expert and partner at Daniel Douglas Norcross, a consulting firm. "That is a healthy process and an important step for them to take."
Agreeing with Fell are hospital executives who have had to endure the glares of their constituencies as consumers, employees and patients deal with access, cost and quality issues. Last month, for example, the CMS cited hospitals as the No. 1 culprit of rising healthcare expenditures that hit $1.6 trillion in 2002 (Jan. 12, p. 8). And it's bound to get worse next month when Congress holds hearings on hospital billing and collection practices. Sure to be paraded in front of lawmakers are poor patients made destitute by overly aggressive attempts by hospitals to collect on unpaid bills.
"The AHA needs to do different things to shape public opinion," said Gary Stein, president and chief executive officer of Touro Infirmary, a 486-bed hospital in New Orleans. "If the association can shape the public's understanding, it could be beneficial."
The cornerstone of the marketing push is the study released by the Value Group, a new coalition that includes the AHA and the Federation of American Hospitals, among other industry groups. The group's goal is to steer public policy discussions to the benefits of healthcare spending, rather than just the amount of spending, AHA President Richard Davidson said at a news conference last week.
The Value Group found that although per-capita healthcare costs have increased by $2,254 since 1980, the nation's annual death rate has dropped 16%, average life expectancy has risen 3.2 years and total annual hospital days have declined 56%. Valuing each one-year gain in life expectancy at $100,000, researchers said every $1 investment in healthcare produces "health gains" of $2.40 to $3. "Is our investment in healthcare worth it? This study shows it is," said Christine McEntee, CEO of the American College of Cardiology. McEntee is a former executive vice president of the AHA. She resigned from the AHA in 1998.
ROI on hospital care
Hospital executives will use the study results when talking to public policy officials and members of their communities about rising healthcare costs, AHA spokesman Richard Wade said.
"There has been a mind-set that healthcare spending is going up," Wade said. "We have to get people to start thinking that what you spend has a return. The information will be used as a framework so hospitals can use it to make their point."
The AHA partnered with other industry groups, including the Healthcare Leadership Council and the National Pharmaceutical Council, to get the message out about the benefits of investing in healthcare.
The National Pharmaceutical Council joined the AHA in the Value Group because it wanted to highlight measures that should be used when looking at healthcare returns.
"We need to get much better at telling the larger story," said Pat Adams, vice president of the council. "We are all concerned about costs, but clearly those decisions should be made after a broader look at returns on investments and on value."
"This is a beginning," Wade said. "This is going to be one more set of ideas. We all wanted to quantify some of this."
The AHA's marketing initiatives are a way to build public support and an attempt to prevent politicians from taking the issue of rising healthcare costs and using it as a campaign issue, said Robert Blendon, professor of health policy and political analysis at Harvard University's School of Public Health.
While voters are complaining that insurance premiums are too high and hospitals argue that more funding is needed for capital projects and staffing, the issue is ripe for political debate, Blendon said.
The association is trying to "get ahead of the curve before more politicians single out rising hospital costs as a centerpiece of their campaigns," he said. "The AHA is trying to lead and say we do an incredible amount and that we might be expensive, but we are worth it."
The AHA campaign is similar to that of recent efforts by the pharmaceutical industry, which embarked on a multimillion- dollar campaign to help elect candidates who would help the industry with additional funding for the development of new drugs, Blendon said.
"An image campaign helps in that it softens the anger," he said. "If you have a big problem, getting ahead is helpful to some level."
Principled approach to care
With rising healthcare costs becoming a possible campaign theme, the AHA has gotten aggressive with politicians by creating an election card that urges congressional candidates to support seven healthcare principles. Hospital executives give the cards to local candidates when they meet to discuss the issues.
In its "Seven Steps to a Healthier America," the AHA calls for politicians to change the healthcare environment by ensuring that their constituents have access to affordable healthcare. Candidates are asked to guarantee health insurance coverage for every child by 2008, provide funding for emergency room and trauma care, and support public and private partnerships aimed at performance improvements, among other steps.
The AHA is also demanding candidates make sure no one becomes impoverished as the result of a major illness or injury, a move that may help soften the public relations blow expected from next month's hearings on hospital billing practices. The AHA began its attempt to neutralize the issue in December 2003, when it sent a letter to HHS Secretary Tommy Thompson with an accompanying white paper on billing, urging Medicare to relax federal regulations that the association says force hospitals to bill full charges to the poor (Dec. 22/29, 2003, p. 8).
In another move to bolster its image among members, the AHA recently unveiled a new logo that appears on the association's Web site, news releases and all official association documents. The move is reminiscent of a similar one by the American Medical Association in 1991, when the AMA attempted to improve its image by defanging and cutting off the tongue of the serpent in its old logo.
The AHA ditched its old logo, which had a bold "AHA" followed by the slogan, "Advancing Health in America," for a more colorful image that spells out American Hospital Association under red and white waves that represent an American flag. A blue and white "H," the official highway designation for hospital, is the dominant feature in the new logo.
Discussions about changing the design began last summer as AHA executives heard members say the logo was confusing because it did not spell out the association's full name, Wade said. Instead, members were left wondering whether AHA was short for the phrase Advancing Health in America.
"When this was done before in 1998, we wanted to blend the old logo with the seal," Wade said. " `Advancing Health in America' caught the mission statement."
Now, the AHA is capitalizing on its core competency of being the voice for the nation's hospitals, Fell said.
"We came up with something simpler and less complicated," Wade said. "When people look at the blue-and-white H, there is no question" that the image represents hospitals.
The AHA paid $60,000 to Monigle Associates, a firm that specializes in brand strategy and corporate identity and has worked with more than 200 clients in healthcare, including Ascension Health and Banner Health System.
"This delivers a crystal-clear message that they are about hospitals and about America," said Rick Jacobs, principal at Monigle, who worked with AHA executives on the logo change. "There was room for some confusion. Their desire was to be very clear and concise."
Old logo confusing
Other organization logos, such as the American Humane Association, led to confusion among hospital members, Jacobs said. "It's alphabet soup out there. This movement is a reflection on what a lot of organizations are doing," he said. "Organizations are looking to more clearly communicate."
The change also represents a shift in philosophy at the AHA, said Fell, the healthcare marketing expert. When the AHA designed its "Advancing Health in America" logo in its 1998 centennial year, the healthcare industry was moving into an era of integrated delivery networks in which hospitals promoted themselves as offering more than basic hospital services, he said. Hospitals have now shifted their marketing focus and are promoting themselves as community hospitals.
"Historically, the AHA has probably not been as aggressive with their branding efforts," Fell said. "They have not been as quick and aggressive as they could be. Your logo has tremendous value because it grows your marketing presence whenever it is used."
Wade said the AHA has received "very positive" responses to the new logo from hospital members who first saw the change when visiting the association in Washington. The association unveiled the logo at the beginning of the year without a lot of fanfare because the AHA did not view the move as a significant change, he said.
AHA members said the image branding campaign is a good move, especially during an election season when healthcare could be a big public policy debate. A new image could change the public's perception of hospitals and healthcare costs, members said.
Hospitals will benefit because legislators will be more likely to support healthcare initiatives if they believe spending produces tangible results, said Touro Infirmary's Stein.
"If the government can have a more balanced view with cost benefits, it will allow us to have a more knowledgeable discussion," Stein said. "This is an attempt to put more balance in the discussion."
The change in the AHA logo and a push to publicize the returns on healthcare spending will attract attention at the Capitol and solidify the association's function as an advocate for hospitals, said Paul Spaude, president and CEO of 215-bed Wausau (Wis.) Hospital.
"The AHA needs to do whatever it needs to do to keep our message in front of the nation's leaders," Spaude said. "Organizations periodically need to stay contemporary and freshen their look if that is what it takes to maintain their credibility and message."
Hospital executives and industry experts will be watching the AHA's efforts to see if the association gets its message across.
"If you don't see legislators coming after hospitals on costs, they probably got their money's worth," Blendon said.
-with Jeff Tieman
What do you think?
Write us with your comments. Via e-mail, it?s [email protected]; through the Web, use modernhealthcare.com; by fax, 312-280-3183; or through the mail, Modern Healthcare, Letters to the Editor, 360 N. Michigan Ave., Chicago, Ill. 60601.