Final Project

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Southern New Hampshire University *

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IHP 510

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Jan 9, 2024

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Final Project: Marketing and Communication Plan Karen Aucella Southern New Hampshire University, IHP 510

2 Marketing and Communication Plan: Bellevue Hospital Diabetes Outreach Bellevue Hospital is a comprehensive health facility in the five boroughs of New York City. As a Safety-Net hospital, Bellevue is committed to providing care to everyone, regardless of their ability to pay. Safety-Net hospitals are urban facilities that generally treat a high percentage of patients on Medicaid or uninsured. (Moura, 2021) As the oldest public hospital in the United States, Bellevue has a rich history of providing care to vulnerable populations and medical innovation. (Fiani et al., 2022) Mission, Vision, and Strategic Goals Bellevue Hospital is founded on the belief that everyone is entitled to high-quality care without regard to the ability to pay. Bellevue seeks to provide service that protects the dignity and respect of its patients through advocacy and innovation. With the whole person in mind -physical, mental, and social – Bellevue strives to collaborate with the communities and other healthcare workers of New York City to advance and safeguard the well-being of those needing services. (NYC Health & Hospitals, 2023) Bellevue is committed to health equity and benevolence, envisioning New Yorkers living the healthiest lives possible. Bellevue incorporates the ICARE values of integrity, customer-first, accountability, respect and excellence. (NYC Health & Hospitals, 2023) Bellevue's mission statement and values are built on the strategic goals of quality and outcomes, care experiences, financial sustainability, access to care, and a culture of safety. Chronic Disease Bellevue's Community Needs Assessment identifies the following risk factors for Type 2 Diabetes: "a family history of diabetes, age of 45 or older, a high BMI/obesity, and low levels of physical activity." (NYC Health & Hospitals, 2022) The increase in a sedentary lifestyle among

3 Americans correlates to the rise in the incidence of Type 2 Diabetes. African Americans, Hispanics, and Latinos have a higher rate of Type 2 Diabetes. Bellevue Hospital treats 11.3% of the diabetes population in the NY Healthcare system, of whom the majority are Black or African American and Hispanic or Latino. Obesity is a contributing factor in most cases. (NYC Health & Hospitals, 2022) One-third of all cases of diabetes are among people who are unaware they have the disease. NYC Health & Hospitals currently offers treatment at all hospitals and neighborhood treatment centers. (NYC Health & Hospitals, 2023) By adopting a Blue Ocean marketing strategy, Bellevue can incentivize the unreached diabetes population for screening, drawing people to their community-based centers. Providing incentives would increase Bellevue's market share while improving the community's health. (Berkowitz, 2021) Stakeholders The stakeholders of Bellevue Hospital include physicians, patients, private and public insurers/payers, board members, family members, and the community at large. As a leader in innovation, Bellevue has the unique opportunity to create programs and services for diabetes and obesity from the inside out. By challenging providers and board members to focus on quality outcomes, services may be designed to improve the community's health and elevate the hospital's status. Service Alignment The page devoted to diabetes treatment is woefully inadequate, given the pervasive chronicity of the disease. There is no mention of outreach services, and the severe complications associated with diabetes are addressed in two lines. Due to Bellevue's commitment to public health, diabetes care and management appears to be side-lined. Bellevue has a long history of

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4 serving the most vulnerable populations of New York. Current marketing strategies do not appear to meet the goal of helping New Yorkers live their healthiest lives. Target Market Bellevue provides services in the five boroughs -Manhattan, the Bronx, Queens, Brooklyn, and Staten Island. Bellevue's clinics currently serve 92,000 patients with diabetes. Women make up 57.40%, while men constitute the remaining 42.50%. Latinos and Hispanics represent 38.5%, followed by Black or African American at 35.2%. 45% are 45 -64, while 38.8% are over 65. Ninety-three thousand emergency visits involve patients with diabetes. Obesity comprises 45.7% of the adult population with Type 2 diabetes, followed by 35.2% clinically overweight. 31.3% of pediatric patients under 18 with Type 2 diabetes are obese. Bellevue focuses on a healthy diet, limiting sugar intake, regular physical activity, and weight loss. (NYC Health & Hospitals, 2022) Bellevue is committed to serving the needs of all seeking care, regardless of their ability to pay. Its location in Manhattan affords it a presence in the city. Bellevue's services range from emergency to neurosurgery and every medical service. With more than 30 subspecialties, Bellevue is prepared to meet any needs. (Fiani et al., 2022) Providing for the indigent, however, is Bellevue's primary weakness. Although costs for services are lower at a safety-net hospital, the average third-party payers are Medicare and Medicaid at 36.6% and 48.2%, respectively. The City of New York subsidizes the hospital to sustain it. (Citizens Budget Commission, 2023) Situational Analysis: Market Factors External market factors include Bellevue's extensive community engagement approach. Using community forums, focus groups, and interviews with community stakeholders, Bellevue identified two critical health needs: improving health equity and fighting chronic disease, and

5 facilitating access to resources. Diabetes was among the chronic diseases discussed. (NYC Health & Hospitals, 2022) Proposed Service Bellevue currently serves more than 60,000 patients with diabetes, but 93,000 emergency room visits per year are related to complications from diabetes and untreated diabetes. Services are presently provided in community clinics, neighborhood health centers, and patient support groups. The proposed goal is to create an outreach service for in-home diabetes management. Diabetes was identified as one of the chronic diseases to be addressed in Bellevue's Community Health Needs Assessment. (NYC Health & Hospitals, 2022) The initial focus would be to reach at least 100 patients diagnosed by a physician but not currently receiving treatment out of concern for costs, transportation issues, or lack of education. Marketing Goal As a teaching hospital, Bellevue has access to medical students who could initially use social media and distribute flyers in the community outlining the service and soliciting participants. Community forums could serve as another method of attracting participants. Increasing the program's visibility and determining patients' needs and expectations should be at the forefront of the marketing plan. Visits would include screening blood sugars, providing glucometers, counseling on diet and exercise, sharing community resources, and assisting with medications if required. Patients would receive high-quality care in the comfort of their homes. Telemedicine and online access to providers during (and since) the COVID pandemic revealed that patients are eager to have remote care. (Grotto, 2021) A 5% decrease in emergency room visits over one year would mark the initial success of the diabetes management program.

6 Alignment with Mission and Vision One of the hallmarks of Bellevue's mission statement is to provide the highest quality care to all who need it and to do it with respect and dignity. It also wants to be an innovator and advocate. The diabetes management program would reflect these values. Bellevue's stated values address staff awareness and engagement with its mission and vision. The diabetes program would provide an exceptional care experience, raise awareness of the issues patients face with the disease, and provide uninhibited access to care. (NYC Health & Hospitals, 2023) Competition Lenox Hill Hospital Northwell in Manhattan is home to the world-class Gerald J. Freeman Diabetes Institute. The Institute provides appointments with endocrinologists, diabetes educators, social workers, exercise physiologists, dieticians, cooking demonstrations, and support groups. Its mission is summed up in ALL: Advance, Learn, and Live. Community outreach programs are available to Latino residents and services in the five boroughs in conjunction with the NY Department of Health. (Northwell Health, 2023) The Naomi Berrie Diabetes Center at Columbia University Irving Medical Center provides care, like Lenox Hill, with a team approach in its clinic. The Berrie Center is committed to research and development for a cure for diabetes. However, they do not provide a community outreach program. (Columbia University, 2023) Ethical Criteria To maintain ethical integrity, Bellevue must be transparent in all aspects of the provision of care. In-home service must be the same high quality as that obtained in its facility. Bellevue must be true to its word that services will be equitably accessible. Direct-to-Consumer advertising (i.e., social media as a marketing tool) must reflect the same transparency and ethical

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7 standards as all other marketing tools Bellevue utilizes. It must educate those personnel involved in the diabetes management program that the same HIPAA standards apply in the community and the facility. Patients should expect the same rights to privacy and protection of health information received in-office. (Berkowitz, 2021) Marketing and Communication Strategies Non-Hispanic black residents of the five boroughs of New York represent nearly 20% of the population and almost 9% of the people of the US (Black Demographics, 2023) Although Bellevue provides care throughout the city, diabetes care is limited to services within a hospital or provider's office. (NYC Health & Hospitals, 2023) The ratio of severe complications from untreated, poorly treated, or undiagnosed diabetes among non-Hispanic blacks versus non- Hispanic whites is 3.8:1. (Office of Minority Health, 2023) Bellevue has a unique opportunity to take diabetes care into people's homes and communities. Marketing Strategies Creating an outreach program for diabetes aligns with Bellevue's Community Health Needs Assessment. Addressing diabetes was identified as a targeted goal. An internal marketing strategy to reach individuals diagnosed with diabetes but not currently receiving treatment would rely on access to phone numbers and EMR patient portals. (Lorin Purcarea, 2019) Due to HIPAA requirements, physicians cannot provide patient names to a third party. However, patients that have provided phone numbers may be contacted by phone, querying patients' interest in participation. Patients with cell phone numbers could also be reached through a patient portal with a brief notice regarding the new program. (Johnson, 2023) The goal is to enroll 100 patients in the new program and reduce the number of patients receiving emergency treatment by 5%.

8 Social media platforms will also be utilized to create awareness of the program, solicit patients, and provide information regarding the dangers of untreated diabetes. Digital marketing has increased the visibility of healthcare services. The program will also be promoted through traditional media, posting fliers in community centers, neighborhood markets, apartment complexes, and PSAs on radio stations. (Lorin Purcarea, 2019) Four and Five Ps Of the four and five Ps, the outreach service focuses on people/patients, place, and product. Many patients rely on the emergency room (93,000 per year) to treat diabetes-related illnesses. (NYC Health & Hospitals, 2022) 16% of NYC's population (including diagnosed and undiagnosed) has diabetes. Although Asians have the highest prevalence at 24%, non-Hispanic blacks are not far behind with 19.4%. (Thorpe et al., 2018) In the National Assessment of Adult Literacy (NAAL) conducted in 2003, 24% of non-Hispanic blacks demonstrated a below-basic understanding of health literacy. These statistics underscore the need to educate people regarding health, provide education and assistance where it is most needed – in the home and community – and meet the demand for services. (Muvuka et al., 2020) The initiative will bring high-quality healthcare to the people with the highest need and forge relationships between patients and providers. Price was not considered as the service will be free to those unable to pay. Although the service promotion will be integral to the marketing plan, the primary focus will be on patients and the product. Politically, the proposal may experience some backlash from the communities. Potential patients may include immigrants, particularly in light of the influx of Hispanic people bussed from the Texas border. Other areas of the US have reported challenges to providing healthcare because of interference by immigration authorities. However, New York City has a long history

9 of assimilating immigrants. Each of the five boroughs is home to many ethnic groups. (Mesa et al., 2020) Target Market Rates of type II diabetes (T2D) among non-Hispanic blacks have doubled, among Asians by 25-50%, and in children aged 10-20 have increased by 30%. (Chittamuru et al., 2020) Addressing diabetes falls under the Community Health Needs Assessment (CHNA). Most diabetic patients in NYC are Hispanic/Latinx (38.5%) and Black or African-American (35.2%). 45% are between the ages of 45-64. Educating and treating T2D is a priority. Reaching people diagnosed but not currently treated due to cost, access to healthcare, lack of education, or homelessness would include self-management techniques, like exercise, diet, and limiting sugar intake. (NYC Health & Hospitals, 2022) In 2019, the death rate from T2D among non-Hispanic blacks was double that of non-Hispanic whites. Non-Hispanic blacks were 2.5 times more likely to suffer severe complications and 3.2 times more likely to suffer from end-stage renal disease. (Office of Minority Health, 2023) While the ACA was enacted to provide healthcare coverage to everyone, whether through expanded Medicaid coverage or subsidies through the healthcare marketplace, once the Trump administration repealed the individual mandate, the number of insured people declined. (Glied et al., 2020) Although Bellevue provides care to all who need it, many uninsured people are reluctant to seek care at a facility because of their inability to pay. The barrier is removed by taking healthcare into people's homes and communities. Currently Used Strategies Three strategic pillars of Bellevue's CHNA are access to care, quality and outcomes, and the care experience. Bellevue uses digital marketing, social media campaigns, and "town hall" meetings to reach its patients and communities. They also rely on patient surveys, focus groups,

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10 and community forums. NYC Care is an initiative to provide free or low-cost care who are uninsured or unable to obtain health insurance. (NYC Health & Hospitals, 2022) Marketing Strategies The global world is 365/24/7. The digital world is always on. Additionally, social media marketing allows Bellevue to segment its use of media platforms, targeting specific demographics. Through embedded links and infographics, social media marketing can drive patients to programs – like the T2D outreach – enabling them to apply online. A Facebook page, a short YouTube video, or an infographic on Instagram can direct patients to the resources needed to enroll. (Berkowitz, 2021) Data-mining the EMR. to identify patients diagnosed with T2D but not being treated will provide opportunities to utilize patient portals to offer access to the program. Patients can view messages on the portal and respond in kind. Preliminary information can be exchanged, and appointments made through patient portals. Although New York City is a vast metropolis, ethnic, geographic, and racial micro- communities thrive throughout the five boroughs. Micro-communities gather around neighborhood markets, community centers, and public parks. Posting fliers in these locations will expose individuals without digital access to the availability of services. Ethical Criteria Bellevue must be transparent in its purpose for promoting the program and its intent in providing the services. It must respect autonomy, allowing patients to decide whether to participate. It must reflect beneficence, detailing the program's positive and negative impacts. The program must be just and equitable, treating patients without regard for race, creed, ethnicity, or sexual orientation. It must be non-maleficent, seeking the best for each patient

11 without harm. (Haddad & Geiger, 2023) The diabetes outreach program is designed to create ease for patients who want to treat diabetes but have lacked the means to do so. Internal Stakeholders The internal stakeholders of this project are physicians, nurses, medical students, the marketing team, the board of directors, the chief executive officers, senior executives, and administrative personnel. As the enabling stakeholders, the board of directors, chief executive officers, and senior executives should initially review the plan. Internal communications could include surveys, Zoom meetings, and employee newsletters. Developing a SWOT for the program would assist in identifying weaknesses and threats, in particular. (Berkowitz, 2021) Creating a project management team is essential to organize the process and keep plans on track. Project management would create a workflow, develop a timeline for each stage, and ensure it meets deadlines and complies with regulatory requirements. (Usability, 2023) External Stakeholders External stakeholders include patients, communities, local government policymakers, pharmaceutical companies, and educators. The same methods used to market the program could be used to inform external stakeholders. Bellevue already uses community forums to reach out to external stakeholders. Additionally, its Community Advisory Board can be looped in to assist with marketing the program. Social media and direct mail would also promote the program and seek feedback. Bellevue's history of providing high-quality care to all underscores its commitment to the community's health. Bellevue must inspire and encourage communities to embrace the program and potentially stimulate volunteers. (NYC Health & Hospitals, 2023)

12 Collaboration and Effectiveness of Plan The outreach program will increase Bellevue's visibility in the community and deepen the connection between internal and external stakeholders. The diabetes outreach program will provide high-quality care and positive healthcare experiences, reduce financial and medical strain on emergency services, and improve access to those struggling to improve their health. Ethical Criteria for Communication Strategies Bellevue must consider marketing and healthcare ethics when communicating the plan to internal and external stakeholders. The six values of the American Marketing Association are honesty, responsibility, fairness, respect, transparency, and citizenship. (American Marketing Association, 2017) The AMA's ethical values are on par with healthcare values. When conveying the plan and purpose of the new program, Bellvue must be transparent with stakeholders, strive to uphold the dignity and integrity of the hospital and its patients, be accountable in all their communications, and, above all else, do no harm.

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13 References American Marketing Association. (2017). AMA. Statement of Ethics . AMA. https://web.archive.org/web/20180326030430/https://www.ama.org/AboutAMA/Pages/St atement-of-Ethics.aspx Berkowitz, E. N. (2021). Essentials of Health Care Marketing (Fifth, pp. 37–38). Jones & Bartlett Learning. Black Demographics. (2023). New York City - BlackDemographics.com . BlackDemographics.Com. https://blackdemographics.com/cities-2/new-york-nj-ny/ Chittamuru, D., Daniels, R., Sarkar, U., & Schillinger, D. (2020). Evaluating values-based Message frames for type 2 diabetes prevention among Facebook audiences: Divergent values or common ground? Patient Education and Counseling , 103 (12), 2420–2429. https://doi.org/10.1016/j.pec.2020.08.042 Citizens Budget Commission. (2023). A New Approach To Funding New York City Health + Hospitals . Citizens Budget Commission Of New York. https://cbcny.org/research/new-approach-funding-new-york-city-health-hospitals Columbia University. (2023). Naomi Berrie Diabetes Center | ColumbiaDoctors - New York . ColumbiaDoctors. https://www.columbiadoctors.org/specialties/endocrinology-diabetes- metabolism/naomi-berrie-diabetes-center Fiani, B., Covarrubias, C., Jarrah, R., Kondilis, A., & Doan, T. M. (2022, November). Bellevue Hospital, the Oldest Public Health Center in the United States of America . ScienceDirect. https://www.sciencedirect.com/science/article/abs/pii/S1878875022011986

14 Glied, S. A., Collins, S. R., & Lin, S. (2020). Did The A.C.A. Lower Americans' Financial Barriers To Health Care? Health Affairs , 39 (3), 379–386. https://doi.org/10.1377/hlthaff.2019.01448 Grotto, E. (2021, March 1). An organization's consumer strategy must change with the times . Healthcare Financial Management. https://eds-p-ebscohost-com.ezproxy.snhu.edu/eds/pdfviewer/pdfviewer?vid=6 Haddad, L. M., & Geiger, R. A. (2023). Nursing Ethical Considerations. National Library of Medicine . https://www.ncbi.nlm.nih.gov/books/NBK526054. Johnson, L. (2023, January 1). What Are The HIPAA Telephone Rules? - 2023 Update . HIPAA Guide. https://www.hipaaguide.net/hipaa-telephone-rules/ Lorin Purcarea, P. Eng. V. (2019). The impact of marketing strategies in healthcare systems. JMedLife , 12 (2), 93–96. https://doi.org/10.25122/jml-2019-1003 Mesa, H., Doshi, M., Lopez, W., Bryce, R., Rion, R., Rabinowitz, E., & Fleming, P. J. (2020, November 1). Impact of anti-immigrant rhetoric and policies on frontline health and social service providers in Southeast Michigan, U.S.A . https://eds-s-ebscohost-com.ezproxy.snhu.edu/eds/pdfviewer/pdfviewer?vid=12 Moura, P. (2021, May 18). What Is A Safety-Net Hospital And Why Is It So Hard To Define? FRONTLINE. https://www.pbs.org/wgbh/frontline/article/what-is-a-safety-net-hospital-covid-19/ Muvuka, B., Combs, R. M., Ayangeakaa, S. D., Ali, N. M., Wendel, M. L., & Jackson, T. (2020). Health Literacy in African-American Communities: Barriers and Strategies. HLRP: Health Literacy Research and Practice , 4 (3). https://doi.org/10.3928/24748307-20200617-01

15 Northwell Health. (2023). Northwell Lenox Hill Hospital . Lenox Hill Northwell. https://lenoxhill.northwell.edu/ NYC. Health & Hospitals. (2022b, June 30). Community Health Needs Assessment . NYC. Health & Hospitals . https://hhinternet.blob.core.windows.net/uploads/2022/07/community- health-needs-assessment-2022.pdf Y.C. Health & Hospitals. (2023b). Diabetes Care - NYC. Health & Hospitals . NYC. Health & Hospitals. https://www.nychealthandhospitals.org/services/diabetes-care/ Office of Minority Health. (2023, February 17). Home Page - Office Of Minority Health (OMH.) . H.H.S. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4 Thorpe, L. E., Kanchi, R., Chamany, S., Rodriguez-Lopez, J. S., Chernov, C., Freeman, A., & Perlman, S. E. (2018). Change in Diabetes Prevalence and Control among New York City Adults: NYC Health and Nutrition Examination Surveys 2004–2014. J Urban Health , 95 (6), 826–831. https://doi.org/10.1007/s11524-018-0285-z Usability. (2023). Project Management Basics | Usability.gov . Usability. https://www.usability.gov/what-and-why/project-management.html

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