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A Santiago Solutions Group (SSG) in-depth analysis of the most recent enrollment data into ACA exchanges from 38 reporting states revealed that multicultural segments continue to lag way behind the enrollment rate of White Non-Hispanic segment. Less than 100 days away from the third Open Enrollment period, the trends are concerning because so much additional effort was put behind Hispanic, African American and Millennial efforts this past period and the results are marginal at best.

The 38 states in the analysis represent 80% of the country’s population and many of the largest multicultural states in the country such as Arizona, California, Florida, Georgia, Illinois, Nevada, New Jersey, North Carolina, Pennsylvania, Texas, and Virginia were among the 38 states which have broken down the ethnicity of those newly enrolled and renewed in exchange Qualified Health Plans. Included amongst these are all of the Federally-facilitated marketplaces and state-partnership and most of the state-based marketplaces, with notable exceptions like New York, Connecticut, and District of Columbia.

On the surface, the multicultural enrollment rate seems adequate at a 91 index, only 9% below its fair share when considering that 39% of those enrolled at the end of Open Enrollment 2 were from multicultural segments compared to 43% of those eligible in these states. In comparison, 61% of those enrolled have been White Non-Hispanics while 57% of those eligible were of that race, for an index of 108, meaning it is 8% above its fair proportion of eligibles – the segment is enrolling exceedingly well.

Nevertheless, a deeper analysis into each race reveals a much more concerning reality. Hispanics are trailing much further behind than any other group despite all the additional resources that went specifically behind that group in the last open enrollment. While Hispanics make about 15% of those enrolled, they are about a quarter of those eligible, net of undocumented in FPL 139-400 – an index of only 63, that is equivalent to 37% below where the segment should be given its proportion of exchange eligibles. Similarly, the African American segment shows an index of 84, or 16 below where it should be. It is the Asian/Other segment that skews the Multicultural trends with an index of 241, or 141% above where it should be, given that it only represents 5% of eligibles versus 11% of those enrolled so far.

On the eve of the third open enrollment period, the national trends clearly suggest that there are major barriers still standing in front of Hispanic and African American eligibles. There are five major factors at play:

• Lack of Trust in the Government – Mixed status families don’t want to risk exposing immigration status of certain members to official entities and prefer to remain without insurance.
• Poor Value – Deductibles for current plans under the affordable care are far from affordable for many. The plans are still above what many middle-income families can afford relative to their income and other living expenses. Many of them choose to continue to pay-as-they go using urgent care/community clinics and gladly pay the tax penalty. Cheaper plans are critical.
• Ineffective Messaging – On one hand, the plans’ mass media messaging is overly-promising and, on the other hand, the fine print is overly-complex to clearly evaluate.  As a result, negative word-of-mouth prevails and a huge portion of the segments are not even seeking official information in-person or digitally.
• Poor Culture & Language Relevancy – While the messages have improved, they are mostly translations or adaptations of communications intended for audiences with high levels of health care and health literacy. For the most part, Hispanic nuances addressing specific barriers and the most effective triggers to adoption have not been brought to the forefront. Exchange communications from the government and insurers are still in cultural diapers.
• Lackluster Customer Experience – The customer experience of those newly enrolled is rampant with stories of poor on-boarding, repeated incorrect bills, systems that don’t reflect conversations with customer service, physicians not in the promised network, communications that are very difficult to understand, inconsistency of in-language communications, and very mixed experiences with call-centers. These unsatisfactory experiences are drowning the exceedingly good ones in physical and digital circles of influence, keeping the undecided eligibles at bay.

At the end of the day, half of the remaining exchange eligibles in these states are Multicultural and 1 in 3 of the overall remaining eligibles (net of undocumented) are Hispanic. The source of growth for ACA is adding critical pressure to getting multicultural engagement, acquisitions, and retention properly focused on the needs of this vast potential. The time for blanket strategies versus dedicated segmentation has passed us. Health insurers which can effectively figure out the nuances of educating, influencing, signing up, and serving multicultural customers are poised to accelerate their growth and win significant share.

Carlos Santiago will delve further into this topic during his presentation, The State of Multicultural ACA Marketing: Hurdles, Opportunities & Return, at the MCH National Conference. His presentation examines the relationship between Hispanic dedicated efforts and overall revenue acceleration, the so called ACA feasible/eligible opportunity gap for Open Enrollment 3 and beyond, as well as the Multicultural opportunity coming from this next Open Enrollment. Learn from Carlos, as well as the rest of our esteemed speaking faculty, at the 2015 MCH National Conference, held Oct 12-13 at The Westin in Fort Lauderdale. Register today!

As a gay man and a supporter of LGBT equality, 2015 has been a momentous year because of the Supreme Court’s decision to extend marriage equality to the entire nation. On the evening of the decision, my husband and I made our way to The Stonewall Inn in New York City – the birthplace of the modern gay rights movement – to celebrate this historic event. As a healthcare advertising professional, I wondered how this watershed moment would impact the way health and wellness is marketed in the United States. As I reflected on this, several key issues and opportunities rose to the top.

LGBTs are becoming increasingly more accepted by mainstream US culture, and brands are taking note. Over time, as LGBT visibility has increased both in the mainstream media and in people’s personal lives through the coming out of friends and loved ones, acceptance of LGBTs and LGBT relationships has grown. We are now at a point in our history where the majority of Americans support LGBTs. According to Gallup, 58% of Americans say that same-sex marriages should be recognized by the law as valid, with the same rights as heterosexual marriages. This increased acceptance has not gone unnoticed by brands looking to attract a customer segment they haven’t specifically targeted in the past. In 2012, Oreos – the epitome of Americana – posted a rainbow-filled Oreo on its Facebook page. In 2014, CVS Health included LGBT characters in its rebranding TV ad as one of the many diverse customers that the company serves (or wants to serve). And this year, Dove included a gay couple as a part of a Father’s Day ad celebrating all kinds of Dads. Marketshare is not easy to win, and more and more brands are adding LGBTs to their target segments.

Taking an inclusive stance toward LGBT consumers can influence non-LGBTs, especially Millennials. Most of us are aware of the fact that Millennials are the most diverse consumer segment we’ve ever seen. And Millennial culture includes respect for and appreciation of diversity, including LGBT. According to Pew, 70% of Millennials support LGBT marriage equality – the highest of any generation. Brands today are taking note of this cultural value and using it as a way to gain sales and share among Millennials. This works particularly well for established brands that are trying to shed an image of being “dated” or not relevant to today’s consumer. Two brands using this approach are Coca Cola, who ran an ad during the Olympics that was a celebration of diversity, including LGBT, and Honey Maid’s This is Wholesome campaign featuring tattooed, interracial, and gay parents in their modern take on the American family. Healthcare could benefit from this more modern image, courtesy of a supportive take on LGBTs.

The definitions of relationships, parents, and families are changing. Are your communications keeping up? Providing culturally competent care is an important objective for hospitals, health plans, and other healthcare providers. Patients seeking healthcare are often in a vulnerable state as they grapple with the myriad issues that come with dealing with a health condition. Having care delivered in a way that is sensitive to one’s culture helps to reduce emotional anxiety and increase outcomes for patients. If all of your communications speak to “husband” and “wife,” then you are completely missing LGBT couples who may be seeking a healthcare solution that you can provide.

Gay marriage will also likely lead to more children in LGBT households. As LGBT couples take the traditional relationship path to marriage, children are the next logical step. This means that your target may not be just “Mom”; it may be “Dad” or “Mom and Mom” or “Dad and Papa.” We are at the point in marketing where acknowledging and celebrating LGBT families is differentiating. Now is an ideal time to jump in and capture this opportunity. At some point, most brands will be speaking directly to LGBT families; those that do not will stand out… for all the wrong reasons.

The LGBT segment has been an opportunity for brand influence and growth for decades. Healthcare marketers – along with travel, financial services, consumer packaged goods, and many others – have been successfully reaching and influencing this segment. The shift in societal attitudes toward LGBTs has now opened up this opportunity to “mainstream” brands and not just those on the “cutting edge.” In addition, the state of the American healthcare consumer has changed forever. Individuals, couples, and families represent a diversity that includes LGBTs. Therefore, our communications must keep up with this new reality if we are to remain relevant in today’s consumer/patient landscape. The upside: this is one of those moments where doing the right thing socially is also the right thing for business. Let’s get started!

Andy Bagnall will delve further into this topic as he moderates a panel discussion, Taste the Rainbow: Best Practices in LGBT Healthcare Marketing, at the MCH National Conference. He will lead a panel of LGBT experts, sharing trade secrets and tips on how to tap into LGBT media and culture to drive business results. Learn from Andy, as well as the rest of our esteemed speaking faculty, at the 2015 MCH National Conference, held Oct 12-13 at The Westin in Fort Lauderdale. Register today!

For years, pharmaceutical marketers have tried to convince themselves that the FDA accepted a standard under which risk information could be presented separately from benefit information via a hyperlink in online communications (the so-called one click rule). And for just as long, the Food and Drug Administration kept taking enforcement actions making clear that it did not accept that position.

Indeed, some people began to referring to one click as the rule that isn’t. But that didn’t stop marketers from dreaming of a world in which they could use social media and other online platforms to communicate benefit information while limiting the presentation of risks to a destination in a link.

Apparently, some members of Congress agree. For the past year and a half, the House of Representatives has been engaged in a bipartisan effort to radically transform healthcare and the approval process for new drugs. That effort is known as the 21st Century Cures Act. The first draft legislation released in January of this year included a provision about social media that would essentially have written into a law a version of the one click rule.

Just last week, on Friday, July 10, the House of Representatives passed the 21st Century Cures in an overwhelming vote (344-77). 21st Century Cures now moves to the Senate, where its future is far from certain. Unfortunately for advocates of the one click rule, that provision wasn’t in the version of the legislation that received the vote; however, that isn’t the end of the road for this item.

The one click provision is now a standalone bill that Representative Billy Long from Missouri is sponsoring. That legislation could either be part of a revised version of 21st Century Cures (for example as part of the Senate bill), or it could pass as a separate item.

In addition, the Prescription Drug User Fee Act (PDUFA), which comes up for renewal every five years, is again being updated. The last time PDUFA was updated in 2012, the bill was called the Food and Drug Administration Safety and Innovation Act (FDASIA). Pharmaceutical marketers might recall that FDASIA mandated FDA release social media guidance by July of 2014. Some people credit that legislation for the three draft guidances on social media that FDA released last year.

So there is extremely recent precedent for Congress to use this vital must-pass legislation to prod the agency about its direction on advertising and promotion of prescription drugs, specifically regarding new and emerging platforms and technologies.

And of course, FDA is itself reviewing the comments received on those draft guidances, and several comments endorsed some version of a one click rule and encouraged the FDA to accept such a provision.

Marketers of pharmaceutical products will need to pay attention in the next few months as all of these pieces fall into place. For now, one click remains the rule that isn’t, but marketers are born dreamers, and this is a dream that clearly won’t die easily.

We’ve all heard about “Meaningful Use,” but where did it come from, what does it mean, and how might healthcare consumers ultimately benefit? Let’s find out!

Back in 2008 the National Quality Forum (NQF) issued a report identifying opportunities for improving public health, efficiency, safety, privacy, and patient engagement, among other areas. The recommendations became the foundation for the “Meaningful Use” of electronic medical and health records (EMR/EHRs), which gained momentum a year later when the American Recovery and Reinvestment Act (ARRA) formalized the need for preserving and improving healthcare affordability.

The HITECH Act soon followed, designed to help meet those goals through Health Information Technology (HIT). Monetary incentives through Medicaid and Medicare were offered to eligible healthcare professionals and hospitals to adopt certified EMR/EHR technology and use it “meaningfully” to improve healthcare. The goal is to ultimately create better clinical outcomes, increased transparency and efficiency, boost individual empowerment, and produce more robust research data.

In July 2010, the Centers of Medicare & Medicaid Services (CMS) established three phases of the EHR Incentive Program applicable over five years, whereby eligible physicians and hospitals would meet meaningful use criteria and gain incentives by adopting certified EHR technology, and use it to achieve specific objectives:

• Stage 1: Data Capture and Sharing (2011-2012)
  The nuts and bolts of EHR integration, including capture and standardization, tracking, internal communication, reporting of quality measures, engaging patients and their families through data.
• Stage 2: Advance Clinical Processes (2014)
  Integration with the Health Information Exchange (HIE) of e-prescriptions and lab results, electronic transmission of patient care summaries, and increasingly utilized patient-controlled data.
• Stage 3: Improved Outcomes (2016)
  Achieving top line benefits, including improved quality, safety, and efficiency, and healthcare outcomes; decision-support; patient access to self-management tools; HIE-based access to patient data.

Implications & Opportunities

Up to now, the integration and adoption of health information technology, especially EHRs, have often been problematic. Whereas most professionals and even patients agree that technology can improve outcomes, the disruptive nature of digital often precludes utilization, and typically spawns fragmentation and interoperability nightmares. Meaningful Use combats these obstacles with genuine incentives, physicians qualifying for as much as $63,750, and hospitals for $2 million or more.

• 88% of providers report that their EHR produces clinical benefits for the practice
• 75% of providers report that their EHR allows them to deliver better patient care

Such an unprecedented synergy between government, healthcare providers, and technology has already created powerful opportunities, especially in EHRs and digital health. Focused on realizing the looming goals of Meaningful Use, technologists are getting closer to the Holy Grail of platform agnosticism, device interoperability, and data universality. The central tenet of patient empowerment – making the healthcare system less paternalistic – is a core objective of Stage 2.

As such, the ACA and Meaningful Use hold tremendous promise for patients and patient-centric communications. Despite many challenges and the ongoing need for caution, unique and compelling opportunities abound for closing the loop between patient data and their physicians through EHRs at the point of care. Additional opportunities for integrating patient data into decision-making tools such as @Point of Care powered by IBM Watson are taking hold, further expanding the vision.

Summary & Key Takeaways

The future of health information technology, especially EHRs, points to a “Coke vs Pepsi” future competitive landscape, where thousands of fragmented vendors eventually coalesce into three, most likely just two, main platforms. Until the inevitable happens Meaningful Use has helped drive adoption, utilization, and innovation. The benefit to the patient is realized not only in terms of reduced costs and heightened efficiencies, but in exciting new opportunities for engagement:

• Patients will gain ever-increasing control of their own data
• Patients will communicate more directly and transparently with their physicians beyond the point of care
• Patients will integrate their EMR/EHR platform with wearables and other biosensors to make biometric data input and sharing seamless
• Patients will share biometric data between appointments, giving their physicians an unprecedented view into their overall health
• Patients will make their data responsive, with alerts and other feedback loops to help heighten adherence and other forms of behavioral modification

So pay close attention to the evolving digital health landscape, where science, communications, and technology merge – sometimes even with helpful impetus from the government – for the benefit of patients and the healthcare systems that serve them.