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October 2009
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  Health Care Reform and the HealthCare Marketing Researcher I was on an airplane in mid-September, returning from a client visit, on the evening when President Obama delivered his long-awaited speech to Congress and the nation on what he had in mind for health care reform. Thanks to the wonders of YouTube, I was able to catch up with the whole speech the next day, and was bowled over by its implications for what it is that you and I do for a living. While acknowledging to some chuckling from the audience that there were some “details” yet to be worked out (I’m not even going to get anywhere near the “You lie” controversy), the president clearly laid out several key elements of his health care vision. First and by far the most familiar was the vision that everyone will be able to obtain health care coverage. Pre-existing conditions and other considerations will not be allowed to block such coverage. Second, to assuage the concerns of many who were responding to the image of a government-run, autocratic health care system, he assured the TV audience that no one would be forced to change doctors or lose coverage they already had in place. Finally, he proffered that the new program would not increase the federal deficit. This speech, as well as many subsequent news reports and articles, make it clear that the conceptualization and execution of health care reform will be far from as straight forward as many believed. Originally, the average person’s understanding of Mr. Obama’s plan was to impose additional taxation on those making significant incomes, and use this money to fund a national program of health insurance. Over time, the national insurance program began to be discussed as an option that would be made available to everyone, interestingly causing some to predict that this would lead to big trouble for commercial insurers, while others predicted it would be a boon for them since they would be called upon to administer various aspects of the program. As this is being written, the president has made it clear that a government program is not a necessary requirement of his reform plan, which can be translated to mean that this component of the plan has received sufficient amounts of unfriendly fire that he believes it is wise to consider alternatives. Key words Mr. Obama has used express his intent to eliminate “waste, fraud and abuse” from the health care delivery system. Although it is refreshing to see that the president understands that a significant percentage of health care spend can be eliminated, with the net result of increasing both the effectiveness and the efficiency of the health care delivered, it is doubtful that he understands just how difficult a task this will be. There is little doubt that he understands the “fraud and abuse” components of this pronouncement, and we can look for regulatory processes to continue to tighten in this regard. Marketing practices were already being clamped down upon when Mr. Obama took office, and we can certainly expect this trend to continue and, in fact, intensify. What I doubt that Mr. Obama fully appreciates is the concept of “waste” in health care delivery, let alone the amount of time and effort it will take to eliminate. As I have described in other writings and presentations, and thus will only touch on here, an estimated 35 percent of health care expenditures are wasted. Not “fraud and abuse” kind of wasted, but the kind of waste we see when medicine is practiced the old-fashioned way, rather than being thoroughly rethought considering new philosophies and technologies. In brief, Mr. Obama, and everyone else including us, have to begin to understand that health care reform means more than changing who has access to what coverage and how this coverage gets paid for. Rather, genuine health care reform must improve the overall efficiency of the way in which health care is provided, or else the planned expansion of access will surely break the bank. As health care marketers and marketing researchers, what does this mean to us? First of all, we must understand that, increasingly, there is a significant trend toward judging the president’s performance based on whether he “succeeds” in his health care initiative. The definition of success varies widely based on whom you ask, but the general thrust is that he has to accomplish something significant, and do so quickly! Thus, my most important takeaway from all this is that, for someone involved in health care marketing or marketing research, we are likely to be on a wild ride over the next year as dissension meets a need for speed in health care reform. My second big takeaway is that each and every health care company should go through a series of scenario-planning exercises that will rate the likelihood of various outcomes and develop initial plans as to what our responses will be under each of these scenarios. Take, for example, the extremely important issue of whether a federal health care plan is a part of the reform package, as alluded to previously. In considering the impact of this on our business plan, we must first see that as the debate on this topic has intensified, we have now come to realize there are several permutations of such an offering. As originally conceptualized by many, the government plan would have been a safety net for those not currently able to obtain health care insurance. Other variations have emerged, however, in which the federal plan would compete with commercial insurance for all comers. A further variation along these lines would be the mandate that everyone must obtain coverage from some source or face significant penalties. For health care manufacturers, it is important to determine and to keep track of changes in the relative probability of each of these and other scenarios, to determine the impact that each would have on our businesses, and thus determine in which direction we should have our lobbyists pushing. We should also determine what actions we could take under each scenario, and which would be optimal. While the above comments pertain to the strategic level of thinking, as marketing researchers we also need to begin to do a significant amount of work at the tactical level. For example, a new cast of characters will become increasingly important as “stakeholders” in health care, and we need to begin to understand how they think. Clients are beginning to come to us to conduct studies on the knowledge, attitudes and practices of these potentially significant decision makers and, while I can’t reveal the specific nature of these respondents since this is proprietary to my clients, I can endorse the obvious, which is that they are wearing business suits, not long white medical coats and stethoscopes. That having been said, many of our clients are far less interested in monitoring and scenario planning for health care reform than one would imagine they would be. One, for example, recently invited me to the company to give a presentation on future trends in health care marketing research. Not surprising was the fact that the presentation was to be given to the entire marketing research department. Rather surprising was the request, which I honored, to avoid the topic of health care reform, since this would be the “wrong audience” to hear a discussion of this topic. Yikes! Along the same lines, like any good marketing researcher, I routinely conduct research about any new product I am considering offering to the industry before I spend the time and money to develop it. Believing that health care reform was going to having a significant impact on our clients’ businesses, and that much of the information required to deal with that impact could be most cost-effectively collected on a multiclient project basis, I and some of my top management set out to investigate clients’ reactions to this notion. In brief, we were told that product management still controlled the marketing research budget and was only interested in spending those moneys on projects that were product related. The most they would do with a proposal for a multiclient study on a meta-issue like health care reform was to use it as an impetus to use the Internet to seek out free information on the topic. Yikes again!! To wrap, let me summarize the obvious by noting that health care research cannot be just about products anymore. Issues like health care reform are big deals to our president, to the citizenry of our country, and need to be to us. Make no mistake about it. The health care reform bill, in some form, will constitute a major tipping point in our industry. Those health care manufacturers who play it right stand to gain big, while those who employ the wrong strategy, e.g., attempting to continue to do business as usual, stand to lose just as big. 
Richard B. Vanderveer, Ph.D. CEO, GfK Healthcare 
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