How To Maximize Your Pop Health Strategies, ft. Amy Comeau

Amy Comeau (00:00):
So by our doing that marketing intervention, we improved the system’s population health goal for annual wellness visit by 50% to 60%. If we hadn’t done that intervention, they would still be sitting at that 30% to 40%. So it’s just proof positive that this works, and it’s important that you spend the time partnering with your clinical and operational and access teams to build the right model to get the work done.

Alan Tam (00:37):
Hello Healthcare. When it comes to healthcare marketing, conversations typically move towards brand awareness, brand marketing, or patient acquisition. Seldom, if ever, does pop health become the star or the focus of the conversation, or quite honestly the action, which is a shame in my opinion. To buck this trend, I have an amazing guest today, Amy Comeau, VP of Marketing at Emory Health. Welcome Amy.

Amy Comeau (01:02):
Thank you so much for having me today.

Alan Tam (01:04):
Absolutely. Amy, you have a very interesting background and I’d like to share that with the audience. So, why don’t we start with that?

Amy Comeau (01:10):
Yeah, sure. So, Emory Healthcare is the first and only health system I’ve ever worked for. I’ve been with Emory for about 18 years, but prior to that, my career, I spent about a decade in the performing arts doing marketing, communications and ticketing for opera companies throughout the United States. Started my undergrad as a music major, so I bring a subscription mindset to healthcare, which is different than I think many other marketers’ mindset as they think about marketing healthcare.

Alan Tam (01:41):
That’s so awesome. I’ve talked to many healthcare leaders and they come from all over the place, different industries, retail, commerce, travel, hospitality, but this is the first time I have the opportunity to speak from someone with a performing arts background. What are some of the similarities and differences between performing arts and healthcare?

Amy Comeau (01:59):
Yeah, great question. As I reflect on that, the first easy answer is they’re both healing arts, right? So in healthcare, there is an art and science to healing the human body and human spirit. In the performing arts, the whole moment of the performing arts is for that emotional moment, and you find joy and escape through the arts.

(02:26):
So, when I’ve looked back on my career and people say, “Gosh, the performing arts in healthcare, that’s odd.” I said, “Well, you know what? In retrospect, I’ve made a career out of making people feel better.” So, that’s one of the easy similarities.

(02:39):
The other similarity, which is a little bit tongue in cheek, is that I’m used to working with difficult personalities. So one of my favorite interview questions, when I interviewed for my early job, my first job at Emory Healthcare, the administrator said, “All this is great, your marketing background is really interesting, but our physicians can be challenging personalities.” So, I looked him straight in the eye and I said, “Habib, I’ve literally worked with opera divas for the past 10 years, I think I can handle physicians.”

(03:12):
Now, we get to the differences. An industry secret, physicians are a little bit more difficult to deal with than divas at times. But no, seriously, I mean, there’s a lot of differences and certainly there’s similarities. Marketing is marketing no matter what industry you’re in or vertical you’re in. But from a differences perspective, when I was in the arts, we knew very clearly what we needed to sell.

(03:39):
I had a season of four or five operas that we were producing, we knew we had four or five performances of each opera. I knew exactly what the tickets I had to sell, and I knew when I had to sell them by. So if I saw that a show was not selling at the pace that I wanted it to, if I needed to get a direct mail piece, this was back in the old days before programmatic and digital marketing, I could do it in 24 hours.

(04:06):
Now in healthcare, while there’s seasonality, there’s not that same seasonality that happens in the performing arts or even sports industries where you’ve got a defined beginning and end to the season and you know what you need to sell, and you know what you need to do to engage and get your customers to return and become return subscribers.

(04:27):
So, you have that piece added to the fact that there aren’t always clear goals as to how many appointments we need to sell. So therefore, the conversation around how do we market healthcare is a little bit more vague at times, because we don’t always have that clear end zone of what are those items that we’re trying to sell.

(04:50):
The other difference is that when I was in the performing arts, I managed the entire experience. So marketing communications front of house, I managed the lead gen, but also the lead closure. Then once that person had their ticket, they would come to the theater and my team managed what their experience was from the moment they bought their ticket to the moment they sat in their seat. Then at that point, then the artists and the production team took over.

(05:19):
In healthcare, my team’s responsible for generating the lead, but it’s the access and scheduling team that’s responsible for closing that deal, and then another team that’s managing that whole front of house experience. So, it’s a different environment and different challenges that we face working in healthcare versus a, I don’t know if it’s traditional, but to me it’s more traditional performing arts environment.

Alan Tam (05:42):
Right. That’s very interesting, especially the way that you break it out, and that definitely highlights just the challenge of healthcare marketing and healthcare systems in general is there’s no single owner of the patient or the consumer journey as they move through that process.

Amy Comeau (05:58):
Right.

Alan Tam (05:59):
So, that in itself obviously presents a lot of different challenges.

Amy Comeau (06:03):
Yeah.

Alan Tam (06:03):
What are some of the other big surprises that kind of caught you off guard when you transitioned into healthcare from performing arts?

Amy Comeau (06:12):
I will say that for me, and particularly in academic medicine, this shared decision-making model is much different than in the performing arts. What I mean by that is that if you think about the performing arts, or even if you think about selling season tickets or marketing a sports team, you’ve got your performers that are the product or your athletes that are the product. In healthcare, it’s your physicians and nurses and other caretakers that are the product.

(06:40):
I was surprised to see how much involvement the physicians and some of the care providers have in generating opinions about marketing strategy. Whereas in the performing arts, none of the artists ever came in and said, “Amy, I think you need to be marketing this way.” While LeBron James might do this at the Lakers, I don’t know that any of the Atlanta Falcons’ defensive line are going into the marketing team and saying, “You really need to market us this way.”

(07:10):
So that is different, but you need the engagement of the physicians in order to market, but you also need … they’re the subject matter experts. So you can’t market deep brain stimulation without knowing what deep brain stimulation is, and you don’t know that without actually building a relationship with the physician and or the researcher that’s doing that work, to be able to then take that at a high academic level and dissecting it for a patient base.

(07:37):
The other thing I’ll share with that is that our physicians often, because they have multiple degrees, very smart, do a lot of research, they tend to write at a grade 36, 40. I mean, a very high academic level, because that’s how they’ve been trained as they do their research publications and their journal publications. But trying to take an article that’s published in The New England Journal of Medicine and then dissecting that and translating that at an eighth grade level in order to talk directly to our patients so they understand what that means, it’s a much different experience.

Alan Tam (08:16):
Yeah, that makes a lot of sense. I can see some of those challenges there, and I love your examples.

Amy Comeau (08:23):
Thank you.

Alan Tam (08:23):
Coming into healthcare, again, I’m very surprised and very curious as to why are you choosing pop health first as one of the core areas of focus?

Amy Comeau (08:35):
Yeah, it’s a great question, and I’ll say it wasn’t initially our first area that we were going to focus on when we implemented CRM. I know as we were talking before to prepare for today’s podcast, I talked about we’ve signed the contract for our CRM in October of 2019 and began implementation in January of 2020. We had always intended to roll out first and use CRM as the traditional marketing route to drive volume, demonstrate ROI.

(09:06):
While we were barely into implementation when COVID and the pandemic hit and we found that we needed to shift almost immediately to what the third year of our CRM plan was, we needed to move that immediately forward, and so we started using our marketing automation and CRM tools to do patient communications.

(09:27):
We always intended to do patient communications and pop health. That was always on our roadmap, but not first. So, here we used CRM market automations to obviously communicate to our patients around safety measures, what they needed to know around COVID, and then certainly around vaccine distribution.

(09:43):
So as we started to emerge from the pandemic, we started looking at return to care and where we could start to drive revenue. We had some areas that were, okay, I’m interested in using CRM and email marketing, marketing automation, but they didn’t really understand it, so it was hard to break them away from the traditional advertising techniques we’d use pre-pandemic.

(10:06):
But the pop health team, I had worked with them for a long time and they had a business challenge in needing to meet their gap fill or their population health goals. They came to us and said, “We need your help in getting a letter out to all of these people who have missed their annual wellness visits or haven’t had their mammograms yet.” They didn’t have a huge budget, and so we said, “Well, instead of doing what you’re asking us to do, we’ve got some tools that we think actually may tackle this better.” They’re like, “Great. We’re not married to how you do it, we need to improve our rates on filling these gaps.”

(10:53):
So, I had an engaged group. They didn’t need to be sold in on what CRM was, they were just happy to have my team’s help in doing it. So we started out with a set, there’s a list of big 15, which are 15 different population health measures, like annual wellness visits, diabetes management adherence, et cetera. We said, “Let us use a combination of email and direct mail to your patient lists of those who have not … your gap lists, and we will deploy that over time.” They were happy, because the email was low or no cost, and they didn’t have a large budget for that.

(11:42):
So, we worked together and it took us a bit to actually figure out exactly what the model needed to be, and then obviously crafting the content, because I had some newer people on my team who weren’t as familiar with what an annual wellness visit was or even pop health, so I can certainly address that in a moment.

(12:00):
So we sat down and we crafted all of that, and then we rolled out the plan to them, and there said, this looks great, and so we launched it. We launched it around June of, what’s this, 2023, June of 2022, and were able to have some incredible results that we hadn’t seen in years previous, so we knew that our marketing interventions worked to help with the pop health goals.

Alan Tam (12:22):
That’s awesome. Can you share what some of those results are and maybe that particular campaign?

Amy Comeau (12:26):
Sure, absolutely. So, the first one that we worked on was annual wellness visit. I brought the team together, because we had been trying to work on some of these pop health goals for a number of years, and I realized that what I needed to do to get my team to better grasp how to solve the pop health needs using our marketing automation tools is to sit down and help them understand what the business opportunity was.

(12:52):
So we had a kickoff meeting that included my team, some of the members in the access team, and then also members of our population health team, our clinically integrated network and our primary care team. We talked through, here’s what this is, explained what an annual wellness visit was and why it was important, how it’s different than the normal annual primary care visit.

(13:13):
But then I actually educated them on here’s what population health is, here’s what a shared savings agreement is, here’s what the shift from fee-for-service to value-based care was, and here’s the revenue opportunity for us as an organization. But then here’s also the lifesaving opportunity that by helping people get these interventions, you are improving their lives and in some cases saving their lives.

(13:37):
So the two that we were able to launch in calendar year 2022, one was annual wellness visit, and we did a series of emails that we used structured content and variable content. So depending on who you were, what age you were, whether you’re male, female, or where you were in your journey, you got different sets of content all automated based off of the data that we put in.

(14:06):
Then we partnered with our primary care operations team. So we didn’t just market to everybody who had missed an annual wellness visit, but we marketed directly to those that we knew our physicians had access to actually provide the annual wellness visit. So therefore, we weren’t telling somebody you need something, then they call and make an appointment and can’t get in, we knew that we had the access for them when they came in.

(14:30):
So, there was a series of about five emails that were in the journey. You’d send the first one out, and then depending on the action they took, either they’d go straight and make an appointment or they would need to be nurtured. By the end of the calendar year, we sent out to 13,000 people, there were 13,000 people that we targeted, and we had a 15% response rate, more than 2,400 people actually scheduled appointments, more than we have ever seen in a year for annual wellness visits. This was just marketing for six months, June, July through the end of the calendar year.

(15:14):
When I shared that with our clinically integrated network and Emory Healthcare Network team, they said, “This is amazing.” They became evangelists just like us for CRM and market automation, which is great, but they said not only were they thrilled with the actual numbers of annual wellness visits that we were able to appoint, they said that they achieved a 60% adherence rate that was more than they’d ever had. They said in years previous, they would have a compliance rate of 35% to 40%.

(15:51):
So by our doing that marketing intervention, we improved the system’s population health goal for annual wellness visit by 50% to 60%. If we hadn’t done that intervention, they would still be sitting at that 30% to 40%. So it’s just a proof positive that this works, and it’s important that you spend the time partnering with your clinical and operational and access teams to build the right model to get the work done.

Alan Tam (16:19):
That’s absolutely incredible, and what an amazing story. Has your success there led you to more inroads with the service line partners potentially?

Amy Comeau (16:29):
Yes, so in addition to annual wellness visit, we are now doing a similar tactic for screening mammography. So, there the response rates are not as high as annual wellness visit. So annual wellness visit, the response rate was 15% against a control group that we had, which was 8%, so marketing intervention has more than double performance of the control group. With mammography, the marketing performance was an 8% appointment and conversion rate against a control group that was a half a percent.

(17:09):
So although the numbers weren’t as high, marketing still had an impact, but in that area I was able to really help translate to my team that the work they’re doing literally is saving lives. I’m going to use my cheat sheet here, because I’ve got some numbers I wanted to share with you.

(17:28):
So most recently, we launched a campaign that I think we emailed to about 6,300 eligible patients from mammography, again, focusing on the imaging centers that we knew we had access. So not blanketing the entire market, but focusing on where we had access. We had that conversion rate of, I want to say it was about 377 people, so it looks like it was about a 6% return.

(17:57):
If you use the average that a half of percent of all women and genders identified as female at birth who get a screening mammogram, 0.5% of those will be diagnosed with breast cancer. So if you take that 377, apply it by that 0.5%, that means that our work as marketers identified 19 people who have breast cancer and are now getting treatment, and hopefully are going to lead a better quality of life because that cancer was caught earlier.

Alan Tam (18:29):
That is so impactful, and I love how you tied it to the patient outcomes. That’s usually a struggle that a lot of healthcare marketers have-

Amy Comeau (18:35):
Yeah.

Alan Tam (18:36):
And working in a healthcare, you want to be able to showcase and talk about the impact that you’ve made.

Amy Comeau (18:41):
Right.

Alan Tam (18:41):
So congrats to you on being able to achieve that, and I’m looking forward to seeing you guys continue to grow that.

Amy Comeau (18:47):
Awesome, thank you.

Alan Tam (18:49):
So this integrated journey that you’ve built up, how has technology helped play a role in terms of helping you guys become more effective, more efficient, and getting that patient volume in?

Amy Comeau (19:02):
Yeah, so what we’re really looking at is how can we use the marketing technology to streamline a lot of processes? So, we’re taking the learnings from pop health and now we’re applying it to standard patient communications. It’s basic stuff, but it seems basic to me, because again, in my background in selling subscriptions and doing subscription renewals, apparently it’s not basic to others.

(19:25):
So, we are now taking the learnings there and applying it to how we message to our patients about location closures or location moves and physician departures. So those are two, and I’ll talk about those, and there’s other areas we’re taking it to.

(19:40):
So, we took the same model and we applied it to how can we do a better job communicating and retaining patients when a location closes? So for example, as all of our health systems, you’re expanding, you’re acquiring practices, sometimes you come to a point where you need to consolidate practices. So it’s not like you’re closing an office because it’s not doing well or you’re shutting down services in that area, but you’re consolidating two practices that are within close proximity to each other to build a more effective practice, and certainly save on some of the retail and rental costs of running that business.

(20:17):
So we piloted this with our Lithonia location, which is a suburb out on the eastern side of Atlanta. Those physicians were moving to another practice that was a few miles closer to town, but not too far from where they originally were. So, what my team did is they took a look at the data and then they striated the data into three categories. Those people who have an appointment with that physician before the location closed, those people who have an appointment with the physician after the location closed, so they’ll need to change their appointment, and those who are attributed to that physician, but don’t have any appointments scheduled whatsoever.

(21:02):
So, then we generated different content blocks, again, that were put in depending on which of those categories they looked into. Then we looked to see, okay, we gave them options. So if that physician was moving and they just need to follow that physician, it was a simple message. So basically we sent out those emails, we were able to determine there was a higher conversion rate for those who had appointments after using marking automation and made sure that they kept their appointment, and more patients did.

(21:40):
But what was most fascinating is that those that didn’t have any appointments at all, we saw an increased engagement rate. So people who didn’t have an appointment, once they found out the location was closing, it prompted them to actually schedule an appointment at the new location.

(21:54):
So that streamlines it, that streamlines it, and it does a great job at retaining our patients and re-engaging those patients that may have lapsed, or just may not have thought about gotten around to making their appointment. We’re doing the same with physician departures.

(22:11):
So, now it used to be we’d just send a letter for physician departure and say, “So sorry, Alan, your primary care physician is leaving. Please call us just to establish care with a new primary care physician.” Then we never look back to see whether or not they did.

Alan Tam (22:25):
Right.

Amy Comeau (22:28):
Right.

Alan Tam (22:28):
Kind of close that loop, yeah.

Amy Comeau (22:30):
Performing arts and as a season ticket holder to one of our local professional soccer teams, you know that they’re going to keep hounding you until you renew your subscription.

Alan Tam (22:41):
Right, right, yeah.

Amy Comeau (22:42):
So we developed a model to have multiple touchpoints to get people to re-engage with a physician, and that’s where we had to use variable content, because if that physician left and their office had another physician and that physician had an open panel, then we could just say, “We want to transition you to this new physician.”

(23:07):
But if perhaps it was a single practice, a single physician practice, or the physician remaining in that practice didn’t have panel capacity to add on, then we said, “We’re sorry, there’s not capacity at this location, but we would like you to consider these two are the next closest locations to you,” and then give them the opportunity to schedule care there. Then if for some reason there wasn’t a next closest location, we then gave them contact information to our find a provider search for them to find somebody closest to them, and or call our call center to try and locate a new physician. Excuse me.

(23:43):
So we’re seeing good results on that, and what we’re hoping now to do is be able to automate and streamline that data at the point of notification in the system, so that our care teams don’t have to reach out to us and say, “Hey, Amy, Emory Healthcare Marketing, we have a physician leaving next month, what’s the process to send a letter to patients that they’re leaving?”

(24:07):
We’d love to be able to streamline that so that it is less work on everybody involved and it becomes more automated and we’re faster to market. So we’re faster to communicating with our patients, but then also hopefully more quickly and more deliberately working to retain them as an Emory Healthcare patient.

Alan Tam (24:27):
How’s that working so far?

Amy Comeau (24:28):
So far it’s working well. I don’t have the data specifically on that one, but we are seeing that there is a lift and that that communication, again, very similar to the location closure work, we’re seeing a lift, particularly in those people who had an appointment scheduled and needed to reschedule them at a new location. More importantly, with those patients that had not had an appointment, we’re re-engaging them and retaining them in the system, instead of forcing them to do the heavy lifting to try and find another care provider within Emory.

Alan Tam (25:03):
Yeah, I think that’s fantastic, and it’s great that you capture those folks that you didn’t think you would be able to capture and reactivate, so that’s fantastic.

Amy Comeau (25:14):
Right, yeah.

Alan Tam (25:15):
Within the journey that you’ve built up, you’ve had a lot of great successes as you’ve shared. What’s still missing from that process as you continue to evolve it and improve it?

Amy Comeau (25:26):
Yeah, so I would say the primary thing right now that I’m working on with the executive teams is trying to establish some governance, especially within our physician group practice, because there are 73 different specialties, and right now the individual specialties will come to us when they need something, whether they have a physician leaving, they’ve got a location opening or they’ve got a clinic that’s shifting to a hospital-based clinic.

(25:50):
What I’d like to do is figure out a way that we can centralize that process, create some codified standard operating procedures, so that it doesn’t have to be individual or what I call craft work every time. We don’t have to reinvent the wheel every time this happens, and instead, hopefully if it’s not automated, at least we’ve got a plan. We can say, all right, we’ve got 10 physicians that are being onboarded this month, or we’ve got five physicians that are departing this month, and so we can consolidate that and we can process it a lot faster. So, there’s governance is a piece of that.

(26:27):
The other thing that we’re wanting to build on, because we shifted so much because of the pandemic to patient education and patient communications, we are not as far along on the continuum as I’d like to be in use of propensity models to actually target new patient acquisition.

(26:45):
So, we have those in place now and we’re building that. We have experimented some over the past year and a half with our orthopedics and spine service line, because they’re first adopters on this kind of stuff, so it was really easy to go to market. We did some tests with the Olympics and World Cup and just seeing how we can activate around that and using propensity models where we have clinics.

(27:07):
Now we’re taking that to the next level, and we’re going to also be building that out more as we’re getting ready to launch campaigns for orthopedics and spine. But also we’ve got a new cancer care facility opening in Midtown Atlanta, so we’re going to use that to actually really try and promote and market and really engage patients there, and then take it next to our heart and vascular service line.

Alan Tam (27:29):
Okay, I think that’s a fantastic approach and very ambitious plan, and I look forward to hearing the success of that. So speaking of success of that, you shared some metrics and stats, especially around patient outcomes, which super exciting. In general, how are you guys measuring the success of your CRM strategy and programs? What are the right metrics there?

Amy Comeau (27:55):
Yeah, yeah. So for us, when we’re looking at how we’re measuring the success of our CRM and our metrics, we are looking at leads generated, leads converted. Did those converted leads actually turn into arrived appointments, and did those appointments develop into any downstream revenue? Did they turn into a procedure, a surgery? So, you need to look at least at a six-month time span for that to happen. Then we’re starting to look at what techniques and what marketing tactics are effective for that.

(28:29):
Our system is then looking at the end of the day, what’s the profit that we’ve brought in? What’s the contribution margin? So, we are working to also then be able to generate ROI. So some people call it ROMI, return on marketing investment, but sometimes we simplify that within our organization just as return on investment, and just say, okay, well, let’s just say we brought in $100,000 in revenue off of a CRM or any marketing campaign, and then our cost was $10,000, then we can say we had a 10 to one return on that investment.

(29:07):
So that’s what the system is looking at, because we’re in a period of industry disruption and finances are challenged right now, we’re looking at what’s the right media mix, what’s the right advertising and marketing spend we need to achieve our objectives? Which goes back to at the beginning of our talk why it’s so important to understand, well, what are those defined goals, so that we’re focusing very specifically on how are we going to drive in appointments and procedures.

(29:40):
So, they’ll be looking at … we’d like to get to the point where we can be predictive that says, okay, if you need 5,000 knee replacement surgeries this year, then we know it’s going to take, and I’m just making these numbers up, and let’s say we know it’s going to take 20,000 appointments and it’s going to take 100,000 leads to generate those appointments.

(29:59):
Well, to generate those 100,000 leads, then we need to spend $600,000, then we can get predictive. So instead of it being, oh, that seems like a lot of money, instead, we can say, “No, if you want to get to this in your budget, this is what the marketing investment is going to need to be.” We’re not there yet, but we’re headed there.

Alan Tam (30:17):
I love it. I really like that approach, and I think more healthcare marketing organizations need to be thinking like that and kind of backing into it. I think it’s a big miss for a lot of healthcare marketers that are not thinking like that and not implementing like that.

Amy Comeau (30:32):
Absolutely.

Alan Tam (30:33):
So Amy, thank you so much again for your insights. Really enjoyed our conversation and I’m really impressed with all the work that you’re doing in pop health. If folks in the audience want to learn more and continue the conversation with you, what’s the best way for them to get ahold of you?

Amy Comeau (30:49):
Probably the best way is to send me an email. It’s amy.comeau@emoryhealthcare.org.

Alan Tam (30:56):
Thank you so much again. So for those of you in the audience, I think pop health is an area that healthcare organizations need to put a lot more focus on, and quite honestly, it’s a shame that more healthcare organizations are not focused on that.

(31:09):
Amy has been amazing in terms of sharing her wealth of knowledge with all of us, so please do get in touch with her and see how she can help you transform your pop health programs. Thank you so much to everyone who’s listening, and until next time, hello.

Outro (31:24):
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