By Kriste Goad, NAMA member
What does a hospital system do when it knows it’s headed toward potentially difficult negotiations with its insurer partners? It gets creative and enlists its community.
Hartford HealthCare (HHC), a four-hospital system based in Hartford, Connecticut, needed a strategy to educate employers, business leaders, health insurance brokers, community influencers, and elected officials about its payor contracting strategy. HHC was preparing for contract negotiations with five different health plans, the largest being Anthem Blue Cross Blue Shield of Connecticut, which held 55% of the state’s market share.
Those five different health plans represented nearly 100% of the organization’s revenue from commercial health insurance, and to renegotiate these contracts in a brief period, HHC needed to build community support to strengthen its position. At the time, HHC was also in the process of buying another community hospital and in negotiations with the State for a public-private partnership to establish Hartford Hospital, its flagship institution, as the primary teaching hospital for the University of Connecticut. HHC needed a thoughtful, organized approach to avoid the heavy public criticism and the market disruption of going out of network with any one of the health plans, especially Anthem.
HHC enlisted the aid of Nashville’s ReviveHealth to develop and execute a communications campaign that:
- Educated the community on key health care finance and quality issues, including HHC’s need for fair payment from health plans.
- Achieved better rates and contract terms with health plans that showed resolve in the community and avoided an out-of-network crisis situation.
Through targeted and carefully nuanced communications, ReviveHealth positioned HHC to directly engage patients, employers, and business leaders to participate in the campaign for a new contract with Anthem Blue Cross Blue Shield of Connecticut, a contract essential to the system’s financial health. This collective call to action prompted thousands of supporters to send emails and letters to Anthem’s President, who walked into a negotiations meeting with his customers’ concerns in hand. The strategy united the health system with its constituents and motivated the health plan to sign a contract, prior to the previous contract’s expiration, that met HHC’s and the community’s needs.
ReviveHealth engaged in a comprehensive, integrated campaign that focused on HHC hospital CEOs and members of the Board, internal audiences (employed physicians, referring physicians, administrators and employees), community stakeholders (employers, brokers, and thought leaders), patients, and local media. After the initial outreach to patients, ReviveHealth was able to identify a group of nearly 2,500 core supporters through response vehicles such as reply cards, email, website, and phone calls. This group of patient supporters became the target audience for the remainder of the campaign. Care was taken to begin communicating with all audiences prior to the heat of the Anthem negotiations, nuancing the messages contained in our outreach to meet the specific interests of each audience, and to set the agenda of debate early in the process. As the intensity of negotiations with Anthem picked up, so did the frequency of the communication with all audiences, which ensured that they remained informed, engaged, and could trust us to provide them with the latest information.
ReviveHealth started with qualitative research among employers, brokers, and community leaders in each of the HHC markets to determine key issues, pressure points, and what these groups wanted from their local hospitals. The research findings provided the foundation for the “Solid Foundation” campaign.
Over the course of 18 months, ReviveHealth worked with HHC to educate internal and external audiences (employers, brokers, community leaders, and the media) about key issues facing HHC’s hospitals, including HHC’s need for fair payment from private payors after years of underpayment and the importance of “Solid Foundation” messages. This long-term education campaign set the stage for the Anthem negotiations, which we knew would be difficult given their size and power in the market. It was particularly critical to leverage support from the business community. If employers pressured Anthem on behalf of Hartford HealthCare to stay in-network by moving business, and brokers communicated that the market was in turmoil, Anthem would see the importance of having HHC hospitals in-network.
The greatest strategic problem was the possibility of several public fights with payors given the size of the rate increases that were required to recalibrate the contracts according to industry benchmarks. When Anthem is 55% of any hospital’s commercial revenue – and that contract was the last in a string of five to be negotiated in a short time frame – any rate increase is going to invite trouble. HHC had to plan for the worst-case scenario and then execute its plan in a disciplined way.
Each hospital in the HHC system serves different communities and patient populations, so we ensured that our campaign had clearly-defined audience segments with distinct messages that conveyed the negotiations’ impact at the individual level. It was important that we stayed in front of the issue. By predicting Anthem’s movements and reactions, we were able to develop and distribute messages that inoculated against Anthem attacks and kept them on their heels through the course of negotiations. We knew the public battle would be ugly given the sheer size and power of an Anthem plan.
To prepare them to act as ambassadors, hospital board members, executives and physicians were guided on negotiations every step along the way. Physicians also received weekly faxes, emails, and FAQs to communicate with patients and direct them to information sources developed specifically for them: a hotline, office handouts, sample letters, and response cards to directly receive negotiation updates.
Letters, call campaigns, and meetings with employers and brokers regarding negotiations were conducted and included presentations, fact books, and testimonials on the “Solid Foundation” initiative. A website provided information on the initiative and negotiation updates, and enabled visitors to sign up in support of HHC as well as contact Anthem.
Anthem patients were contacted through letters and calls to explain the genesis of negotiations. With response cards and follow-up calls, this audience could ask questions and receive information, including negotiations fact sheets, potential patient impact, and direction on access to care if a contract termination occurred).
We prepared a standby statement in case Anthem attacked through media, along with a Q&A, Op-Eds from physicians, Letters to the Editor, social media content and print advertisements, all aimed at reassuring the community and allaying fears.
Two days before out-of-network status would have become a reality for tens of thousands of Anthem members accessing HHC hospitals (and 13% of Hartford’s total revenue risk), the president of Anthem Blue Cross Blue Shield of Connecticut walked into a negotiations meeting carrying thousands of printed emails and letters from patients and employers that he had recently received. The efforts with HHC had proven fruitful: concerned patients and employers had been mobilized to action. The meeting ended with a signed contract from Anthem that met HHC’s financial needs.
The following spring, we conducted a public opinion survey to measure perception and reputation of HHC hospitals once the dust settled from the Anthem negotiations. We tested everything from the cost of care at our hospitals to specialists provided, quality of care, and what people remembered from the Anthem negotiations. The results were very favorable toward HHC hospitals. It was clear that the negotiations were no longer a primary concern and that we successfully thwarted the negative attacks by Anthem.
Lastly, the Solid Foundation campaign has become an important part of HHC’s ongoing strategy, serving as both a demonstration of Hartford’s commitment to transparency and frequent communication as well as the vehicle to provide regular progress updates to the community. HHC described it this way: “The Solid Foundation strategy is a major endeavor by Hartford Healthcare to further its commitment to quality healthcare through strengthening its solid financial foundation, including: further reducing costs through process improvement; creating new economies of scale; continuing its cost savings initiatives without sacrificing quality or diminishing programs; and negotiating new contracts with all major managed care companies.”
In a press release the following year, HHC announced that because of its Solid Foundation strategy, “For the first time in nearly a decade, Hartford Hospital operated in the black. The system overall is working toward an operating margin of 1% to 2% to allow for reinvestment in new technologies, the modernization of facilities, and improved access to critical care for the community. All of these important investments require a Solid Foundation that is supported by more efficient operations, carefully targeted process improvement, and fair payment from managed care companies.”