Strategies for Bridging the Healthcare Disparity Gap ft. Bonnie Ward, CHI St. Vincent

Bonnie Ward (00:00):
Sometimes as marketers, we kind of check the analytics box and we’re like, “Done.” This many impressions, this many clicks. But really where you look at where we’re at in this day and age in healthcare is we have to move beyond those statistics and we have to show our senior leaders what does that mean from a downstream revenue perspective.

Alan Tam (00:29):
Hello Healthcare. It’s no surprise to many of us today that healthcare disparity and equity gaps are quite prevalent in our health systems. The good news is that it has been identified as a top initiative for many of our health systems. Today, I have the pleasure of Bonnie Ward joining us from CHI St. Vincent. Bonnie is the market director for marketing and communications, and we’re going to be talking about bridging the healthcare disparity gap and what health systems are doing to address that concern. So Bonnie, welcome to Hello Healthcare.

Bonnie Ward (01:03):
Thank you. Good to be here.

Alan Tam (01:04):
So Bonnie, you have quite an interesting title, and I know within healthcare the titles don’t really cover the entirety of the responsibilities that you have. So why don’t we start with the fact of what is your mission and what’s your initiative at CHI St. Vincent?

Bonnie Ward (01:20):
Yeah, absolutely. My title, it sounds really fancy, but there’s a lot that’s encompassed within that title. My team, we’re very small, and so we handle internal and external communication. We handle crisis and PR, but we also handle everything digital, from our websites, both external and internal websites and everything else in between. Sometimes we even get involved with things that really don’t fall in our scope, but that they know we’re a good collaborative partner and we’ll help them out.

Alan Tam (01:51):
Right. So I think that’s then a perfect group and a perfect team then to talk about what are some of the disparity gaps and what are some of the things that you guys are working on to address it?

Bonnie Ward (02:04):
Yeah. I would say, prior to COVID, I mean, we’ve been talking about health disparity, especially in a healthcare setting, for probably five or six years. But we really saw it come to light during COVID. Our non-Caucasian majorities were the highest group that did not return to care during COVID, and we just kept seeing that gap get bigger and bigger and bigger as time went by. For a lot of reasons, there was a lot of fear that they had. They didn’t want to catch COVID.
(02:39):
They weren’t quite sure about the safety of the vaccinations when they came out. So we really had to think through and do a pause, and say, what is the most effective way to reach this audience? And what’s the most effective way for us to take a look at the images we use, the words that we use, the places we target, whether it’s digitally or even at their homes, so they felt like they could trust us as a healthcare partner? And so we really started that journey a couple of years ago to start to bridge that gap.

Alan Tam (03:16):
That’s interesting. I mean, getting to the root of the problem, what have you learned in terms of where does this mistrust come from? Why haven’t they received the messages that, say, Caucasians have that alleviate that fear? What have you learned from that research?

Bonnie Ward (03:34):
One of the big things that we learned is it wasn’t that they weren’t receiving the same information. They didn’t receive the information where it looked like them, so they didn’t really identify with the topic. So that’s where my team, we did a very large brainstorming session and we even pulled in some focus groups from our social channels, even our friend groups, African American and Spanish physicians that were within our practice. And we just asked them, what is a good way to reach this audience? How can we make them feel and understand the message from a personal point of view? So yeah, we really started with focus groups where we started just testing pictures and words that we used, and that’s really where it began.

Alan Tam (04:23):
I really like the resourcefulness and actually starting internally, because oftentimes there’s so much insight, especially within the healthcare system, that you can leverage and borrow from. So what’s been some of the most effective techniques, tactics and strategies that you guys have employed reaching out to this particular audience?

Bonnie Ward (04:45):
Well, we did a really cool campaign during Heart Month. And we had developed a brand new program, it’s a cash pay program, where anyone who has heart condition concerns can pay a small fee. It doesn’t go through your insurance. And they can get a comprehensive heart screening for peace of mind. And we decided during Heart Month, I worked with our compliance team to be able to offer it at a discounted rate during the month of February. So even those who fall around the poverty level or are lower income or on fixed incomes, they could afford to also participate. And then what we also learned is that we needed to meet people where they already were. And one of the things we learned in the focus groups is that for African American males, barber shops on Friday nights and Saturdays are like Irish pubs.

Alan Tam (05:38):
Wow, okay.

Bonnie Ward (05:38):
They go and play dominoes, they play cards, they gossip about their girlfriends and wives and parents. And they will literally spend hours and hours at the barbershop, even if they’re not getting their hair cut. It’s just a socialization. So on Friday evenings and on Saturdays, we developed a digital campaign where we targeted several major barbershops in the area that serviced primarily ethnic origins, African American and Spanish populations, with ads about heart health.
(06:12):
And we created some really cute taglines that really resonated with the focus groups. So one was, “Your hair should fade, but your heart health shouldn’t.” And it’s a picture of an African American male sitting in a barber chair with this beautiful fade design on his hair. That really resonated because, again, it looked like the people we were targeting. It was the age group and we wanted to make it relatable for them.

Alan Tam (06:39):
I love it. I mean, that’s so creative and I think that would resonate so well. So kudos to you for coming up with that campaign. You did mention these digital campaigns. I do want to double click on that a little bit. Talk to me more about this digital campaign, not only the content, but channels that you guys employed, why did you select those channels? What have you learned to be most effective in those channels?

Bonnie Ward (07:07):
Our healthcare system is in Arkansas, and Arkansas, while we wear shoes, are still pretty internet poor. But one thing we do know is that no matter what income level you fall in, whether you’re of a Spanish background, African American background, African descent, everyone has a cell phone. So we utilized a lot of channels and geotargeting where we knew people would have their cell phones. And we found that to be very, very lucrative. We didn’t just lean on a digital web banner on ESPN or things of that nature. While we did them, we really made sure that we put it on and near where they’re searching on their cell phone.
(07:53):
The other thing we also did, especially when we talk about our older demographics that come from lower income neighborhoods, is we sent them direct mail postcards as well, especially for some of those grandmas and grandpas that they might have an older cell phone or still might utilize a home phone to make sure that they could still get the message as well. So it really was a multichannel approach. And we also put one of our leading African American cardiologists on predominant African American radio stations as PSAs, talking about what is the difference? Are heart attack symptoms the same for African American men and women as it is for every other ethnicity? And they really were able to talk about what those differences are.

Alan Tam (08:44):
That’s very fascinating. And actually, I’m half surprised and half not surprised that you brought up the mobile devices. I mean, there’s so many studies out there that talk about the pervasiveness of mobile devices, and yet when you try to share that information sometimes back out to health systems, they kind of deny the fact that people have cell phones and cell phones are probably the best way to get ahold of folks. I’m just curious, are you also employing SMS and text as well in terms of communicating with these ethnic groups?

Bonnie Ward (09:17):
We did not as part of this campaign. And the reason is because we wanted to see if we targeted them and made the information available if they would even interact with it. Because the last thing we wanted to do was utilize texting and they unsubscribe right away, because that would just shut the door for us to be able to get the message out in a personal way. And actually, what we found were people were extremely engaged in the message. We also had a cute headline that also focused on more African American families that it said, “It’s okay to have heartburn, but your heart shouldn’t hurt.”
(09:54):
And it’s a cute African American couple watching a football game, eating some pizza. But we wanted to make sure that they understood what the symptoms meant. Do you just need a Tums, or do you need to get it checked out, depending on how many Tums you’ve eaten and your chest still hurts? But we wanted to kind of deflate some of those myths on, “Eh, my chest hurts, but I’m okay. I don’t need to do anything about it.”

Alan Tam (10:22):
Right. Okay. So you’ve shared with me a significant amount of extremely creative content that you guys have put together and delivered to this group. I’m curious as to how do you identify this particular audience? Do you go into your EHR and segment out based on ethnicity or race? How does that come about?

Bonnie Ward (10:46):
Yeah, absolutely. Great question. I’m a huge advocate of a CRM system for health systems. And one thing I always tell individuals that I run across from other health systems, they’re like, “I just can’t afford a CRM. How do you pay for it?” And I said, “Well, I can’t afford not to pay for it,” because while it can be pricey, you can track downstream revenue and show that return to your executive leadership on actual conversions from your campaign to what I call body in beds or patient in the door. So it is very expensive. So we did utilize our CRM to pull the data.
(11:27):
And we pulled a mixture of data. We pulled a mixture of who are those groupings that have already been patients of ours that just were not returning? And that’s where we started. Then what we did is I went to our CRM and I said, let’s also pull a list of folks that’s a lookalike based on lookalike insurance information that we can utilize, and who aren’t our patients but have not been in for a heart checkup, and probably need to, whether it’s because they’re a type 2 diabetic or they have a family history, or maybe they’ve been diagnosed at some point with uncontrolled high blood pressure. Those are the ones that we want to target.

Alan Tam (12:12):
But from that particular list, you can’t segment by race, or can you?

Bonnie Ward (12:16):
You can, you can. You can get as granular as I want everyone who is African American descent with a household income less than $30,000 a year. Blue collar worker, and maybe they don’t have commercial insurance. Maybe they’re a government insured patient. And so you can get very granular if you have a CRM system. If you don’t have a CRM system, it’s not impossible to do. You can still pull the data based on if they’re your patients. So if they’re in your EMR, they’re already going to be a patient. But you can still segment by race and zip code. You just can’t add on a lot of the other lifestyle factors if you have a CRM like [inaudible 00:13:00].

Alan Tam (13:00):
Right. That’s really interesting because as I listen to you talk about the types of variables and factors that you’re using to pull this audience list, it’s pretty standard, in my opinion, coming not directly within healthcare marketing, but oftentimes there is this fear of leveraging perhaps more personal clinical data to target audiences. But I think race is just as sensitive as clinical data when you’re targeting patients. What do you think is the line there? What is the right balance?

Bonnie Ward (13:46):
I think that’s a great question, and that’s certainly something that your marketing teams and communication teams really need to have at the forefront when they build these kinds of custom campaigns. Because you can do it very wrong and get in trouble.

Alan Tam (14:02):
Right.

Bonnie Ward (14:03):
So what my team did, and again, the focus group was a big part of this, is we said, how can we make it not personable? Which sounds backwards to everything that you know about marketing, personalization is better. But we did want people to be offended because we were pointing them out at such a personal level. So we did not put their name on it. We put “To anyone at this address,” so we did not put Betty Sue.
(14:36):
And also knowing too, that the information that was on the postcard, while there was imagery that was either Hispanic or African American and Caucasian, based on the audience it was going to, it still looked like our brand and felt like our brand. So if for some reason, Susie Smith didn’t live at her address anymore, whoever received the postcard, it would not seem so out of the blue that it was so targeted just to Susie Smith. It would still be applicable if she didn’t live there anymore.

Alan Tam (15:11):
Right. So based on what I’m hearing and understanding, it’s not so much about how that audience list is comprised and how you’re targeting, but really in the delivery of the content. And that’s really where the rubber hits the road and where the magic happens.

Bonnie Ward (15:26):
Absolutely. And a lot of it is human nature. I certainly don’t like to get a postcard that says, “Oh, you need to sign up for AARP because you’re old,” which I’m not old enough to sign up for AARP, I just want to throw that out there. But it is something you have to think about because you don’t want to make them feel embarrassed or demeaned because their postman now thinks that they have this condition. So that is where you really have to get creative with delivering what you want to deliver that is still actionable while not being offensive. And that’s also why we used the digital tactics with the cell phones, is they could be shopping for shoes and they would be served an ad that they could or didn’t have to interact with. And what we found was if we made it fun and relevant, they actually were more apt to interact with it.

Alan Tam (16:24):
So where do you draw the line? I mean, as a patient, I have a personal take that I want to hear from my health system. I want it to be personalized. I expect my health system to know me better than me. I expect them to tell me, “Alan, you’re at risk for hypertension, Alan, you’re at risk for diabetes. You need to do X, Y, Z.” But yet a lot of health systems fear communicating that, for whatever reason.

Bonnie Ward (16:55):
There’s a lot of ways that you can make people feel like it’s custom to them without saying, “You have a problem.” So that’s where the words that you use, the mediums that you use, are really, really important is because we want to stay on the balance of we want to educate you so you can make the right decision, but we don’t want to be overbearing where we’re like your mom telling you to do something that you really don’t want to do. So we do walk that balance all the time.
(17:26):
I would also say it depends on the channel. You can get a lot more personal if you use social media and talk to people in social media just because, well, it’s become a little more difficult to be as customized, but you can do a spray a pray approach. But when you look at direct mail especially is where we tend to see a lot of pushback on making people feel like they have a condition. So in direct mail especially, we tend to be a little more, “to whoever lives at this residence,” compared to a first and last name.

Alan Tam (18:03):
Okay. That makes plenty of sense. So I don’t think we can talk about marketing without talking about metrics and how you measure success. What are some of the core metrics and KPIs that you guys have used to measure the impact of these amazing campaigns that you guys have delivered?

Bonnie Ward (18:22):
Absolutely. For this campaign, we went beyond clicks and form fills. We actually went to who actually came in for the heart screening, because that was our call to action. Our goal was to obtain 100 registrations for our Heart Smart screening program.

Alan Tam (18:44):
For what time period?

Bonnie Ward (18:45):
One month, and actually February is a short month, so in 28 days. We had over 100 in the first week. We capped out in February at just over 300 registrations for the Heart Smart screening program. But we didn’t stop there. We didn’t say, “Oh, yay, look at this great thing we did,” and put a little feather in our cap. We followed the operational team and we did a pro forma of how many patients that came through the screening actually converted and needed services from a cardiologist. 18% who came in actually needed follow-up cardiology care because of whether they had indicated that a blockage was there, they had uncontrolled high blood pressure, whatever the factors were. 18% converted.

Alan Tam (19:42):
That’s huge. It’s giving me literally goosebumps. I mean, that’s true impact that a healthcare marketer is having to the patient outcome, right?

Bonnie Ward (19:51):
Yes.

Alan Tam (19:52):
You’re not necessarily the one saving a life, but you’re bringing the right folks in who are at high risk so that they can have a positive outcome. So that’s an amazing, amazing stat.

Bonnie Ward (20:04):
Well, and I will say too, I feel like sometimes as marketers we kind of check the analytics box and we’re like, “Done.” This many impressions, this many clicks. But really where you look at where we’re at in this day and age in healthcare is we have to move beyond those statistics and we have to show our senior leaders, what does that mean from a downstream revenue perspective?
(20:26):
Because at the end of the day, we have to pay bills. And so it shows the value. So anytime me and my team can move beyond impressions and clicks and can show bodies in beds or conversion to services, that’s the number I like to focus on. And that’s where having a CRM builds that bridge for you to be able to see that data. So you don’t have to lean on your clinic managers or someone in the hospital because we know that they’re already overworked and the last thing they want to do is pull numbers for you. A CRM actually will take that work off of their shoulders and will give you that information in a pretty little dashboard.

Alan Tam (21:11):
Right. Nice. So going back to the initial campaign, measuring how you guys are bridging that disparity gap, what type of metric are you using there to measure your effectiveness and success?

Bonnie Ward (21:31):
It’s similar. We look at everyone that we targeted that was non-Caucasian. What’s our conversion rate of coming in for care? And so same metric, same metric. The only identifier is on the front end, if you use a CRM, make sure you have your lists broken out ahead of time, because then your tracking is so much easier because it’s already segmented for you on the backend.
(22:04):
And so it was a great learning experience. We’re still utilizing this, so this was not a one and done, because you have to reach your patients and consumers where they are. And if they’re telling us they want to see more people in healthcare that look like them, talk like them, feel like them, then we can’t just do one campaign in February and then everything else we do is not tailored for that audience. It has to become an ongoing part. You have to be very purposeful in the voices you use in radio and the imagery, so you don’t get stuck in just one type of person that represents your ministry.

Alan Tam (22:46):
Right. So I know that healthcare disparity and equity is a top initiative for many health systems today, and you guys, seems like you’ve done a tremendous job. Many of your peers don’t even know where to start or how to begin. What would your advice be to help them get started?

Bonnie Ward (23:06):
Use the plan already have. Because here’s the thing, it doesn’t take a lot of extra strategy, it just takes thoughtfulness. So if you’re already doing a digital campaign, just break a portion of it off in your financial bucket to say, we’re going to allocate this much to non-Caucasian targeting. Because really it’s the same tactics. You just have to be mindful, especially if you do not have a marketing team that looks like the audience you’re trying to go after, pull those resources.
(23:44):
Because it’s funny how a lot of folks that are in your organization will walk alongside you and help you learn how to talk to that consumer, how to use imagery that looks like that consumer. They’re very willing to do that. And they have a sense of pride, that I helped with this. And they like to be heard. So be very collaborative, bring a lot of people to the table, but start with the plan that you already have put together and just add an extra layer of thoughtfulness towards it.

Alan Tam (24:16):
Absolutely. So what’s next? I mean, what’s next on your guys’ initiative list to further this success?

Bonnie Ward (24:27):
We are launching, this month actually, a brand new blood pressure e-newsletter, because one of the things in the state of Arkansas is heart disease is the number one killer of individuals in the state of Arkansas. And it really starts with something very basic and that’s blood pressure. So it is a monthly campaign that is going to be delivered through social channels and also through a digital e-newsletter targeted at individuals that we have identified across all ethnicities.
(25:01):
But again, we’re going to put that extra layer of thoughtfulness and customize it towards our Spanish-speaking audiences and our African American audiences. But it just teaches them the basics. How often should you check your blood pressure? What should your blood pressure be? You’d be surprised how many people do not know what a normal blood pressure is. So just giving them tools that they can utilize to be able to make better-informed decisions.

Alan Tam (25:29):
That sounds like the right next step. It’s interesting that you also go on social as well. I do want to scratch on social a little bit in terms of what the impact and success has been, say, compared to other mediums and other channels that you guys have been working on.

Bonnie Ward (25:47):
Social is a great tool. One thing you just have to look at though, and all marketers know this, is all platforms are not equal, so it really depends on who you’re trying to reach. The great thing is, most people, no matter what their age, they’re on social somewhere. And so I would start and offer support to those teams to say, know who your current followers are on those social channels, know where they’re going, look at the research for your area. And then think of some out of the box opportunities because, not going to lie, Facebook can make it… They’ve made it a little more difficult to do some hyper-segmentation.
(26:32):
So we’ve had to look at some alternate opportunities to really do some health disparity work in a social landscape. But frequency. Frequency, frequency, frequency. Just because you don’t see huge engagement doesn’t mean that people are not interacting with your content. So again, I think you have to ask yourself, what’s the goal? What am I trying at the end of the day to really help solve this problem?

Alan Tam (27:00):
Bonnie, thank you so much. I really enjoyed this conversation. I think it’s definitely been super enlightening for me to hear it directly from you in terms of some of the key strategies and tactics that you guys have used to bridge that healthcare disparity. To our audience who may want to learn more, pick your brain on really cool ideas for content in the campaigns, what’s the best way for them to get ahold of you?

Bonnie Ward (27:26):
Absolutely. They can email me. It’s bonnie.ward@commonspirit.org. I’m always available to, and respond annoyingly quick to emails. They can also find me on LinkedIn, Bonnie Ward. So I’m super easy to find. And so yeah, email or LinkedIn are really good ways to find me.

Alan Tam (27:52):
Wonderful. Again, Bonnie, thank you so much. To our audience that’s watching or listening, please do give Bonnie a ping. She has some amazing insights and obviously has proven herself through many of these campaigns to really address top and top level initiative for many of these health systems. So thank you for joining in today, and until next time, hello.

Voiceover (28:18):
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