Campaign to get young insured people to get annual health screenings

Francis Secada

AbstractThis is a campaign plan to reach young individuals with insurance, to promote Annual

Health Screenings as a free service that they should utilize. Survey results and national health care trends are analyzed to demonstrate the need for preventative healthcare

services, and the analysis seeks to find ways of bridging having insurance with utilizing it. The conclusion is that needing a regular physician and having ease of access towards

scheduling an appointment is vital towards facilitating the most effective pathway towards complying with the desired behavior.

ContentsAudience Analysis........................................................................................................................................2

Campaign Design.........................................................................................................................................6

The Rider, the Elephant, and the Path.......................................................................................................10

Directing the Rider.................................................................................................................................10

Motivating the Elephant........................................................................................................................10

The Path................................................................................................................................................11

Non-course References.............................................................................................................................13

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Executive SummaryAs national healthcare spending increases, the more the importance of preventative health

services and annual health screenings becomes pronounced. Preventative healthcare is an

effective way of working towards controlling healthcare costs, by helping physicians establish

long-term relationships with their patients, by establishing baselines for health status, and by

providing opportunities for medical and clinical interventions at early stages of disease

progression. Preventative health measures have demonstrable benefits, as detailed in the

attached Social Marketing Worksheet. This is why it is also important to ensure that younger,

healthier people engage in utilizing preventative health services now as opposed to when they

become older and sicker. This is a major reason why the free benefit of Annual Health

Screenings are afforded to insured Americans, and why preventative health is emphasized in the

Affordable Care Act.

A survey conducted for this public campaign statistically demonstrates that, within the sample,

having insurance does not necessarily lead to people either 1) having a regular physician, or 2)

getting annual health screenings. While a significant number of responders were not aware that

this was their right as afforded through the ACA, a significant number of responders stated that

they would not get annual health screenings even with the knowledge that it was a benefit

afforded to them. This signifies that there is disconnect between people having the means for

care, and not engaging in the desired behavior, to promote greater probability for better long-

term health outcomes.

This campaign seeks to determine how to persuade the intended public audience to engage in the

desired behavior of getting their annual health screenings.

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Audience AnalysisThe writer for this public campaign is a 30-year old Healthcare Policy student in a Masters of

Public Administration Program within New York City. The secondary and tertiary authors for

this campaign would be other stakeholders from the non-profit and government worlds with a

strong background in Public Health, working in partnership with a marketing/advertising

company that specializing in public health initiatives. The finalize form of this campaign would

be determined after a thorough review process that fine-tuned and redefined demographic details

and messaging components prior to launch.

The primary audience for this campaign would be younger American adults who already have

insurance. The age range would be 25-39, with individuals in that age range having insurance

either through their parents’ coverage, through their employer, or privately through state

exchanges. The imagined location would be within New York City, but the parameters of the

population framework, prerequisite for insurance, and access to medical providers would allow

the campaign to expand to other major metropolitan areas across the United States. Secondary

audience members will be medical providers, primarily community health centers that already

utilize Electronic Medical Record systems for administrative use, and who can serve large

quantities of patients (and who will likely be affiliated with major hospital and outpatient

networks, like St. Lukes or Columbia Presbyterian). Tertiary audience members will likely be

private insurers (and in some markets, Medicaid Managed-Care providers), who will bear the

costs of preventative health service provisions (because the Affordable Care Act allows for

annual health screenings and select preventative screening services on an annual basis, at no cost

to policyholders).

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Consideration towards promoting Annual Health Screenings as a cost-effective service for all

involved audience members should occur, in order to build in-roads with private insurers to bring

them on board with the campaign as a stakeholder. If private insurers would be willing to

provide tangible goods in exchange for the desired behavior (such as reduced premium rates for

those who complete their Annual Health Screening), then there would be a significant incentive

towards achieving compliance.

The primary issue with complying with Annual Health Screenings is the disconnect individuals

have with having insurance and improving health outcomes. Healthcare policy research yields

that having insurance is an important prerequisite for accessing care, although generosity of

benefits (i.e.: benefits design) is also very important. The Rand Corporation released a major

study in the 1980s that demonstrates how coinsurance can limit utilization of healthcare services,

which can be beneficial to healthy individuals (because they do not need care), but can be

detrimental to those with chronic conditions (because they can get sicker if they do not get

proper medical care and oversight).1 Additionally, individuals mostly lack expertise in medical

and health care fields, thus having imperfect knowledge of how to manage their health over

longer time horizons. The imperative, therefore, is to encourage individuals to have consistent

contact with their physicians during moments of health, in order to establish baselines in health

status. Waiting for care until moments of significant illness encourages the development and

proliferation of chronic medical conditions and dread diseases. This is partially what contributes

to increased healthcare spending in the United States from the 1960s to today2.

In order to promote proper medical oversight without promoting unnecessary health care

spending, the emphasis on care would need to shift from providing secondary and tertiary care 1 (Brook, et al., December 1984)2 (Radnofsky, 2014)

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(treatment of specialized and chronic conditions) towards preventative care. After all, it is easier

to treat for discoveries of cancers or symptoms that may be precursors to chronic conditions at

earlier stages than later stages. Individuals screened for appropriate conditions have a better

chance of receiving care at earlier stages of detection, which is cheaper and safer.

Original survey data demonstrates that people who have insurance may not have a regular

doctor. People without regular doctors may be more likely to avoid getting annual health

screenings, which does nothing to address larger trends in healthcare spending or mortality rates

with chronic conditions. The purpose of this public campaign is to induce younger, statistically

healthier individuals towards getting screened annually, to ensure their health in the long-term

while also safeguarding against personal costs from failure to do so (e.g.: time off for being sick,

cost of medical care, increased risk for developing chronic illnesses).

The latitude of preferences across these demographics can vary, depending on cultural

characteristics of young individuals (i.e.: the cultural background of individuals may inform how

they interpret or understand their condition or how they approach communicating with

physicians3). They may be hostile, indifferent or even positive towards medical providers or

healthcare in general, but those attitudes may not hold much significance if a person becomes

sick and is unable to manage the condition themselves. The importance of this campaign is to

present the screenings as being a cheaper and more desirable alternative to pursuing care when

sick, and positioning that as secondary to the long-term positive effects.

3 (DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2001)

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Campaign DesignThe attached mock-up of a potential advert serves to demonstrate how the public campaign

would try to reach its intended demographic. The model is depicting a young professional

woman, sitting on a park bench in a metropolitan setting while using her laptop. This image

portrays this individual as being energetic, ambitious and full of potential (read: young), but also

as someone who may be pressed for time. The outfit of the model is professional and not overtly

gendering, but is not asexual in style (note the skirt). By drawing attention to the downloadable

smartphone app, this advert is conveying to the audience that even a very busy person on the go

can go about finding a doctor for an annual health screening, and answer some questions

regarding their family history and health status.

The consumer in mind is noted to not be in a position of financial peril (the persona may be at

risk of peril if sufficiently sick, but this concern is not a persistent or real concern on his/her

mind), but is still cost-conscious. The cost that one would incur from not seeing a physician

annually for a health screening is minimal in the short-term, but the costs can potentially become

substantial I the long-term. By emphasizing that annual health screenings are a free benefit, it

minimizes the supposed costs of actually going to the doctor once a year, while also raising the

potential point that not utilizing the benefit is equitable to squandering it (i.e.: throwing out a

“free” thing, or suffering a cost from non-use).

Different models to reflect different segments of the population frame would be used, as well as

slight alterations towards messaging. The various themes that could be touched upon in the

advertising campaign could be of the following:

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1. Hate paying for things? Did you know that you could get an annual health screening

each year for free? Now you know. Download this app to answer some questions and

find a doctor in your area. Take your results to your doctor. Get a screening before you

get sick. If you wait, you will have to pay for it.

2. Don’t have time to see the doctor? Would you rather use your time off to treat your

illness, or take a single day off to see your doctor for a free annual screening? Do not

waste your time off. Download this app to answer some questions and find a doctor in

your area. Take your results to your doctor. Get a free screening. Better to spend a day

being in charge of your health than many days being sick.

3. So you have insurance, but you don’t have a doctor? And you don’t get annual health

screenings? That is not how you Adult. Download this app to answer some questions

and find a doctor in your area. Take your results to your doctor. You have insurance,

and health screenings are free, so why not use it? That is how you Adult.

4. Worried about getting sick? Worried about how expensive health care is? Fear not.

Download this app to answer some questions and find a doctor in your area. Take your

results to your doctor. Free health screenings keeps you and your doctor in the know.

Being in the know keeps you healthier. Healthier is definitely cheaper.

This kind of campaign is utilizing audience segmentation to curate the message towards

consumers that would be most receptive to the messages. It would not be appropriate to

communicate these adverts towards people over 40, who will statistically be more likely to

develop symptoms associated with chronic medical conditions (the purpose is to reach people

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BEFORE they reach this age group). It would also not be appropriate to target this messaging

towards the significantly wealthy, who are most likely to utilize health services and not care

about utilizing a perceived free benefit. The campaign is looking to utilize explicit conclusions

regarding its advertising (do this to achieve X) as a way of priming the audience through

incentives, but the long-term outcome from the campaign is that the audience reaches the

implied conclusion about long-term benefits of screenings on their own. The short-term

incentive helps the consumer to model the desired behavior, but the implications of such a

behavior should persuade him/her that the behavior is good and that it should be repeated at the

direction of their physician.

Consumers who would be motivated by being healthier and being in control of their health

outcomes would respond to the direct content of the advert, where they can download the app or

reach the online web portal to begin the process of securing an appointment with a physician.

This central-route messaging would serve these individuals well, whereas people who are not

motivated by these concerns may be drawn to the attractiveness and youth of the model, and the

availability of ways to reach the resource (perhaps to see more images of attractive models, and

because they get to use a free resource). These attributes would benefit those consumers who are

more receptive to peripheral processing.

An important component of the campaign is to emphasize the tagline “Be Healthier… and Don’t

Pay For It!” This repetition of the tagline in various permutations of the advert will help to

maintain repetition and exposure of the message. The progressing familiarity with the

campaign contributes to the increasing potential for the message to be received by the intended

audience, even if the content is not received based on its substance (i.e.: made its way through to

the person’s consciousness through via peripheral processing). Additionally, by emphasizing

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specific locations for the adverts (as opposed to general blanketing of the messages through all

available communications channels), associations can be formed that may serve to help trigger

awareness of the campaign after receiving the message (for example, sitting in a subway car

reminds a commuter that they saw the advert during their previous morning commute).

The product for this campaign is really the free smartphone app or web portal, which provides

the tools needed by consumers to begin the process of 1) documenting their health status and

family history, 2) finding a doctor in their area, and 3) scheduling an appointment for an Annual

Health Screening. The application can be accessed anywhere with an internet access, and

physician locations are relevant to the end-user. It would not be feasible to provide physician

listings in Chicago for a person residing in Los Angeles, after all. The Health Screenings are

emphasized as being free, because it is a benefit afforded through the Affordable Care Act.

Promotion of the campaign should take place through adverts strategically placed for young

professionals, so along commuter lines and in pharmacy/drug stores may be most advised. An

online presence is also important, as the primary mode of accessing this benefit is via the

internet. By cultivating a social media presence, the network involved in the public campaign

can promote a platform for participating consumers to share and persuade their peers. Utilizing

social influence as a promotion tool is significant to measuring the success of the campaign.

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The Rider, the Elephant, and the PathDirecting the RiderThe success of the campaign really hinges on the compliance with the critical move (go see your

doctor once a year!). Seeing the doctor for an annual health screening is a specific behavior that

leads to better health outcomes in the long-term, and it being a one-time event (repeated

annually) demonstrates how a blue-dot behavior can have huge positive effects. The destination

that consumers can be directed to is finding themselves as they are, slightly older, perhaps

significantly farther in their career than when they were first contacted through the campaign, but

seeing that their health has been maintained at much better rates than compared to those who did

not get screenings. Perhaps some consumers with a history of dread diseases in their family can

find themselves feeling more secured, in knowing that health screenings have helped to either

rule out or perhaps detect such conditions very early in their development stages. If significant

numbers of people benefit greatly from the screenings (such as catching Breast Cancer very

early, or addressing symptoms associated with being pre-Diabetic through small behavioral

changes), they can be the bright spots that the campaign can point to as evidence that the path is

a good one.

Motivating the ElephantThe campaign is attempting to motivate consumers emotionally, by reducing the needed change

into a single change in behavior, while also emphasizing that the targeted demographic are

ambitious and successful people. The messaging is to emphasize that the targeted demographics

are capable, that they are able to manage significant things like their career, time, resources,

modern technology and their social spheres of influence. The deficiency is in how they utilize

their insurance, and how they lack a regular doctor to help them manage their health. This can

be changed, and the change is small. One only has to download the app (or reach the web

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portal), answer questions, then select a doctor in their area and schedule the appointment (the app

would then create an event in Google Calendar or iOS).

The PathThe true difficulty of this campaign is trying to change a behavior that lacks a clear barrier.

Individuals with insurance should be able to see their physician one time a year for a health

screening, and not be billed for it. This is an essential right, and part of all private insurance

benefits packages. However, people with insurance lack a regular physician, and yet this may

not be due to geographic restrictions (although this can be the case in certain major areas). The

campaign is looking to facilitate the most efficient pathway towards achieving the desired

behavior.

The public campaign would ideally be able to utilize a cloud-based scheduling interface with

community health centers, to integrate with their EMR systems on the backend, in order to

promote ease of scheduling for consumers in need of Annual Health Screenings. The scheduling

and questionnaire data that would be available to medical providers would help to inform

physicians on what to look for when assessing and screening their new patients. This removal of

guesswork would theoretically help to promote efficiencies and trust between the consumer and

the medical providers.

While the application and medical provider mechanisms may be new to consumers, the use of

smartphone applications and web 2.0 interfaces are very much the norm for millennials in 2015.

The practice of downloading an application is almost second nature, especially when considering

the digital design of the major smartphone operating systems. This should facilitate the habit of

using touch-input to answer questions related to health and family history, while also navigating

an application towards finding a medical provider and scheduling an appointment. While

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making this an annual habit may be an issue due to the timing of the intervals (once a year),

syncing contact information between medical providers and consumers should help the former to

track the latter for future appointments and screenings. In the very least, a year-round campaign

would help to keep the knowledge of the campaign fresh in the minds of the targeted

demographics.

Lastly, the campaign would be able to “rally the herd” by maintaining a social media platform,

both for the campaign network to promote and share content, and for end-users to share their

status and progress with promoting the desired behavior to their social spaces. Allowing people

who appropriately model the desired behavior to share their results and content with their friends

helps to empower those users to serve as unofficial ambassadors for the campaign. People can

identify with their friends and peers, and if they are proactive in ensuring their health, then it is

easier for them to identify with the behavior for themselves (even if they do not explicitly

understand the merit of such behaviors). If the success of the campaign permits the collaborating

with insurance companies, a further incentive can be introduced in the form of lowered monthly

premiums. This benefit would resonate with some individuals, but then reshaping the

arrangement so that others see it as a cost (i.e.: see your physician today, or else risk losing your

discount!). This may induce individuals to change, because the path facilitates the need for it.

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Non-course ReferencesBrook, R. H., Ware, J. E., Rogers, W. H., Keeler, E. B., Davies, A. R., Sherbourne, C. D., . . . Newhouse, J. P.

(December 1984). The Effect of Coinsurance on the Health of Adults : Results from the RAND Health Insurance Experiment. Santa Monica: The Rand Corporation.

DEPARTMENT OF HEALTH AND HUMAN SERVICES. (2001). CULTURE COUNTS: THE INFLUENCE OF CULTURE AND SOCIETY ON MENTAL HEALTH. In D. O. SERVICES, MENTAL HEALTH: CULTURE, RACE, AND ETHNICITY (pp. 23-49). Washington DC: U.S. Public Health Service.

Radnofsky, L. (2014, February 24). How Health-Care Spending Got So High. Wallstreet Journal, p. 1.

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