“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.”