©2013 The Advisory Board Company • advisory.com Finding New Value in CRM Building Loyalty and Managing Population Health Marketing and Planning Leadership Council
copy2013 The Advisory Board Company bull advisorycom
Finding New Value in CRM Building Loyalty and Managing Population Health
Marketing and Planning
Leadership Council
copy2013 The Advisory Board Company bull 28008 advisorycom
LEGAL CAVEAT
The Advisory Board Company has made efforts to verify the accuracy of the information it provides to members This
report relies on data obtained from many sources however and The Advisory Board Company cannot guarantee the
accuracy of the information provided or any analysis based thereon In addition The Advisory Board Company is not in
the business of giving legal medical accounting or other professional advice and its reports should not be construed as
professional advice In particular members should not rely on any legal commentary in this report as a basis for action or
assume that any tactics described herein would be permitted by applicable law or appropriate for a given memberrsquos
situation Members are advised to consult with appropriate professionals concerning legal medical tax or accounting
issues before implementing any of these tactics Neither The Advisory Board Company nor its officers directors
trustees employees and agents shall be liable for any claims liabilities or expenses relating to (a) any errors or
omissions in this report whether caused by The Advisory Board Company or any of its employees or agents or sources
or other third parties (b) any recommendation or graded ranking by The Advisory Board Company or (c) failure of
member and its employees and agents to abide by the terms set forth herein
The Advisory Board is a registered trademark of The Advisory Board Company in the United States and other countries
Members are not permitted to use this trademark or any other Advisory Board trademark product name service name
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Advisory Board Company is not affiliated with any such company
IMPORTANT Please read the following
The Advisory Board Company has prepared this report for the exclusive use of its members Each member acknowledges and
agrees that this report and the information contained herein (collectively the ldquoReportrdquo) are confidential and proprietary to The
Advisory Board Company By accepting delivery of this Report each member agrees to abide by the terms as stated herein
including the following
1 The Advisory Board Company owns all right title and interest in and to this Report Except as stated herein no right license
permission or interest of any kind in this Report is intended to be given transferred to or acquired by a member Each member
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2 Each member shall not sell license or republish this Report Each member shall not disseminate or permit the use of and
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5 Each member is responsible for any breach of its obligations as stated herein by any of its employees or agents
6 If a member is unwilling to abide by any of the foregoing obligations then such member shall promptly return this Report and
all copies thereof to The Advisory Board Company
2
Project Director
Anna Yakovenko
Contributing Consultant
Emily Zuehlke
Design Consultant
Nini Jin
Practice Manager
Alicia Daugherty
Marketing and Planning Leadership Council
Managing Director
Shay Pratt
copy2013 The Advisory Board Company bull 28008 advisorycom 3
Table of Contents
Executive Summary 7
Marketing Goals Expanding Under Population Health 9
Refining Segmentation Parameters 15
Customizing Content and Modality 23
Pinpointing Delivery Opportunities 33
copy2013 The Advisory Board Company bull 28008 advisorycom 4
The Marketing and Planning
Leadership Council has developed
numerous resources to help marketing
leaders develop successful consumer
marketing strategies All of these
resources are available in unlimited
quantities through your Marketing and
Planning Leadership Council
membership
To Order via Advisorycom
To order copies of these and other Marketing and Planning Leadership Council
presentations please visit our website advisorycommplcpublications
Available Within Your Marketing and Planning Leadership Council Membership
Capturing ROI on Social
Media Outreach
Webconference details new metrics for
evaluating social mediarsquos impact on
population health management goals
and profiles how leading organizations
are elevating social media ROI
Marketing 2020
Webconference covering the new risks
rules and roles facing marketing
departments as a result of new payment
models demographic changes
increased physician employment and
shifting referral streams
Representative Resources for Consumer Marketing
Engaging Patients in Primary Care
Publication outlining strategies for
using marketing techniques to build
patient loyalty and care compliance
Precision Marketing
Guide compiling resources for
targeting tailoring and measuring ROI
of consumer outreach best practices
Marketing Primary Care
Publication exploring how to raise
patient awareness of primary care by
elevating facility and provider visibility
streamlining access points and
highlighting care quality and service
Case Studies of CRM
Implementation Use and ROI
Brief offering representative case
studies that profile the efforts of
progressive providers to overcome
implementation hurdles and adopt
best practices to establish marketing
ROI utilizing CRM systems
copy2013 The Advisory Board Company bull 28008 advisorycom
In addition to the resources available
through the Marketing and Planning
Leadership Council membership The
Advisory Board Company offers
Crimson Market Advantage
Crimson Market Advantage leverages
total market visibility to strategically
drive referral-based growth
strengthen physician loyalty and
improve physician alignment
5
Beyond the Marketing and Planning Leadership Council Crimson Market Advantage
Contact Us
For more information on how you can
use total market visibility to improve
physician referral management at your
hospital or health system please visit
our website advisorycomtechnology
crimson-market-advantage
Or email us at crimsonadvisorycom
Case Study Using Referral Analytics to Drive a $5M+ Growth Initiative
bull Two-hospital market in the Northeast
bull Hospital ldquoArdquo invested in a large liaison programmdash4 FTEs large marketing budget
bull Hospital ldquoBrdquo focused on data and analytics working with a smaller outreach staff
Target
PCPs
Target
Splitters
Target
Employed
Physicians
Ancillary
Business
Growth
Target
$067M
$223M
$131M
$092M $513M Hospital Arsquos
growth projection
was flat while
Hospital B
developed an
18-month $5M+
referral-based
growth initiative
Crimson Market Advantage provides the technology expertise and staff to help identify the top-
referring PCPs and specialists in your market Grounded in best-practice research our business
intelligence technology solution quickly and accurately identifies potential sources of growth
bull Identify top growth opportunities at the individual physician level
bull Capitalize on total market visibility to achieve first-mover advantage within key service lines
physician groups and geographic regions
bull Investigate out-of-network referral chains to steer market expansion efforts
bull Quantitatively measure physician loyalty to manage essential relationships over time
Hospitals are leveraging our novel physician network analytics to
Expanding the Physician Referral Network
copy2013 The Advisory Board Company bull 28008 advisorycom 6
Advisors to Our Work
With Sincere Appreciation The Marketing and Planning
Leadership Council is grateful to the
individuals and organizations that
shared their insights analysis and
time with us We would especially like
to recognize the following individuals
for being particularly generous with
their time and expertise
Banner Health
Phoenix AZ
Michelle Witte
Cleveland Clinic
Cleveland OH
Paul Matsen
Sylvia Morrison
George Fay
Sunny Lu
Gundersen Health System
La Crosse WI
Pamela Maas
Indiana University Health Goshen
Goshen IN
Larry Brooks PhD
Deb Stacks
Kaweah Delta Health Care District
Visalia CA
Dru Quesnoy
Tea Leaves Health
Roswell GA
James Schleck
Vanguard Health Systems
Nashville TN
Devin Carty
Virtua
Marlton NJ
Jane Yepez
copy2013 The Advisory Board Company bull 28008 advisorycom 7
Executive Summary
Finding New Value in CRM
Source Marketing and Planning Leadership Council interviews and analysis
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health
Under risk-based reimbursement models providers face new goals of gaining and retaining patient loyalty delivering improved clinical outcomes for patients
and reducing total costs of care With their deep expertise in behavior change hospital and health system marketers are well positioned to support these new
goals through effective patient communications and education However driving patient engagementmdashboth cross-continuum loyalty and care compliancemdashwill
require a more persuasive responsive and efficient outreach approach To facilitate this personalization and efficiency marketers are turning to Customer
Relationship Management (CRM) systems to elicit stronger patient response rates resulting in improved patient engagement and loyalty Still to be effective
even those providers who already use a CRM system must make significant changes in their CRM strategy The following nine tactics outline how progressive
institutions have adapted their CRM-enabled strategy to hone patient targeting enhance message tailoring and automate communication timing to reach care
management goals and show returns in both fee-for-service and risk-based reimbursement environments
1 Identify patients under risk-based reimbursement for care
management messaging All providers assume some financial risk for a
subset of their patient pool such as hospital employees uninsured patients
or ACO participants Identifying these individuals with CRM systems allows
marketers to target the groups whose health outcomes affect reimbursement
for care management messaging
2 Segment the patient pool by health risk status to help prevent risk
escalation CRM systems can use clinical and consumer data to target
rising-risk patients for enhanced primary care and low-risk patients for
preventive care services to reduce risk factors for both groups
3 Target household health managers to incite action Many families
have a designated health care decision makermdashoften the oldest femalemdash
who can influence behavior change on a household level CRM systems can
track and adapt to changes in decision-maker status and create customized
messages for the family group
4 Personalize communications using psychographic variables to
improve response rates CRM systemsrsquo ability to automate tailoring of
message content and style on an individual level creates psychographically
and demographically relevant materials to which patients are more likely to
connect and respond
5 Tailor perceived sender to leverage physician relationships and
brand equity Some providers have found that communications sent from
clinicians instead of the hospital increases patient compliance with a
message CRM systems can match patients to their physicians to customize
outreach
6 Communicate with patients through their preferred channel to
increase receipt rates and gather additional data As patient attention
continues to shift toward digital platforms CRM systems can predict and
track patientsrsquo communication channel preferences ensuring that messages
are sent through the channelmdashbe it email text print mail Facebook or other
expanding modalitiesmdashor channels that a patient is most apt to check
increasing receipt and response rates
7 Automate responsive messaging to reinforce or reform an
individualrsquos health-based behavior CRM algorithms can enable
immediate responses to time-sensitive behavior-based triggers By
recognizing a wide range of patient actions this CRM function enables
marketing departments to encourage or modify patient behavior
8 Track care pathways to automate timely communication and care
management By predicting a patientrsquos care trajectory CRM systems can
send critical care management reminders at preset clinically-based trigger
points to keep patients engaged
9 Reactivate lapsed patients to maintain engagement and minimize
reimbursement risk CRM systems can track time since a patientrsquos last
system activity and generate automatic reminders for patients who have
disengaged
copy2013 The Advisory Board Company bull 28008 advisorycom 8
copy2013 The Advisory Board Company bull 28008 advisorycom 9
Marketing Goals Expanding Under Population Health
copy2013 The Advisory Board Company bull 28008 advisorycom 10
Providers Seeking Marketersrsquo Support in Population Management
With the shift to value-based
reimbursement models providers are
re-evaluating their marketing goals
and underlying strategies Rather than
focusing predominately on increasing
volumes for high-margin primarily
inpatient procedures progressive
organizations are charging their
marketing departments with growing
and retaining population share and
supporting organization-wide
population health goals
Accordingly marketing departments
will increasingly be asked to leverage
their behavior change expertise to
support appropriate utilization
enhance patient engagement and
reduce cost of care
Marketing Goals Expanding Under Value-Based Competition
Source Marketing and Planning Leadership Council interviews and analysis
Grow Revenue
bull Drive latent demand for most
profitable procedures
bull Position institution as first
choice provider for procedural
volumes among commercially
insured populations
bull Help patients navigate within
service line to protect referral
chains and build loyalty
Support Population Management
bull Discourage inappropriate facility
utilization
bull Prevent avoidable acute care
utilization
bull Identify and target at-risk
patients for care management
bull Improve engagement
bull Support patient self-
management
ldquoWe think that it will be so much more valuable for us as an enterprise to do both
marketing and care management together We donrsquot want to create the isolated
function of marketing anymore Itrsquos not a good return on our investment in our minds
We want to become overall care managers in the continuumrdquo
VP Marketing and Outreach
Health System in the South
rdquo
Increase Population Share
bull Drive primary care utilization for
patient panel attribution share
capture and share protection
bull Help patients navigate full
continuum of care to build
loyalty
bull Build relationships with
employers
Fee-for-Service
Value-Based Competition
copy2013 The Advisory Board Company bull 28008 advisorycom 11
Communications Must Shift Across Multiple Attributes With these new goals aimed at
building loyalty and supporting
population health management
efforts marketers face a shifting set of
demands Rather than using outreach
to entice individuals to consume
specific high-margin services
marketing must educate and motivate
entire patient populations to engage in
health improvement and management
and care compliance
Accordingly communications must be
geared to care for patient populations
and promote coordination across the
care continuum and system offerings
Further with the need for complex
behavior change marketing materials
should become more persuasive and
accessible through a multitude of new
channels to encourage increased
patient involvement Finally
messaging must become more
frequent and be driven by patient
needs allowing marketers to provide
reinforcing communications that
prompt appropriate patient behavior
In turn these new demands
emphasize the need for outreach to
be even more coordinated efficient
persuasive accessible frequent and
responsive than ever before
New Goals Require More Direct Nuanced Outreach Approach
Source Marketing and Planning Leadership Council interviews and analysis
Marketing for
Volume Growth
Marketing for
Share and
Population
Management
Necessary
Outreach
Attributes
Coordinated
Multi-
Focus
Promote
services across
full care
continuum
service lines
and care sites
Single
Focus
Promote single
service or
service line
Expanded
Targets
Expand focus to
populations
Efficient
Narrow
Targets
Primarily target
new patients
with the ability
to pay
Call to
Change
Inspire complex
behavior
change
Persuasive
Call to
Action
Instigate simple
actions
Multi-
Channel
Send messages
through
patientsrsquo
preferred
channels to
ensure
adherence
Accessible
Single
Channel
Communicate
via one method
Ongoing
Contact
Sustain
ongoing regular
communication
to reinforce
message
Frequent
One-and-
Done
Conscribe
campaign
timing to
strategic plan
Patient
Driven
Base
communication
on both
strategic goals
and patientrsquos
individual needs
Responsive
Institution
Driven
Ground
campaigns on
strategic plan
goals
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom
LEGAL CAVEAT
The Advisory Board Company has made efforts to verify the accuracy of the information it provides to members This
report relies on data obtained from many sources however and The Advisory Board Company cannot guarantee the
accuracy of the information provided or any analysis based thereon In addition The Advisory Board Company is not in
the business of giving legal medical accounting or other professional advice and its reports should not be construed as
professional advice In particular members should not rely on any legal commentary in this report as a basis for action or
assume that any tactics described herein would be permitted by applicable law or appropriate for a given memberrsquos
situation Members are advised to consult with appropriate professionals concerning legal medical tax or accounting
issues before implementing any of these tactics Neither The Advisory Board Company nor its officers directors
trustees employees and agents shall be liable for any claims liabilities or expenses relating to (a) any errors or
omissions in this report whether caused by The Advisory Board Company or any of its employees or agents or sources
or other third parties (b) any recommendation or graded ranking by The Advisory Board Company or (c) failure of
member and its employees and agents to abide by the terms set forth herein
The Advisory Board is a registered trademark of The Advisory Board Company in the United States and other countries
Members are not permitted to use this trademark or any other Advisory Board trademark product name service name
trade name and logo without the prior written consent of The Advisory Board Company All other trademarks product
names service names trade names and logos used within these pages are the property of their respective holders Use
of other company trademarks product names service names trade names and logos or images of the same does not
necessarily constitute (a) an endorsement by such company of The Advisory Board Company and its products and
services or (b) an endorsement of the company or its products or services by The Advisory Board Company The
Advisory Board Company is not affiliated with any such company
IMPORTANT Please read the following
The Advisory Board Company has prepared this report for the exclusive use of its members Each member acknowledges and
agrees that this report and the information contained herein (collectively the ldquoReportrdquo) are confidential and proprietary to The
Advisory Board Company By accepting delivery of this Report each member agrees to abide by the terms as stated herein
including the following
1 The Advisory Board Company owns all right title and interest in and to this Report Except as stated herein no right license
permission or interest of any kind in this Report is intended to be given transferred to or acquired by a member Each member
is authorized to use this Report only to the extent expressly authorized herein
2 Each member shall not sell license or republish this Report Each member shall not disseminate or permit the use of and
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(except as stated below) or (b) any third party
3 Each member may make this Report available solely to those of its employees and agents who (a) are registered for the
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5 Each member is responsible for any breach of its obligations as stated herein by any of its employees or agents
6 If a member is unwilling to abide by any of the foregoing obligations then such member shall promptly return this Report and
all copies thereof to The Advisory Board Company
2
Project Director
Anna Yakovenko
Contributing Consultant
Emily Zuehlke
Design Consultant
Nini Jin
Practice Manager
Alicia Daugherty
Marketing and Planning Leadership Council
Managing Director
Shay Pratt
copy2013 The Advisory Board Company bull 28008 advisorycom 3
Table of Contents
Executive Summary 7
Marketing Goals Expanding Under Population Health 9
Refining Segmentation Parameters 15
Customizing Content and Modality 23
Pinpointing Delivery Opportunities 33
copy2013 The Advisory Board Company bull 28008 advisorycom 4
The Marketing and Planning
Leadership Council has developed
numerous resources to help marketing
leaders develop successful consumer
marketing strategies All of these
resources are available in unlimited
quantities through your Marketing and
Planning Leadership Council
membership
To Order via Advisorycom
To order copies of these and other Marketing and Planning Leadership Council
presentations please visit our website advisorycommplcpublications
Available Within Your Marketing and Planning Leadership Council Membership
Capturing ROI on Social
Media Outreach
Webconference details new metrics for
evaluating social mediarsquos impact on
population health management goals
and profiles how leading organizations
are elevating social media ROI
Marketing 2020
Webconference covering the new risks
rules and roles facing marketing
departments as a result of new payment
models demographic changes
increased physician employment and
shifting referral streams
Representative Resources for Consumer Marketing
Engaging Patients in Primary Care
Publication outlining strategies for
using marketing techniques to build
patient loyalty and care compliance
Precision Marketing
Guide compiling resources for
targeting tailoring and measuring ROI
of consumer outreach best practices
Marketing Primary Care
Publication exploring how to raise
patient awareness of primary care by
elevating facility and provider visibility
streamlining access points and
highlighting care quality and service
Case Studies of CRM
Implementation Use and ROI
Brief offering representative case
studies that profile the efforts of
progressive providers to overcome
implementation hurdles and adopt
best practices to establish marketing
ROI utilizing CRM systems
copy2013 The Advisory Board Company bull 28008 advisorycom
In addition to the resources available
through the Marketing and Planning
Leadership Council membership The
Advisory Board Company offers
Crimson Market Advantage
Crimson Market Advantage leverages
total market visibility to strategically
drive referral-based growth
strengthen physician loyalty and
improve physician alignment
5
Beyond the Marketing and Planning Leadership Council Crimson Market Advantage
Contact Us
For more information on how you can
use total market visibility to improve
physician referral management at your
hospital or health system please visit
our website advisorycomtechnology
crimson-market-advantage
Or email us at crimsonadvisorycom
Case Study Using Referral Analytics to Drive a $5M+ Growth Initiative
bull Two-hospital market in the Northeast
bull Hospital ldquoArdquo invested in a large liaison programmdash4 FTEs large marketing budget
bull Hospital ldquoBrdquo focused on data and analytics working with a smaller outreach staff
Target
PCPs
Target
Splitters
Target
Employed
Physicians
Ancillary
Business
Growth
Target
$067M
$223M
$131M
$092M $513M Hospital Arsquos
growth projection
was flat while
Hospital B
developed an
18-month $5M+
referral-based
growth initiative
Crimson Market Advantage provides the technology expertise and staff to help identify the top-
referring PCPs and specialists in your market Grounded in best-practice research our business
intelligence technology solution quickly and accurately identifies potential sources of growth
bull Identify top growth opportunities at the individual physician level
bull Capitalize on total market visibility to achieve first-mover advantage within key service lines
physician groups and geographic regions
bull Investigate out-of-network referral chains to steer market expansion efforts
bull Quantitatively measure physician loyalty to manage essential relationships over time
Hospitals are leveraging our novel physician network analytics to
Expanding the Physician Referral Network
copy2013 The Advisory Board Company bull 28008 advisorycom 6
Advisors to Our Work
With Sincere Appreciation The Marketing and Planning
Leadership Council is grateful to the
individuals and organizations that
shared their insights analysis and
time with us We would especially like
to recognize the following individuals
for being particularly generous with
their time and expertise
Banner Health
Phoenix AZ
Michelle Witte
Cleveland Clinic
Cleveland OH
Paul Matsen
Sylvia Morrison
George Fay
Sunny Lu
Gundersen Health System
La Crosse WI
Pamela Maas
Indiana University Health Goshen
Goshen IN
Larry Brooks PhD
Deb Stacks
Kaweah Delta Health Care District
Visalia CA
Dru Quesnoy
Tea Leaves Health
Roswell GA
James Schleck
Vanguard Health Systems
Nashville TN
Devin Carty
Virtua
Marlton NJ
Jane Yepez
copy2013 The Advisory Board Company bull 28008 advisorycom 7
Executive Summary
Finding New Value in CRM
Source Marketing and Planning Leadership Council interviews and analysis
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health
Under risk-based reimbursement models providers face new goals of gaining and retaining patient loyalty delivering improved clinical outcomes for patients
and reducing total costs of care With their deep expertise in behavior change hospital and health system marketers are well positioned to support these new
goals through effective patient communications and education However driving patient engagementmdashboth cross-continuum loyalty and care compliancemdashwill
require a more persuasive responsive and efficient outreach approach To facilitate this personalization and efficiency marketers are turning to Customer
Relationship Management (CRM) systems to elicit stronger patient response rates resulting in improved patient engagement and loyalty Still to be effective
even those providers who already use a CRM system must make significant changes in their CRM strategy The following nine tactics outline how progressive
institutions have adapted their CRM-enabled strategy to hone patient targeting enhance message tailoring and automate communication timing to reach care
management goals and show returns in both fee-for-service and risk-based reimbursement environments
1 Identify patients under risk-based reimbursement for care
management messaging All providers assume some financial risk for a
subset of their patient pool such as hospital employees uninsured patients
or ACO participants Identifying these individuals with CRM systems allows
marketers to target the groups whose health outcomes affect reimbursement
for care management messaging
2 Segment the patient pool by health risk status to help prevent risk
escalation CRM systems can use clinical and consumer data to target
rising-risk patients for enhanced primary care and low-risk patients for
preventive care services to reduce risk factors for both groups
3 Target household health managers to incite action Many families
have a designated health care decision makermdashoften the oldest femalemdash
who can influence behavior change on a household level CRM systems can
track and adapt to changes in decision-maker status and create customized
messages for the family group
4 Personalize communications using psychographic variables to
improve response rates CRM systemsrsquo ability to automate tailoring of
message content and style on an individual level creates psychographically
and demographically relevant materials to which patients are more likely to
connect and respond
5 Tailor perceived sender to leverage physician relationships and
brand equity Some providers have found that communications sent from
clinicians instead of the hospital increases patient compliance with a
message CRM systems can match patients to their physicians to customize
outreach
6 Communicate with patients through their preferred channel to
increase receipt rates and gather additional data As patient attention
continues to shift toward digital platforms CRM systems can predict and
track patientsrsquo communication channel preferences ensuring that messages
are sent through the channelmdashbe it email text print mail Facebook or other
expanding modalitiesmdashor channels that a patient is most apt to check
increasing receipt and response rates
7 Automate responsive messaging to reinforce or reform an
individualrsquos health-based behavior CRM algorithms can enable
immediate responses to time-sensitive behavior-based triggers By
recognizing a wide range of patient actions this CRM function enables
marketing departments to encourage or modify patient behavior
8 Track care pathways to automate timely communication and care
management By predicting a patientrsquos care trajectory CRM systems can
send critical care management reminders at preset clinically-based trigger
points to keep patients engaged
9 Reactivate lapsed patients to maintain engagement and minimize
reimbursement risk CRM systems can track time since a patientrsquos last
system activity and generate automatic reminders for patients who have
disengaged
copy2013 The Advisory Board Company bull 28008 advisorycom 8
copy2013 The Advisory Board Company bull 28008 advisorycom 9
Marketing Goals Expanding Under Population Health
copy2013 The Advisory Board Company bull 28008 advisorycom 10
Providers Seeking Marketersrsquo Support in Population Management
With the shift to value-based
reimbursement models providers are
re-evaluating their marketing goals
and underlying strategies Rather than
focusing predominately on increasing
volumes for high-margin primarily
inpatient procedures progressive
organizations are charging their
marketing departments with growing
and retaining population share and
supporting organization-wide
population health goals
Accordingly marketing departments
will increasingly be asked to leverage
their behavior change expertise to
support appropriate utilization
enhance patient engagement and
reduce cost of care
Marketing Goals Expanding Under Value-Based Competition
Source Marketing and Planning Leadership Council interviews and analysis
Grow Revenue
bull Drive latent demand for most
profitable procedures
bull Position institution as first
choice provider for procedural
volumes among commercially
insured populations
bull Help patients navigate within
service line to protect referral
chains and build loyalty
Support Population Management
bull Discourage inappropriate facility
utilization
bull Prevent avoidable acute care
utilization
bull Identify and target at-risk
patients for care management
bull Improve engagement
bull Support patient self-
management
ldquoWe think that it will be so much more valuable for us as an enterprise to do both
marketing and care management together We donrsquot want to create the isolated
function of marketing anymore Itrsquos not a good return on our investment in our minds
We want to become overall care managers in the continuumrdquo
VP Marketing and Outreach
Health System in the South
rdquo
Increase Population Share
bull Drive primary care utilization for
patient panel attribution share
capture and share protection
bull Help patients navigate full
continuum of care to build
loyalty
bull Build relationships with
employers
Fee-for-Service
Value-Based Competition
copy2013 The Advisory Board Company bull 28008 advisorycom 11
Communications Must Shift Across Multiple Attributes With these new goals aimed at
building loyalty and supporting
population health management
efforts marketers face a shifting set of
demands Rather than using outreach
to entice individuals to consume
specific high-margin services
marketing must educate and motivate
entire patient populations to engage in
health improvement and management
and care compliance
Accordingly communications must be
geared to care for patient populations
and promote coordination across the
care continuum and system offerings
Further with the need for complex
behavior change marketing materials
should become more persuasive and
accessible through a multitude of new
channels to encourage increased
patient involvement Finally
messaging must become more
frequent and be driven by patient
needs allowing marketers to provide
reinforcing communications that
prompt appropriate patient behavior
In turn these new demands
emphasize the need for outreach to
be even more coordinated efficient
persuasive accessible frequent and
responsive than ever before
New Goals Require More Direct Nuanced Outreach Approach
Source Marketing and Planning Leadership Council interviews and analysis
Marketing for
Volume Growth
Marketing for
Share and
Population
Management
Necessary
Outreach
Attributes
Coordinated
Multi-
Focus
Promote
services across
full care
continuum
service lines
and care sites
Single
Focus
Promote single
service or
service line
Expanded
Targets
Expand focus to
populations
Efficient
Narrow
Targets
Primarily target
new patients
with the ability
to pay
Call to
Change
Inspire complex
behavior
change
Persuasive
Call to
Action
Instigate simple
actions
Multi-
Channel
Send messages
through
patientsrsquo
preferred
channels to
ensure
adherence
Accessible
Single
Channel
Communicate
via one method
Ongoing
Contact
Sustain
ongoing regular
communication
to reinforce
message
Frequent
One-and-
Done
Conscribe
campaign
timing to
strategic plan
Patient
Driven
Base
communication
on both
strategic goals
and patientrsquos
individual needs
Responsive
Institution
Driven
Ground
campaigns on
strategic plan
goals
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 3
Table of Contents
Executive Summary 7
Marketing Goals Expanding Under Population Health 9
Refining Segmentation Parameters 15
Customizing Content and Modality 23
Pinpointing Delivery Opportunities 33
copy2013 The Advisory Board Company bull 28008 advisorycom 4
The Marketing and Planning
Leadership Council has developed
numerous resources to help marketing
leaders develop successful consumer
marketing strategies All of these
resources are available in unlimited
quantities through your Marketing and
Planning Leadership Council
membership
To Order via Advisorycom
To order copies of these and other Marketing and Planning Leadership Council
presentations please visit our website advisorycommplcpublications
Available Within Your Marketing and Planning Leadership Council Membership
Capturing ROI on Social
Media Outreach
Webconference details new metrics for
evaluating social mediarsquos impact on
population health management goals
and profiles how leading organizations
are elevating social media ROI
Marketing 2020
Webconference covering the new risks
rules and roles facing marketing
departments as a result of new payment
models demographic changes
increased physician employment and
shifting referral streams
Representative Resources for Consumer Marketing
Engaging Patients in Primary Care
Publication outlining strategies for
using marketing techniques to build
patient loyalty and care compliance
Precision Marketing
Guide compiling resources for
targeting tailoring and measuring ROI
of consumer outreach best practices
Marketing Primary Care
Publication exploring how to raise
patient awareness of primary care by
elevating facility and provider visibility
streamlining access points and
highlighting care quality and service
Case Studies of CRM
Implementation Use and ROI
Brief offering representative case
studies that profile the efforts of
progressive providers to overcome
implementation hurdles and adopt
best practices to establish marketing
ROI utilizing CRM systems
copy2013 The Advisory Board Company bull 28008 advisorycom
In addition to the resources available
through the Marketing and Planning
Leadership Council membership The
Advisory Board Company offers
Crimson Market Advantage
Crimson Market Advantage leverages
total market visibility to strategically
drive referral-based growth
strengthen physician loyalty and
improve physician alignment
5
Beyond the Marketing and Planning Leadership Council Crimson Market Advantage
Contact Us
For more information on how you can
use total market visibility to improve
physician referral management at your
hospital or health system please visit
our website advisorycomtechnology
crimson-market-advantage
Or email us at crimsonadvisorycom
Case Study Using Referral Analytics to Drive a $5M+ Growth Initiative
bull Two-hospital market in the Northeast
bull Hospital ldquoArdquo invested in a large liaison programmdash4 FTEs large marketing budget
bull Hospital ldquoBrdquo focused on data and analytics working with a smaller outreach staff
Target
PCPs
Target
Splitters
Target
Employed
Physicians
Ancillary
Business
Growth
Target
$067M
$223M
$131M
$092M $513M Hospital Arsquos
growth projection
was flat while
Hospital B
developed an
18-month $5M+
referral-based
growth initiative
Crimson Market Advantage provides the technology expertise and staff to help identify the top-
referring PCPs and specialists in your market Grounded in best-practice research our business
intelligence technology solution quickly and accurately identifies potential sources of growth
bull Identify top growth opportunities at the individual physician level
bull Capitalize on total market visibility to achieve first-mover advantage within key service lines
physician groups and geographic regions
bull Investigate out-of-network referral chains to steer market expansion efforts
bull Quantitatively measure physician loyalty to manage essential relationships over time
Hospitals are leveraging our novel physician network analytics to
Expanding the Physician Referral Network
copy2013 The Advisory Board Company bull 28008 advisorycom 6
Advisors to Our Work
With Sincere Appreciation The Marketing and Planning
Leadership Council is grateful to the
individuals and organizations that
shared their insights analysis and
time with us We would especially like
to recognize the following individuals
for being particularly generous with
their time and expertise
Banner Health
Phoenix AZ
Michelle Witte
Cleveland Clinic
Cleveland OH
Paul Matsen
Sylvia Morrison
George Fay
Sunny Lu
Gundersen Health System
La Crosse WI
Pamela Maas
Indiana University Health Goshen
Goshen IN
Larry Brooks PhD
Deb Stacks
Kaweah Delta Health Care District
Visalia CA
Dru Quesnoy
Tea Leaves Health
Roswell GA
James Schleck
Vanguard Health Systems
Nashville TN
Devin Carty
Virtua
Marlton NJ
Jane Yepez
copy2013 The Advisory Board Company bull 28008 advisorycom 7
Executive Summary
Finding New Value in CRM
Source Marketing and Planning Leadership Council interviews and analysis
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health
Under risk-based reimbursement models providers face new goals of gaining and retaining patient loyalty delivering improved clinical outcomes for patients
and reducing total costs of care With their deep expertise in behavior change hospital and health system marketers are well positioned to support these new
goals through effective patient communications and education However driving patient engagementmdashboth cross-continuum loyalty and care compliancemdashwill
require a more persuasive responsive and efficient outreach approach To facilitate this personalization and efficiency marketers are turning to Customer
Relationship Management (CRM) systems to elicit stronger patient response rates resulting in improved patient engagement and loyalty Still to be effective
even those providers who already use a CRM system must make significant changes in their CRM strategy The following nine tactics outline how progressive
institutions have adapted their CRM-enabled strategy to hone patient targeting enhance message tailoring and automate communication timing to reach care
management goals and show returns in both fee-for-service and risk-based reimbursement environments
1 Identify patients under risk-based reimbursement for care
management messaging All providers assume some financial risk for a
subset of their patient pool such as hospital employees uninsured patients
or ACO participants Identifying these individuals with CRM systems allows
marketers to target the groups whose health outcomes affect reimbursement
for care management messaging
2 Segment the patient pool by health risk status to help prevent risk
escalation CRM systems can use clinical and consumer data to target
rising-risk patients for enhanced primary care and low-risk patients for
preventive care services to reduce risk factors for both groups
3 Target household health managers to incite action Many families
have a designated health care decision makermdashoften the oldest femalemdash
who can influence behavior change on a household level CRM systems can
track and adapt to changes in decision-maker status and create customized
messages for the family group
4 Personalize communications using psychographic variables to
improve response rates CRM systemsrsquo ability to automate tailoring of
message content and style on an individual level creates psychographically
and demographically relevant materials to which patients are more likely to
connect and respond
5 Tailor perceived sender to leverage physician relationships and
brand equity Some providers have found that communications sent from
clinicians instead of the hospital increases patient compliance with a
message CRM systems can match patients to their physicians to customize
outreach
6 Communicate with patients through their preferred channel to
increase receipt rates and gather additional data As patient attention
continues to shift toward digital platforms CRM systems can predict and
track patientsrsquo communication channel preferences ensuring that messages
are sent through the channelmdashbe it email text print mail Facebook or other
expanding modalitiesmdashor channels that a patient is most apt to check
increasing receipt and response rates
7 Automate responsive messaging to reinforce or reform an
individualrsquos health-based behavior CRM algorithms can enable
immediate responses to time-sensitive behavior-based triggers By
recognizing a wide range of patient actions this CRM function enables
marketing departments to encourage or modify patient behavior
8 Track care pathways to automate timely communication and care
management By predicting a patientrsquos care trajectory CRM systems can
send critical care management reminders at preset clinically-based trigger
points to keep patients engaged
9 Reactivate lapsed patients to maintain engagement and minimize
reimbursement risk CRM systems can track time since a patientrsquos last
system activity and generate automatic reminders for patients who have
disengaged
copy2013 The Advisory Board Company bull 28008 advisorycom 8
copy2013 The Advisory Board Company bull 28008 advisorycom 9
Marketing Goals Expanding Under Population Health
copy2013 The Advisory Board Company bull 28008 advisorycom 10
Providers Seeking Marketersrsquo Support in Population Management
With the shift to value-based
reimbursement models providers are
re-evaluating their marketing goals
and underlying strategies Rather than
focusing predominately on increasing
volumes for high-margin primarily
inpatient procedures progressive
organizations are charging their
marketing departments with growing
and retaining population share and
supporting organization-wide
population health goals
Accordingly marketing departments
will increasingly be asked to leverage
their behavior change expertise to
support appropriate utilization
enhance patient engagement and
reduce cost of care
Marketing Goals Expanding Under Value-Based Competition
Source Marketing and Planning Leadership Council interviews and analysis
Grow Revenue
bull Drive latent demand for most
profitable procedures
bull Position institution as first
choice provider for procedural
volumes among commercially
insured populations
bull Help patients navigate within
service line to protect referral
chains and build loyalty
Support Population Management
bull Discourage inappropriate facility
utilization
bull Prevent avoidable acute care
utilization
bull Identify and target at-risk
patients for care management
bull Improve engagement
bull Support patient self-
management
ldquoWe think that it will be so much more valuable for us as an enterprise to do both
marketing and care management together We donrsquot want to create the isolated
function of marketing anymore Itrsquos not a good return on our investment in our minds
We want to become overall care managers in the continuumrdquo
VP Marketing and Outreach
Health System in the South
rdquo
Increase Population Share
bull Drive primary care utilization for
patient panel attribution share
capture and share protection
bull Help patients navigate full
continuum of care to build
loyalty
bull Build relationships with
employers
Fee-for-Service
Value-Based Competition
copy2013 The Advisory Board Company bull 28008 advisorycom 11
Communications Must Shift Across Multiple Attributes With these new goals aimed at
building loyalty and supporting
population health management
efforts marketers face a shifting set of
demands Rather than using outreach
to entice individuals to consume
specific high-margin services
marketing must educate and motivate
entire patient populations to engage in
health improvement and management
and care compliance
Accordingly communications must be
geared to care for patient populations
and promote coordination across the
care continuum and system offerings
Further with the need for complex
behavior change marketing materials
should become more persuasive and
accessible through a multitude of new
channels to encourage increased
patient involvement Finally
messaging must become more
frequent and be driven by patient
needs allowing marketers to provide
reinforcing communications that
prompt appropriate patient behavior
In turn these new demands
emphasize the need for outreach to
be even more coordinated efficient
persuasive accessible frequent and
responsive than ever before
New Goals Require More Direct Nuanced Outreach Approach
Source Marketing and Planning Leadership Council interviews and analysis
Marketing for
Volume Growth
Marketing for
Share and
Population
Management
Necessary
Outreach
Attributes
Coordinated
Multi-
Focus
Promote
services across
full care
continuum
service lines
and care sites
Single
Focus
Promote single
service or
service line
Expanded
Targets
Expand focus to
populations
Efficient
Narrow
Targets
Primarily target
new patients
with the ability
to pay
Call to
Change
Inspire complex
behavior
change
Persuasive
Call to
Action
Instigate simple
actions
Multi-
Channel
Send messages
through
patientsrsquo
preferred
channels to
ensure
adherence
Accessible
Single
Channel
Communicate
via one method
Ongoing
Contact
Sustain
ongoing regular
communication
to reinforce
message
Frequent
One-and-
Done
Conscribe
campaign
timing to
strategic plan
Patient
Driven
Base
communication
on both
strategic goals
and patientrsquos
individual needs
Responsive
Institution
Driven
Ground
campaigns on
strategic plan
goals
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 4
The Marketing and Planning
Leadership Council has developed
numerous resources to help marketing
leaders develop successful consumer
marketing strategies All of these
resources are available in unlimited
quantities through your Marketing and
Planning Leadership Council
membership
To Order via Advisorycom
To order copies of these and other Marketing and Planning Leadership Council
presentations please visit our website advisorycommplcpublications
Available Within Your Marketing and Planning Leadership Council Membership
Capturing ROI on Social
Media Outreach
Webconference details new metrics for
evaluating social mediarsquos impact on
population health management goals
and profiles how leading organizations
are elevating social media ROI
Marketing 2020
Webconference covering the new risks
rules and roles facing marketing
departments as a result of new payment
models demographic changes
increased physician employment and
shifting referral streams
Representative Resources for Consumer Marketing
Engaging Patients in Primary Care
Publication outlining strategies for
using marketing techniques to build
patient loyalty and care compliance
Precision Marketing
Guide compiling resources for
targeting tailoring and measuring ROI
of consumer outreach best practices
Marketing Primary Care
Publication exploring how to raise
patient awareness of primary care by
elevating facility and provider visibility
streamlining access points and
highlighting care quality and service
Case Studies of CRM
Implementation Use and ROI
Brief offering representative case
studies that profile the efforts of
progressive providers to overcome
implementation hurdles and adopt
best practices to establish marketing
ROI utilizing CRM systems
copy2013 The Advisory Board Company bull 28008 advisorycom
In addition to the resources available
through the Marketing and Planning
Leadership Council membership The
Advisory Board Company offers
Crimson Market Advantage
Crimson Market Advantage leverages
total market visibility to strategically
drive referral-based growth
strengthen physician loyalty and
improve physician alignment
5
Beyond the Marketing and Planning Leadership Council Crimson Market Advantage
Contact Us
For more information on how you can
use total market visibility to improve
physician referral management at your
hospital or health system please visit
our website advisorycomtechnology
crimson-market-advantage
Or email us at crimsonadvisorycom
Case Study Using Referral Analytics to Drive a $5M+ Growth Initiative
bull Two-hospital market in the Northeast
bull Hospital ldquoArdquo invested in a large liaison programmdash4 FTEs large marketing budget
bull Hospital ldquoBrdquo focused on data and analytics working with a smaller outreach staff
Target
PCPs
Target
Splitters
Target
Employed
Physicians
Ancillary
Business
Growth
Target
$067M
$223M
$131M
$092M $513M Hospital Arsquos
growth projection
was flat while
Hospital B
developed an
18-month $5M+
referral-based
growth initiative
Crimson Market Advantage provides the technology expertise and staff to help identify the top-
referring PCPs and specialists in your market Grounded in best-practice research our business
intelligence technology solution quickly and accurately identifies potential sources of growth
bull Identify top growth opportunities at the individual physician level
bull Capitalize on total market visibility to achieve first-mover advantage within key service lines
physician groups and geographic regions
bull Investigate out-of-network referral chains to steer market expansion efforts
bull Quantitatively measure physician loyalty to manage essential relationships over time
Hospitals are leveraging our novel physician network analytics to
Expanding the Physician Referral Network
copy2013 The Advisory Board Company bull 28008 advisorycom 6
Advisors to Our Work
With Sincere Appreciation The Marketing and Planning
Leadership Council is grateful to the
individuals and organizations that
shared their insights analysis and
time with us We would especially like
to recognize the following individuals
for being particularly generous with
their time and expertise
Banner Health
Phoenix AZ
Michelle Witte
Cleveland Clinic
Cleveland OH
Paul Matsen
Sylvia Morrison
George Fay
Sunny Lu
Gundersen Health System
La Crosse WI
Pamela Maas
Indiana University Health Goshen
Goshen IN
Larry Brooks PhD
Deb Stacks
Kaweah Delta Health Care District
Visalia CA
Dru Quesnoy
Tea Leaves Health
Roswell GA
James Schleck
Vanguard Health Systems
Nashville TN
Devin Carty
Virtua
Marlton NJ
Jane Yepez
copy2013 The Advisory Board Company bull 28008 advisorycom 7
Executive Summary
Finding New Value in CRM
Source Marketing and Planning Leadership Council interviews and analysis
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health
Under risk-based reimbursement models providers face new goals of gaining and retaining patient loyalty delivering improved clinical outcomes for patients
and reducing total costs of care With their deep expertise in behavior change hospital and health system marketers are well positioned to support these new
goals through effective patient communications and education However driving patient engagementmdashboth cross-continuum loyalty and care compliancemdashwill
require a more persuasive responsive and efficient outreach approach To facilitate this personalization and efficiency marketers are turning to Customer
Relationship Management (CRM) systems to elicit stronger patient response rates resulting in improved patient engagement and loyalty Still to be effective
even those providers who already use a CRM system must make significant changes in their CRM strategy The following nine tactics outline how progressive
institutions have adapted their CRM-enabled strategy to hone patient targeting enhance message tailoring and automate communication timing to reach care
management goals and show returns in both fee-for-service and risk-based reimbursement environments
1 Identify patients under risk-based reimbursement for care
management messaging All providers assume some financial risk for a
subset of their patient pool such as hospital employees uninsured patients
or ACO participants Identifying these individuals with CRM systems allows
marketers to target the groups whose health outcomes affect reimbursement
for care management messaging
2 Segment the patient pool by health risk status to help prevent risk
escalation CRM systems can use clinical and consumer data to target
rising-risk patients for enhanced primary care and low-risk patients for
preventive care services to reduce risk factors for both groups
3 Target household health managers to incite action Many families
have a designated health care decision makermdashoften the oldest femalemdash
who can influence behavior change on a household level CRM systems can
track and adapt to changes in decision-maker status and create customized
messages for the family group
4 Personalize communications using psychographic variables to
improve response rates CRM systemsrsquo ability to automate tailoring of
message content and style on an individual level creates psychographically
and demographically relevant materials to which patients are more likely to
connect and respond
5 Tailor perceived sender to leverage physician relationships and
brand equity Some providers have found that communications sent from
clinicians instead of the hospital increases patient compliance with a
message CRM systems can match patients to their physicians to customize
outreach
6 Communicate with patients through their preferred channel to
increase receipt rates and gather additional data As patient attention
continues to shift toward digital platforms CRM systems can predict and
track patientsrsquo communication channel preferences ensuring that messages
are sent through the channelmdashbe it email text print mail Facebook or other
expanding modalitiesmdashor channels that a patient is most apt to check
increasing receipt and response rates
7 Automate responsive messaging to reinforce or reform an
individualrsquos health-based behavior CRM algorithms can enable
immediate responses to time-sensitive behavior-based triggers By
recognizing a wide range of patient actions this CRM function enables
marketing departments to encourage or modify patient behavior
8 Track care pathways to automate timely communication and care
management By predicting a patientrsquos care trajectory CRM systems can
send critical care management reminders at preset clinically-based trigger
points to keep patients engaged
9 Reactivate lapsed patients to maintain engagement and minimize
reimbursement risk CRM systems can track time since a patientrsquos last
system activity and generate automatic reminders for patients who have
disengaged
copy2013 The Advisory Board Company bull 28008 advisorycom 8
copy2013 The Advisory Board Company bull 28008 advisorycom 9
Marketing Goals Expanding Under Population Health
copy2013 The Advisory Board Company bull 28008 advisorycom 10
Providers Seeking Marketersrsquo Support in Population Management
With the shift to value-based
reimbursement models providers are
re-evaluating their marketing goals
and underlying strategies Rather than
focusing predominately on increasing
volumes for high-margin primarily
inpatient procedures progressive
organizations are charging their
marketing departments with growing
and retaining population share and
supporting organization-wide
population health goals
Accordingly marketing departments
will increasingly be asked to leverage
their behavior change expertise to
support appropriate utilization
enhance patient engagement and
reduce cost of care
Marketing Goals Expanding Under Value-Based Competition
Source Marketing and Planning Leadership Council interviews and analysis
Grow Revenue
bull Drive latent demand for most
profitable procedures
bull Position institution as first
choice provider for procedural
volumes among commercially
insured populations
bull Help patients navigate within
service line to protect referral
chains and build loyalty
Support Population Management
bull Discourage inappropriate facility
utilization
bull Prevent avoidable acute care
utilization
bull Identify and target at-risk
patients for care management
bull Improve engagement
bull Support patient self-
management
ldquoWe think that it will be so much more valuable for us as an enterprise to do both
marketing and care management together We donrsquot want to create the isolated
function of marketing anymore Itrsquos not a good return on our investment in our minds
We want to become overall care managers in the continuumrdquo
VP Marketing and Outreach
Health System in the South
rdquo
Increase Population Share
bull Drive primary care utilization for
patient panel attribution share
capture and share protection
bull Help patients navigate full
continuum of care to build
loyalty
bull Build relationships with
employers
Fee-for-Service
Value-Based Competition
copy2013 The Advisory Board Company bull 28008 advisorycom 11
Communications Must Shift Across Multiple Attributes With these new goals aimed at
building loyalty and supporting
population health management
efforts marketers face a shifting set of
demands Rather than using outreach
to entice individuals to consume
specific high-margin services
marketing must educate and motivate
entire patient populations to engage in
health improvement and management
and care compliance
Accordingly communications must be
geared to care for patient populations
and promote coordination across the
care continuum and system offerings
Further with the need for complex
behavior change marketing materials
should become more persuasive and
accessible through a multitude of new
channels to encourage increased
patient involvement Finally
messaging must become more
frequent and be driven by patient
needs allowing marketers to provide
reinforcing communications that
prompt appropriate patient behavior
In turn these new demands
emphasize the need for outreach to
be even more coordinated efficient
persuasive accessible frequent and
responsive than ever before
New Goals Require More Direct Nuanced Outreach Approach
Source Marketing and Planning Leadership Council interviews and analysis
Marketing for
Volume Growth
Marketing for
Share and
Population
Management
Necessary
Outreach
Attributes
Coordinated
Multi-
Focus
Promote
services across
full care
continuum
service lines
and care sites
Single
Focus
Promote single
service or
service line
Expanded
Targets
Expand focus to
populations
Efficient
Narrow
Targets
Primarily target
new patients
with the ability
to pay
Call to
Change
Inspire complex
behavior
change
Persuasive
Call to
Action
Instigate simple
actions
Multi-
Channel
Send messages
through
patientsrsquo
preferred
channels to
ensure
adherence
Accessible
Single
Channel
Communicate
via one method
Ongoing
Contact
Sustain
ongoing regular
communication
to reinforce
message
Frequent
One-and-
Done
Conscribe
campaign
timing to
strategic plan
Patient
Driven
Base
communication
on both
strategic goals
and patientrsquos
individual needs
Responsive
Institution
Driven
Ground
campaigns on
strategic plan
goals
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom
In addition to the resources available
through the Marketing and Planning
Leadership Council membership The
Advisory Board Company offers
Crimson Market Advantage
Crimson Market Advantage leverages
total market visibility to strategically
drive referral-based growth
strengthen physician loyalty and
improve physician alignment
5
Beyond the Marketing and Planning Leadership Council Crimson Market Advantage
Contact Us
For more information on how you can
use total market visibility to improve
physician referral management at your
hospital or health system please visit
our website advisorycomtechnology
crimson-market-advantage
Or email us at crimsonadvisorycom
Case Study Using Referral Analytics to Drive a $5M+ Growth Initiative
bull Two-hospital market in the Northeast
bull Hospital ldquoArdquo invested in a large liaison programmdash4 FTEs large marketing budget
bull Hospital ldquoBrdquo focused on data and analytics working with a smaller outreach staff
Target
PCPs
Target
Splitters
Target
Employed
Physicians
Ancillary
Business
Growth
Target
$067M
$223M
$131M
$092M $513M Hospital Arsquos
growth projection
was flat while
Hospital B
developed an
18-month $5M+
referral-based
growth initiative
Crimson Market Advantage provides the technology expertise and staff to help identify the top-
referring PCPs and specialists in your market Grounded in best-practice research our business
intelligence technology solution quickly and accurately identifies potential sources of growth
bull Identify top growth opportunities at the individual physician level
bull Capitalize on total market visibility to achieve first-mover advantage within key service lines
physician groups and geographic regions
bull Investigate out-of-network referral chains to steer market expansion efforts
bull Quantitatively measure physician loyalty to manage essential relationships over time
Hospitals are leveraging our novel physician network analytics to
Expanding the Physician Referral Network
copy2013 The Advisory Board Company bull 28008 advisorycom 6
Advisors to Our Work
With Sincere Appreciation The Marketing and Planning
Leadership Council is grateful to the
individuals and organizations that
shared their insights analysis and
time with us We would especially like
to recognize the following individuals
for being particularly generous with
their time and expertise
Banner Health
Phoenix AZ
Michelle Witte
Cleveland Clinic
Cleveland OH
Paul Matsen
Sylvia Morrison
George Fay
Sunny Lu
Gundersen Health System
La Crosse WI
Pamela Maas
Indiana University Health Goshen
Goshen IN
Larry Brooks PhD
Deb Stacks
Kaweah Delta Health Care District
Visalia CA
Dru Quesnoy
Tea Leaves Health
Roswell GA
James Schleck
Vanguard Health Systems
Nashville TN
Devin Carty
Virtua
Marlton NJ
Jane Yepez
copy2013 The Advisory Board Company bull 28008 advisorycom 7
Executive Summary
Finding New Value in CRM
Source Marketing and Planning Leadership Council interviews and analysis
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health
Under risk-based reimbursement models providers face new goals of gaining and retaining patient loyalty delivering improved clinical outcomes for patients
and reducing total costs of care With their deep expertise in behavior change hospital and health system marketers are well positioned to support these new
goals through effective patient communications and education However driving patient engagementmdashboth cross-continuum loyalty and care compliancemdashwill
require a more persuasive responsive and efficient outreach approach To facilitate this personalization and efficiency marketers are turning to Customer
Relationship Management (CRM) systems to elicit stronger patient response rates resulting in improved patient engagement and loyalty Still to be effective
even those providers who already use a CRM system must make significant changes in their CRM strategy The following nine tactics outline how progressive
institutions have adapted their CRM-enabled strategy to hone patient targeting enhance message tailoring and automate communication timing to reach care
management goals and show returns in both fee-for-service and risk-based reimbursement environments
1 Identify patients under risk-based reimbursement for care
management messaging All providers assume some financial risk for a
subset of their patient pool such as hospital employees uninsured patients
or ACO participants Identifying these individuals with CRM systems allows
marketers to target the groups whose health outcomes affect reimbursement
for care management messaging
2 Segment the patient pool by health risk status to help prevent risk
escalation CRM systems can use clinical and consumer data to target
rising-risk patients for enhanced primary care and low-risk patients for
preventive care services to reduce risk factors for both groups
3 Target household health managers to incite action Many families
have a designated health care decision makermdashoften the oldest femalemdash
who can influence behavior change on a household level CRM systems can
track and adapt to changes in decision-maker status and create customized
messages for the family group
4 Personalize communications using psychographic variables to
improve response rates CRM systemsrsquo ability to automate tailoring of
message content and style on an individual level creates psychographically
and demographically relevant materials to which patients are more likely to
connect and respond
5 Tailor perceived sender to leverage physician relationships and
brand equity Some providers have found that communications sent from
clinicians instead of the hospital increases patient compliance with a
message CRM systems can match patients to their physicians to customize
outreach
6 Communicate with patients through their preferred channel to
increase receipt rates and gather additional data As patient attention
continues to shift toward digital platforms CRM systems can predict and
track patientsrsquo communication channel preferences ensuring that messages
are sent through the channelmdashbe it email text print mail Facebook or other
expanding modalitiesmdashor channels that a patient is most apt to check
increasing receipt and response rates
7 Automate responsive messaging to reinforce or reform an
individualrsquos health-based behavior CRM algorithms can enable
immediate responses to time-sensitive behavior-based triggers By
recognizing a wide range of patient actions this CRM function enables
marketing departments to encourage or modify patient behavior
8 Track care pathways to automate timely communication and care
management By predicting a patientrsquos care trajectory CRM systems can
send critical care management reminders at preset clinically-based trigger
points to keep patients engaged
9 Reactivate lapsed patients to maintain engagement and minimize
reimbursement risk CRM systems can track time since a patientrsquos last
system activity and generate automatic reminders for patients who have
disengaged
copy2013 The Advisory Board Company bull 28008 advisorycom 8
copy2013 The Advisory Board Company bull 28008 advisorycom 9
Marketing Goals Expanding Under Population Health
copy2013 The Advisory Board Company bull 28008 advisorycom 10
Providers Seeking Marketersrsquo Support in Population Management
With the shift to value-based
reimbursement models providers are
re-evaluating their marketing goals
and underlying strategies Rather than
focusing predominately on increasing
volumes for high-margin primarily
inpatient procedures progressive
organizations are charging their
marketing departments with growing
and retaining population share and
supporting organization-wide
population health goals
Accordingly marketing departments
will increasingly be asked to leverage
their behavior change expertise to
support appropriate utilization
enhance patient engagement and
reduce cost of care
Marketing Goals Expanding Under Value-Based Competition
Source Marketing and Planning Leadership Council interviews and analysis
Grow Revenue
bull Drive latent demand for most
profitable procedures
bull Position institution as first
choice provider for procedural
volumes among commercially
insured populations
bull Help patients navigate within
service line to protect referral
chains and build loyalty
Support Population Management
bull Discourage inappropriate facility
utilization
bull Prevent avoidable acute care
utilization
bull Identify and target at-risk
patients for care management
bull Improve engagement
bull Support patient self-
management
ldquoWe think that it will be so much more valuable for us as an enterprise to do both
marketing and care management together We donrsquot want to create the isolated
function of marketing anymore Itrsquos not a good return on our investment in our minds
We want to become overall care managers in the continuumrdquo
VP Marketing and Outreach
Health System in the South
rdquo
Increase Population Share
bull Drive primary care utilization for
patient panel attribution share
capture and share protection
bull Help patients navigate full
continuum of care to build
loyalty
bull Build relationships with
employers
Fee-for-Service
Value-Based Competition
copy2013 The Advisory Board Company bull 28008 advisorycom 11
Communications Must Shift Across Multiple Attributes With these new goals aimed at
building loyalty and supporting
population health management
efforts marketers face a shifting set of
demands Rather than using outreach
to entice individuals to consume
specific high-margin services
marketing must educate and motivate
entire patient populations to engage in
health improvement and management
and care compliance
Accordingly communications must be
geared to care for patient populations
and promote coordination across the
care continuum and system offerings
Further with the need for complex
behavior change marketing materials
should become more persuasive and
accessible through a multitude of new
channels to encourage increased
patient involvement Finally
messaging must become more
frequent and be driven by patient
needs allowing marketers to provide
reinforcing communications that
prompt appropriate patient behavior
In turn these new demands
emphasize the need for outreach to
be even more coordinated efficient
persuasive accessible frequent and
responsive than ever before
New Goals Require More Direct Nuanced Outreach Approach
Source Marketing and Planning Leadership Council interviews and analysis
Marketing for
Volume Growth
Marketing for
Share and
Population
Management
Necessary
Outreach
Attributes
Coordinated
Multi-
Focus
Promote
services across
full care
continuum
service lines
and care sites
Single
Focus
Promote single
service or
service line
Expanded
Targets
Expand focus to
populations
Efficient
Narrow
Targets
Primarily target
new patients
with the ability
to pay
Call to
Change
Inspire complex
behavior
change
Persuasive
Call to
Action
Instigate simple
actions
Multi-
Channel
Send messages
through
patientsrsquo
preferred
channels to
ensure
adherence
Accessible
Single
Channel
Communicate
via one method
Ongoing
Contact
Sustain
ongoing regular
communication
to reinforce
message
Frequent
One-and-
Done
Conscribe
campaign
timing to
strategic plan
Patient
Driven
Base
communication
on both
strategic goals
and patientrsquos
individual needs
Responsive
Institution
Driven
Ground
campaigns on
strategic plan
goals
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 6
Advisors to Our Work
With Sincere Appreciation The Marketing and Planning
Leadership Council is grateful to the
individuals and organizations that
shared their insights analysis and
time with us We would especially like
to recognize the following individuals
for being particularly generous with
their time and expertise
Banner Health
Phoenix AZ
Michelle Witte
Cleveland Clinic
Cleveland OH
Paul Matsen
Sylvia Morrison
George Fay
Sunny Lu
Gundersen Health System
La Crosse WI
Pamela Maas
Indiana University Health Goshen
Goshen IN
Larry Brooks PhD
Deb Stacks
Kaweah Delta Health Care District
Visalia CA
Dru Quesnoy
Tea Leaves Health
Roswell GA
James Schleck
Vanguard Health Systems
Nashville TN
Devin Carty
Virtua
Marlton NJ
Jane Yepez
copy2013 The Advisory Board Company bull 28008 advisorycom 7
Executive Summary
Finding New Value in CRM
Source Marketing and Planning Leadership Council interviews and analysis
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health
Under risk-based reimbursement models providers face new goals of gaining and retaining patient loyalty delivering improved clinical outcomes for patients
and reducing total costs of care With their deep expertise in behavior change hospital and health system marketers are well positioned to support these new
goals through effective patient communications and education However driving patient engagementmdashboth cross-continuum loyalty and care compliancemdashwill
require a more persuasive responsive and efficient outreach approach To facilitate this personalization and efficiency marketers are turning to Customer
Relationship Management (CRM) systems to elicit stronger patient response rates resulting in improved patient engagement and loyalty Still to be effective
even those providers who already use a CRM system must make significant changes in their CRM strategy The following nine tactics outline how progressive
institutions have adapted their CRM-enabled strategy to hone patient targeting enhance message tailoring and automate communication timing to reach care
management goals and show returns in both fee-for-service and risk-based reimbursement environments
1 Identify patients under risk-based reimbursement for care
management messaging All providers assume some financial risk for a
subset of their patient pool such as hospital employees uninsured patients
or ACO participants Identifying these individuals with CRM systems allows
marketers to target the groups whose health outcomes affect reimbursement
for care management messaging
2 Segment the patient pool by health risk status to help prevent risk
escalation CRM systems can use clinical and consumer data to target
rising-risk patients for enhanced primary care and low-risk patients for
preventive care services to reduce risk factors for both groups
3 Target household health managers to incite action Many families
have a designated health care decision makermdashoften the oldest femalemdash
who can influence behavior change on a household level CRM systems can
track and adapt to changes in decision-maker status and create customized
messages for the family group
4 Personalize communications using psychographic variables to
improve response rates CRM systemsrsquo ability to automate tailoring of
message content and style on an individual level creates psychographically
and demographically relevant materials to which patients are more likely to
connect and respond
5 Tailor perceived sender to leverage physician relationships and
brand equity Some providers have found that communications sent from
clinicians instead of the hospital increases patient compliance with a
message CRM systems can match patients to their physicians to customize
outreach
6 Communicate with patients through their preferred channel to
increase receipt rates and gather additional data As patient attention
continues to shift toward digital platforms CRM systems can predict and
track patientsrsquo communication channel preferences ensuring that messages
are sent through the channelmdashbe it email text print mail Facebook or other
expanding modalitiesmdashor channels that a patient is most apt to check
increasing receipt and response rates
7 Automate responsive messaging to reinforce or reform an
individualrsquos health-based behavior CRM algorithms can enable
immediate responses to time-sensitive behavior-based triggers By
recognizing a wide range of patient actions this CRM function enables
marketing departments to encourage or modify patient behavior
8 Track care pathways to automate timely communication and care
management By predicting a patientrsquos care trajectory CRM systems can
send critical care management reminders at preset clinically-based trigger
points to keep patients engaged
9 Reactivate lapsed patients to maintain engagement and minimize
reimbursement risk CRM systems can track time since a patientrsquos last
system activity and generate automatic reminders for patients who have
disengaged
copy2013 The Advisory Board Company bull 28008 advisorycom 8
copy2013 The Advisory Board Company bull 28008 advisorycom 9
Marketing Goals Expanding Under Population Health
copy2013 The Advisory Board Company bull 28008 advisorycom 10
Providers Seeking Marketersrsquo Support in Population Management
With the shift to value-based
reimbursement models providers are
re-evaluating their marketing goals
and underlying strategies Rather than
focusing predominately on increasing
volumes for high-margin primarily
inpatient procedures progressive
organizations are charging their
marketing departments with growing
and retaining population share and
supporting organization-wide
population health goals
Accordingly marketing departments
will increasingly be asked to leverage
their behavior change expertise to
support appropriate utilization
enhance patient engagement and
reduce cost of care
Marketing Goals Expanding Under Value-Based Competition
Source Marketing and Planning Leadership Council interviews and analysis
Grow Revenue
bull Drive latent demand for most
profitable procedures
bull Position institution as first
choice provider for procedural
volumes among commercially
insured populations
bull Help patients navigate within
service line to protect referral
chains and build loyalty
Support Population Management
bull Discourage inappropriate facility
utilization
bull Prevent avoidable acute care
utilization
bull Identify and target at-risk
patients for care management
bull Improve engagement
bull Support patient self-
management
ldquoWe think that it will be so much more valuable for us as an enterprise to do both
marketing and care management together We donrsquot want to create the isolated
function of marketing anymore Itrsquos not a good return on our investment in our minds
We want to become overall care managers in the continuumrdquo
VP Marketing and Outreach
Health System in the South
rdquo
Increase Population Share
bull Drive primary care utilization for
patient panel attribution share
capture and share protection
bull Help patients navigate full
continuum of care to build
loyalty
bull Build relationships with
employers
Fee-for-Service
Value-Based Competition
copy2013 The Advisory Board Company bull 28008 advisorycom 11
Communications Must Shift Across Multiple Attributes With these new goals aimed at
building loyalty and supporting
population health management
efforts marketers face a shifting set of
demands Rather than using outreach
to entice individuals to consume
specific high-margin services
marketing must educate and motivate
entire patient populations to engage in
health improvement and management
and care compliance
Accordingly communications must be
geared to care for patient populations
and promote coordination across the
care continuum and system offerings
Further with the need for complex
behavior change marketing materials
should become more persuasive and
accessible through a multitude of new
channels to encourage increased
patient involvement Finally
messaging must become more
frequent and be driven by patient
needs allowing marketers to provide
reinforcing communications that
prompt appropriate patient behavior
In turn these new demands
emphasize the need for outreach to
be even more coordinated efficient
persuasive accessible frequent and
responsive than ever before
New Goals Require More Direct Nuanced Outreach Approach
Source Marketing and Planning Leadership Council interviews and analysis
Marketing for
Volume Growth
Marketing for
Share and
Population
Management
Necessary
Outreach
Attributes
Coordinated
Multi-
Focus
Promote
services across
full care
continuum
service lines
and care sites
Single
Focus
Promote single
service or
service line
Expanded
Targets
Expand focus to
populations
Efficient
Narrow
Targets
Primarily target
new patients
with the ability
to pay
Call to
Change
Inspire complex
behavior
change
Persuasive
Call to
Action
Instigate simple
actions
Multi-
Channel
Send messages
through
patientsrsquo
preferred
channels to
ensure
adherence
Accessible
Single
Channel
Communicate
via one method
Ongoing
Contact
Sustain
ongoing regular
communication
to reinforce
message
Frequent
One-and-
Done
Conscribe
campaign
timing to
strategic plan
Patient
Driven
Base
communication
on both
strategic goals
and patientrsquos
individual needs
Responsive
Institution
Driven
Ground
campaigns on
strategic plan
goals
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 7
Executive Summary
Finding New Value in CRM
Source Marketing and Planning Leadership Council interviews and analysis
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health
Under risk-based reimbursement models providers face new goals of gaining and retaining patient loyalty delivering improved clinical outcomes for patients
and reducing total costs of care With their deep expertise in behavior change hospital and health system marketers are well positioned to support these new
goals through effective patient communications and education However driving patient engagementmdashboth cross-continuum loyalty and care compliancemdashwill
require a more persuasive responsive and efficient outreach approach To facilitate this personalization and efficiency marketers are turning to Customer
Relationship Management (CRM) systems to elicit stronger patient response rates resulting in improved patient engagement and loyalty Still to be effective
even those providers who already use a CRM system must make significant changes in their CRM strategy The following nine tactics outline how progressive
institutions have adapted their CRM-enabled strategy to hone patient targeting enhance message tailoring and automate communication timing to reach care
management goals and show returns in both fee-for-service and risk-based reimbursement environments
1 Identify patients under risk-based reimbursement for care
management messaging All providers assume some financial risk for a
subset of their patient pool such as hospital employees uninsured patients
or ACO participants Identifying these individuals with CRM systems allows
marketers to target the groups whose health outcomes affect reimbursement
for care management messaging
2 Segment the patient pool by health risk status to help prevent risk
escalation CRM systems can use clinical and consumer data to target
rising-risk patients for enhanced primary care and low-risk patients for
preventive care services to reduce risk factors for both groups
3 Target household health managers to incite action Many families
have a designated health care decision makermdashoften the oldest femalemdash
who can influence behavior change on a household level CRM systems can
track and adapt to changes in decision-maker status and create customized
messages for the family group
4 Personalize communications using psychographic variables to
improve response rates CRM systemsrsquo ability to automate tailoring of
message content and style on an individual level creates psychographically
and demographically relevant materials to which patients are more likely to
connect and respond
5 Tailor perceived sender to leverage physician relationships and
brand equity Some providers have found that communications sent from
clinicians instead of the hospital increases patient compliance with a
message CRM systems can match patients to their physicians to customize
outreach
6 Communicate with patients through their preferred channel to
increase receipt rates and gather additional data As patient attention
continues to shift toward digital platforms CRM systems can predict and
track patientsrsquo communication channel preferences ensuring that messages
are sent through the channelmdashbe it email text print mail Facebook or other
expanding modalitiesmdashor channels that a patient is most apt to check
increasing receipt and response rates
7 Automate responsive messaging to reinforce or reform an
individualrsquos health-based behavior CRM algorithms can enable
immediate responses to time-sensitive behavior-based triggers By
recognizing a wide range of patient actions this CRM function enables
marketing departments to encourage or modify patient behavior
8 Track care pathways to automate timely communication and care
management By predicting a patientrsquos care trajectory CRM systems can
send critical care management reminders at preset clinically-based trigger
points to keep patients engaged
9 Reactivate lapsed patients to maintain engagement and minimize
reimbursement risk CRM systems can track time since a patientrsquos last
system activity and generate automatic reminders for patients who have
disengaged
copy2013 The Advisory Board Company bull 28008 advisorycom 8
copy2013 The Advisory Board Company bull 28008 advisorycom 9
Marketing Goals Expanding Under Population Health
copy2013 The Advisory Board Company bull 28008 advisorycom 10
Providers Seeking Marketersrsquo Support in Population Management
With the shift to value-based
reimbursement models providers are
re-evaluating their marketing goals
and underlying strategies Rather than
focusing predominately on increasing
volumes for high-margin primarily
inpatient procedures progressive
organizations are charging their
marketing departments with growing
and retaining population share and
supporting organization-wide
population health goals
Accordingly marketing departments
will increasingly be asked to leverage
their behavior change expertise to
support appropriate utilization
enhance patient engagement and
reduce cost of care
Marketing Goals Expanding Under Value-Based Competition
Source Marketing and Planning Leadership Council interviews and analysis
Grow Revenue
bull Drive latent demand for most
profitable procedures
bull Position institution as first
choice provider for procedural
volumes among commercially
insured populations
bull Help patients navigate within
service line to protect referral
chains and build loyalty
Support Population Management
bull Discourage inappropriate facility
utilization
bull Prevent avoidable acute care
utilization
bull Identify and target at-risk
patients for care management
bull Improve engagement
bull Support patient self-
management
ldquoWe think that it will be so much more valuable for us as an enterprise to do both
marketing and care management together We donrsquot want to create the isolated
function of marketing anymore Itrsquos not a good return on our investment in our minds
We want to become overall care managers in the continuumrdquo
VP Marketing and Outreach
Health System in the South
rdquo
Increase Population Share
bull Drive primary care utilization for
patient panel attribution share
capture and share protection
bull Help patients navigate full
continuum of care to build
loyalty
bull Build relationships with
employers
Fee-for-Service
Value-Based Competition
copy2013 The Advisory Board Company bull 28008 advisorycom 11
Communications Must Shift Across Multiple Attributes With these new goals aimed at
building loyalty and supporting
population health management
efforts marketers face a shifting set of
demands Rather than using outreach
to entice individuals to consume
specific high-margin services
marketing must educate and motivate
entire patient populations to engage in
health improvement and management
and care compliance
Accordingly communications must be
geared to care for patient populations
and promote coordination across the
care continuum and system offerings
Further with the need for complex
behavior change marketing materials
should become more persuasive and
accessible through a multitude of new
channels to encourage increased
patient involvement Finally
messaging must become more
frequent and be driven by patient
needs allowing marketers to provide
reinforcing communications that
prompt appropriate patient behavior
In turn these new demands
emphasize the need for outreach to
be even more coordinated efficient
persuasive accessible frequent and
responsive than ever before
New Goals Require More Direct Nuanced Outreach Approach
Source Marketing and Planning Leadership Council interviews and analysis
Marketing for
Volume Growth
Marketing for
Share and
Population
Management
Necessary
Outreach
Attributes
Coordinated
Multi-
Focus
Promote
services across
full care
continuum
service lines
and care sites
Single
Focus
Promote single
service or
service line
Expanded
Targets
Expand focus to
populations
Efficient
Narrow
Targets
Primarily target
new patients
with the ability
to pay
Call to
Change
Inspire complex
behavior
change
Persuasive
Call to
Action
Instigate simple
actions
Multi-
Channel
Send messages
through
patientsrsquo
preferred
channels to
ensure
adherence
Accessible
Single
Channel
Communicate
via one method
Ongoing
Contact
Sustain
ongoing regular
communication
to reinforce
message
Frequent
One-and-
Done
Conscribe
campaign
timing to
strategic plan
Patient
Driven
Base
communication
on both
strategic goals
and patientrsquos
individual needs
Responsive
Institution
Driven
Ground
campaigns on
strategic plan
goals
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 8
copy2013 The Advisory Board Company bull 28008 advisorycom 9
Marketing Goals Expanding Under Population Health
copy2013 The Advisory Board Company bull 28008 advisorycom 10
Providers Seeking Marketersrsquo Support in Population Management
With the shift to value-based
reimbursement models providers are
re-evaluating their marketing goals
and underlying strategies Rather than
focusing predominately on increasing
volumes for high-margin primarily
inpatient procedures progressive
organizations are charging their
marketing departments with growing
and retaining population share and
supporting organization-wide
population health goals
Accordingly marketing departments
will increasingly be asked to leverage
their behavior change expertise to
support appropriate utilization
enhance patient engagement and
reduce cost of care
Marketing Goals Expanding Under Value-Based Competition
Source Marketing and Planning Leadership Council interviews and analysis
Grow Revenue
bull Drive latent demand for most
profitable procedures
bull Position institution as first
choice provider for procedural
volumes among commercially
insured populations
bull Help patients navigate within
service line to protect referral
chains and build loyalty
Support Population Management
bull Discourage inappropriate facility
utilization
bull Prevent avoidable acute care
utilization
bull Identify and target at-risk
patients for care management
bull Improve engagement
bull Support patient self-
management
ldquoWe think that it will be so much more valuable for us as an enterprise to do both
marketing and care management together We donrsquot want to create the isolated
function of marketing anymore Itrsquos not a good return on our investment in our minds
We want to become overall care managers in the continuumrdquo
VP Marketing and Outreach
Health System in the South
rdquo
Increase Population Share
bull Drive primary care utilization for
patient panel attribution share
capture and share protection
bull Help patients navigate full
continuum of care to build
loyalty
bull Build relationships with
employers
Fee-for-Service
Value-Based Competition
copy2013 The Advisory Board Company bull 28008 advisorycom 11
Communications Must Shift Across Multiple Attributes With these new goals aimed at
building loyalty and supporting
population health management
efforts marketers face a shifting set of
demands Rather than using outreach
to entice individuals to consume
specific high-margin services
marketing must educate and motivate
entire patient populations to engage in
health improvement and management
and care compliance
Accordingly communications must be
geared to care for patient populations
and promote coordination across the
care continuum and system offerings
Further with the need for complex
behavior change marketing materials
should become more persuasive and
accessible through a multitude of new
channels to encourage increased
patient involvement Finally
messaging must become more
frequent and be driven by patient
needs allowing marketers to provide
reinforcing communications that
prompt appropriate patient behavior
In turn these new demands
emphasize the need for outreach to
be even more coordinated efficient
persuasive accessible frequent and
responsive than ever before
New Goals Require More Direct Nuanced Outreach Approach
Source Marketing and Planning Leadership Council interviews and analysis
Marketing for
Volume Growth
Marketing for
Share and
Population
Management
Necessary
Outreach
Attributes
Coordinated
Multi-
Focus
Promote
services across
full care
continuum
service lines
and care sites
Single
Focus
Promote single
service or
service line
Expanded
Targets
Expand focus to
populations
Efficient
Narrow
Targets
Primarily target
new patients
with the ability
to pay
Call to
Change
Inspire complex
behavior
change
Persuasive
Call to
Action
Instigate simple
actions
Multi-
Channel
Send messages
through
patientsrsquo
preferred
channels to
ensure
adherence
Accessible
Single
Channel
Communicate
via one method
Ongoing
Contact
Sustain
ongoing regular
communication
to reinforce
message
Frequent
One-and-
Done
Conscribe
campaign
timing to
strategic plan
Patient
Driven
Base
communication
on both
strategic goals
and patientrsquos
individual needs
Responsive
Institution
Driven
Ground
campaigns on
strategic plan
goals
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 9
Marketing Goals Expanding Under Population Health
copy2013 The Advisory Board Company bull 28008 advisorycom 10
Providers Seeking Marketersrsquo Support in Population Management
With the shift to value-based
reimbursement models providers are
re-evaluating their marketing goals
and underlying strategies Rather than
focusing predominately on increasing
volumes for high-margin primarily
inpatient procedures progressive
organizations are charging their
marketing departments with growing
and retaining population share and
supporting organization-wide
population health goals
Accordingly marketing departments
will increasingly be asked to leverage
their behavior change expertise to
support appropriate utilization
enhance patient engagement and
reduce cost of care
Marketing Goals Expanding Under Value-Based Competition
Source Marketing and Planning Leadership Council interviews and analysis
Grow Revenue
bull Drive latent demand for most
profitable procedures
bull Position institution as first
choice provider for procedural
volumes among commercially
insured populations
bull Help patients navigate within
service line to protect referral
chains and build loyalty
Support Population Management
bull Discourage inappropriate facility
utilization
bull Prevent avoidable acute care
utilization
bull Identify and target at-risk
patients for care management
bull Improve engagement
bull Support patient self-
management
ldquoWe think that it will be so much more valuable for us as an enterprise to do both
marketing and care management together We donrsquot want to create the isolated
function of marketing anymore Itrsquos not a good return on our investment in our minds
We want to become overall care managers in the continuumrdquo
VP Marketing and Outreach
Health System in the South
rdquo
Increase Population Share
bull Drive primary care utilization for
patient panel attribution share
capture and share protection
bull Help patients navigate full
continuum of care to build
loyalty
bull Build relationships with
employers
Fee-for-Service
Value-Based Competition
copy2013 The Advisory Board Company bull 28008 advisorycom 11
Communications Must Shift Across Multiple Attributes With these new goals aimed at
building loyalty and supporting
population health management
efforts marketers face a shifting set of
demands Rather than using outreach
to entice individuals to consume
specific high-margin services
marketing must educate and motivate
entire patient populations to engage in
health improvement and management
and care compliance
Accordingly communications must be
geared to care for patient populations
and promote coordination across the
care continuum and system offerings
Further with the need for complex
behavior change marketing materials
should become more persuasive and
accessible through a multitude of new
channels to encourage increased
patient involvement Finally
messaging must become more
frequent and be driven by patient
needs allowing marketers to provide
reinforcing communications that
prompt appropriate patient behavior
In turn these new demands
emphasize the need for outreach to
be even more coordinated efficient
persuasive accessible frequent and
responsive than ever before
New Goals Require More Direct Nuanced Outreach Approach
Source Marketing and Planning Leadership Council interviews and analysis
Marketing for
Volume Growth
Marketing for
Share and
Population
Management
Necessary
Outreach
Attributes
Coordinated
Multi-
Focus
Promote
services across
full care
continuum
service lines
and care sites
Single
Focus
Promote single
service or
service line
Expanded
Targets
Expand focus to
populations
Efficient
Narrow
Targets
Primarily target
new patients
with the ability
to pay
Call to
Change
Inspire complex
behavior
change
Persuasive
Call to
Action
Instigate simple
actions
Multi-
Channel
Send messages
through
patientsrsquo
preferred
channels to
ensure
adherence
Accessible
Single
Channel
Communicate
via one method
Ongoing
Contact
Sustain
ongoing regular
communication
to reinforce
message
Frequent
One-and-
Done
Conscribe
campaign
timing to
strategic plan
Patient
Driven
Base
communication
on both
strategic goals
and patientrsquos
individual needs
Responsive
Institution
Driven
Ground
campaigns on
strategic plan
goals
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 10
Providers Seeking Marketersrsquo Support in Population Management
With the shift to value-based
reimbursement models providers are
re-evaluating their marketing goals
and underlying strategies Rather than
focusing predominately on increasing
volumes for high-margin primarily
inpatient procedures progressive
organizations are charging their
marketing departments with growing
and retaining population share and
supporting organization-wide
population health goals
Accordingly marketing departments
will increasingly be asked to leverage
their behavior change expertise to
support appropriate utilization
enhance patient engagement and
reduce cost of care
Marketing Goals Expanding Under Value-Based Competition
Source Marketing and Planning Leadership Council interviews and analysis
Grow Revenue
bull Drive latent demand for most
profitable procedures
bull Position institution as first
choice provider for procedural
volumes among commercially
insured populations
bull Help patients navigate within
service line to protect referral
chains and build loyalty
Support Population Management
bull Discourage inappropriate facility
utilization
bull Prevent avoidable acute care
utilization
bull Identify and target at-risk
patients for care management
bull Improve engagement
bull Support patient self-
management
ldquoWe think that it will be so much more valuable for us as an enterprise to do both
marketing and care management together We donrsquot want to create the isolated
function of marketing anymore Itrsquos not a good return on our investment in our minds
We want to become overall care managers in the continuumrdquo
VP Marketing and Outreach
Health System in the South
rdquo
Increase Population Share
bull Drive primary care utilization for
patient panel attribution share
capture and share protection
bull Help patients navigate full
continuum of care to build
loyalty
bull Build relationships with
employers
Fee-for-Service
Value-Based Competition
copy2013 The Advisory Board Company bull 28008 advisorycom 11
Communications Must Shift Across Multiple Attributes With these new goals aimed at
building loyalty and supporting
population health management
efforts marketers face a shifting set of
demands Rather than using outreach
to entice individuals to consume
specific high-margin services
marketing must educate and motivate
entire patient populations to engage in
health improvement and management
and care compliance
Accordingly communications must be
geared to care for patient populations
and promote coordination across the
care continuum and system offerings
Further with the need for complex
behavior change marketing materials
should become more persuasive and
accessible through a multitude of new
channels to encourage increased
patient involvement Finally
messaging must become more
frequent and be driven by patient
needs allowing marketers to provide
reinforcing communications that
prompt appropriate patient behavior
In turn these new demands
emphasize the need for outreach to
be even more coordinated efficient
persuasive accessible frequent and
responsive than ever before
New Goals Require More Direct Nuanced Outreach Approach
Source Marketing and Planning Leadership Council interviews and analysis
Marketing for
Volume Growth
Marketing for
Share and
Population
Management
Necessary
Outreach
Attributes
Coordinated
Multi-
Focus
Promote
services across
full care
continuum
service lines
and care sites
Single
Focus
Promote single
service or
service line
Expanded
Targets
Expand focus to
populations
Efficient
Narrow
Targets
Primarily target
new patients
with the ability
to pay
Call to
Change
Inspire complex
behavior
change
Persuasive
Call to
Action
Instigate simple
actions
Multi-
Channel
Send messages
through
patientsrsquo
preferred
channels to
ensure
adherence
Accessible
Single
Channel
Communicate
via one method
Ongoing
Contact
Sustain
ongoing regular
communication
to reinforce
message
Frequent
One-and-
Done
Conscribe
campaign
timing to
strategic plan
Patient
Driven
Base
communication
on both
strategic goals
and patientrsquos
individual needs
Responsive
Institution
Driven
Ground
campaigns on
strategic plan
goals
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 11
Communications Must Shift Across Multiple Attributes With these new goals aimed at
building loyalty and supporting
population health management
efforts marketers face a shifting set of
demands Rather than using outreach
to entice individuals to consume
specific high-margin services
marketing must educate and motivate
entire patient populations to engage in
health improvement and management
and care compliance
Accordingly communications must be
geared to care for patient populations
and promote coordination across the
care continuum and system offerings
Further with the need for complex
behavior change marketing materials
should become more persuasive and
accessible through a multitude of new
channels to encourage increased
patient involvement Finally
messaging must become more
frequent and be driven by patient
needs allowing marketers to provide
reinforcing communications that
prompt appropriate patient behavior
In turn these new demands
emphasize the need for outreach to
be even more coordinated efficient
persuasive accessible frequent and
responsive than ever before
New Goals Require More Direct Nuanced Outreach Approach
Source Marketing and Planning Leadership Council interviews and analysis
Marketing for
Volume Growth
Marketing for
Share and
Population
Management
Necessary
Outreach
Attributes
Coordinated
Multi-
Focus
Promote
services across
full care
continuum
service lines
and care sites
Single
Focus
Promote single
service or
service line
Expanded
Targets
Expand focus to
populations
Efficient
Narrow
Targets
Primarily target
new patients
with the ability
to pay
Call to
Change
Inspire complex
behavior
change
Persuasive
Call to
Action
Instigate simple
actions
Multi-
Channel
Send messages
through
patientsrsquo
preferred
channels to
ensure
adherence
Accessible
Single
Channel
Communicate
via one method
Ongoing
Contact
Sustain
ongoing regular
communication
to reinforce
message
Frequent
One-and-
Done
Conscribe
campaign
timing to
strategic plan
Patient
Driven
Base
communication
on both
strategic goals
and patientrsquos
individual needs
Responsive
Institution
Driven
Ground
campaigns on
strategic plan
goals
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 12
To support organizationsrsquo ability to
communicate in this increasingly
nuanced manner a number of health
systems and hospitals have invested in
Customer Relationship Management
(CRM) systems
While not a prerequisite to marketing
success under risk-based contracting
a CRM system can drastically improve
outreach efficiency and effect by
bull Appropriately segmenting patient
populations for relevant
communication
bull Tailoring content and modality to
improve response and adherence
bull Automating outreach to ensure that
the timing of communications elicits
desired patient action
CRM Provides Support for New Marketing Approach
Key CRM Capabilities for Segmenting Customizing Timing
CRM Capabilities Outreach Characteristics
Aggregates information from across disparate
database systems such as claims EMR and
call center databases
Coordinated
Efficient
Utilizes predictive analytics to identify patients and
prospects most likely to need care and utilize
services identifies those under risk contracts
Segmentation
Persuasive
Uses patient demographics and psychographics
to customize message content matches patient
to clinician for communications
Accessible Integrates with digital mobile and social
communication channels adapts communication
channels to individualrsquos behavior pattern over time
Customization
Automates communication triggers based on
patient behavior Responsive
Activates communications and reminders based
on last appointment adapts frequency based on
patient characteristics
Frequent
Timing
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 13
However to be effective even those
providers who already use a CRM
system must make significant
changes to their CRM strategy As
more providers adopt population
health-driven CRM approaches
once-progressive organizations that
fail to adapt their methods may soon
find themselves behind the curve
First marketing must add and shift
segmentation variables By sectioning
the patient pool by health risk
financial status and other factors
marketers can reprioritize audiences
for new messaging goals
Rather than be broad and generic
message content must be tailored by
demographic and psychographic
variables to match patient needs and
personality to best promote care
compliance The probability of eliciting
a patient response also partly
depends on the providerrsquos ability to
reach patients through the
communication channels which
patients prefer meaning CRM
systems must integrate with
expanding communication platforms
Finally communication must now
detect and respond to lapses in care
compliance and to periods of patient
inactivity
Shifting CRM Strategy to Support Population Health Goals
CRM-Enabled Marketing Strategy
Target patients prospects
with propensity to utilize
and pay for service
Volume Payer-Mix
Targeting
Use demographic data
to tailor communications
send via mail campaigns
Demographically Tailored
Mail Campaigns
Time campaign based
on service line
provider needs
Institution-Driven
Outreach Schedule
Refine segmentation
parameters to target
patients prospects based
on health risk status level
of influence on family
care and risk contract
coverage
Expanded Segmentation
for Population Health
Customize content and
modality by personalizing
a messagersquos style
sender and channel
Increasingly Customized
Multi-Channel Communication
Pinpoint care delivery
opportunities by timing
communications based
on patient health needs
and in response to
specific behaviors
Patient Centered
Communication Design
Yesterday
Today
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 14
Nine Tactics for Using CRM to Build Loyalty and Manage Population Health This publication details nine
imperatives that marketers can use to
leverage their CRM systems to
achieve care management and cross-
continuum loyalty goals Each
imperative is supported by case
studies from leading health systems
that have used their CRM system to
refine segmentation customize
content and modality and pinpoint
delivery opportunities
Finding New Value in CRM
Refining Segmentation
Parameters
I
Customizing Content and
Modality
II
Pinpointing Delivery
Opportunities
III
1 Prioritize New Patient Groups
Affecting Reimbursement
2 Use Analytics to Identify Rising-
Risk Patients
3 Enfranchise Health Managers to
Drive Family Care Compliance
4 Hone Personalization to
Facilitate Behavior Change
5 Position Clinician as Message
Author
6 Integrate with Digital Channels
for Outreach and Data Collection
7 Track Behaviors to Identify
Messaging Opportunities
8 Automate Outreach Along
Care Pathways
9 Customize Reactivation Using
Clinical Indicators
Source Marketing and Planning Leadership Council interviews and analysis
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 15
Imperative 1 Prioritize New Patient Groups Affecting Reimbursement
Imperative 2 Use Analytics to Identify Rising-Risk Patients
Imperative 3 Enfranchise Health Managers to Drive Family Care Compliance
Refining Segmentation Parameters
Section 1
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 16
Segment Targets Across Multiple Parameters Under Population Health Across the past decade hospital and
health system marketers have used
CRM systems to target outreach to the
current and prospective patients most
likely to need and be able to afford
specific health services However as
value-based reimbursement models
shift growth objectives marketers
must both narrow and shift their
targeting strategies by adding
segmentation parameters and
modifying criteria within existing
parameters Increasingly marketers
will segment by
bull Financial risk status to prioritize
patients for whom the institution
is financially at risk for
preventive care
bull Health risk status to prevent
escalation of health risk and
associated costs
bull Decision-maker status to improve
household-wide care engagement
and health
Redefining Segmentation Parameters to Support New Goals
Source Marketing and Planning Leadership Council interviews and analysis
Optimize financial
performance under risk-
based contracting
Prevent escalation of
health risk to avoid
unnecessary acute care
utilization
Engage all household
members in preventive
care and wellness
bull ACO patients for care
management
bull Patients for whom the
institution is at risk (ex
health system employees
Medicaid and uninsured
patients)
bull High-risk patients to
prevent acute episodes
bull Rising-risk patients to
keep them from becoming
high risk
bull Low-risk patients to
promote appropriate
utilization preventive
services affecting care
quality metrics
bull Household care manager
as proxy for patient when
appropriate
Ob
jecti
ve
Targ
et
Financial Risk Status Health Risk Status Decision-Maker Status
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 17
IU Health Goshen Flags ACO Patients for Health Education Preventive Services As providers assume risk for care
costs and outcomes marketers
should prioritize patients for whom the
organization is at risk to receive
preventive health and patient
engagement communications
For example Indiana University
Health Goshen is in the process of
gaining clinical buy-in for a CRM
functionality that flags ACO patients in
their CRM system1 and generates
personalized prescription lists for
each ACO patient Marketers will
include the list in a mailing
encouraging these individuals to
discuss drug interactions and generic
alternatives with their physician
Marketers may also wish to target
ACO patients with articles about
relevant health conditions
personalized screening and
immunization schedules and
reminders and applicable classes
1 Prioritize New Patient Groups Affecting Reimbursement
Identify ACO Participants to Support Care Management
Source Marketing and Planning Leadership Council interviews and analysis 1) ACO arrangements with CMS require the use of CMS-provided templates for communication and
health related and educational communications must be first approved by CMS
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull As an ACO wants to ensure that ACO patients are prioritized for care management
bull CRM will target ACO patients with personalized prescription list mailings will encourage
patient to discuss prescription management with doctor
Immunization
reminders
Appointment
follow-up
scheduling
Prescription
management
Appointment
reminders
Chronic disease
classes
Relevant health
articles
preventive
screenings
Wellness tips
recipes
and lessons
Customizable Care Management
and Health Education Services
ACO Patient Name
Salado Juan
Salaman Kristin
Salander Lisbeth
Sales Michael
Sageser Thomas
IU Health Goshenrsquos Segmentation Process
2
1 Identify patients
in an ACO
Prioritize ACO
patients for care
management
messaging
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 18
Algorithms Target Individuals to Improve Preventive Screening Rates Under value-based reimbursement
models all institutionsmdashregardless of
ACO statusmdasheffectively assume
some financial risk for select patient
groups CRM systems can be useful
tools for driving preventive and
chronic care utilization to minimize
unnecessary acute episodes
Gundersen Health System uses a
CRM system to increase utilization of
preventive services such as
mammograms with a goal of
improving care quality scores
particularly on metrics that are tied to
reimbursement The CRM tool uses
demographic and prior utilization data
to target current and prospective
patients in areas with low preventive
care utilization rates For example to
improve mammogram rates the CRM
system identified female
bull Current and prospective patients
who recently turned 40
bull Current patients who were overdue
for a mammogram screening
bull Prospective patients over age 40
Reactivation messaging to these
women helped improve population
health patient engagement and
volumes The 11-month campaign
realized an incremental lift of 756
patients and an ROI of 4721
Targeting Preventive Services to Improve Quality Scores
Source Marketing and Planning Leadership Council interviews and analysis
Demographic
Targeting
bull CRM identifies prospects and
patients of the correct age
gender etc under pre-
established target criteria
Geographic
Targeting
bull Geotargeting identifies markets
with lower preventive screening
rates for colonoscopies
mammograms and
immunizations
Care Utilization Targeting
bull CRM tracks patients who do not meet
preventive care guidelines
bull Predefined patient cohorts (ex those
receiving treatment for related health
conditions) excluded from targeting
Population Health Targeting at Gundersen Health System
Case in Brief Gundersen Health System
bull 325-bed teaching hospital with four critical access hospitals and 50 clinics headquartered in La Crosse Wisconsin
bull System had areas of low preventive health screening rates resulting in lower-than-desired quality scores
bull CRM targets relevant consumers who do not meet preventive care guidelines within service areas with low
colonoscopy mammography and immunization rates
bull 11-month mammography campaign saw incremental lift of 756 patients and an ROI of 4721 campaign will be
expanded in the future
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 19
Traditional marketing typically targets
highest-risk patients most likely to
need a service Under value-based
payment models however providers
will need to target patients across all
risk levels for different purposes
Using clinical demographic and
consumer data CRM systems can
segment patients by health risk
bull High-risk patientsmdashthose with a
complex disease multiple
comorbidities and psychosocial
problemsmdashtypically comprise about
5 of a patient pool
bull Rising-risk patientsmdashthose with
multiple risk factors that could push
them to become high-cost if left
unaddressedmdashtypically comprise
15-35 of a patient population
Without specific care management
efforts 18 of this population
becomes high-risk annually
bull Low-risk patientsmdashthose who are
healthy or have a well-managed
chronic conditionndashconstitute the
remaining 60-80 of the pool
CRM systems can target high-risk
patients for intensive care
management rising-risk patients for
enhanced primary care and low-risk
patients for preventive services
2 Use Analytics to Identify Rising-Risk Patients
Segment by Health Risk Status for Different Care Management Goals
Source The Advisory Board Company The Health Care Advisory
Board ldquoPlaybook for Population Healthrdquo Washington DC Marketing
and Planning Leadership Council interviews and analysis
Low-Risk Patients
60-80 of patients
any minor conditions
are easily managed
Rising-Risk Patients
15-35 of patients
chronic conditions at risk
of escalation
High-Risk
Patients
5 of patients
usually with
complex disease(s)
comorbidities
Patient Segmentation and Communication Goals
Under Risk-Based Contracting
Goals for High-Risk
bull Deliver intensive comprehensive
and proactive management
bull Trade high-cost acute care services
for low-cost care management
whenever clinically effective
bull Sample services Diabetes
management
Goals for Rising-Risk
bull Avoid unnecessary spending
and keep patients from becoming
high-risk
bull Manage in enhanced primary care
bull Sample services Medical home
enrollment
Goals for Low-Risk
bull Keep patient healthy
bull Maintain loyalty to the system
bull Collect data on patients to treat
them more effectively when they
do need care
bull Sample services Preventive
screenings immunizations
Nationally 18 of the
rising-risk patient
population becomes
high-risk each year
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 20
Map Pre-disease Pathways to Create Early Warning System for At-Risk Patients Each year 18 of the average US
providerrsquos rising-risk patients become
high-risk This means that managing
high-risk patients alone will not be
sufficient to ensure financial
sustainability under risk contracts
Rather providers will have to engage
in care management for their rising-
risk population
To help prevent rising-risk patients
from becoming high-risk Vanguard
Health System is using its CRM
system to identify patients at risk for
13 disease states found to have the
most substantial impact on population
health management1
To ensure all potential rising-risk
patients are identified and targeted
Vanguard identifies the full spectrum
of conditions associated with pre-
disease pathways for these disease
states The CRM system then pulls
patients from its database based on
corresponding ICD-10 codes for each
condition and comorbidity
Vanguard targets these patients with
communications to help them manage
their conditions and prevent them
from moving into the high-risk
category
Use Leading Indicators to Track Shifting Rising-Risk Population
Source McGlynn E et al ldquoThe Quality of Health Care Delivered to Adults in the United Statesrdquo New
England Journal of Medicine June 2003 wwwnejmorgdoifull101056NEJMsa022615t=article
Marketing and Planning Leadership Council interviews and analysis
1) Vanguard and Tea Leaves identified disease states based on findings in ldquoThe Quality of
Health Care Delivered to Adults in the USrdquo in the New England Journal of Medicine June
2003
Case in Brief Vanguard
Health System
bull 28-hospital system based in
Nashville Tennessee
bull Seeking to help rising-risk
patients manage health
conditions and avoid disease
escalation
bull Focuses on reducing patientsrsquo
risk for 13 disease states with
the greatest impact on cost and
quality metrics
bull CRM predictive modeling uses
ICD-10 codes to identify rising-
risk patients who have
conditions associated with these
disease states
2500 Diabetes mellitus
without complication
2780 Overweight and obesity
4010 High blood pressure
7902 Abnormal glucose
bull Schedule of diabetes
prevention programs
bull Pre-diabetes messages
Identifies Disease States1
Maps Pre-disease
Pathway Using
Related ICD-10 Codes
bull Breast cancer
bull Colon cancer
bull Pneumonia
bull Heart disease
bull Heart failure
bull Wellness and
screenings
bull Asthma
bull Hypertension
bull Diabetes
bull Lower back
pain
bull Arthritis
bull ED redirects
bull COPD
Targets for Preventive Care Messaging
1
2
3
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 21
Vanguard Targets Household Health Managers to Build Relationships Many households have an individual
who has significant influence over
other family membersrsquo health
decisions Segmenting the patient
population by household and targeting
this household health manager with
messages about all household
membersrsquo health needs can increase
the likelihood of eliciting behavior
change Household caregivers are
also important targets because they
often have the same chronic
conditions as family members but
may not have received a diagnosis
Vanguard often targets the oldest
female in a family unless the patient
has indicated alternative preferences
for a household health manager The
CRM system compiles household
health information such as all family
membersrsquo immunization reminders
into one mailing to the health
manager Vanguard believes this
convenience promotes loyalty among
health managers improves household
health and can make a positive
impact on chronic conditions that tend
to run within families
3 Enfranchise Health Managers to Drive Family Care Compliance
Target Decision Maker to Promote Household Loyalty Care Compliance
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Vanguard Health Systems
bull 28-hospital system based in Nashville Tennessee
bull Data shows most households have a health manager who
influences decision making for other household members
bull CRM groups individualsrsquo information by household and
addresses messages toward the health manager
Rationale for Targeting a
Household Health Manager
Promotion of preventive services
to health managers can improve
household health
Condensing multiple mailings into
one stretches marketing budget
Convenience for household
decision maker begets loyalty to
health system
Chronic diseases tend to run within
a family behavior change often
occurs at household level
Adaptive Targeting Process Identifies Key Influencer
Adjust
Accordingly
Foster
Relationship
CRM sets oldest
female in the
household as the
default target
Target is updated
if patient indicates
presence of
different health
manager
Vanguard builds
relationship with
health manager to
help manager
make sound health
decisions
Target Oldest
Female
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 22
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 23
bull Imperative 4 Hone Personalization to Facilitate Behavior Change
bull Imperative 5 Position Clinician as Message Author
bull Imperative 6 Integrate with Digital Channels for Outreach and Data Collection
Customizing Content and Modality
Section 2
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom
Personalized Mailings
Generate Stronger
Response Rate
24
CRM Allows for Tailoring to Individualize Each Message
As messaging goals become more
complex and other industries compete
for consumersrsquo attention with large
budgets and highly sophisticated
analytics hospital and health system
marketers must develop effective
messages to attract attention change
beliefs and motivate action
Intensive personalization is one
demonstrated method for improving
outreach effectiveness as measured
by call-to-action response rates CRM
systems can personalize a messagersquos
style sender and channel using
dynamic data collection and analysis
to improve messagesrsquo relevancy and
appeal
For example surveys indicate that
patients trust clinicians more than
hospitals as sources of health
information suggesting that messages
from clinicians may have more
credibility Likewise as the number of
digital communications channels
grows marketers can use CRM
systems to track and match patientsrsquo
channel preferences
Personalizing Message Style Sender and Modality to Motivate Behavior Change
Source Calnan ldquoPublic Trust in Healthcare The System or the Doctorrdquo httpqualitysafetybmjcomcontent13292fullpdf+html ldquoResponse Rate Reportrdquo Caslon amp Co
httpwwwbridgebcicombridge-directResponseRateReport_2008-dec_v65B15Dpdf ldquoWhat Do Customers Wantrdquo Varolii
httpwwwvaroliicom~mediaFilesOffersWhatCustomersWant_ResearchReportashx Marketing and Planning Leadership Council interviews and analysis
Standing Out from the Daily Deluge
ldquoWersquore not just competing with other health care systems Wersquore competing with every consumer product
company that is trying to get brand attention and share of mind Irsquom competing for peoplesrsquo eyes with Nike and
Coke and every other great marketer thatrsquos out there We need to be interesting and vital to everyonersquos liferdquo
Jane Yepez
Vice President of Marketing and Public Affairs Virtua
rdquo
Em
ail
Pri
nt
Ma
il
Ph
on
e
Te
xt
So
cia
l
Me
dia
79
54
23 21 18
Top Preferred Communication
Channels
Greater response rate
for personalized
than static
campaigns
15x-5x
Patients with Confidence in
Providersrsquo Key Players
Hospital
Administrators
Health
Systems
General
Practitioner
40
29
89
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 25
Tailored Campaign Guides Potential Patients from Front Door to Facility CRM systems can automatically
adapt content to create a unique
message for each patient For
example features such as mapping
capabilities allow providers to include
driving directions from the prospectrsquos
home to the nearest health facility
Especially important for ldquoNew Moverrdquo
campaigns the map emphasizes the
facilityrsquos convenience and reduces
patient effort required to access care
Aceso Health System (pseudonym)
leveraged this capability in one of its
recent ldquoNew Moversrdquo campaigns In
addition to personalizing the mailing
with a picture reflecting household
demographics the CRM system used
geographic data and mapping
capabilities to include personalized
maps with drive times directing
patients from their home to the
nearest Aceso facility As a result the
2012 campaign produced a 481 ROI
and led to 5377 visits from new
movers
4 Hone Personalization to Facilitate Behavior Change
Provide Customized Tools to Simplify Desired Call to Action
Source Marketing and Planning Leadership Council interviews and analysis
Multiple versions of picture reflect
patientrsquos demographic information
Case in Brief Aceso Health System
bull 600-bed health system with affiliates located in the Northeast
bull Seeking to attract ldquoNew Moversrdquo to health system
bull CRM generates custom maps with directions from the new home to the nearest system facility
bull ldquoNew Moversrdquo 2012 campaign credited with 5377 visits 250 incremental individuals over
expected and an ROI of 47681
Aceso Health Systemrsquos1 New Mover Mailing
Results from Aceso
Health Systemrsquos New
Movers Campaign
481 Return on
investment
for campaign
5377 System visits
credited to
campaign
Aceso Health System
100 Deity Drive
Northeast US
P Sherman
42 Wallaby Way
Sydney NH
Map provides route dynamic
driving time to the nearest facility
1) Pseudonym
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 26
Apollo Health System1 Persuades by Personalizing the ldquoWhyrdquo Some CRM systems now go beyond
demographic variables and
incorporate psychographic variables
to design unique messages based on
an individualrsquos personality traits
values and view of health care
These CRM systems then adjust
presentation content and tone
accordingly to increases in response
rates
Apollo Health System (pseudonym)
used its CRMrsquos psychographic models
to tailor communications for a recent
preventive health campaign Patients
motivated by healthy lifestyles
received mailings rich in health
information while self-reliant patients
who predominately consume high-
acuity care received a call to action
with fewer details
Targeting the message by
psychographic factors increased the
campaignrsquos return by 700 patients and
$626 per dollar spent relative to a
previous generic preventive health
campaign
Use Psychographic Data to Tap Motivators Values
Source ldquoPsychographics and Lifestylerdquo University of Dayton
httpcampusudaytonedu~jrstoolsnotespsychographics20and20lifestyl
epdf Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Apollo Health System1
bull 2000-bed health system based in the Mid-West
bull Recognized need to further target marketing messages to improve patient buy-in for preventive health
bull Used psychographic variables such as preferred message tone and proclivity toward text or graphics for
tailoring messages to reflect patientsrsquo consumer profile
bull Preventive health campaign return increased by nearly 700 patients and $626 per dollar spent over an
identical generic mailing campaign
Sample Psychographic Variables Used to Customize Message
Personality
bull Introvert
bull Extrovert
bull Analytical
bull Creative
Lifestyle
bull Motivated by success
bull Motivated by pleasure
bull Physically active
bull Physically inactive
Values
bull Family friends
bull Work recognition
bull Health wellness
bull Wealth stability
Customized consumer profile reflects patient variables in
presentation of material motivating message and message tone
Results of
Campaign Using
Psychographic
Tailoring
626x Increase in ROI
over identical
generic campaign
700 Additional
patients than
generic campaign
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 27
CRM Capable of Matching Patients to Their Physicians Beyond tailoring message content and
style leading providers have
increased response rates by
customizing the purported sender of
the communication
For example Banner Health has
found that patients are more likely to
read and respond to a messagersquos
content if they see their own doctorrsquos
photo on the mailing Banner Healthrsquos
marketers use their CRM system to
create over 70 versions of a message
for each of their 300 physiciansrsquo
patient panels Likewise Cleveland
Clinic found that patients respond
more favorably to health-based
messages addressed from a relevant
clinician than from the health system
Both institutions experienced an
improved patient response when a
clinician was positioned as the
message author however no direct
comparison is available to compare
the effectiveness of a patientrsquos
specific physician versus any relevant
physician as the purported sender
5 Position Clinician as Message Author
Communications from Clinicians Not Facility Increase Response Rates
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed health system based in
Cleveland Ohio
bull Finds patients more likely to respond to specific
health information if they perceive it coming from
physician rather than from the hospital system
bull Uses CRM to automate mailing content based
on campaign
Case in Brief Banner Health
bull 3229-bed health system based in Phoenix
Arizona
bull Finds patients more likely to read mailings that
show their physicianrsquos face
bull CRM includes picture of patientrsquos PCP in
their mailing
bull Creates up to 22000 different personalized
messages for each campaign
Banner Health Includes CRM-Matched Clinician Photo
Patient CRM System Physician Customized Mailing with
Physicianrsquos Photo
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 28
CRM-Linked App Provides Instant Personalized Communication As patient preferences have shifted to
digital communication channels
progressive health systems have
begun investing in CRM systems that
integrate with email smartphone
apps patient portals and social
media
Patients in the Indiana University
Health Goshen system can download
a free app on their mobile devices
The CRM system then uses
information from across health data
systems to personalize the messages
which are sent to the patientrsquos phone
through the app Click-to-call and text
response options allow patients to
respond to these notification alerts
instantly
Currently Indiana University Health
Goshen is piloting this capability with
appointment reminders at one
practice but plans to expand to health
management and reminder messages
such as screening recommendations
to mobile devices in the future
6 Integrate with Digital Channels for Outreach and Data Collection
Deploy Targeted Messages Across All Channels
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Wants to securely provide personalized information to patients on their mobile devices
bull IU Health Goshen piloting app to send out automated appointment reminders
bull After pilot IU Health Goshen plans to expand to personal health management messages and
time sensitive adhoc practice notification to patients on their mobile phones
Reminders
From Dr Lahiri
Current Notification Function
bull Automatic appointment reminders Monday 900 am
Dr Lahiri
Thursday 200 pm
Dr Castellano
Time to schedule a
mammogram
Have you gotten 30
mins of exercise
Future Notification Functions
bull Screening recommendations
bull Personalized health reminders
bull Alerts to patients and caregivers
Patient Response Functions
bull Click-to-call
bull Instant text response to
provider within the app
IU Health Goshen
Features of IU Health Goshenrsquos eCare Connect
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 29
Select Modality Using Indicated Predicted and Tested Preferences With this emergence of more CRM-
integrated communication channels
however some marketers have found
that messages sent via multiple
channels may overwhelm patients
and lead them to ignore all
communications while those sent via
only one channel may not be received
at all To ensure patients receive
messages via their preferred
channel(s) marketers are using CRM
systems to dynamically track
preferences and deploy messages
across channels
Vanguardrsquos CRM system predicts and
tracks an individualrsquos preference for
email print mail text or Facebook
message If a patient indicates a
preference during registration the
CRM system will default to that
channel if no preference is selected
the system predicts the patientrsquos
preferred modality based on trends
among patients from similar
demographic groups The system also
adjusts to changes over time by
tracking the individualrsquos response to
communication and automatically
testing new modalities for individuals
who fail to respond
Adapt Messaging Modality Using Dynamic Response Tracking
Source Marketing and Planning Leadership Council interviews and analysis
Patient modality
preference indicated 1 No preference indicated
CRM predicts preference
based on demographics
2
CRM automatically sends
message via indicated
or predicted preference
3
CRM gauges
patient response
to communication
4
If patient responds CRM
defaults to that modality for
future communication
5 If patient does not respond
CRM automatically
tries different modality or
combination of modalities
6
Vanguardrsquos Automated Process for Determining Patientsrsquo Preferred Communication Channels
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull Using CRM system to increase patient response
bull CRM tracks individualsrsquo preference and will record an individualrsquos response to that
means of communication
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 30
CHRISTUS Integrates CRM and Patient Portal for lsquoAmazon-Likersquo Experience Beyond improving response rates
digital platforms can also collect
additional data that can be used to
refine future targeting and tailoring
For example as organizations work to
communicate through patient portals
for Meaningful Use compliance and
for automation of scheduling billing
and lab reporting CRM systems can
use portals as both a source of patient
data and an integrated communication
channel
CHRISTUS Health integrated its CRM
system with its patient portals with the
goal of creating an ldquoAmazon-likerdquo
experience CHRISTUSrsquos CRM
system tracks patient activity within
the portal and combines this data with
information from other hospital data
systems including EMR and call
center data The system uses this
information to create tailored content
that the patient sees each time they
log into their portal Additionally the
health system can send individualized
messages through the portal email
function with CRM
Digital Platforms Serve as Both Communication Channels and Data Sources
Source CHRISTUS Health Creates an lsquoAmazon-Likersquo Experience for
Patientsldquo Medseek httpmedseekcomclient-storieschristus-health
Marketing and Planning Leadership Council interviews and analysis
Case in Brief CHRISTUS Health
bull 6670-bed health system in the Southwest
bull Wanted its web-based patient portal to give users an experience like Amazonrsquos
bull Integrating CRM into portal system makes patient portals both a data source
and secure communication channel
bull Integration allows highly targeted behavior-influencing messaging to improve
patient health while driving higher returns for CHRISTUS
Data Source for
bull Researched topics
bull Diagnoses
bull Lab Results
Channel for
bull Updates to
personalized
content
Patient Portal CRM
Patient
Patient Access to
bull Lab results
bull Billing
bull Physician message
bull Health library
CRM Captures
bull Data on patient
interaction with health
system
bull Third party patient
information
Customized
bull Banners
bull Call outs
bull Health articles
bull Reminders
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 31
Moving from Static to Dynamic Information Some CRM systems have also
developed capabilities for collecting
data to customize content for
prospective and current patients
Instant CRM (ICRM) an interactive
web service allows marketers to
personalize their institutionrsquos website
with information tailored to each site
visitor even if the visitor has not
logged in to the portal This
functionality is particularly useful in
providing tailored content to
prospects with whom providers
cannot communicate via portals
Epione Health System (pseudonym)
has recently invested in this
capability Using a cookie to
remember each device that accesses
the health systemrsquos website ICRM
records personal information that
users enter into the site such as their
name when registering for a
newsletter ICRM then links that user
and the userrsquos device to a record
stored in the CRM database and uses
this pairing to generate tailored
content for the websitersquos banners
articles and call-out boxes For
example when ICRM recognizes a
user as an Epione cancer patient it
uses the userrsquos demographics and
health history to select one of six
relevant cancer messages to display
Personalizing Website Content for Current and Prospective Patients
Source Marketing and Planning Leadership Council interviews and analysis 1) Pseudonym
Case in Brief Epione Health System1
bull 2000-bed health system based in the Midwest
bull Launching Instant CRM (ICRM) to personalize patientrsquos experience on systemrsquos website
bull First-time site visitorrsquos website cookie linked with CRM records upon returning to the website the visitor
sees personalized web content based on previous activity and other information drawn from CRM
Process for Customizing Content for Website Visitors
User sees personalized
content upon next visit
to health systemrsquos website
Patient accesses health
systemrsquos website cookie
placed on userrsquos device
CRM matches user to
patient record or creates
new user record in CRM
database
Website content tailored to
visitor content linked to
the cookie
User enters personal info into
the site (logs in to portal
takes health screening etc)
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 32
Combining Demographics Psychographics Modality Preferences to Tailor Outreach Dynamically tracking patient
preferences for communication
channel is only one type of tailoring
that Vanguard Health System
employs Vanguardrsquos CRM system
also uses demographic and
psychographic variables to create an
extensive decision tree The system
processes each patient through this
decision tree to ensure that the style
and content of the message matches
the individualrsquos demographics and
lifestyle values This tailoring
increases the odds that the patient will
relate and respond to the message
Vanguardrsquos dynamic and elaborate
process ensures the right message is
delivered to the right person in the
right style and through the right
channel
Simplify Comprehensive Tailoring with CRM System
Psychographic
Variables
Modality
Preference
Demographic
Data
Case in Brief Vanguard Health System
bull 28-hospital system based in Nashville Tennessee
bull CRM processes each targeted patient through extensive decision tree ensuring patient receives the most relevant
message through the communication channel most likely to elicit response be it print email text or Facebook
Source Marketing and Planning Leadership Council interviews and analysis
Illustrative CRM Decision Tree for Tailoring Communication
Targeted
Patient
20-40
yrs old
40-60
yrs old
60+
yrs old
Childless Children Childless Children
Caucasian
Childless Children
Hispanic Black
Feel-good
tone Fear tactic
Graphics
heavy
Data
heavy
Text Email Facebook Print
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 33
bull Imperative 7 Track Behaviors to Identify Messaging Opportunities
bull Imperative 8 Automate Outreach Along Care Pathways
bull Imperative 9 Customize Reactivation Using Clinical Indicators
Pinpointing Delivery Opportunities
Section 3
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 34
Under fee-for-service reimbursement
the timing of marketing outreach has
been driven largely by the
organizationrsquos needs and schedule
As outreach goals change to include
supporting care compliance and self-
management timing must be dictated
by patient needs and customized to
each individual patient
For example preventive proactive
outreach must be provided before a
patient becomes high-risk and
responsive care management
messaging should be sent after
service utilization to reduce the
chance of readmission
Marketers can set algorithms in CRM
systems to recognize a wide range of
patient behaviors clinical care
pathway steps and time lapse
indicators
These triggers simplify and automate
messaging timetables enabling
marketing departments to
communicate both proactively and
reactively to promote patient
engagement
CRM Algorithms Recognize Respond to Wide Range of Triggering Events
Source Marketing and Planning Leadership Council interviews and analysis 1) Emergency department
Behavioral
Clinical Care
Pathways
Reactivation
bull First-time patient
bull Improper use of ED1
bull On-time payment
bull No-show for an appointment
bull Diabetes mismanagement
bull New mover to primary service
area
bull List of noncompliant patients to
their physician
bull Pain management
bull Hypertension
bull Diabetes management
bull Heart failure
bull Pregnancy
bull Neonatal immunizations
bull Cardiology
bull Coronary artery disease
bull Influenza vaccination reminder
bull Pneumococcal vaccination
reminder
bull Mammography screening
bull Colorectal cancer screening
bull Stroke diagnostic screening
bull Turning 65mdasheligibility for
Medicare
bull Turning age to enter senior
program
Sample Programmable Triggers in CRM Systems
Timing of Messages A Balancing Act
ldquoWhatrsquos going to drive patient compliance Frequency of messaging It might drive
people away too if you donrsquot use it correctlyrdquo
System VP and Chief Marketing Officer
rdquo
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 35
CRM Triggers Identify Automatically Respond to Inappropriate ED Use Progressive systems are using CRM
to recognize patient behaviors that
indicate a communications need or
opportunity to encourage or modify
patient behavior
Kaweah Delta Health Care Districtrsquos
CRM system uses behavioral triggers
to reduce inappropriate ED utilization
and redirect patients to appropriate
care sites The system scans
discharge data for diagnoses that
constitute an inappropriate ED visit
and generates a personalized letter to
the patient explaining appropriate ED
use and alerting them to the nearest
Kaweah Delta Urgent Care Center
After a third inappropriate ED visit the
CRM system alerts Kaweah Deltarsquos
Bridging Care Program staff to reach
out to the ldquoED Frequent Flierrdquo to
connect uninsured patients to
community resources as needed
With these programmed triggers
Kaweah Deltarsquos CRM system can
send reminders at pertinent times for
individuals rather than as one mass
mailing thereby creating a more
engaging patient experience and
improving continuity of care
7 Track Behaviors to Identify Messaging Opportunities
Redirect Educate Reward with Responsive Outreach
Source Marketing and Planning Leadership Council interviews and analysis
1) Emergency department
2) Urgent care
Case in Brief Kaweah
Delta Health Care
District
bull 581-bed health system in
Central Valley California
bull Improper ED utilization
costly to system and
inconvenient to patient
bull CRM identifies
inappropriate ED utilization
sends customized mailing
to patient on alternative
care sites
Illustrative Example of ED1 Misuse Trigger
in Kaweah Deltarsquos CRM System
Appropriate urgent care use
First inappropriate ED use
Second inappropriate ED use
Third inappropriate ED use
Patient identified for
enrollment in Bridging
Care Program
CRM recognizes inappropriate visit
generates UC redirect letter
CRM recognizes inappropriate visit
generates UC2 redirect letter
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 36
CRM can also be used to generate
messages along preset clinical
pathways to send educational
mailings or appointment reminders
IU Health Goshenrsquos marketing
department is working with physicians
to launch clinical time triggers in their
CRM system to remind diabetic
patients about the screenings for
which they are due in order to catch
and mitigate complications The CRM
system recognizes a patientrsquos
appointment date and will trigger a
mailing a set number of months later
reminding patients to schedule a
personalized list of preventive
screenings such as an LDL-C
screening for diabetes management
If a patient proactively seeks out the
specific screening before reaching the
trigger the CRM system will restart
the time tracking
8 Automate Outreach Along Care Pathways
Activate Care Reminders Based on Last Appointment
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Indiana University Health Goshen
bull 123-bed hospital in Goshen Indiana part of 3541-bed hospital system
bull Diabetic patients need to be reminded to get screening tests to catch
complications as early as possible
bull Working to launch clinically based triggers set in CRM system to
automatically remind diabetic patients to schedule LDL-C screening or
other pertinent test if patient is inactive for a set time period
bull CRM algorithms will also include list of other preventive screenings
based on patientrsquos demographic information in the reminder mailing
IU Health Goshenrsquos Diabetic Screening Reminder Letter
Tracks Diabetic Patientrsquos
Appointment Date
Date of diabetic patientrsquos appointment
uploaded into CRM system
Monitors Time Elapsed
CRM tracks months since patientrsquos last
appointment trigger set based on patientrsquos
specific condition
Patient Response Functions
When trigger reached CRM generates
personalized letter asking patient to
schedule an LDL-C screening and any
other demographically relevant screenings
based on CRM algorithms
3
2
1
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 37
CRM Adapts Reactivation Frequency Using Biometrics Additionally CRM systems can be
used to customize reactivation
triggers based on clinical indicators
Rather than sending out periodic
mass mailings to all lapsed patients
CRM systems can track individualsrsquo
progress through care pathways and
dynamically alter reactivation
messaging schedules based on each
patientrsquos personal information
Cleveland Clinic sets system-wide
reactivation triggers to identify
patients who have become inactive or
disengaged All inactive patients
receive a mailing after 12 months of
inactivity and those with any one of
275 chronic conditions may be
targeted for more frequent follow-up
For example although pre-diabetic
patients with stable A1C levels
receive a standard 12-month
reactivation letter Cleveland Clinicrsquos
CRM system monitors patientsrsquo A1C
levels between appointments and
contacts those with increases after
only six months of inactivity
9 Customize Reactivation Using Clinical Indicators
Redefining ldquoInactiverdquo Based on Health Status Changes
Source Marketing and Planning Leadership Council interviews and analysis
Case in Brief Cleveland Clinic
bull 4450-bed system based in Cleveland Ohio
bull Inactive patients at heightened risk of disease progression and more likely to incur higher
health costs downstream
bull CRM targets pre-diabetic patients for reactivation after 12 months of system inactivity
bull Patients whose A1C levels cross a clinical threshold are targeted for reactivation after
six months of inactivity
Reactivation Schedule for Pre-diabetic
Patients at Cleveland Clinic
Trigger set to respond to time
lapses indicative of inactive or
disengaged patients
Patient remains in 12
month reactivation group
Patient moved to six-
month reactivation group
Patientrsquos A1C
level stable
Patientrsquos A1C
level spikes
12-month reactivation
trigger set with CRM
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom 38
While basic mailing programs allow
for patientsrsquo names to be inserted in
messages CRM systems vastly
increase the degree of personalization
possible With segmentation based on
behavior health payment model and
decision-maker statuses tailoring
based on more variables and
preferred communication channels
and timing triggers to automate
messaging schedules CRM systems
create increasingly customized
messages designed to elicit higher
response rates build loyalty and
support care compliance
Tying It All Together
Incorporating More Variables Increases Personalization Response
Source Marketing and Planning Leadership Council interviews and analysis
Variables Used in Tailoring Message Style
Timing
bull Patient behaviors
bull Lapses in system activity
bull Progression through clinical
care pathways
Emerging Set
of Variables
Basic patient information
bull Patient name
No CRM
Basic patient information
bull Patient name
Basic patient information
bull Patient name
Targeting
bull Most likely to need service
bull Most likely to afford
service
bull Patients v non-patients
Tailoring
bull Demographic variables
bull Print medium (postcard
letter etc)
Traditional Set
of Variables
Targeting
bull Health risk status
bull ACO v non-ACO patients
bull Decision-maker status
bull Active or lapsed patients
Tailoring
bull Demographic variables
bull Psychosocial variables
bull Geographic location
bull Sender
bull Communication channel
preference
Sample Variables Used to Customize Campaigns
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
copy2013 The Advisory Board Company bull 28008 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom
2445 M Street NW I Washington DC 20037
P 2022665600 I F 2022665700 advisorycom