Using Target Marketing to Serve the Uninsured

Business Challenge

One of the leading Catholic, not-for-profit health systems in the country, CHRISTUS Health consists of more than 60 facilities dedicated to the mission of providing the highest quality care to all those in need. Like many hospitals nationwide, CHRISTUS is experiencing an increase in the number of uninsured and charity care cases seeking primary care in its emergency rooms (ERs) and leads Catholic Health Care in charity care and community benefits spending.

CHRISTUS operates in areas with large and growing uninsured populations, including Texas, which leads the nation in the number of uninsured residents. Low incomes and high utilization rates common to the uninsured population are further complicated by shrinking reimbursement rates and the changing demographics of the uninsured. These factors prompted the health system to take action to address the situation.

CHRISTUS approached the situation as an opportunity, rather than a problem. According to Anne Messbarger, system director, strategic planning for CHRISTUS, as the demographics of the uninsured shift, a significant portion is composed of employed individuals and families that do not have access to affordable health insurance. This population has different healthcare needs and utilization patterns than the indigent uninsured. CHRISTUS needed an innovative strategy that could reduce use of the emergency room for non-emergent and primary care while providing excellent, cost-effective options to both the indigent and the emerging middle-class uninsured.

Identifying the opportunity that the uninsured population represents was only the first step for CHRISTUS. By using data to affect outcomes, CHRISTUS was able to develop an effective communication and intervention plan to reach the uninsured population.

Challenge #1: Identify and reach emergency room over-utilizers

Result: An in-depth understanding of the uninsured population

CHRISTUS decided to implement crmView™ to gather data about the uninsured population as it would for a traditional target market. “Using crmView in this way,” says Messbarger, “was like turning traditional marketing on its ear. Although crmView is typically used to help health systems target paying patients — which we have also done effectively — we thought that it could also be successfully used to help us with our greatest operational and mission-related challenge: caring for the uninsured.”

Two CHRISTUS facilities — CHRISTUS St. Frances Cabrini (CSFC) Hospital in Alexandria, La., and CHRISTUS St. Michael Hospital in Texarkana, Texas — used crmView data and analysis to effectively target the uninsured. Patient utilization, demographic and geographic data were analyzed to create a comprehensive profile of the group.

Staff at CSFC Hospital learned that the top volume and cost drivers for ER self-pay and Medicaid patients include bronchitis, urinary tract infections, abdominal pain, chest pain and headache, most of which are considered non-emergent. A market segmentation profile provided details as to the most frequent users of the SFC ER for low acuity cases. These patients were primarily single females, 18-34, of all income levels, with children. The second highest group was single males, 35-54, from lower to lower-middle income levels, with no children.

Challenge #2: promote awareness of other primary care options

Result: Reduced ER utilization rate among target audience

At both facilities, crmView data was used to launch campaigns focused on managing the uninsured. Collaboration between the system community health, strategic planning and marketing, and communications departments was essential to the success of the project.

The goal of each campaign was to teach Medicaid and uninsured patients about the appropriate treatment of non-emergent conditions and communicate how and where these patients can find appropriate primary care. Target groups were surveyed and focus groups were conducted to gain a better understanding of lifestyles and healthcare habits.

In one campaign, a targeted group of uninsured patients received communications and a control group did not. The result was a 6 percent lower utilization rate for the group that received the communications. This campaign proved successful in reducing utilization from targeted households, both overall and in the ER. In addition, because more non-emergent care was being handled in settings other than the ER, net revenue for targeted households was also higher on average than those in the control group.

Integral to the CHRISTUS strategy is the idea that serving the uninsured population requires a partnership with healthcare providers across the community. Other healthcare resources and providers (not always CHRISTUS-owned or on a CHRISTUS facility campus) had to be engaged to become part of the necessary infrastructure.

As Messbarger points out, “If you are going to refer the uninsured elsewhere, there must be somewhere to refer them. Simply shifting uninsured patients from our emergency room to that of a competitor accomplishes nothing. Our goal is to find or create a medical home for these patients which provides appropriate and effective access to care for the long term.”

One communications tactic involved providing information to direct the uninsured population to nearby, cash-based clinics for primary-care needs. These clinics provide quality care at a lower cost than an ER. For example, a visit to the ER for an ear infection may cost $120, but the same visit to the cash-based clinic may cost $40.

Moving forward

The steps that CHRISTUS took to understand the uninsured population provided the organization with an in-depth knowledge of who this group is, where they live and how they seek out healthcare. The staff at CHRISTUS strongly believes that the new approach they developed could significantly impact their ability to provide quality care to everyone in need. It's an approach they feel could be valuable to other healthcare organizations, too.

“While our efforts are still in their infancy, we have made great progress in changing our underlying approach to caring for the uninsured through strategically and proactively researching utilization patterns, demographics and market segmentation groupings to develop a comprehensive approach to charity care management,” says Messbarger.

CHRISTUS is planning to apply the same approach used for the uninsured population with a much broader target audience: chronic disease patients. Messbarger notes that chronic disease management has many parallels to charity care management in the ER. The analysis at CSFC Hospital revealed that among the insured users of the ER, Medicare patients with diabetes were the loss drivers, suggesting an opportunity for effective intervention with this population as well. For example, a diabetic can usually be treated more efficiently and cost-effectively in an alternative setting outside of the ER.

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