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Marketing Plan

This is a plan developed by Naval Hospital Pensacola and used to successfully


retain and regain OB market share.
S. Michael Ludvigsen, MBA, Marketing Analyst
W. D. Carroll, LT, MSC, USNR, Head, Managed Care
TABLE OF CONTENTS
Page No.

EXECUTIVE SUMMARY ……………………………………………………… 1

BACKGROUND ………………………………………………………………... 2

Military Healthcare System and TRICARE ………………………….. 2


TRICARE Options ……………………………………………………… 2
Naval Hospital Pensacola ……………………………………………... 3

SITUATIONAL ANALYSIS ……………………………………………………. 2

Current Market Condition ……………………………………………… 4


Internal Analysis ………………………………………………………… 6
External Analysis ……………………………………………………….. 11
Market Segmentation and Target Market ……………………………. 12
Survey ……………………………………………………………………. 15

MARKETING PLAN OBJECTIVES …………………………………………… 20

SP3 MARKETING MODEL ……………………………………………………. 21

STRATEGY ……………………………………………………………………… 27

Brand / Image Development ………………………………………….. 27


How to Compete? ………………………………………………………. 27

ACTION PROGRAMS …………………………………………………………. 29

Access to Care …………………………………………………………. 29


Customer Relations Refresher Training …..…………………………. 32
Customer Relations Recognition Program ………………………….. 33
Community Involvement …..………………………………………….. 34
Family Centered Care …………………………………………………. 35
Health Information Library …………………………………………….. 36
Provider Advertisements ………………………………………………. 36
Health Promotions ……………………………………………………… 38
Electronic Sign / Message Center ……………………………………. 39
Health Services Consumer Council ………………………………….. 41
Television Media ……………………………………………………….. 42
Brochures ……………………………………………………………….. 43
Yellow Pages …………………………………………………………… 44
PRIME Program ………………………………………………………… 46
Naval Hospital Pensacola Logo …………..…………………………... 47
BUDGETS, CONTROL, AND ACCOUNTABILITY …………………………. 50

Action Programs Matrix ………………………………………………… 50


Control and Accountability …………………………………………….. 50

APPENDICES:

Refrigerator Magnet
LDRP Logo – Another Sailor Joins the Fleet
LDRP insert in Pensacola News-Journal
Physician Advertisement – Meet the Doc Ad
Health Promotions Advertisement (Public Awareness) – 2x6, 2 Gold Star Copy
Electronic Sign Mockup
Yellow Pages Advertisement
EXECUTIVE SUMMARY

The United States Military Health System (MHS) has a primary mission of operational
readiness and support to military fighting forces. A secondary charge is providing
healthcare to active duty, their family members, retirees and their family members, and
survivors. The MHS has historically enjoyed adequate funding, manpower, and other
operational resources.

In response to Defense spending cuts in 1994, a number of military bases were closed.
Military treatment facilities (MTF) affiliated with these bases were also closed. To
address the needs of beneficiaries, TRICARE was developed which created a civilian
healthcare network. Those eligible for care were afforded an opportunity to continue
receiving care at MTFs or enroll into the civilian network. A significant number of
eligibles enrolled to the civilian network leaving MTFs a manageable patient population.
Over time, MTFs have continued to lose market share. Additional funding cuts and
increased scrutiny have compelled MTFs to compete and support funding.

In response to this mandate, the Naval Hospital Pensacola (NHP) chartered a


committee to develop capacity models for the hospital’s primary care clinics to
determine if additional enrollment opportunities existed. The newly developed models
indicated additional capacity for 5,000 enrollees.

To encourage enrollment to fill the additional capacity, NHP tasked the Managed Care
Department to develop a marketing plan. To assist in this endeavor, the hospital
implemented a policy which requires TRICARE Prime enrollees moving within NHP’s
catchment area of 40 miles, to use NHP. The policy does not prevent them from
receiving care via more costly programs, TRICARE Standard and extra.

The Managed Care Department established a marketing committee consisting of a


multidisciplinary staff from throughout the hospital, including patients. Critical
information was ascertained from this committee. First, access to care was an existing
problem at the hospital and staff satisfaction was problematic. Secondly, the
bureaucratic nature of military hospitals had created a culture of complacency. Federal
law prevents military organizations to spend appropriated funds on marketing therefore
promotional programs would be limited. Lastly, the ability to tie patient needs with
marketing programs that were consistent with the hospital’s mission, vision, and
objectives was needed to garner administration’s support and approval. To accomplish
this, a model was developed to articulate the intent and justify Action Programs.

This marketing plan contains fourteen Action Programs that satisfy these needs. They
are aligned according to implementation recommendations. Access to care is
prioritized, then patient and staff customer relations, community outreach, and
promotion. Also provided is the budget, departmental responsibilities and accountability
and timelines.

1
BACKGROUND
I. MILITARY HEALTHCARE SYSTEM AND TRICARE

Military medical care in the United States has been provided to active duty
soldiers and sailors since the 1700s. In 1884, Congress passed legislation that required
the Army and contract surgeons to provide care to active duty family members when
possible, free of charge. With the expansion of the military in subsequent wars, the size
of Army and Navy Military Medical Departments increased. In 1956, after the Korean
War, the Military health system (MHS) was strained and Congress enacted the
Dependents Medical Care Act into law that became the Civilian Health and Medical
Program of the Uniform Services, or CHAMPUS. This law provided a civilian healthcare
payor system to augment the MHS with the expansion of benefits to retirees and
survivor families. In 1967 the CHAMPUS budget was $106 million.

In an attempt to reduce the rapidly expanding CHAMPUS budget, the


Department of Defense began CHAMPUS Reform Initiatives in California and Hawaii in
1988 to improve access to care and beneficiary satisfaction via a civilian network.
These initiatives proved fruitful and were included in the 1994 National Defense
Authorization Act (NDAA) creating a managed care entity by the name of TRICARE.
TRICARE was also necessitated by the Base Realignment and Closure (BRAC)
requirements of Congress that closed many military hospitals and branch medical
clinics to reduce cost in the military after Operation Desert Storm. By 1996, the
TRICARE budget grew to over $3.5 billion, with many beneficiaries of military medicine
receiving care via the civilian healthcare network created by TRICARE. TRICARE has
proven successful. However, with decreasing funds and a dwindling number of
beneficiaries accessing care within military treatment facilities (MTFs), the MHS is
compelled to recapture an excessively lost market share. This would ensure MTFs
operate at their full capacity and enhance their mission of supporting and maintaining
operational readiness.

II. TRICARE OPTIONS

a. TRICARE Standard. TRICARE Standard is virtually identical to CHAMPUS.


TRICARE beneficiaries may choose any provider to receive medical care. After an
annual deductible is met, beneficiaries pay a percentage of total charges for any
medical care received. Providers who do not accept TRICARE assignment may bill for
charges over the Standard Allowable Rates up to 115 percent of Civilian Health and
Medical Program of the Uniformed Services (CHAMPUS) care Maximum Allowable
Charge (CMAC) whose reimbursement schedule parallels to Medicare fees. There are
no enrollment fees or forms to complete. TRICARE beneficiaries are eligible for
TRICARE Standard if they are not enrolled in TRICARE Prime.

b. TRICARE Extra. TRICARE Extra is similar to a civilian Preferred Provider


Organization (PPO). Providers accepting TRICARE Extra agree to discounted rates,
CMAC. This reduction is passed on to beneficiaries using their services. Beneficiaries

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in general pay 5 percent less than TRICARE Standard cost shares after their annual
deductible is met. TRICARE beneficiaries are eligible for TRICARE Extra if they are not
enrolled in TRICARE Prime.

c. TRICARE Prime. TRICARE Prime is a managed care program patterned


after civilian Health Maintenance Organizations (HMO). TRICARE Prime does not have
a deductible and eliminates almost all claims filing. Beneficiaries enrolling in Prime are
provided a Primary Care Manager (PCM) at Naval Hospital Pensacola or in the civilian
TRICARE network, who assist in the management of both primary and specialty care.
Those enrolling in Prime pay an annual enrollment fee of $230 for an individual or $460
for a family of two or more. Copayments are charged when utilizing the TRICARE
Prime civilian network.

III. NAVAL HOSPITAL PENSACOLA

Established in 1826, Naval Hospital Pensacola (NHP) is the second oldest hospital
command in the United States Navy. NHP is an integral part of the greater Pensacola
community as over 48,000 military members and retirees reside within its metropolitan
service area (MSA). NHP is a 60 inpatient bed facility which can be expanded to 186
beds. It has five operating rooms and a variety of specialty services, which include
urology, orthopedics, obstetrics and gynecology, among others. The dominant service
provided to beneficiaries is primary care. NHP delivers this care through its Family
Practice, Internal Medicine, and Pediatric clinics that provide services primarily to
beneficiaries enrolled in TRICARE PRIME. The hospital is home to one of only four
Family Practice Residency Programs in the Navy, which provides over three years of
General Medical Education (GME) training. The hospital's pharmacy is the fourth
busiest in the Navy with over 3,000 prescriptions filled daily and over 782,000 annually.
The hospital recently underwent a $23 million capital improvement project which
produced a new outpatient clinic and pharmacy, refurbishment of many areas of the
existing building and creation of seven new Labor, Delivery, Recovery, and Post Partum
(LDRP) suites.

NHP's operational budget is $64.5 million, of which $18 million is for civilian and
contract personnel salaries. An additional $61 million in military salaries is funded by
the DoD. Total personal required to operate NHP is 1,126. NHP's mission is to
maintain the health of Naval fighting forces, provide care to their families and
beneficiaries of the TRICARE system. NHP also consists of a 500 bed Fleet Hospital,
which can be activated and deployed for operational support in times of conflict.

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SITUATIONAL ANALYSIS

I. CURRENT MARKET CONDITION

a. Market Share. NHP defines market share by direct and purchased care
since eligibility for care is predetermined by Federal legislation. Direct care is provided
within the NHP system. Purchased care is provided by the TRICARE civilian network
and funded by the DoD. The following is NHP’s inpatient and outpatient market share
percentages for FY00 and FY01.

1. FY00

(a) Inpatient

(1) Direct Care Bed Days – 2,455

(2) Purchased Care Bed Days – 1,945

(3) Market Share – 55.8%

(b) Outpatient

(1) Direct Outpatient Visits – 429,456

(2) Purchased Outpatient Visits – 179,576

(3) Market Share – 70.5%

2. FY01

(a) Inpatient

(1) Direct Care Bed Days – 2,584

(2) Purchased Care Bed Days – 2,020

(3) Market Share – 56.1%

(b) Outpatient

(1) Direct Outpatient Visits – 480,070

(2) Purchased Outpatient Visits – 194,952

(3) Market Share – 70.1%

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Outpatient market share declined slightly in FY01, which played a role in the
development of primary care capacity models for the hospital's three primary care
clinics.

b. Primary Care Capacity Model. The NHP Primary Care Capacity Model was
developed to determine if additional enrollment opportunities existed within NHP’s
primary care clinics. The marketing plan enrollment target is based on evidence that
increased enrollment was possible for outpatient services. Inpatient services are a
derivative of enrollment and are not used as a target for increased market share.
Section 1, provides the capacity model methodology including the formulas, data
sources, data limitations, and assumptions determined by the Program Analysis and
Evaluation Department.

c. Market (Enrollment) Trends. Enrollment will be the critical factor in


determining the effectiveness of the marketing plan. The Executive Steering Council
(ESC) at NHP reviews enrollment monthly. Additional metrics will be tracked to ensure
enrollment increases are not adversely affecting quality of care. These include access
standards, appointment availability, customer relations, and referral percentages.

Enrollment trends indicate that primary care enrollment has increased due to TRICARE
Plus (Medicare eligible >65) enrollment to the Internal Medicine and Family Practice
clinics and policy changes requiring TRICARE Prime enrollment to the MTF for
individuals new to the Pensacola MSA. May enrollment data and trends, catchment
area enrollment data, and appointment availability are provided in Section 2. In
addition, referral rates to specialty care within the MTF and to the civilian network are
reviewed for increases. The associated cost of increased civilian specialty care would
offset the financial benefits of increasing MTF primary care enrollment.

d. Market Potential. Market potential is all eligible TRICARE beneficiaries


within the NHP catchment area, limited by primary care and inpatient bed capacity.
NHP established a new enrollment target at 5,000, based on the Primary Care Capacity
Model which indicated space availability within the Internal Medicine and Family
Practice clinics.

e. Cost Implications to MHS and NHP. NHP’s funding is based on historical


costs and projected workload. Per the most recent Vital and Health Statistics published
by the Centers for Disease Control and Prevention, National Center for Health Statistics
for data collected in 1996, enrolling 5,000 TRICARE eligible individuals to NHP’s
primary care clinics would generate significant savings to the MHS and redirect
additional funding to NHP. Rationale to support this position is provided below:

1. For outpatient care in 1996, 79.8% of the civilian non-institutionalized


population had contact with a physician. Of this percentage, physician utilization
averaged 5.9 visits per year. This included office visits, telephone consults, and other

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locations. Based on this information, an enrollment population of 5,000, and the
average CHAMPUS cost for an outpatient visit at $92.05, the following can be deduced.

(a) 3,990 would utilize outpatient physician care per year (5,000 x .798).

(b) 23,541 outpatient visits per year would occur (3,990 x 5.9).

(c) $2.167 million in CHAMPUS paid claims per year (23,541 x $92.05)

2. For inpatient care in 1996, 7.3 percent of the civilian population required
inpatient care. This excludes persons who died or were institutionalized. The average
length of stay for inpatient care was 6.8 days. The average CHAMPUS paid claim for
an inpatient stay was roughly $3,600. Based on this information, the following would
occur within the enrollment population of 5,000.

(a) 365 would be hospitalized per year (5,000 x .073)

(b) 2,482 patient bed days per year would occur (365 x 6.8)

(c) $1.314 Million in CHAMPUS paid claims per year (365 x $3,600)

Using the above rationale, consistent with the assumption that NHP has additional
capacity, the total savings to the MHS would be $3.481 million per year. Though this
savings is significant, it does not take into consideration the recapture of accompanying
ancillary services such as radiology, laboratory, and pharmacy as well as higher levels
of physician care which is more costly. This is offset somewhat by the necessity to
obtain specialty care for MTF TRICARE Prime enrollees due to unavailability within the
MTF. These issues apart, successfully increasing TRICARE Prime enrollment by 5,000
at NHP provides additional funding justification from DoD, savings to the MHS,
enhances the clinical capabilities of providers, and supports the overall mission of the
facility.

II. INTERNAL ANALYSIS

A SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis was conducted


for NHP. The information accumulated for this analysis was obtained from focus
groups, interviews, surveys, scan of the competitive environment, internet, and informal,
anecdotal information. The following strengths, weaknesses, and differential
advantages were derived from the SWOT.

a. NHP Strengths. (Internal)

1. Adequate Funding/Staff. NHP’s overall budget is roughly $64.5


million per year which does not include $60.725 million in military salaries. The hospital
is staffed by 107 physicians, 114 nurses, 528 Hospital Corpsman of varying specialties,

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327 civilian, and 50 contract personnel. NHP is over 100 percent manned, based on
prescribed manning requirements.

The amount of operating capital and manpower is more than adequate to maintain
normal operations and provide the highest quality of care. More significantly, the
hospital administration is not encumbered by financial and personnel constraints that
typically influence the allocation of funds. In for-profit organizations, funding cuts are
typically tied to personnel and other variable costs that directly impact the quality of care
provided to patients and overall services to consumers. Because NHP derives its funds
via Federal appropriations, NHP’s administration does not experience the financial
pressures that civilian counterparts face, and can focus on quality issues. These factors
provide a marketing advantage to NHP over competing facilities.

2. Quality of Staff. Naval physicians are required to be board certified


when eligible. As such, over 95 percent are board certified, with many obtaining more
than one certification. In general, NHP personnel enjoy extensive training
opportunities which typically exceed those afforded to civilian counterparts due to
financial and manning constraints. These factors provide NHP with a well trained and
credentialed staff which provides a marketing advantage over our competitors.

3. Capital Improvements. Historically, military hospitals were not built


with patient comfort in mind. Patients often found dark, stale, and unattractive facilities.
These same individuals are today surprised by the surroundings provided by NHP.
Though completed in 1974, NHP was a dramatic departure from historical military
hospitals. In March, the hospital completed a $23 million capital improvement. This
included a new outpatient clinic, modern pharmacy, and remodeling of specialty care
and ancillary care clinics. Additionally, seven LDRP suites were completed to improve
the child delivery experience. These were built consistent with patient needs and
desires identified with surveys and in anticipation of the elimination of obstetric non
availability statements (NAS) in December 2003. The elimination of Obstetric NAS will
force NHP to compete with surrounding hospitals in this service area, which plays a
significant role in the hospital's Family Practice Residency Program. Initial response to
the capital improvements have been dramatic with anecdotal information indicating that
it has improved the quality of care and patient experience at NHP.

4. One Stop Shopping. Though NHP has four surrounding clinics, the
majority of the target population would receive their care at NHP. Those who are
currently enrolled in TRICARE Prime at the MTF enjoy an extensive number of services
under one roof. This includes primary care, emergency care, and a wide variety of
specialty care, ancillary care to include pharmacy, radiology, and laboratory services,
and patient education and health promotion services. Due to the surveyed needs of the
target population, one stop shopping provides patients the opportunity to receive a
multitude of healthcare services in one setting decreasing the demand on the patient's
time. Demographic data indicates that the majority of the target populations are dual
income families with children. The one stop shopping attribute limits the amount of time
working adults are absent from work and time children spend away from school. The

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benefits of one stop shopping must be further exploited for opportunities and a focus in
direct marketing efforts.

5. Family Centered Health Program. The DoD has initiated a program


to engage the entire family in the delivery of their healthcare. This creates a more
personal experience, which is consistent with current trends in the delivery of care.
Additionally, NHP physicians and other providers do not practice under the imperative to
see as many patients daily as possible. While seeing an adequate number to achieve
access standards is necessary, this environment allows physicians to spend quality time
with patients and the opportunity to provide adequate information about their diagnosis
and appropriate treatment protocol. These factors, along with a multitude of services
which include patient education and health promotion, provide NHP the ability to create
a more personal experience with its patients and generate increased loyalty and a
positive brand image.

b. NHP Weaknesses.

1. Access to Care. Access to care is the hospital's greatest vulnerability.


This is a prevailing problem throughout the MHS, which mandated the approval of 32
CFR Section 119.17 in 1998. This established objective system performance standards
for appointment wait times. The established standards are:

(a) Urgent Care - 24 hours or less

(b) Routine Care - 7 days or less

(c) Well Patient Care - 30 days or less

(d) Specialty Care - 30 days or less

The ESC accepted these access standards as a critical metric to monitor while pursuing
increased enrollment. Baseline date indicates that these standards are being met.
Although this is encouraging, it is just barely within standards. Exceptions are specific
specialty services, which have experienced the loss of a military provider. With
increased enrollment, the access standards may not be achieved.

This coincides with the fact that a target population, retirees and their family members,
once enjoyed access to MTFs and were forced to utilized civilian care as a result of
BRAC. Many have perceived this as a “broken promise.” Exceeding access standards
may create a lack of trust when appointments cannot be obtained within a reasonable
time. This is contrary to the delivery of high quality of care. If access standards
become a critical problem, it could force the administration to curtail enrollment. Under
this condition, it would create a negative image and perpetuate the myth of the “broken
promise.” To prevent this, the capacity models must be validated and access standards
maintained.

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2. Provider Instability (PCM by Name). By May 2001, all TRICARE
Prime enrollees at any MTF were provided a Primary Care Manager (PCM) by name.
This initiative was intended to enhance the relationship between the patient and the
provider, and improve continuity of care. While this is a well intended effort, it has
created unfulfilled expectations as training, operational commitments, leave, and other
situations which require PCMs to be absent from the hospital, have been met with
opposition. Patients are forced to see other providers. With the intensity of military
requirements, this can be often. Patients surveyed indicate that it is important to see
their PCM and express dissatisfaction with the current PCM by name policy, and feel
this could be alleviated by seeking care in the civilian setting.

3. Culture. The MHS has been funded adequately since its inception.
Though budget cuts and facility closures ultimately led to the need to develop
TRICARE, the MHS has been immune to the financial constraints and necessity to meet
the bottom line faced by civilian facilities. As such, leaders have not been compelled to
mandate productivity and efficiencies. Over time this has created a culture of
complacency and lethargy. Consistent with governmental organizations with endless
regulations and scrutiny, the hospital reflects this influence. It is highly
compartmentalized in authority and functional areas. This creates impediments and the
inability to react aggressively to market changes and consumer needs.

4. Marketing Funds / Federal Regulations. Due to Congressional


legislation, the MHS has been placed in competition with the civilian healthcare sector.
Effectively competing requires improving quality of care, creating access, improving
facilities, providing amenities, and promoting these accomplishments. Federal
legislation, however, prevents the latter. For example, Naval policy (NAVSUPINST
4200.85C) prevents the use of Federal appropriation funds for promotional purposes.
Though appropriation language does provide latitude for the dissemination of
information, it restricts the full capability of promotional efforts. This creates a
disadvantage as our competing facilities maintain an extensive presence in the market
via print, television, radio, and other promotional mediums. In 2001, these facilities
spent $3.5 million in television advertisements alone.

c. NHP Differential Advantages.

1. Loyalty. Despite the impact of BRAC and the accompanying need to


develop a civilian TRICARE network, surveys indicate an overall preference for care
within the MHS. Surveys of those receiving care within MTFs routinely display higher
satisfaction rates with their care, compared to those in the civilian sector. The Bureau
of Medicine and Surgery (BUMED), via a contractor, conducts national and MTF
specific surveys of patient satisfaction. NHP results for FY01 as well as complaints and
compliments collected locally are provided in Section 3. The data for NHP indicate
greater patient satisfaction in both clinical and medical care compared to other Navy
and MHS wide facilities. Patient satisfaction within the TRICARE Prime program is
superior to the national civilian HMO average. Anecdotal information obtained from
community meetings, patient interaction, and other mediums indicates the existence of

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loyalty to the military medical setting. Many of these individuals have used the MHS
throughout the majority of their adult lives. Many were children of military families who
have used military medicine even longer. This has not been quantified and surveys are
needed to validate this position. However, based on the available information and
eligibility of the target population, this dynamic provides a marketing advantage which
does not exist with competing facilities.

2. Cost. One of the primary benefits of receiving care at NHP is cost.


Currently, retirees and their family members enrolling in TRICARE PRIME pay $230 for
an individual, or $460 for a family, annually. They do not pay deductibles for outpatient
care and pay nominal copayments ranging from $12 to $40 for civilian inpatient care,
pharmaceuticals, ancillary services, emergency care, and mental health, among others.
The majority of the target population uses TRICARE Standard, Extra, or other employer
based health insurance. These costs can be significantly higher. For TRICARE
Standard costs, copayments can amount to 20 percent of fees or more for certain
services. Though a catastrophic cap exists, these costs are dramatically higher than
those incurred under TRICARE Prime, and can be problematic to consumers based on
the target population’s average annual income.

In relation to employer based insurance, national health care costs continue to rise. As
more healthcare providers are finding it harder to meet financial obligations, and
employers are experiencing smaller profit margins, healthcare costs are being
increasingly shifted to the consumer. National HMO rates will increase roughly 20
percent in 2003. Some HMO rates will increase 94 percent, Section 4. According to
Hewitt, which conducted the study, these rate increases are unprecedented, with no
clear solutions on the horizon ensuring increased costs in the following years. HMO
copayments will increase 24 percent in 2003 for all types of care, including
pharmaceuticals.

Based on the cost of living index for the Pensacola MSA obtained from the Pensacola
Chamber of Commerce, these increases would appear to have a limited impact on our
target population. However, the impact is significant due to the number within the target
population who obtain their health insurance via employer based plans. Additionally,
the 2000 Pensacola MSA mean family income was$62,185 with healthcare consuming
only 5 percent of the family incomes. This percentage, however, is rising faster than
any other cost of living criteria (Food, housing, transportation, miscellaneous goods and
services) at 107.4 percent.

CHAMPUS reimbursement is aligned with Medicare rates. In an effort to reduce


Federal spending on healthcare, these rates fell 5.4 percent in 2002. While this has not
decreased physician participation in TRICARE, it has prevented providers from
accepting new patients. Physicians have complained that increased overhead costs
have dictated this policy, creating concern within veteran organizations and advocacy
groups. Since the Pensacola MSA is composed of a significant number of military
retirees, this dynamic may have less of an impact but it presents physicians with a
choice when competing reimbursement rates/patients exists.

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Conclusion: The largest segments of the target population obtain their healthcare via
employer based plans. This presents the clearest opportunity to benefit from the
reduced cost of TRICARE Prime at the MTF. For those within the civilian TRICARE
Prime network, the reduced TRICARE reimbursement rates and provider frustration
provides an opportunity to emphasize value added benefits at the MTF to this market
segment. In general a number of those eligible for care under the TRICARE Program
are unaware of the financial benefits. Providing marketing materials highlighting the
financial benefits along with the value added services provided at the MTF are a
differential advantage to NHP.

d. Marketing Resources.

1. Managed Care Department. The Managed Care Department is


responsible for all marketing efforts for NHP and its 12 Branch Medical Clinics. In this
capacity, the department has one person dedicated to this function. Though this plan
can be implemented with current manpower, departmental assistance will be required
for associated components of the plan.

2. Non-Appropriated Funds. The Federal government prohibits the use


of appropriated funds for promotion. Appropriated funds can be used for health
information dissemination and some funds are provided within the hospital’s budget. To
implement this plan, significant funds must be allocated. To accomplish this, the
Managed Care Department recently renegotiated Memorandums of Understanding
(MOUs) with the Veterans Administration Health Care System to generate additional
non-appropriated funds. These MOU’s require NHP to provide a limited number of
inpatient care as well as emergency, ancillary, and selected outpatient services to area
VA patients. The renegotiated rates will generate an additional $330,512.50, of which
20 percent for a total of $66,102.50 has been requested to implement this plan. Some
facets of this plan will be funded by the associated department.

IIII. EXTERNAL ANALYSIS

a. Industry Conditions. Industry conditions, to include increased competition,


increased healthcare costs both nationally and locally, decreased Medicare spending,
and stress within the managed care industry, has been described in detail in other parts
of the plan.

b. Competitors Strengths.

1. Sacred Heart Hospital. Sacred Heart Hospital is a leader in cardiac


programs, home health, patient education, mobile health services, and health
information. Sacred Heart promotes a women's and children's hospital, which will be in
direction competition with NHP with the elimination of NAS’s in December 2003.
Sacred Heart's main hospital is located in north Pensacola, with multiple outlying clinics

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throughout Pensacola. Sacred Heart does not have a strong presence in NHP's target
geographical area. In 2000, Sacred Heart Hospital obtained a JCAHO score of 90.

2. Baptist Health System. The Baptist Health System is a leader in


women's and senior health programs. They specialize in high-risk obstetric care, sleep
disorders, and air transport. The main hospital is located near downtown Pensacola.
They have a significant presence throughout the Pensacola MSA with a multitude of
family medicine clinics, which serve as feeder clinics to the main hospital and its
services. They have a hospital in Gulf Breeze, which serves Pensacola Beach and
Navarre. Though they have a number of locations, they are less prominently located
within NHP's service and target geographical area. In 2000, the Baptist Health System
obtained a JCAHO score of 94. The Baptist Health System was recently recognized as
a Malcolm Baldrige award winner for quality of care and customer relations.

3. West Florida Medical Center. West Florida Medical Center is a


leader in cancer treatment, orthopedics, rehabilitation, nutrition services, diabetes,
neurosciences, wound care, and mental health programs. They have attempted to
carve out these specialized services rather than compete in primary care, which would
require the development of satellite feeder clinics. West Florida is located in northeast
Pensacola. In their most recent JCAHO survey in 1998, West Florida Medical Center
obtained a score of 91.

IV. MARKET SEGMENTATION and TARGET MARKET

a. Demographics. Demographics were obtained via utilizing DEERS (Defense


Eligibility Enrollment System). Attachments 3-7 identify the hospitals geographic
location, catchment area, and density of individuals eligible for care and their proximity
to the facility. The demographics represent those individuals eligible for care within the
MHS that reside within the hospital's catchment area. The catchment areas are
federally designated as a 40-mile radius around a military hospital.

1. Geographic - A ZIP code analysis was conducted for the hospital's


catchment area with the following results identified for those not enrolled in TRICARE
Prime at NHP:

(a) 30,584 eligible for care

(b) 28,361 retirees and their family members

(c) 15,897 under the age 65

(d) 2,223 active duty family members

(e) 10,021, under age 65 and reside within 10 miles of the hospital.

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A breakdown of the population is as follows:

AGE NUMBER FAMILY MEMBER PROFILE NUMBER


< 18 3,194 Active Duty Spouse 933
18 – 24 1,570 Active Duty Child 1,239
25 – 34 541 Active Duty Other (Dependent) 51
35 – 44 1,428 Retiree 12,060
45 – 54 4,742 Retiree Spouse 12,743
55 – 64 6,645 Retiree Child 3,497
> 65 12,464 Retiree Other (Dependent) 61
TOTAL 30,584 TOTAL 30,584

2. Age, family status.

(a) 62% are under 49 years old

(b) 63% are married

(c) 33% have one or more children under 18 in the household

3. Income, employment status.

(a) 60% have a household income over $35,000

(b) 65% are employed

(c) 51% have some college education

(d) 74% are homeowners

4. Life styles, activities.

(a) Enjoy gardening, home improvement, fast food, Chinese restaurants,


exercise, and family vacations.

(b) Disposable income index to sporting goods, hobbies and crafts, video
rental, apparel, automobiles, and pets.

(c) 86% has television

(d) 72% own a computer

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(e) 61% have Internet access

(f) Index to radio stations that play country, light rock, or oldies

(g) Index to CNN, Headline News, local news, Discover, TLC, and A&E
channels.

b. Market Potential. The market potential for NHP is limited by the primary care
capacity established in the capacity model, which was identified as 5,000. Additional
enrollment could be accommodated by the Bid Price Adjustment provision of the
Humana Managed Care Support Contract (MCSC) which manages the NHP catchment
area TRICARE benefit. Under this provision, additional providers, support staff, and
some services can be contracted at a reduced rate via resource sharing agreements at
the NHP. This eliminates overhead costs as part of the service fees incurred by both
the DoD and Humana. The cost of the MCSC was reduced consistent with number and
type of projected resource sharing. For Region IV which includes Florida (NHP),
Alabama, Mississippi, Louisiana, and Tennessee, this amount has not been reached.
Therefore this would be a viable mechanism for additional enrollees. Any additions,
however, must be weighed against the associated cost of providing specialty care to
this population not available at the MTF with existing MTF funds. Taking the above in
consideration, though additional enrollment beyond 5,000 is possible, it would require
additional analysis and will not be pursued at this time.

c. Target Market

1. Beneficiary Groups.

(a) Retirees (Not enrolled in TRICARE Prime). The size of this target
population is 20,146. Due to the rising costs of civilian healthcare, this population
presents the greatest potential for recapture.

(b) Retirees (Enrolled in TRICARE Prime in civilian network). The size of


this target population is 10,438. Marketing efforts must focus on TRICARE Prime value
added benefits at the MTF.

(c) Active Duty Family Members. This beneficiary group is targeted for
improvements to active duty perceptions on the quality of care at MTFs and military
providers. These family members, largely wives, are typically the decision makers in
families. Appealing to their healthcare needs and promoting the credentials of
providers and the quality of care will influence the active duty members. This population
presents the greatest barrier and opportunity in disseminating the positive attributes to
the greater Pensacola market.

2. Geographical Analysis. A geographical analysis of the Pensacola

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MSA was conducted. ZIP codes determined the location of those eligible for TRICARE.
Section 5 contains maps which identify this population by location and density. Based
on this analysis, it was recognized that 10,021 of the target market resides within 10
miles of NHP. This provides an opportunity to promote the proximity of NHP and isolate
those promotional mediums that provide the greatest coverage in this area. The
remaining target market resides predominately in the northeastern part of Pensacola
near the competing facilities. Adequate promotional mediums exist to reach this
market.

d. Meeting Target Markets Needs. Mechanisms to meet the target market’s


needs were identified in earlier information and are a part of the “Five C” methodology
which is discussed in detail in later sections.

V. SURVEY

a. Methodology. A comprehensive survey was conducted in 2001 to determine


the needs and wants of those eligible for care. This survey combined qualitative and
quantitative questions designed to elicit emotional and perceptual responses. The
survey was distributed to all potential target populations which included; active duty
spouses not enrolled in TRICARE Prime, Retirees under the age 65 not enrolled in
TRICARE Prime, and sponsors or spouses enrolled in TRICARE Prime at the MTF.
The breakdown of those surveyed within the MTF catchment area (40-mile radius from
the hospital) is as follows:

TARGET POPULATION NUMBER


Active Duty Sponsor/Spouse not enrolled in 932
TRICARE Prime
Retiree (includes family members) 2,500
MTF TRICARE Prime Enrollees 1,000
TOTAL 4,432

Sampling: Active Duty Sponsor/Spouse and Retirees were randomly sampled using the
Defense Eligibility and Enrollment System (DEERS) data. Active Duty and Retirees
enrolled in TRICARE Prime at the MTF were randomly sampled using the DoD
Composite Healthcare System (CHCS) software program which maintains patient
medical information. All populations were randomly sampled using ZIP codes selected
proportionately due to population density.

b. Results. The survey resulted in a 9 percent response rate. Of the 4,432 sent
to households, 432 were returned due to incorrect address data. Of the remaining
4,000 surveys, 355 were completed and returned for a 9 percent response rate. Of
those returned, 10 percent represented TRICARE Prime enrollees at the MTF, 4
percent Active Duty Sponsor/Spouse, and 9 percent Retirees.

15
In general, there were no significant differences between groups or within groups.
TRICARE Prime beneficiaries enrolled to the MTF were generally happier with the
services they received compared to those not enrolled at the MTF, and with fewer
dissatisfactions. The needs, wants, and areas of dissatisfaction were common to all
groups.

The specific results of the survey are as follows:

QUANTITATIVE RESULTS
Likert Scale (1 = High Importance; 4 = Low Importance)
ITEM MEAN ITEM MEAN
Quality of Care 1.137 Saturday Clinics 2.338
Timely Appointments 1.359 One-Stop Shopping 2.446
Time with Provider 1.456 Morning Hours 2.548
Friendly Staff 1.602 Drive-Thru Pharmacy 3.160
Short Wait Time 1.665 Child Care Drop-Off 3.533
Evening Hours 2.282 Valet Parking 3.744

QUALITATIVE RESULTS
QUESTION ANSWER
1. What do you look for when choosing your Quality of care, accessible/available provider,
healthcare provider? location/proximity, providers who listen,
care/concern, knowledgeable providers,
friendly provider staff, reputation, provider
takes time with patient, promptness
2. What bothers you when you visit a Long wait time, being rushed through, bad
healthcare provider or facility? attitude or unfriendly personnel, rudeness,
uncaring attitude, provider/staff don't listen,
treated like a number, unclean facility,
provider is rushed/too busy, not time to ask
questions
3. What would make your health care visits Promptness, timely appointments, expanded
more "hassle-free"? office hours, faster turn-around in pharmacy,
immediate care available, friendlier staff,
accepts insurance/files in a timely manner,
see same provider every time, takes time with
me, one-stop shopping
4. What services would you like when you One-stop shopping, promptness/seen on time,
visit a healthcare provider? quality of care, friendly provider/staff, takes
time with me, health promotion information,
timely appointments, accessible/available
provider, fast turn-around in pharmacy,

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care/concern
5. Generally, are you happy with your current Active Duty Family Member - 82%, Retiree -
healthcare provider? 75%, TRICARE Prime Enrollee at MTF - 88%,
Overall 79%
Satisfiers - quality of care, provider who
listens, friendly staff, taking time with patients
Dissatisfiers - cost, not timely appointments,
being rushed
6. What factors made you choose Naval Location, no choice, low cost/no pay,
Hospital Pensacola as your healthcare convenient, one-stop shopping, satisfied with
provider (enrolled only)? facility, quality of care
7. Have you considered using Naval Hospital YES - 49%, location and quality of care
Pensacola as your healthcare provider (non-
NO - 51%, poor quality of care, too far away,
enrolled only)?
no timely appointments, have to wait a long
time

c. Active Duty Survey: Dissatisfaction with Military Treatment Facilities.


A survey conducted by the Inspector General for the Department of Defense revealed
that active duty members are less satisfied with health care delivery than other
beneficiaries. Issues cited were related to access to care, availability of services, wait
times, timeliness, staff qualifications, continuity of care, quality of care, lack of privacy,
and hospitality. (The data are available on the TRICARE Management Activity website:
http://www.tricare.osd.mil/survey/hcsurvey/).

Of particular concern is the fact that NHP data shows less satisfaction by active duty
members than the overall active duty population (6 of 10 major items). In addition,
survey data show that active duty family members also displayed lower satisfaction
rates than the general beneficiary population. The marketing plan must address those
issues that are creating dissatisfaction within this target population. It can be
conjectured that active duty members are influencing family members and this
expression of dissatisfaction may spill over to the retiree population through informal
means. It is also possible that adverse attitudes are initiated by the active duty member
upon entry into the military system. The military processing system is far from friendly,
and access to health care during “A” schools is discouraged. This attitude may, or may
not, change during the course of the active duty member’s career. For these reasons, a
survey instrument will be developed and provided to the active duty population to
validate attitudes towards competency, convenience, quality of care, and hospitality with
attention provided to length of service. Though marketing efforts will be directed
towards this population immediately, the results of the survey are imperative to
accurately meet the expectations of this important population.

d. Application. Qualitative and quantitative information gathered by the surveys


were reviewed and categorized by needs and desires. The five primary areas identified
were compassion, convenience, communication, competence, and cost. Of these
established categories, a Pareto Chart was used to identify the top five responses in

17
each category to determine the principle needs, desires, or concerns of our
patients/consumers. The following is a breakdown of these responses and the total
percentage of the top five criteria in each category.

1. Convenience – The top five responses below accounted for 84


percent of all responses.

a. Access to care (available/timely appointments)

b. Location and proximity

c. Promptness (seen on time)

d. One-stop shopping

e. Parking

2. Communication – The top five responses below accounted for 80


percent of all responses.

a. Providers listen

b. Providers take time with patient

c. Providers explain tests, procedures, DX, and TX

d. Providers have good communication skills

e. Provider and patient team approach to health care management

3. Compassion – The top five responses below accounted for 74 percent


of all responses.

a. Care and concern

b. Friendly

c. Good bedside manner and personality

d. Treat patient with respect

e. Treat patient as an individual

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4. Competence – The top five responses below accounted for 64 percent
of all responses.

a. Knowledge

b. Reputation

c. Experience

d. Qualified / Credentialed

e. Professional

5. Cost

a. No or low cost

b. Claims filed in a timely manner

c. State of art technology

d. Pharmaceuticals

e. Facility amenities / clean

d. Analysis. These primary areas of needs, desires, and concerns along with
dominate criteria were analyzed to target prominent areas to address in the
development of a marketing plan.

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MARKETING PLAN OBJECTIVES

Increase TRICARE Prime enrollment at NHP by 5,000 in two years.


Naval Hospital Pensacola provides care to roughly 19,000 beneficiaries enrolled in
TRICARE Prime. Based on industry standards for primary care utilization, underutilized
capacity exists within the hospital's three primary care clinics; internal medicine, family
practice, and pediatrics. As the Department of Defense experiences increased funding
cuts and more Congressional scrutiny over spending, MTF's are compelled to increase
TRICARE Prime enrollment to support existing and future funding. The hospital's
Executive Steering Council chartered a GOAL Team to validate increased capacity
potential. Based on the information derived, the ESC agreed to increase availability for
TRICARE Prime enrollment by 5,000 over the next two years. This amount would be
allocated appropriately across the three primary care clinics in accordance with the
target population's demographics. To assist in this plan, the ESC approved a policy
requiring all personnel moving within the hospital's catchment area (40 miles from NHP)
who desire TRICARE Prime to enroll at NHP. Previously, these individuals had a
choice between the MTF and civilian network. As part of this policy change, the ESC
agreed that all individuals currently enrolled in TRICARE Prime within the local civilian
healthcare network would be grandfathered and be immune from this policy change.
Analysis of beneficiaries moving into the Pensacola market within the hospital's
catchment area indicates that enrollment will increase by roughly 3,000 due to this
policy change alone within the designated enrollment increase period. However, this is
based on prior PRIME enrollment and individuals could elect to utilize TRICARE
Standard or Extra if opposed to enrolling to NHP. Based on these estimates, the
marketing plan must increase enrollment at a minimum of 2,000 over the next two
years.

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SP3 SPATIAL MARKETING MODEL

a. Purpose. There are three purposes of the SP3 spatial marketing model.

1. Use as a framework to create marketing action programs that meet identified


patient needs, desires, and expectations. Create action programs that are founded in
basic and acceptable marketing industry strategies, product, place, price, and
promotion. Ensure action programs meet the aims of the IOM which have been
adopted by NHP as organizational objectives in the delivery of quality care in and
consistent with its pursuit of a world class organization.

2. Create a model to justify action programs and associated funding to the


Executive Steering Committee (ESC). By verifying that action programs are validated
by the patient survey and market analysis, acceptable marketing industry strategies,
and consistent with the hospital's organizational objectives and goals, the Marketing
Department will increase the potential of action program approval and allocation of
sufficient funds.

3. To use as a simplistic example which everyone within the organization can


understand and apply regardless of his or her experience or position within the hospital
hierarchy. As an example easily understood, it will enhance internal marketing in its
attempt to generate support for and highlight the intent of the hospital's objectives and
goals established by the aims of the IOM.

b. Background. The traditional Marketing Mix model has accounted for a balance of
the “Four Ps” in the manner an organization approaches business practices:

1. Product: The service or product provided by the organization.

2. Place: The distribution of the product/service to the consumer.

3. Price: The cost of the product/service.

4. Promotion: The communication of the product/service and its benefits to the


consumer.

Unfortunately, this model does not always work well in health care organizations. The
industry is predominately service oriented, and distribution is limited. In addition, price is
nominally “fixed,” with most organizations tying price to one or more national fee
schedules. And, until recently, promotion has been minimal. The model does not
address directly the ultimate consumer: the patient.

Studies performed by Marketing at Naval Hospital Pensacola have indicated another


model, based on the consumer’s (i.e. patient) needs, wants, expectations, and desires.
The model developed portrays these needs as the “Four Cs” of health care:

21
1. Competence: The perceived quality of care received and qualifications of
the health care provider.

2. Convenience: Location, availability of services; timeliness.

3. Communication: Ability of provider to communicate effectively with the


consumers; effective listening.

4. Compassion: Friendliness, concern, and dedication of providers and staff.

This model does not address directly another factor: cost of health care. Of the
population sampled, those who are enrolled within the TRICARE Prime civilian network
are not concerned with cost. They have become immune to financial implications and
demands that influence utilization due to rising national healthcare costs. They pay
nominal enrollment costs and few copayments. This varies greatly with those not
enrolled who primarily obtain their health insurance through employer based policies.
Cost is extremely important to this population.

A third model, produced by the Institute of Medicine, is based on operational objectives


and goals, and has been adopted by Navy Medicine as a standard for health services
within the health care system. According to those standards, health care must be:

Aims of the Institute of Medicine (IOM)


Safe Avoiding injuries to patients from the care that is intended to
help them.
Effective Providing Services based on scientific knowledge to all who
could benefit and refraining from providing services to those
not likely to benefit.
Patient-centered Providing care that is respectful of and responsive to individual
patient preferences, needs, and values and ensuring that
patient values guide all clinical decisions.
Timely Reducing waits and sometimes harmful delays for both those
who receive and those who give care.
Efficient Avoiding waste, in particular waste of equipment, supplies,
ideas and energy.
Equitable Providing care that does not vary in quality because of
personal characteristics such as gender, ethnicity, geographic
location and socioeconomic status.

22
This model presents ideals, but does not address any “how to” issues. It can be argued
that this model is rhetorical.

b. Synthesis. The challenge presented to the Managed Care Department at


Naval Hospital Pensacola was to integrate the three models into a working model,
which synthesizes marketing theory, health care expectations, and organizational goals.
The first step was to reconcile the Four Ps with the Four Cs. As mentioned previously,
the missing factors (Patient in the Four Ps, Cost in the Four Cs) were placed into those
models. Thus, they became the Five Ps and Five Cs.

When placed in a matrix, along with the IOM model, it became obvious that they were
readily interconnected:

Criterion "Four Ps" "Four Cs" Aims of IOM


1 Product Competence Safe/Effective
2 Place Convenience Timely
3 Price [Cost] Efficient
4 Promotion Communication Equitable
5 [Patient] Compassion Patient-Centered

1. Criterion 1 relates the product to competence and safety issues, as well as


effectiveness. The product must be of high quality, defined as a service performed by
qualified personnel, in a safe and effective environment of care.

2. Criterion 2 relates place (distribution) to convenience and timeliness.


Obviously, for a service to be convenient, it must be available in a timely manner in an
efficient distribution area.

3. Criterion 3 relates price to cost to efficiency. By definition, these three items


are interchangeable, and almost synonymous.

4. Criterion 4 relates promotion to communication and equitable practices


including the Navy's Core Values. In order to promote any service, effective
communications must exist, in a variety of media, and it must be universal, i.e., and not
segmenting markets by ethnographies.

5. Criterion 5 relates the patient to compassion and being patient-centered. This


is the crux of the model: everything that is said, done, or thought must be oriented about
the consumer. All of the other four criteria are process-oriented. This criterion is results-
oriented. Unless the patient is satisfied, nothing else will matter.

23
To illustrate this concept, within Naval Hospital Pensacola, the patients have the right to
render any dissatisfaction to the Customer Relations Department.

1. If criterion 1 (product/competence/safety/effectiveness) is lacking, then there


is definite cause for concern by the patient. (“They caused an infection when they
removed the staples!”)

2. If criterion 2 (place/ distribution/ convenience/timeliness) is lacking, then there


is also a rationale for complaints. (“I waited for three hours, and then had to drive across
town for lab tests!”)

3. If criterion 3 (price/cost/efficiency) is lacking, there are legitimate grounds for


dissatisfaction. (“They said it wouldn’t cost anything!”)

4. And if criterion 4 (promotion/communication/equity) is lacking, then there is


also a cause for concern. (“They didn’t tell me I could save money by using the NMOP
program!”)

Clearly, criteria 1,2,3, and 4 are processes that, although independent, are
interconnected. Criterion 5 is dependent on the other four criteria. As an analogy, it
could be argued that, statistically, criteria 1 through 4 are independent variables, and
criterion 5 is the dependent variable. Changes to any of the other four criteria will
definitely affect criterion 5. If any of the four process criteria fail, then the result is a
failure to criterion 5.

c. Representation. Early attempts to represent, in a graphic format; this model


had many shortcomings. Initially, it was realized that criterion 5 must be in the middle
(patient-centered), with the other four criteria around it, and somehow be
interconnected:

Criterion 1 Criterion 2

Criterion 5

Criterion 3 Criterion 4

24
This does not work very well, as criteria 1 and 4 do not connect directly, nor do criteria 2
and 3. The solution for the representation came from an unlikely source: quantum
mechanics.

d. Three-dimensional. A major problem with representation in two-dimensions


is that, at times, it does not fully represent the true facts. As an example, trying to
represent an organizational chart for any state-affiliated university in two dimensions is
nearly impossible (it could be argued one must think in n-dimensional space!). The
same applies in chemistry: the two-dimensional representation of a molecule does not
show spatial orientation. Thus, a methane molecule (CH4) can be represented in two
dimensions as:

H C H

In actuality, the hydrogen atoms surround the carbon atom in a tetrahedral pattern,
known as the sp3 configuration. But this cannot be readily represented in two
dimensions.

Applying the analogy, this marketing model contains similar elements: 4 criteria
surrounding the fifth. Also, applying the analogy, the methane molecule is fairly stable.
However, remove one hydrogen atom, and you create a methyl radical, which is highly
reactive (explosive). Similarly, removing one of the four process criteria creates an
explosive radical (angry patient).

This model incorporates the fact that all process criteria must be in balance in order for
the fifth criterion to stay within the marketing/health care/goals matrix.

25
Product
Competence
Safe & Effective

Place
Convenience
Timely
Patient
Compassion
Patient-Centered

Promotion
Communication Price
Equity Cost
Efficient

26
STRATEGY
I. Brand / Image Development. The overall goal of the marketing plan is to develop
action programs that create a positive brand and image to ensure long term viability.
This can only be achieved by improving the patient/customer experienced throughout
the organization. Action Programs will support the following:

a. Enhance NHP’s services to patients, customers, and staff through:

1. Customer Relations services and training improvements.

2. Providing contemporary health information to promote wellness and improve


services to patients and customers.

3. Identification of problematic touch points for improvement.

4. Concerted effort to eliminate access to care impediments.

5. Community involvement and informational initiatives.

6. Value added benefits to patients, customers, and staff.

b. Produce a consistent and persistent message that is founded in proven


marketing approaches (“Four Ps”), consistent with patient needs, wants, and desires
(“Five Cs”), that parallel to NHP’s objectives (Aims of the IOM), and most importantly
are obtainable and/or deliverable.

By fulfilling these needs and requirements, NHP has the potential to create a brand and
image which represents quality in a way that it distinguishes itself from competitors, has
increased value to patients and customers, and creates pride within the organization
sufficient to motivate staff to meet these expectations.

II. How to Compete?

The NHP marketing plan will implement Action Programs that meet the criteria identified
in the SP3 model. Marketing emphasis will be directed towards NHP differential
advantages that include consumer/patient cost savings, and consumer loyalty.
Additional target areas include internal marketing efforts to improve the quality of care,
access to care, and customer relations.

a. Five “Ps”. The four Ps of marketing (Product, Place, Price, and Promotion)
are basic standards, when used appropriately create the marketing mix for a product or
service. These are used as the framework for the development of this plan. We have
included a "Fifth P", the Patient, which is the focal point of any healthcare organizations
existence.

27
b. Five “Cs”. NHP conducted a patient survey to identify their needs, wants,
and desires. The information obtained from this survey was aggregated and placed in
related categories or criteria. All responses fell within five criteria (Competence,
Convenience, Communication, Cost, and Compassion) creating the "Five Cs." These
criteria are based on the uniqueness of the healthcare setting and parallel to the
applicable “Five Ps.” Compassion, central to the delivery of healthcare, corresponds to
the Patient.

c. Aims of the Institute of Medicine (IOM). Consistent with national


leaders in the pursuit of quality healthcare, NHP adopted the six aims of the Institute of
Medicine as guiding principles. These criteria were aligned with the “Five Cs” and “Five
Ps” to ensure marketing action programs satisfy these core needs.

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ACTION PROGRAMS
I. ACCESS TO CARE

a. SP3 Criteria.

1. Competence. Improve services to patients creating an overall improved


perception of competence.

2. Convenience. Patients can be seen when care is needed and on time


preventing unnecessary time away from work or family.

3. Communication. Increased access communicates quality of care, which is


conveyed by patients throughout the target population. Conversely, lack of access and
timeliness is conveyed negatively.

4. Cost. Reduced time away from work saves patients money. Meeting
patient’s immediate needs curtails increased cost incurred from more costly care due to
exacerbated conditions.

5. Compassion. Meeting patient needs immediately project compassion and


concern regarding their condition.

b. Background. Historically, military medicine has enjoyed an existence without


funding and reimbursement pressures. With the advent of TRICARE, a significant
amount of the MHS workload was shifted to the civilian setting. This perpetuated a
culture that was immune to production quotas, clinical and medial oversight, and cost
constraints. With DoD budget constraints after Operation Desert Storm, MHS funding
cuts were viewed as a viable alternative to the reduction of additional operational
manpower and assets. To encourage efficiency, legislative and DoD policy changes
have forced the MHS into competition. The culture of the MHS has not readily adapted
to this course and access to care has been a pervasive problem throughout the system.
Most recent national access to care data is provided in Section 1.

With TRICARE, patients now have a choice and are exercising it daily, often choosing
to obtain care at our competitors. Our target population has financial demands, which
require that they work, and children that must remain in school. Excessive time away
from work cost these patients more from lost wages than the cost of copayments under
the TRICARE Standard and Extra options. Competing facilities understand these needs
and managed their resources appropriately to satisfy the demand for their services. In
response, the MHS has developed the MHS Optimization Plan to assist hospitals and
clinics in this effort.

c. Purpose. Access to care is a critical element in the delivery of quality


healthcare and an imperative to the success of the NHP marketing plan. It is principle
to the SP3 Model. Of the “Four Ps” place is tied to distribution. Without providing

29
access to care, the other attributes of the model are destined to fail regardless of the
quality of care, cost, or success of promotional efforts. NHP is currently meeting
access standards established for TRICARE (Section 2), however, with increased
enrollment it is likely that this cannot be maintained. The negative impact if this occurs
would be hard to overcome.

d. Recommendation.

1. Access to Care Focus group. Establish an Access to Care Focus Group


comprised of multi-disciplinary personnel. Personnel should represent all clinical areas
and professions, most importantly physicians. This committee should also have
patient/customer representation.

2. Identify opportunities to improve access to care. The focus group must


collect and analyze workload data (clinic and provider), patient survey data, and
anecdotal information to develop recommendations to improve access. All
recommendations must adhere strictly to core NHP objectives consistent with the Aims
of the IOM. In the interim, the Marketing Department and Program Analysis and
Evaluation Department are investigating the following proposals to increase access
within the primary care clinics and accommodate additional enrollment.

(a) Inpatient Grand Rounds. Currently, one physician from the Internal
Medicine and Family Practice clinics conduct a one-week rotation on the hospital
inpatient ward. This was designed to assist the Family Practice Residency Program.
This system is inefficient and dilutes appointment availability within the associated
clinics. Recommendation:

(1) Implement a policy that requires physicians to admit and follow


their patients when they require inpatient care. For patients not empanelled to a
physician, develop a physician rotation schedule. A patient would be provided a
physician for admission and follow up. This would create an opportunity to develop a
personal relationship between the physician and patient and encourage TRICARE
Prime enrollment to the MTF. Required specialty care would be referred to the
appropriate physician by the patient’s primary care physician.

(2) To accommodate the Family Residency Training Program


requirements, all physicians and residents would be required to attend grand rounds
from 0700 to 0800 Monday through Friday. This would create efficiencies with the
resident’s clinical schedule and enhance their training.

(3) Primary care clinic hours would begin at 0830, however, by


returning the two primary care physicians to the clinics, roughly 600 additional
appointments would be created.

30
(4) The relationship maintained between the patient and their
physician would improve continuity of care and accommodate patient survey needs,
desires, and expectations related to seeing one’s PCM provider.

(b) Nurse Triage Center. Currently, Central Appointments forward


telephone consults to the primary care clinics. Nurses within the clinics must respond to
these calls along with their clinical duties. A persistent complaint from physicians is the
lack of support staff and a contributor to inefficiencies within the clinics reducing the
number of patients that can be seen. It is reasonable to assume that the nurses cannot
be efficient in this situation. In an attempt to improve the efficiency within the primary
care clinics, create a nurse triage center in the following manner.

(1) The Internal Medicine, Family Practice, and Pediatric clinics


would provide one RN each during normal working hours to respond to telephone
consults. Though the clinics would be losing one nurse daily, it provides the remaining
nurses an opportunity to be more productive. Nurses and providers would not be
distracted from competing demands and the nurse triage center would be more
productive and meet the immediate needs of these patients.

(2) A derivative of this program is the potential elimination of


unnecessary appointments due to the inability to address patient needs which could be
handled over the phone.

(c) Open Access Appointment Program. Open Access is an


appointment methodology which mandates that today’s work be performed today for
both primary and specialty care. It is a process to ensure all appointment needs are
met regardless of the demand. This program has been implemented at other military
facilities with mix results. Indications are that those commands with strong leadership
have met success. Due to existing backlogs of appointments, it takes a concerted effort
and time to accommodate all appointment needs initially. After this demand has been
met, commands have experienced a manageable workload with increased patient and
staff satisfaction. Implementing this program is a daunting task requiring great analysis
and political prowess. The above recommendations as well as potential others
developed by the Access to Care focus group should first be considered prior to this
option.

e. Conclusion. This marketing plan and success of NHP lies on the ability to
provide access to care consistent with increased enrollment. Unfulfilling this demand
will be detrimental and result in ultimate failure. This occurrence will compound the
perception of “broken promises” and create a negative marketing situation, which may
be impossible to overcome. NHP has the manpower, funding, facility, and intellectual
resources to ensure that this does not occur. The command must be convicted in
pursuing and implementing initiatives that eliminate barriers and provide adequate
access to care.

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II. CUSTOMER RELATIONS REFRESHER TRAINING (Section 3)

a. SP3 Criteria.

1. Competence. Providing corporate information describes the importance and


success of NHP and exhibits competence to our staff who conveys this image to our
customers.

2. Communication. Communicate the importance and success of NHP to staff


and indirectly to customers.

3. Compassion. Providing real scenarios where quality of care was not adhered
to is intended to emphasis the importance of IOM aims and increase empathy towards
patients.

b. Background. Per BUMED policy, Naval medical personnel are only required
to receive customer relations training once in their career. This training requires one full
day and consists of five core elements including customer relations, knowing your
customers, communication skills, telephone techniques, and handling difficult situations.

It is generally accepted within the healthcare industry that quality of care is determined
by the interaction between staff and patients and the perceptions generated by this
relationship. Per the NHP survey, quality of care was a critical factor. Items identified
as contributing to the delivery of quality care include;

1. Providers who listen

2. Care and concern

3. Friendly provider staff

4. Provider takes time with patient

5. Bad attitude or unfriendly staff

6. Rudeness

7. Uncaring attitude

8. Numerous others.

c. Purpose. The BUMED mandated training is productive, however, it is


required only once in a career and requires one full day to accomplish. Requiring all
NHP personnel to obtain this training during indoctrination would result in significant
loss of productivity. Customer Relations Training surveys express boredom and lack of
applicability.

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d. Recommendation. Provide customer relations refresher training annually to
all staff. Training would be limited to 2.5 hours to maintain attentiveness and the
content will be modified to include organizational strategies. General training topics
include:

1. Corporate Self- Talk;

2. Marketing plan and customer perception;

3. SP3 Model purpose and intent;

4. Role plays to emphasize topics;

5. BUMED mandated topics in abbreviated format;

6. Scenarios of NHP successes and failures applied to IOM aims

e. Conclusion. Appropriate and compassionate customer/patient interaction is


critical to the success of the NHP marketing plan. The BUMED customer relations
training is general, time consuming, and required only once in a career. Providing an
abbreviated training session with a focus on critical customer/patient needs, consistent
with the SP3 framework and based on actual scenarios for realism would improve staff
interest and applicability in daily activities.

III. CUSTOMER RELATIONS RECOGNITION PROGRAM

a. SP3 Criteria.

1. Competence. Exhibits quality care and individual professionalism.

2. Communication. Communicates to customers and staff quality care, values


consistent with the command’s objectives, corporate self-talk, and instills pride within
departments and individuals.

3. Compassion. Conveys compassion by staff towards customers/patients.

b. Background. The command currently provides GOTCHAs for outstanding


customer relations. This is a valuable program, which brings attention to those
representing exceptional customer relations. There are no departmental awards or a
systematic process to identify individual success by the command. Currently,
individuals are singled out by individual customer/patient compliments or supervisor
recommendations.

c. Purpose. Create a systematic process to identify high performers as role


models for compassionate and quality care. Provide departmental recognition to

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promote patient survey solicitation and departmental initiatives designed to resolve
problems and improve overall services consistent with the command’s objectives.
Create pride and bring levity to awards to stimulate interest.

d. Recommendation. In addition to GOTCHAs, implement a departmental


customer relations award to be given monthly. In addition to this award, recognize the
star performers in each department winning the award. To improve command and
customer awareness, stimulate interest and pride, and fun, produce skits using the
hospital’s CCTV system. These skits will highlight the successes of the departments
and individuals with levity and executive participation. Provide departments and
individuals with gifts (plaques, flowers, etc.) representing their achievements and
provide other awards within federal regulations, such as time off.

e. Conclusion. Healthcare is a service industry which depends on providers


and support staff to deliver care consistent with the hospital’s objectives and Aims of the
IOM. It is critical to provide departments and individuals appropriate recognition for high
performance. It is also important to convey these awards in a manner and format that
generates pride and stimulates motivation to others. Lastly, it is important that our
customers are informed of our successes conveying a high level of competence and
quality of care.

IV. COMMUNITY INVOLVEMENT

a. SP3 Criteria.

1. Competence. Expose providers and staff to best business practices and


other performance improvement opportunities, which improve competence.

2. Communication. Provide a medium to convey organizational competence.

3. Compassion. Articulate NHP’s desire to contribute to the community and


concern for our patients.

b. Background. Because military hospitals have primarily provided services to


a select population based on eligibility, they have not pursued greater visibility with the
local healthcare community. This is a critical factor for civilian healthcare facilities
competing for market share.

c. Purpose. NHP is compelled to compete for retiree and active duty families
within the Pensacola MSA. These populations are to the Birth Product Line and Family
Practice Residency Program. Though they currently can utilize TRICARE Standard and
Extra, they are required by policy to utilize NHP for obstetrics and associated care.
Congress recently passed legislation which eliminated NASs which will force NHP to
compete more intensely for this population’s healthcare need.

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d. Recommendation. NHP needs to become more visible in the greater
Pensacola healthcare community. To achieve this, representatives from the Managed
Care, Health Promotions, Women’s and Children’s, and primary care departments to
name a few must participate in local healthcare activities. This includes the Pensacola
Chamber of Commerce healthcare committees, Council on Aging, and all related
healthcare advocacy organizations. Additionally, the Marketing and Health Benefits
Division of the Managed Care Department must solicit and provide presentations to all
appropriate organizations (TROA, VFW, VA, etc.) to highlight our care and services,
facility amenities, cost savings, among others to these target populations. Initiate an
aggressive agenda for community participation. Require appropriate departments to
maintain a community presence and report activities to the ESC quarterly.

e. Conclusion. NHP will benefit by becoming more involved in the Pensacola


healthcare community. It will provide a medium to display competitive attributes,
expose hospital staff to civilian healthcare industry strengths and weaknesses and help
build a long lasting relationship between NHP and the Pensacola community as a
whole.

V. FAMILY CENTERED CARE.

a. SP3 Criteria.

1. Competence. Improve the overall quality of care and perception of


competence for NHP and its providers.

2. Convenience. By engaging family decisions and personal involvement, the


patient has the latitude to improve services and create a more convenient treatment
protocol.

3. Communication. The patient and family become active participants which


require increased and improved communication with providers.

4. Compassion. By becoming more engaged with family conveys empathy and


compassion to the patient and family members.

b. Background. Eligible beneficiaries for obstetrical services in the Pensacola


area, including those living near Whiting Field Branch Medical Clinic, are currently
directed to use NHP for those services. NASs are only issued in extremely difficult or
urgent cases, allowing the beneficiary to use civilian facilities capable of handling these
specific needs. The NAS will no longer be in effect as of December, 2003. This will
allow beneficiaries free access to other facilities, and NHP will be in direct competition
for those beneficiaries. Currently, approximately 600 live births are recorded per year at
NHP. A recent BUMED survey revealed that, Navy wide, only half of beneficiaries who
had delivered at a Navy MTF would do so given the choice. A survey performed by
NHP of the last 800 beneficiaries who gave birth at this facility revealed a higher
percentage (78%), but it also revealed that the competition is strong. The institution of

35
LDRPs will assist in making the L&D experience better, but the competitive forces are
still present.

c. Purpose. The Family Centered Care Program was initiated by BUMED to


engage the entire family in the delivery of their healthcare and increase patient
satisfaction. This program is designed to create a more personal experience between
the patient and providers, which is consistent with current trends in the delivery of
healthcare.

d. Recommendation. Implement the Family Centered Care Program within the


Women and Children’s Health Department and in all other appropriate and applicable
areas.

e. Conclusion. The Family Centered Care Program, along with a multitude of


services which include patient education and health promotion, provide NHP the ability
to create a more personal experience with its patients, promote preventive care, and
generate increased loyalty and a positive brand image.

VI. HEALTH INFORMATION LIBRARY

(Under development)

VII. PROVIDER ADVERTISEMENTS (Section 8 - Sample)

a. SP3 Criteria.

1. Competence. Describes the educational background, board certifications,


follow-on training, and overall clinical and medical skills.

2. Communication. Communicates to the target population provider


competency. Also communicates quality of acre and TRICARE enrollment
opportunities.

3. Compassion. Provider input conveys compassion towards their patients.

b. Background. One of the core marketing elements as defined by the


customer survey is competency. When asked to quantify quality of care, most
respondents indicated it can only be delivered by a professional staff at all levels. While
this includes nurses, corpsman, and support staff, the physician is the pinnacle of the
provision of healthcare and the individual who is most entrusted with someone’s care.
The survey requested qualitative responses to this question and there were a wide
variety of responses. In an effort to isolate the primary factors related to competency,
the Managed Care Department has selected the top five responses. The top five
amount to 64 percent of all responses. The top five criteria representing competence
include:

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1. Knowledge,

2. Reputation,

3. Experience,

4. Qualified, Credentialed

5. Professional

c. Purpose. A DoD study indicated that military physicians were perceived to


be less qualified and competent as compared to their civilian counterparts. Anecdotal
information obtained in consumer council meetings indicates that this is an existing
problem locally. These perceptions contrast with the following facts:

1. Military providers are required to be board certified when eligible.

2. Military providers are not stressed by financial factors which distracts from the
provision of care.

3. The NHP consumer surveys indicate that our patients are typically more
satisfied with our services than like patients in the civilian TRICARE Prime network.
Common reasons for this disparity are physician time spent with patients.

4. DoD survey routinely indicates that MHS and NHP quality of clinical
and medial care is superior to civilian counterparts.

c. Recommendation. Provide monthly physician advertisements/notifications in


the Pensacola News Journal and Gosport to reflect the education, experience, and
other qualifications relevant to competency. To maintain a monthly presence in the print
media, one physician or other provider advertisement should be submitted monthly.
The following is a breakdown of the costs:

1. Pensacola News Journal (4”x4”)

(a) Sunday plus three days - $704, Color - $894

(b) Annual (12 months) - $8,448, Color - $10,752

2. Gosport (4”x4”)

(a) Fridays (Per Copy) - $167

(b) Annual (12 months) - $2,004

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d. Conclusion. Providing notification of the arrival of new physicians or other
information relevant to the credentials and experience of physicians at Naval Hospital
Pensacola would enhance the credibility of NHP providers, allow the solicitation of
TRICARE Prime enrollment, and contribute to improved morale and pride among our
physicians and other providers.

VIII. HEALTH PROMOTIONS (Section 9 - Gold Star Sample)

a. SP3 Criteria.

1. Competence. Displays professionalism and success.

2. Communication. Communicates information desired by consumers

3. Cost. Provides information, which can save patient and DoD costs through
prevention, eliminating unnecessary care.

4. Compassion. Providing preventive care information and promoting healthy


lifestyles conveys compassion.

b. Background. Health promotions if a critical element in today’s healthcare


industry. It provides information to patients and customers and engages them in their
personal health care and promotes preventive services. It can reduce overall
healthcare cost by preventing unnecessary utilization or higher cost care due to
exacerbated conditions due to delayed care.

c. Purpose. NHP has a dynamic and successful Health Promotions


Department. They recently won the 2002 Navy and Marine Corps Command
Excellence in Health Promotion Award for the second consecutive year. They conduct
a multitude of health promotion and prevention classes each month, however, the full
impacts and benefit of this department is unrealized. Health promotion classes are
largely unattended and the success of this department is relatively unknown.

d. Recommendation.

1. Promote the success of the Health Promotions Department.

2. Advertise health promotion and preventive care classes and promote MTF
TRICARE PRIME enrollment.

(a) Back injury prevention

(b) Cardio-pulmonary resuscitation (CPR)

(c) Cholesterol issues

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(d) Senior wellness

(e) Depression

(f) Tobacco cessation

(g) Prenatal classes

(h) Children’s weight management

(i) Adolescent substance abuse

(j) Multitude of others

e. Conclusion. Increasing patient participation in health promotion and


prevention classes improves patient care, reduces unnecessary care and associated
costs, and is consistent with patient needs and desires throughout the industry.
Promoting the success of this department provides a marketing opportunity and projects
an image of quality care and competence.

IX. ELECTRONIC SIGN / MESSAGE CENTER

(Section 10 - Proposed sign and location)

a. SP3 Criteria.

1. Competence. By providing internal marketing information such as customer


relations' recognition and staff awards on the message center, competence is conveyed
to patients, customers, and staff.

2. Communication. A medium to provide a wealth of information.

b. Background. Though a $23 million capital improvement was recently


completed, the Naval Hospital Pensacola does not have a prominent sign identifying the
location and purpose of the facility. Naval Hospital resides on Highway 98 which is a
primary artery connecting downtown and Northeast Pensacola with Perdido Key. The
majority of the metropolitan population resides east of the hospital, which is located
adjacent to the Navy Commissary and Exchange thus creating increased traffic and
visibility surrounding the facility.

The State of Florida, Department of Transportation (DOT) was solicited for traffic
density and volume data to determine the marketing potential of a commercial sign with
an electronic message center. Per DOT data, the traffic volume west of NHP on
Highway 98 at Dr. Farina Drive, 300 feet west of Navy Boulevard, is 22,000 vehicles per
day. On Highway 98 east of NHP, at Fairfield Drive, traffic volume is 17,000 vehicles
per day. See Section 10 for a visual representation of the traffic volume and flow.

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c. Purpose. A commercial sign with an electronic message center has multiple
applications. These include the enhancement of a corporate image, internal and
external marketing, and customer relations among others. The following is a sample of
information which can be provided:

1. Internal Marketing:

a. Promotions,

b. Awards (Sailor/Civilian/Contract of Quarters/Year),

c. Customer Service recognition,

d. Corporate self-talk,

e. Training,

f. Social Events

2. External Marketing:

a. Health Promotion,

b. TRICARE promotional campaigns including cost benefits,

c. Birth Announcements,

d. Emergency Information,

e. Fund Raisers.

Per Federal procurement requirements, three electronic sign companies were solicited
for bids based on general design, construction, technology, size, and maintenance
criteria established by the Managed Care Department. A multitude a designs and
variations of prices were submitted. Based on the established criteria bids ranged from
$60,900 to $90,000.

d. Recommendation. An analysis was conducted on the submitted bids.


Though cost was a factor, the technology, customer support, and casualty statistics
were considered significant drivers of a selection. Based on all the information, the J.M.
Stewart Sign Corporation proposal at a cost of $75,800 was selected for the following
reasons:

1. Size: The size is appropriate for the proposed sign location, traffic volume,
and speed limit on Highway 98 for optimal viewing.

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2. Cost: This cost is justified by a construction built to withstand a 180-mph wind
load and anticipated maintenance needs.

3. Electronics: The electronics are superior to other proposals as it includes a


DayStar High Density with 64 LED with photo realistic technology and associated
software upgrade for enhanced marketing applications.

4. Warranty: 5-year materials and in-house warranty on all electronic


components.

e. Conclusion. The significant traffic volume on Highway 98 presents an


opportunity to market utilizing the electronic message center. Our target population as
they consistently use the Navy Commissary and Exchange and the Naval Hospital’s
pharmacy. The electronic sign provides a marketing medium 365 days a year 24 hours
per day. Though it is a significant investment, its ability to attract TRICARE Prime
enrollees offset this cost. Its derivative attributes in relation to internal marketing would
provide a vehicle to increase command morale and pride and recognize those who
contribute significantly in our quest to become a world class organization.

X. HEALTH SERVICES CONSUMER COUNCIL

a. SP3 Criteria.

1. Competence. Provides an opportunity to provide information that exhibits


quality care and clinical competence.

2. Communication. Provides a medium to exchange information and solicit


patient input for organizational improvements.

b. Background. The Health Services Consumer Council (HSCC) is managed


by NHP’s Public Affairs Officer (PAO). The PAO is an assistant and reports directly to
the hospital’s Executive Officer.

c. Purpose. The HSCC is conducted quarterly and is designed to provide basic


hospital information and solicit input from the active duty line community, command
ombudsmen, and community veterans’ organizations.

d. Recommendation.

1. Improve the content of the HSCS to meet the needs of the target
audience/population.

2. Promote the time, place, and content of the HSCS adequate to maximize
attendance.

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3. Involve multiple facets of the hospital to provide diversity of information.

4. Utilize different mediums to generate group participation.

5. Provide amenities (food, beverages, other) to participants to create a


comfortable environment conducive to the objectives of the council.

e. Conclusion. The active duty family member population is important to the


future success of NHP. The HSCS is designed to provide information to and solicit
information from this population in an effort to better service their needs. This avenue
has exploited for its full potential. Improving this communication stream would provide
information to NHP to improve services to better serve this population's needs.

XI. TELEVISION MEDIA

a. SP3 Criteria.

1. Competence. Opportunity to provide information on the qualifications of staff,


quality of care, and amenities related to services.

2. Convenience. Provide information on value added services which improve

3. Communication. Communicate competitive and differential advantages to


target markets.

4. Cost. Articulate cost savings to patients. Provide a medium with greater


exposure and efficiency to target populations.

5. Compassion. Provide information on Family Centered Care Program and


other services and attributes geared towards the conveyance of compassion.

b. Background. NHP is in a competitive market, with three major civilian


hospitals in the immediate area all vying for TRICARE patients and dollars. Their
combined budget for advertising is well over $3.5 million per year, with approximately
40% spent on local television and cable advertisements. The advertisements are
designed to increase awareness of the facilities and related services, and to establish
an image and brand of those facilities. Unfortunately, Naval Hospital Pensacola has not
established an image or brand in a widespread manner. It can be argued that TRICARE
has a stronger brand and image than Naval Hospital Pensacola, for better or worse.

c. Purpose. To market NHP, we must establish a brand and image, using the
same media as our competitors. The local ABC affiliate, WEAR, and COX Cable, have
a definitive market share of our potential beneficiaries. WEAR local news leads all
competitors in the Nielsen reports, and the COX Cable distribution is in the geographic
area where we have already identified a large population of non-Prime beneficiaries.
Additional local sources with high target market viewership are WPMI early morning

42
news and WKRG afternoon news. Another local station, WALA, has very little
viewership in the Pensacola market. On cable, high target market viewership is
identified with CNN, Headline News, Fox News, Discover, Lifetime, and TBS channels.

Preliminary work has been performed by WEAR on a sample “doughnut” 30-second


advertisement. The concept is to have a versatile advertisement that has a consistent
beginning and end, which establishes an image, and then inserting different brands in
the middle segment. WEAR has quoted production costs of $500 for the first spot, and
then $100-$200 for additional spots. Alternate sources are WKRG and Cox Cable, but
the quality of the work from WEAR is far superior.

Costs for running the spots vary according to frequency and time of day with the local
stations, but are consistent with COX cable. As examples, a spot on WEAR during the
5:00 pm news costs $450, and a similar spot on WPMI costs $150. COX Cable offers
310 spots on target channels for $2224. An effective advertisement campaign can be
instituted combining local news spots and cable spots during high activity periods
(sweeps months) for $5000 to $6000, with combined exposures reaching 76% of the
target market segment at least 3 times during the month.

d. Recommendation. Fund the production of four television spots, using the


WEAR production team, for a cost of $800. During the month of August, 2002, fund
$5000 for a combination of spots on WEAR, Cox Cable, and limited spots on WPMI and
WKRG.

e. Conclusion. Providing television spots during prime viewing dates and times
will increase NHP’s visibility and provide an opportunity to convey its positive attributes,
improvement initiatives, and value added services to our patients.

XII. BROCHURES

a. SP3 Criteria.

1. Competence. Show the wealth of services and convey a quality of care.

2. Convenience. Provide information necessary for patients to manage their


time wisely and efficiently.

3. Cost. Reduce patient cost and unnecessary care from “A” school students
due to misinformation.

4. Communication. Provide needed information to patients and potential


customers.

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b. Background. The TRICARE Management Activity which manages and
oversees the TRICARE benefit produces a wealth of brochures and other marketing
products that describe the TRICARE Program and its benefits. These products are
advantageous to the TRICARE Program of which NHP is but one of four hospital
providers in the Pensacola MSA. These brochures do not meet the immediate
marketing needs of NHP.

c. Purpose. Brochures will be produced to highlight NHP’s services and


attributes. Of particular need is a brochure to describe the services, improvements,
amenities, and benefits associated with the new LDRPs. This has increased
importance with the anticipated elimination of the NAS for this service and its
importance to the Family Practice Residency Program. An additional brochure is
needed for the local Branch Medical Clinics which primarily provide services to Navy “A”
school students. By emphasizing the services, days, and times of clinic hours, it may
assist in reducing appointments being utilized in NHP’s primary care clinics and
unnecessary care in the emergency room.

d. Recommendation. Produce brochures for the following to be placed


throughout the hospital, associated clinics, Navy Housing Office, Personnel Support
Detachment (PSD) for incoming personnel, Navy Welcome Center, and other entities
which are frequented by the target populations.

1. Corporate Self-Talk. Provide services/days/hours, hospital history,


mission/vision/objectives, workload, accomplishments, and role within the greater
Pensacola community.

2. Primary Care Clinics.

3. LDRPs. Provide information on the Family Centered Care Plan, patient


satisfaction, amenities provided, and other relevant information.

4. Local Branch Medical Clinics. Provide services/days/hours,


mission/vision/objectives, accomplishments, and other relevant information.

e. Conclusion. TRICARE Program brochures are important in conveying the


complexity of the program to those eligible for care, however, they do little for the
specific marketing needs of NHP. NHP specific brochures will provide another medium
to articulate the positive attributes of receiving care at this facility.

XIII. YELLOW PAGES

a. SP3 Criteria.

1. Convenience. Patients and prospective patients can readily obtain NHP’s


phone number rather than using the convoluted Blue Pages.

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3. Communication. Provides a medium to promote services, location, and
hours.

b. Background. Based on market surveys initiated by NHP, and an impetus to


promote TRICARE Prime at NHP, marketing of the new and existing programs should
be implemented on an aggressive manner. A large part of this effort should be in
accessibility, specifically in the area of contact availability. Although we have distributed
business cards and refrigerator magnets with telephone numbers to key areas (central
appointments, pharmacy, health benefits, etc.), the most readily used source for
telephone information is vastly underserved: the telephone directory. The telephone
numbers to the hospital are listed in the Blue Pages section, with half the sections listed
incorrectly under the wrong heading.

c. Purpose. Overall, the average individual has become accustomed to


referring to the local telephone directory to look up a telephone number. Locally, the
Bellsouth Yellow Pages are the pre-eminent source for this service. BestTalk has made
an impact as a competitor, but they rely on BellSouth for their information, and their
directories tend to be incomplete, with inaccuracies. Information from CRM Associates
and NFO Research (marketing research) provide the following statistics regarding
Yellow Pages usage, specifically for looking up the number of a physician or hospital:

1. Females are more than twice as likely to use as males.

2. Usage increases with age and number of years at current residence.

3. 81% of usage is for personal reasons.

4. 32% are “shoppers” with a decision choice to make; 80% of those follow-up
with an appointment.

5. 27% of active “shoppers” go to the Yellow pages, six times more than for any
other media

6. The average display ad is almost a half page, resulting in 5,190 new


patient calls per year (The full page ad in Mobile for the University of South Alabama
generated 24 new patient calls per workday (@6,200 per year).

7. Hospitals are experiencing a highly competitive environment, with media


spending increasing 14% per year

d. Recommendation. From a purely mission-oriented case, NHP must be


accessible to beneficiaries. Placing an advertisement in the Pensacola area Bellsouth
Yellow Pages will allow better access to current, and future, beneficiaries. A double half
column black and white ad, including artwork and preparation, costs $8,184. Color
addition would cost $10,740. A triple half column costs $12,132, and $16,164 in color.

45
Implement and fund a triple half column black and white advertisement at $12,132 in the
Pensacola area Bellsouth Yellow Pages.

e. Conclusion. These initiatives are proposed in order for NHP to compete


effectively with the other three large health care organizations in Pensacola, and
increase enrollment to TRICARE Prime at NHP. As we have realized, we are in
competition with the private sector, and we must be pro-active and aggressive, utilizing
all proven techniques to increase our visibility, accessibility, and brand image in a
sustained manner.

XIV. PRIME PROGRAM

a. SP3 Criteria.

1. Convenience. Improve access and wait times.

3. Cost. Reduce time and associated cost to patients. Improve access


decreasing peripheral facility cost, increase enrollment and associated funding.

4. Communication. Provide mediums to communicate positive attributes of NHP


and value added services to our customers.

5. Compassion. By seeing patients as soon as possible, exhibits a caring


environment.

b. Background. The Managed Care Department was tasked to identify


opportunities to improve PRIME at the MTF to encourage enrollment for the remaining
2,000. A presentation was provided to the Executive Steering Council in December
2001 outlining a proposal to provide value added services to those enrolled in PRIME.
These proposals were submitted to the associated clinical and administrative areas to
determine their viability and implementation requirements.

c. Purpose. NHP has experienced a reduction over the last two years in
its local market share. In FY 2000, NHP experienced a 56.1% inpatient market share
and a 71.1% outpatient market share. That number decreased FY 2001 as more
patients chose to access care in the civilian network. The reduced market share has
the potential to impact command readiness and funding. Capacity modules were
completed for NHP’s primary care clinics indicating increased opportunity for PRIME
enrollment.

d. Recommendation: In response to this tasking, the marketing


committee recommends the following value added services.

1. Prime Parking benefit – COST: $1,000 (estimate)

(a) Dedicate the front OP clinic parking lot for PRIME Patients,

46
(b) Provide appropriate signage,

(c) Control access with current front gate personnel,

(d) Establish parking policy and monitor compliance with existing Security
personnel.

2. PRIME Preferred Appointment System – COST: $0

(a) Implement policy providing a daily window of time (0700-0900) for


accepting PRIME Same day appointments only.

(b) Central Appointments verify eligibility by CHCS.

3. PRIME Pharmacy priority – COST: $55

(a) Provide priority to PRIME Patients.

(b) Enhance current Q-Matic system to include PRIME Category.

(c) Pharmacy technicians will verify eligibility (PRIME Gold Card and ID).

4. Patient Rapid Registration System / PRIME Gold Cards – COST: $7,375

(a) Provide MTF PRIME patients a Gold Card with bar code identifier.

(b) Gold Card will be used to verify parking and pharmacy benefit.

(c) Implement Patient Rapid Registration system for clinic check-


in/medical records.

(d) Enhance current DataCard system: Printer and 20,000 cards.

e. Conclusion. Though enrollment has increased, it is imperative that Naval


Hospital Pensacola continue to encourage enrollment by improving its services and
maintaining a marketing presence in our community. The total cost of $8,430 and
administrative effort for these initiatives is minimal, however, the potential impact is
significant. Implementing these initiatives will not only improve PRIME enrollment, they
will benefit our pursuit of excellence in becoming a world class organization.

XV. NAVAL HOSPITAL PENSACOLA LOGO

a. SP3 Criteria.

1. Competence. Represent a quality service, staff, and facility.

47
2. Communication. Communicate quality.

b. Background. The success of any business or consumer product/service


depends in part on the target market’s ability to distinguish one product from another.
An organization’s brand name and mark is the main tool used by marketing to
accomplish this. An organization’s brand should also come to represent other branding
elements of the organization’s product/service such as quality of care and staff
competency in healthcare. Branding has three main purposes: product/service
identification, repeat sales/visits, and new product sales/visits.

c. Purpose. Naval Hospital Pensacola uses different images to represent


the organization in its administrative materials, marketing materials, and electronic
mediums such as the website. When using the hospital’s name, various fonts in
different forms are used. The command’s military seal is used in the civilian sector,
which is not easily identifiable and understood. This exhibits a lack of uniformity,
professionalism, and inconsistent corporate image.

d. Command Brand Mark: The elements of a brand that cannot be spoken


(NHP).*

e. Command Brand Name: A term, symbol, design, or combination thereof.*

(Shaded brand name/mark should be used on large scale marketing products or high definition applications)

f. Command Seal: Military command identifier.

g. Recommendation. Create a uniform corporate image by requiring all


directorates, departments, and staff to use the hospital’s established brand mark, name,
and command seal on all appropriate administrative materials in a predescribed format.

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This includes, but is not limited to, fax cover sheets, business cards, and marketing
materials. Marketing materials would include all materials released within the public
domain. Provide a brief command guide with templates, developed by the Marketing
and Public Affairs Office, to all directorates and departments to assist in this effort.
Provide the command brand name, mark, and seal in a share file for command use.

h. Conclusion. To achieve success with marketing efforts, a brand identity


must be established with consumers and others to differentiate our product/services
from those of our competitors. As Naval Hospital Pensacola strives to become a world
class organization, it is imperative that it establish a brand identity, internally and
externally, that is easily identifiable and represents quality care and service.

* Definitions obtained from Lamb, Hair, and McDaniel. Marketing. Cincinnati, OH, Southwestern College Publishing. 1996.

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TRICARE PRIME - MARKETING PLAN

Plans, Objectives, Actions, and Maintenance (POA&M)

ACTION COST RESPONSIBLE START DATE COMPLETION MAINTENANCE EVALUATION / METRICS


PROGRAM DEPARTMENT / DATE REQUIREMENTS
POC / POC

Access to Unknown Access to Care Pending ESC Unknown Managed Care Staff Surveys
Care Focus Group approval
needed
PA&E Patient Surveys

Primary Care Market Share


Clinics
Enrollment
Specialty Care
Clinics
Cost Benefits

Customer $0 Customer August 2002 Ongoing Customer Staff Surveys


Relations Relations Relations
Refresher
Manpower cost Patient Surveys
Training

2.5 work hours


lost per year
for training

Customer $500 Customer September 2002 Ongoing Customer Staff Surveys


Relations Relations Relations
Recognition
Gifts Patient Surveys
Program

Community 0$ Managed Care Ongoing Ongoing Managed Care Staff Surveys


Involvement
Manpower cost Health Community interaction
Promotions
Time spent
outside clinical Primary Care
responsibilities
Command Suite

Family $0 Women and Began March 2002 Ongoing Women and Staff Surveys
Centered Care Children’s Health Children’s Health
Plan
Process Patient Surveys

Market Share

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Health $1,000 Managed Care August 2002 Ongoing Marketing Use/time data obtained from
Information software
Library (HIL)
Marketing Medical
Information Patient Surveys
Medical
Information Staff Surveys

Market Share

Provider $10,452 Manpower August 2002 Ongoing Marketing Staff Surveys


Advertisemen
ts
Marketing Patient Surveys

Enrollment

Health $8,000 Health July 2002 Ongoing Health Promotions Patient Surveys
Promotions Promotions
Market Share
Marketing

Electronic $75,800 Directorate for FY03 One time Directorate for Staff Surveys
Sign / Administration purchase Administration
Message
Center New Item Patient Surveys
Purchase Public Affairs Public Affairs
Office Office
Market Share

Marketing Marketing
Enrollment

Health $0 Public Affairs Next Meeting – Ongoing Public Affairs Patient Surveys
Services Office July 2002 Office
Consumer
Council
Branch Medical Marketing needed
Clinics

Managed Care

Marketing

Television $5,800 Managed Care August 2002 Routine Marketing Staff Surveys
Media
Public Affairs Patient Surveys
Office
Market Share
Marketing
Enrollment

Brochures $2,000 Managed Care FY03 Maintain Stock Marketing Staff Surveys

Marketing Patient Surveys

Clinics

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Yellow Pages $12,132 Managed Care August 2002 Yearly Marketing Patient Surveys

Market Share

Enrollment

PRIME $1,000 Director for September 2002 October 2002 Director for Staff Surveys
Program (Parking) Administration (FY03) Administration
Patient Surveys
$0 Central Central
(Appt. System) Appointments Appointments
Market Share

$55 Pharmacy Pharmacy


Enrollment
(Pharmacy)
Patient Patient
$7,375 Administration Administration Cost
(Rapid
Registration) Access Metrics
Managed Care Managed Care

$8,430
Total Marketing Marketing

NHP Logo $1,000 Director for FY03 Ongoing Operating Staff Surveys
Administration Management
Patient Surveys
Operating
Management

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Refrigerator Magnet

Quick Reference
TRICARE
TRICARE Service Center (850) 457-7878

Health Care Information Line (800) 333-5331

Health Care Finder Line (800) 333-4040

Beneficiary Services Information (800) 444-5445

Claim Services (800) 403-3950

CHOICE Behavioral Health (800) 700-8646

NAVAL HOSPITAL
Central Appointments (850) 505-7171

Pharmacy Refills (850) 505-6459

Health Benefits Office (850) 505-6709

Customer Relations (850) 505-6434

Quarter Deck/Information (850) 505-6601

http://psaweb.med.navy.mil

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Logo

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Meet the doc ad

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Yellow Pages ad copy

DIRECTORY NO: 012328 FL Grtr Pensacola


CLIENT NAME: Naval Hospital Pensacola
CMR/CLIENT NO: 340-0000
HEADING: Hospitals
ART ID #:
SIZE: THCO (37 x 30.6)

COME HOME TO
YOUR HEALTH CARE FAMILY
Naval Hospital Pensacola provides most of the health care
services you need under one roof:
Primary Care Clinics with extended hours • Specialty Clinics
Pharmacy • Laboratory & Radiology Services
Central Appointments/Nurse Call Center 505-7171
Pharmacy Refills 505-6459
Health Benefits Office 505-6709
Quarterdeck / Information 505-6601
Health Promotions 505-6339
Branch Medical Clinics
Whiting Field 623-7173
Naval Air Station 452-5242
NTTC Corry 452-6326
NATTC 452-8970
6000 West Highway 98 • Pensacola, FL • 32512-0003
http://psaweb.med.navy.mil
This information is provided for the benefit of entitled military beneficiaries.

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