Building a Consumer Brand.

An integrated delivery system in Southern California is relying on technology to build consumer and physician loyalty.

By Tyler L. Chin

Three years ago, when Memorial Health Services Inc. grew from a two-hospital to a five-hospital integrated delivery system, it faced a tough business climate. A number of its Southern California competitors all charged similar fees for services.

To avoid entering a competitive battle based solely on price-cutting, executives and physicians at Memorial Health Services instead decided to compete on the basis of quality. If they could prove they offered better care than their competitors, then consumers would select Memorial and pay more for quality, the organization's executives reasoned.

Memorial also bet this strategy would lead the best physicians to affiliate with and admit more of their patients to Memorial Health facilities rather than facilities owned by the competition.

So Long Beach, Calif.-based Memorial Health Services, which has more than 2,800 affiliated physicians, created a branding program. This marketing effort is designed to create consumer awareness of the organization's products and services.

The delivery system is marketing its health care services to consumers under the MemorialCare brand name. Its goal is to associate the brand with quality care in the minds of consumers.

To improve the quality and delivery of health care, and back up its branding program's claim of superior care, Memorial Health has been using information technology since January 1997 to:

* Develop clinical guidelines for caregivers. These guidelines lay out a standard care plan for physicians to follow, when appropriate, for patients with certain diagnoses.

* Implement a virtual private network on the Internet to enable physicians to access hospital-based clinical data from home.

* Post consumer health information on its Web site and on America Online.

* Streamline the patient registration process and enable physicians to collect insurance copayments more easily via a magnetic stripe card program.

A competitive edge

Memorial Health is hoping these initiatives will set it apart in an increasingly competitive market.

When a market is saturated with hospitals and physicians, providers either compete on price or attempt to differentiate themselves to give consumers a reason to pick them over the competition, says Thomas J. Collins, CEO of Memorial Health Services.

"We've opted to differentiate ourselves on the basis of quality to gain a competitive edge and position our organization in people's minds as the place to go for quality health care," he says.

To help build a reputation for quality, the delivery system is implementing clinical guidelines for caregivers.

After creating and distributing the paper-based guidelines, the organization monitors the outcomes of patients treated using the guidelines. It then benchmarks those outcomes against local and national outcomes to show whether its patients have higher survival rates, get better quicker or get sick less.

The delivery system then uses the outcomes data in marketing brochures, highlighting how its results measure up against those of local competitors and national benchmarks, Collins says.

To achieve its strategic goals, Memorial Health Services has invested $3 million in its MemorialCare program during the last three years. This investment includes marketing costs as well as the cost of acquiring online health information from Empower Health Corp., Austin, Texas, to post on its Web site and on America Online Inc., Herndon, Va.

The investment includes the purchase of 180 PCs from Dell Computer Corp., Round Rock, Texas, which enable clinicians to access the organization's e-mail system and intranet, as well as online medical libraries. It also includes the cost of magnetic stripe ID cards, encryption technology and other software for its virtual private network.

Collins believes the investment has paid for itself in new revenue because it has helped the delivery system increase the total number of admissions/discharges up to 30% over a three-year period at each of its five medical centers in Los Angeles, Orange and San Diego counties.

Collins acknowledges it's difficult to tell just how much of the increase is due to the MemorialCare program. But he notes that the branding program has been the major strategic focus of the delivery system during the last three years.

Memorial Health's information technology strategy, particularly its Internet and online health information components, shows the organization is headed in the right direction, says Tom Ferguson, M.D., adjunct associate professor of health informatics at the University of Texas Health Science Center in Houston. Ferguson also is a consultant specializing in Internet and online consumer health issues.

"I wouldn't be surprised to see the more I.T.-sophisticated health systems and physicians steal away market share from less I.T-sophisticated colleagues within the next five years," he adds.

Core element

Clinical guidelines are at the heart of the MemorialCare program because its success depends on the organization's ability to prove improved quality of care, says Annette Walker, a vice president at Memorial Health Services who is responsible for the branding effort and physician integration issues.

The guidelines show clinicians optimal treatments. The delivery system hopes that by steering more clinicians down a proven path, the organization will improve care and trim costs. It then can publish the outcomes of patients treated using those standardized care guidelines to "prove" quality of care, comparing their outcomes to those of other institutions.

All physicians participating in the MemorialCare program must sign a contract requiring them to help develop and use the guidelines, Walker says. They also must submit data to physician-led clinical task forces responsible for developing clinical guidelines.

To obtain the clinical information needed to create and refine guidelines, the organization has set up homegrown databases to capture data electronically from hospital-based clinical information systems, such as those used for obstetrics, open heart surgeries and breast cancer. The organization hopes to eventually collect data from physicians' offices, but no timetable has been set.

Once data is gathered in the databases, the organization uses homegrown and commercial software to enable physicians to develop, analyze and refine guidelines, and monitor outcomes.

Guidelines are printed out and mailed to participating physicians, who have admitting privileges at Memorial's five hospitals, she says. Guidelines are distributed on paper because the organization's hospitals use four different hospital information systems. "It would be a huge challenge to integrate this into only one hospital information system," Walker says.

When Memorial Health eventually installs a computer-based patient records system, it expects to incorporate guidelines into the records system so they will be easily accessible to physicians, Walker says.

So far, the delivery system has implemented 15 clinical guidelines, including guidelines for Cesarean deliveries; labor and delivery; newborn care; pediatric pneumonia; and heart attacks.

Benchmarking performance

In addition to collecting clinical data to create and refine guidelines, Memorial Health also analyzes that data to create custom reports measuring a physician's performance. The reports are designed to enable participating physicians to benchmark themselves against their peers.

During the past three years, the number of physicians participating in the guidelines program has grown from six to 600, says Walker, the vice president responsible for physician integration issues. She hopes that number will eventually increase to 1,000.

Those who sign the agreement-usually the doctors who admit many patients to Memorial's facilities-are marketed as MemorialCare physicians, which can help the doctors attract more business, executives say.

"Memorial Health has opened up a tremendous amount of communication among my colleagues at other hospitals," says David Lagrew, M.D., chair of the delivery system's information infrastructure steering committee. "What it's really doing is taking a lot of the clinical things we do at each hospital, standardizing them and making them more efficient."

To further improve clinician access to information, Memorial Health since August 1998 has been testing a program enabling physicians to access hospital-based clinical information from their PCs at home.

In the ongoing pilot, 10 physicians are accessing data over a virtual private network on the Internet, says Scott Cebula, executive director of information services at Memorial Health Services. The delivery system is using security and encryption software from a commercial vendor, he says, declining to identify the vendor.

Most of the physicians have Internet access through their local cable television companies. When they turn on their PCs, they immediately are asked to enter their user ID and password. After they enter that information, the security software in their PC authenticates them. Once the software authenticates physicians' user IDs and passwords, it automatically allows them to use a Netscape or Microsoft Web browser to access the virtual private network and hospital-based servers behind a firewall. The servers house information systems from Eclipsys Corp., Delray Beach, Calif., and McKesson HBOC Inc., San Francisco.

Microsoft's Exchange e-mail system, and laboratory information systems from Cerner Corp., Kansas City, Mo., and Sunquest Information Systems Inc., Tucson, Ariz., also can be accessed through the virtual private network.

Participating physicians must pay for their own PCs, Internet access and phone lines. The organization hopes to increase the number of physicians after the pilot is completed in the spring.

While the remote access program focuses on improving physician access to data, Memorial Health also is working to provide online health information to consumers.

One way it's doing this is through its Web site, www.memorialcare.org.

The site enables consumers to access information about the organization and the personal Web pages of more than 200 physicians.

Online information

Consumers also can access online health information about medications, illnesses and clinical trials via a hyperlink from Memorial's Web site to another site: http://drkoop.com. Information on the site comes from Empower Health, co-founded by former U.S. Surgeon General C. Everett Koop, M.D. Koop's site is "co-branded," meaning that those accessing it see the MemorialCare name alongside Koop's.

Memorial Health also is packaging the Empower information in a different format and posting it on America Online's Digital Cities services. The online information available via Memorial's Web site and AOL's Digital City is part of Memorial Health's broader campaign to reach out to consumers as well as physicians.

"We have to strengthen communication with both consumers and physicians so they know about us and can distinguish between our services and our competitors'," Walker says. "Technology is helping us accomplish this strategy."