The com­mu­ni­ca­tor

Modern Healthcare - - HEALTHCARE MARKETING IMPACT AWARDS - By Mer­rill Goozner

“It was re­ally good for the staff morale in see­ing ads about the great things be­ing done by the or­ga­ni­za­tion.”

In mid-2003, about a year into his 11-year ten­ure as CEO of Kaiser Per­ma­nente, Ge­orge Halvor­son rec­og­nized the or­ga­ni­za­tion had an im­age prob­lem.

Sur­veys showed the 8 mil­lion peo­ple then signed up for Kaiser in­sur­ance plans liked its team-based ap­proach to care. But to out­siders, bom­barded by news ac­counts high­light­ing the pa­tient back­lash against HMOs, be­long­ing to Kaiser meant not hav­ing a per­sonal physi­cian and lower qual­ity care for se­ri­ous ill­nesses.

The re­al­ity was far dif­fer­ent. Kaiser, founded in the 1940s as an in­te­grated in­sur­ance plan and ser­vice provider, ranked among the best-per­form­ing health­care sys­tems in the coun­try. But Halvor­son had no way of com­mu­ni­cat­ing that to out­siders.

Each of the sys­tem’s eight re­gions had dif­fer­ent elec­tronic health records. Its then-30 hos­pi­tals and scores of clin­ics had 125 ac­count­ing sys­tems. It had the high­est qual­ity and low­est cost in most of its mar­kets, but no way of pulling to­gether the data to tell the story.

His so­lu­tion—a brand­ing cam­paign—might seem a stretch for a leader who learned health­care on the in­sur­ance side of the busi­ness. Halvor­son be­gan his ca­reer at Blue Cross of Min­nesota and helped knit to­gether HealthPart­ners, a mini-Kaiser in that state, which he ran for 18 years be­fore be­ing re­cruited by KP’s board and top med­i­cal staff.

“I knew there was great power in hav­ing a re­demp­tive ad cam­paign that en­cour­aged the best be­hav­iors,” he said. “It was re­ally good for the staff morale in see­ing ads about the great things be­ing done by the or­ga­ni­za­tion. And you want the pa­tient feel­ing good about re­ceiv­ing great care.”

The strat­egy in­volved com­mu­ni­cat­ing his vi­sion for health­care to both in­ter­nal and ex­ter­nal au­di­ences. He tapped Bernard Tyson, then lead­ing Kaiser’s non-Cal­i­for­nia op­er­a­tions, to run it.

At first Tyson thought it was a de­mo­tion, an ef­fort by Halvor­son to get him out of day-to-day op­er­a­tions, which tra­di­tion­ally had been the surest path to ad­vance­ment in Kaiser. But Tyson, now the CEO, soon re­al­ized “he wanted me to work on a brand strat­egy so peo­ple would re­ally know who we are,” he re­called. “It was a fun job that trans­lated into one word, which is ‘thrive.’ ”

A dozen years later, the award-win­ning “Thrive” cam­paign by the Detroit-based Camp­bell Ewald ad agency re­mains ubiq­ui­tous in Cal­i­for­nia and other Kaiser mar­kets. Its ads of­ten use “West Wing” star Allison Jan­ney for in­stantly rec­og­niz­able voice-over. Some ads pro­mote healthy nu­tri­tion, ex­er­cise and preven­tion. Oth­ers high­light the care Kaiser gives peo­ple faced with life-threat­en­ing or life-al­ter­ing con­di­tions.

That two-track brand­ing strat­egy re­flected a vi­sion for health­care that Halvor­son had honed in Min­nesota at HealthPart­ners and doc­u­mented in two books: Strong Medicine, pub­lished by Ran­dom House in 1993; and Epi­demic of Care: A Call for Safer, Bet­ter, and More Ac­count­able Care, which he co-au­thored a decade later with Dr. Ge­orge Isham, who is still the med­i­cal di­rec­tor of HealthPart­ners.

The core of that vi­sion re­quires de­liv­er­ing high-qual­ity care at an af­ford­able cost, and then demon­strat­ing that achieve­ment to pa­tients, staff and em­ploy­ers, who pay most of the freight. “A brand is a be­lief sys­tem,” said Halvor­son, who last week was given the Health­care Mar­ket­ing IM­PACT Vi­sion­ary Award. “If peo­ple be­lieve the No. 1 value is to im­prove health, then every­thing you do is in­ter­preted in the con­text of im­prov­ing health. If peo­ple be­lieve the No. 1 thing is to save money, then peo­ple be­lieve the No. 1 thing the or­ga­ni­za­tion is about is sav­ing money.

“The ‘Thrive’ brand was the pub­lic brand and the brand with our em­ploy­ees. But we also cre­ated a ‘Best Care’ brand: We had the best re­search, the best data, the best in­for­ma­tion flow. That was the in­sider brand … We did a brand for the heart and a brand for the head,” he said.

Tyson, charged with de­vel­op­ing the brand, had to en­sure Kaiser had the data to demon­strate it was liv­ing up to its claims. “The fo­cus was on the build­ing block of the elec­tronic med­i­cal record and our abil­ity to look at data … to de­ter­mine if we were de­liv­er­ing the best care pos­si­ble,” Tyson said. “He was will­ing to bet the farm on that.”

GROW­ING UP IN THE TINY TOWN of Me­nahga, Minn., Halvor­son, now 68, was sur­rounded by farms. His fa­ther taught in the lo­cal high school; his mother was the li­brar­ian. His grand­fa­ther and fa­ther both served as mayor of the town and pres­i­dent of the lo­cal Lutheran church. “When I lis­ten to Gar­ri­son Keil­lor, it’s like go­ing home,” he

said. “My mother didn’t think (‘Prairie Home Com­pan­ion’) was funny. She thought that is the way it is.”

While at­tend­ing Con­cor­dia Col­lege in Moor­head, he picked up the writ­ing bug. Be­sides edit­ing the col­lege lit­er­ary mag­a­zine, he worked part time at the Fargo (N.D.) Fo­rum news­pa­per as an obit­u­ary writer. “It was great train­ing,” he said. “It was un­for­giv­ing. If you make a mis­take in an obit­u­ary, the fam­ily will never for­give you.”

His col­lege years co­in­cided with the tur­bu­lence of the late 1960s, and he was no by­stander. One of his first non-obit pieces for the Fo­rum re­ported the ex­pe­ri­ences of an African-Amer­i­can friend who had been de­nied a room even though it was rented to an­other white friend a short time later. In the win­ter of 1967-68, he got “clean for Gene,” work­ing in the anti-Viet­nam War pres­i­den­tial cam­paign of Min­nesota Sen. Eu­gene McCarthy—the poet sen­a­tor—whose strong show­ing in the New Hamp­shire Demo­cratic pri­mary led Pres­i­dent Lyn­don B. John­son to with­draw from the elec­tion.

Af­ter col­lege, he ap­plied for a job in Min­neapo­lis as un­der­writer at Blue Cross, think­ing it was some type of as­sis­tant writ­ing po­si­tion. Co­in­ci­den­tally, the or­ga­ni­za­tion was look­ing for some­one to as­sist the ad di­rec­tor and work in pub­lic re­la­tions. “The guy in HR thought it would be funny to put a guy who ap­plied for a job as an un­der­writer in that job,” he said.

But they also thought it was im­por­tant for him to un­der­stand un­der­writ­ing, so they sent him to classes on how to form risk pools, which he loved. “I liked the math­e­mat­i­cal,” he said. “I have found that train­ing has been very use­ful over the years in many, many con­ver­sa­tions.” He even­tu­ally moved into strate­gic plan­ning.

By the mid-1980s, the HMO rev­o­lu­tion was gath­er­ing steam. Work­ing with Dr. Paul Ell­wood, a Stan­ford health­care econ­o­mist and early pro­po­nent of the model who had set up a Min­neapo­lis think tank, he knit to­gether about two dozen physi­cian-run clin­ics into a net­work. He met with the prac­tices to find out what they needed to live in a world where they re­ceived a set pay­ment for each mem­ber. “We learned cap­i­ta­tion from do­ing it,” he said.

He even­tu­ally be­came CEO of the Blue Cross plan, which later merged with three hos­pi­tals to be­come HealthPart­ners. The ex­pe­ri­ence laid the ba­sis for his first ma­jor book. But a few years af­ter Strong Medicine ap­peared in 1993, pub­lic opin­ion turned against the man­aged-care model. Halvor­son again took to the air­waves and news­pa­pers.

“We ran full-page ads show­ing 100 ba­bies who were at high risk of be­ing born pre­ma­turely who weren’t born pre­ma­turely, re­ally cute,” he said. “We showed an African-Amer­i­can woman who had got­ten a heart trans­plant af­ter not want­ing one, who was back do­ing so­cial work and she said how it had trans­formed her life. Other health plans were do­ing just the op­po­site—try­ing to re­cruit healthy peo­ple. We went against that flow. It was in­cred­i­bly good for staff morale.”

When mem­bers of the Kaiser board in 2002 reached out to re­cruit him as a re­place­ment for Dr. David Lawrence, who had presided over the most trou­bling pe­riod in KP’s his­tory, he at first de­murred. The or­ga­ni­za­tion had lost money for three straight years dur­ing the mid-1990s, and con­sumer groups in the late 1990s re­peat­edly blasted the or­ga­ni­za­tion for im­pos­ing fac­tory-style medicine.

Karen Ig­nagni, then head of the Amer­i­can As­so­ci­a­tion of Health Plans, called him up. “I thought his em­pha­sis on well­ness and care co­or­di­na­tion would fit in very well with the Kaiser sys­tem,” she said. Halvor­son would be­come a key voice on the board of the suc­ces­sor or­ga­ni­za­tion, Amer­ica’s Health In­sur­ance Plans, which he even­tu­ally chaired. He pushed for uni­ver­sal cov­er­age and cost con­trol well be­fore Barack Obama was elected pres­i­dent. The group even­tu­ally threw its sup­port be­hind the Af­ford­able Care Act.

Dur­ing his last years at Kaiser, Halvor­son in­creas­ingly re­lied on key lieu­tenants to di­rect day-to-day op­er­a­tions, es­pe­cially Tyson who be­came chief op­er­at­ing of­fi­cer. “He wasn’t hands on. He was clear about need­ing out­comes. He weighed in when he needed to, but he didn’t mi­cro­man­age,” Tyson said. “He made sure he had the right peo­ple work­ing on the right project.”

“A brand is a par­a­digm,” Halvor­son said. “It cre­ates an ex­pec­ta­tion and tells you what ought to hap­pen.” With the mis­sion in mind, he de­voted time to com­mu­ni­cat­ing Kaiser’s core mes­sage to its 175,000 em­ploy­ees through a weekly col­umn that launched in Septem­ber 2007. The let­ters cel­e­brated Kaiser’s ac­com­plish­ments. “He loves to write,” Tyson said. “He crys­tal­lizes his think­ing through writ­ing. When you want to know what he’s think­ing, you’ll find it on those pages.”

Halvor­son, who left Kaiser in 2013, hasn’t left health­care. As chair of the First 5 Cal­i­for­nia Com­mis­sion, he’s work­ing to re­verse the per­ma­nent in­tel­lec­tual deficits suf­fered dur­ing the first five years of life by many chil­dren grow­ing up in poverty. The com­mis­sion has launched a $25 mil­lion ad cam­paign, “Talk Read Sing,” that is run­ning dur­ing San Fran­cisco 49ers games and other times likely to reach the tar­geted au­di­ence.

His next set of books, how­ever, will be on strate­gies to avoid the kind of con­flicts that have en­gulfed com­mu­ni­ties like Fer­gu­son, Mo. “I’m now work­ing on world peace be­cause health­care re­form was too hard,” he tells peo­ple dur­ing speeches. “Most au­di­ences laugh, ex­cept peo­ple in the health­care world.”

“A brand is a par­a­digm. It cre­ates an ex­pec­ta­tion and tells you what ought to hap­pen.”

Ge­orge Halvor­son

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