Sunday, April 15, 2018

Grassroots Marketing in Radiology Chandana Lall, MD, MBA, Richard J. Gannotta, NP, DHA, MBA, Andrew B. Rosenkrantz, MD, MPA

Grassroots Marketing in Radiology
Chandana Lall, MD, MBA, Richard J. Gannotta, NP, DHA, MBA, Andrew B. Rosenkrantz, MD, MPA
Grassroots refers to the most basic level of an activity or organization [1]. In turn, grassroots marketing refers to a ground-up, energetic, and practical way of relaying a targeted message that then generates its own mo- mentum [2]. Unlike the large-scale efforts of traditional marketing methods, grassroots marketing con- veys a succinct message designed to attract a defined group. As the group receives the message, it spreads the word and further propagates the communication, thereby creating a widening ripple effect. Therefore, with minimal cost, grassroots marketing may produce better results compared with traditional marketing. Social media, including Twitter (Twitter Inc, San Francisco, Califor- nia) and Facebook (Facebook, Inc, Menlo Park, California), [3,4] is increasingly being adopted in such marketing.
Radiology departments, now more than ever, need an effective marketing strategy to ensure future business and growth. As a continu- ously evolving field, there is a need for timely communication of new services or capabilities and a vision for new imaging service lines. Here, radiologists can control the narrative [5], whereby simple grassroots marketing allows them to act as their own best marketing agent. The target audience includes referring physicians, trainees, and patients, with the main aim being
to convey a clear vision for the new imaging study, multidisciplinary treatment team, or service line [6]. As radiology evolves, our field can offer a widening array of valuable services and products. However, if other stakeholders do not know of these, then the impact of such opportunities will be diminished.
The essence of grassroots mar- keting is interpersonal effort and networking, establishing local pres- ence, and creativity. Stakeholders need to be included in the educa- tional efforts. Thus, grassroots mar- keters need to invest in their education and training to be able to market a new service. Basic leader- ship and people skills will also aid in success. Radiologists can serve as a bridge for physicians, trainees, and perhaps most importantly, patients, and are called upon to find an op- portunity and seize it.
Networking is vital for radiolo- gists who are at the very hub of the hospital. Making a concerted effort to reach out to colleagues, establish rapport, improve camaraderie be- tween groups, continually inform them of new imaging trends, and emphasize the high quality of imaging provided all play a role in increasing referrals. It also helps to be creative by sending out radiology newsletters to relevant physician groups as well as appropriate and timely use of social media to further promote the mes- sage. Continuing medical education, lunch-and-learn sessions, and grand
rounds are other venues. Goals include building confidence among referrers in ones group and learning about new services that referring physicians may need or desire.
Multidisciplinary tumor confer- ences and grand rounds are an optimal way to reach out to a multi- tude of referring clinicians and to emphasize imaging expertise. Multi- disciplinary tumor conferences pro- vide face-to-face interaction with referring clinicians and are a good forum to introduce and discuss novel radiological procedures or tech- niques. For example, a hematology- oncology tumor board attended by one of the authors discussed liver iron and fat quantification. By simply saying Sure we can do this,followed by e-mailing relevant articles to participating physicians, the institu- tion now routinely offers liver MRI for fat and iron quantification, answering an important clinical question. Another example involves one of the authors colon diseaseoriented team meetings. Approxi- mately 3 years ago, the oncologists and colorectal cancer surgeons were informed about the accuracy of pelvic MRI for rectal cancer staging by a short PowerPoint (Microsoft Corpo- ration, Redmond, Washington) talk. A survey was sent out regarding the impact of that talk on referring rectal cancer patients for pelvic MRI and the utility of MRI staging for treat- ment planning and performing sur- gery. According to the colorectal
a 2018 American College of Radiology

cancer surgeons and oncologists, their referral rate reached 100% of eligible patients, compared with negligible referrals historically. The program now routinely performs MRI for rectal cancer staging.
A study reviewing methods to improve cancer screening participa- tion showed that more personalized approaches, including primary care endorsement and enhanced person- alized reminders, were effective in increasing participation rates [7,8]. In contrast, traditional methods were relatively ineffective even when targeted toward a narrower group of people [9]. Grassroots advertising, unlike conventional advertising, relies primarily on word of mouth to a few people or a small group, not on print media, television, or radio targeting of a wider audience. It is, therefore, far more personal. It also relies on the social aspect of the consumers and creates enthusiasm among them, making the current generation very receptive to it.
Investing time and interest in marketing toward medical students benefits the field of radiology in the long term. By educating students, we not only nurture them into becoming great physicians, but gain future allies for our specialty. Although only a small fraction of the students end up as radiologists, the majority will become referring phy- sicians. Their proper training in imaging utilization is of future value to both radiologists and patients.
To target patients, a patient- centric website is essential. This can incorporate a patient portal that provides information regarding examinations provided, preparation instructions, robust online sched- uling, automated appointment reminders, convenient evening and weekend imaging options, payment information, including cash options, among other features [10]. The website should be easy to navigate, informational, and accessible by mobile devices. The website should be image rich with pertinent layperson education. A brief summary of the radiologists, including their training, publications, and other academic interests, is helpful. With increasing patient concern regarding radiation exposure, a radiation exposure guide with typical radiation doses associated with imaging studies is useful to alleviate patient anxiety.
Grassroots marketing is an effective way to target a defined audience and speak directly to physicians, trainees, and patients. Marketing costs are minimal compared with conven- tional media marketing and can be more effective. By creating enthu- siasm among consumers, generating momentum, and progressive expan- sion of the client base, grassroots marketing can be among the simplest yet most impactful tools available to radiologists within their health systems. Radiologists are
encouraged to embrace grassroots marketing as they look to expand imaging service lines and add greater value to patient care.
1. dictionaries-thesauruses-pictures-and-press- releases/grass-roots. Accessed January 17, 2018.
2. Myers C. Definition of grassroots marketing. Chron. Available at: http://smallbusiness. 23210.html. Accessed January 17, 2018.
3. Seidel RL, Jalilvand A, Kunjummen J, Gilliland L, Duszak R Jr. Radiologists and social media: do not forget about Facebook. J Am Coll Radiol 2018;15(1 Pt B):224-8.
4. Hawkins CM, Duszak R, Rawson JV. So- cial media in radiology: early trends in Twitter microblogging at radiologys largest international meeting. J Am Coll Radiol 2014;11:387-90.
5. European Society of Radiology. The future role of radiology in healthcare. Insights Imaging 2010;1:2-11.
6. Hawkins CM. Building a radiology service line: key elements and necessary actions. Curr Probl Diagn Radiol 2016;45:107-10.
7. Duffy SW, Myles JP, Maroni R, Mohammad A. Rapid review of evaluation of interventions to improve participation in cancer screening services. J Med Screen 2017;24:127-45.
8. Wardle J, von Wagner C, Kralj-Hans I, et al. Effects of evidence-based strategies to reduce the socioeconomic gradient of up- take in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials. Lancet 2016;387:751-9.
9. Page A, Morrell S, Tewson R, Taylor R, Brassil A. Mammography screening partic- ipation: effects of a media campaign tar- geting Italian-speaking women. Aust N Z J Public Health 2005;29:365-71.
10. Johnson EJ, Doshi AM, Rosenkrantz AB. Strengths and deficiencies in the content of US radiology private practiceswebsites. J Am Coll Radiol 2017;14:431-5.
Chandana Lall, MD, MBA, is from the Department of Radiological Sciences, University of California Irvine Health, Orange, California. Richard J. Gannotta, NP, DHA, MBA, is Interim Chief Executive Officer, University of California Irvine Health, Orange, California. Andrew B. Rosenkrantz, MD, MPA, is from the Department of Radiology, NYU Langone Health, New York, New York.
The authors have no conflicts of interest related to the material discussed in this article.
Dr Andrew B. Rosenkrantz MD, MPA: NYU Langone Health, Department of Radiology, 660 First Avenue, 3rd Floor,
New York, NY 10016; e-mail: 2
Journal of the American College of Radiology
Volume - n Number - n - 2018 

Sunday, December 17, 2017

First Quarter Forecast; 2018…

Its has been quite a year…

Some things worth considering as we end 2017 and enter 2018;

First, in general; It only takes one highly loaded and disruptive issue in the geopolitical/military, social or economic arena to turn the market sectors (collectively) upside down.

Globally healthcare spending increases will be around 4 to 6% as efforts are advanced to improve quality and access in systems which may have lacked investment in infrastructure due to limited funding.
This may in some part be influenced by increasing “globalization” and will likely impact the cost of care to the individual consumer.

In the United States the country continues to not be in “lock step” as it relates to many factors.

External pressures at the national, regional and local level such as geography (rural vs. urban), population density, demographics, unemployment, insurance coverage and immigration are just some of the variables.

In addition (no specific order) some top of mind areas to consider;

  • The future of the 340B program as well as the ACA are areas to watch and in advance of any changes put measures in place that limit any unintended consequences.
  • The proposed Tax Bill will have an impact on federally funded research.
  • At the current “run rate” China will surpass the United States in biomedical research.
  • Technology will play an ever increasing role in connecting the consumer/patient with the healthcare system.
  • “Cost shifting” to consumers may be slowing down as what may be considered “reasonable” limits (think high deductibles etc.) are increasingly exceeded.
  • Narrow networks.
  • Wellness initiatives to guard against burnout (in and out of the health sector) increase.
  • Mergers, acquisitions and enhanced affiliations give rise to more health system “super regionals”.
  • The demand for Population Health initiatives which focus on leveraging new technologies to address social determinants will expand.
  • Novel financial models aimed at mitigating downward economic pressures will be tested.
  • Cost containment measures will continue.
  • New care delivery constructs which enhance effectiveness and efficiency will be pursued. 
Stay tuned

Sunday, July 30, 2017

A New Alchemy in Healthcare; A Periodic Table for Healthcare Delivery ©

Chemistry and action;
Second law of thermal dynamics, Law of Entropy
Order to chaos

Complexity builds with discovery
Discovery in this sense meaning a new and perhaps unrecognized requirement or variable that when understood and applied creates conditions necessary for a positive outcome be it clinically, experientially, regulatory or financially.
Healthcare delivery in the aggregate has historically dealt with ever increasing complexity in a variety of ways in the search for  “goldilocks” conditions, not hot not cold, just right.

One can posit that every healthcare “discovery” created essential elements or necessary conditions which described those factors, there interdependencies and relationships; a periodic table for Healthcare. Lets check out the elements;

1) Co
Positive clinical outcomes, starting with “first do no harm” is the key element in the healthcare periodic table. This is the element to which all others must “interrelate” and without it, no other sustainable structure can be created. It incorporates; safety, human factors and high reliability
2) Pe
Patient Experience
            Patient > and = Customer

3) Fp
Financial Performance
            Positive margins

4) Ee
Employee Engagement
            A staff that derives meaning from there work and translates that into the             patient experience

5) G
            Ease of access,
            a sub element; maturity as an organization

6) Msh
Market Share
            A strategic approach to serving more

7) Ca
Competitive Advantage
            Differentiated “destination” programs

8) Ca2
Clinical Alignment
            Medical Staff, & Clinical Enterprise, strategically and economically

9) Pm
Payor Mix
            An understanding of the delicate balance of this “catabolic” element in your             market is essential

10) L
            If you can choose it you can influence G, Msh & Pm

11) R
            Essential component of Ca not found in most cases without AcM

12) GL
Governance & Leadership
            The wrong group of alchemist can turn lead to gold or gold to ash

13) AcM
Academic Medical Center
            A critical component for many of the elemental structures noted if you are             fortunate enough to have it as part of your Periodic Table

If the elements come together in just the right order you may have those
Goldilocks Conditions previously noted:
Integrated healthcare delivery platform
Safe, positive clinical outcomes
Clinical staff; quality providers
Academics, medical school, research & pipeline of clinicians
Market relevancy
Differentiated services & indispensability
Aligned clinicians & clinical enterprise
No silos, synergy throughout
Low cost structure, low debt, low age of plant, net assets &reserves
Positive margins

Richard Gannotta NP, DHA, FACHE

Sunday, July 23, 2017

Healthcare 2018 early predictions & areas to watch

My thoughts on a few areas of keen interest for 2018 and beyond. 
Patient care, healthcare policy, delivery, technology and economics sure to be impacted by these examples with more to come…

1) Medication & Pharma
I am still a believer that genetic, genomic and nanotech will have a tremendous influence on health and disease in the future, right now watch;
           PCSK9 Inhibitors, a very promising class of cholesterol lowering drugs

2) Augmented Reality for Healthcare
The applications in healthcare delivery are endless, the tech companies that are exploring this arena  are absolutely worth looking into.
For a better idea of what I am referring to, click on the University of Maryland site below, a “glimpse of things literally right around the corner;

3) Artificial Intelligence
From Google to Watson the future of healthcare delivery is being changed by AI. Nothing more to say…

4) In home care (not to be confused with home healthcare)
Care in the home,  from what historically would be found in an inpatient general med surg 
unit to ICU care will increasingly be “pushed out” of hospitals. Coupled with a well developed clinical infrastructure and advanced by remote technology it can be a safe and economically favorable alternative to inpatient care (think disease specific and operative bundled payments)…

5) Social Media
One of the most, perhaps singularly influential and game changing areas that will impact consumer driven healthcare. 
From a market perspective, ignore this sector and its opportunities at you own “peril”.