Marketing to the Modern Healthcare Consumer with HCA Healthcare’s Andrew Henderson

Announcer: Welcome to the Ignite Podcast, the only healthcare marketing podcast that digs into the digital strategies and tactics that help you accelerate growth. Each week, Cardinal’s experts explore innovative ways to build your digital presence and attract more patients. Buckle up for another episode of Ignite.

Alex Membrillo: What’s going on, everybody? We got the biggest and the best today, right out of Smashville, Hendersonville, out of God’s country, Andrew Henderson. Welcome to Ignite, brother.

Andrew Henderson: Thank you, Alex. Appreciate you having me on. I will say you are, you are stealing my podcast virginity. This is the first time I have been a guest and we will see how this goes.

Alex: Nobody’s ever accused me of that. That’s really fun. It sounds legal.

Andrew: Now you got a different idea for a shirt, you got another skirt idea here.

Alex: I do. For those that can’t see the shirt, because you might be listening on your jog or whatever, just got jolted away by my ridiculous intro. I have a shirt that says “Putting the hip in hip hop since ’09”, which is like kind of true, but kind of we just became fully compliant two years ago, so kind of not true, but you got to wear the t-shirt, marketing always leads the horse. Andrew, where do you work?

Andrew: I’m at HCA Healthcare here at our corporate office in Nashville. I’ve been here about a year. Supporting our teams coast to coast on all things, marketing strategy.

Alex: I love it. Left coast to right coast. You’ve been in healthcare for quite some time. Somebody might hear, “Oh, only one year.” This is healthcare, but you’ve been doing it for quite some time.

Andrew: Yes. Longer than some, not as long as others, as I like to say. I’ve come up through it. My mom was a, was a VP at Kindred Healthcare, started her own hospice, started the hospice division for them many years ago, is surrounded by, you know, PTs, nurses. I got a brother who’s an engineer in the pharmaceutical space. Healthcare is a constant in our in our family. I joined and should say joined the dark side back in 2017. Again, not as long as some, but longer than others.

Alex: You know they say the agency space is the dark side, well, you’re at Gannett, which is the same thing. Now, you’re with [unintelligible 00:02:00]— [crosstalk]

Andrew: That’s for another episode of the podcast [unintelligible 00:02:03] we want to talk about that.

Alex: Hey man, that’s fun. If you can survive in the Gannetts and Cogs Medias and stuff like that, then you’d learn to sell. You learned to help the local plumber. It’s good. It’s honorable work. I love the small business. That’s how Cardinal started. We didn’t have these big medical groups 15 years ago. You know, those are the people that are actually putting food on the plate to the people that we live next to.

Andrew: Totally.

Alex: It’s good. It’s good, honorable work. Then you went into healthcare. Your medical marketing, marketing is that matter. You’re marketing that matters. You’re surrounded by healthcare. Now you got to make the music actually happen, which is really fun. What are you most passionate? You said digital strategy, ACA. ACA is what, the biggest health system is the best, biggest–

Andrew: It’s in the world. I think that’s, in the United States, we’ve got a footprint in the United Kingdom, well over a thousand points of care, roughly $80 billion. The transition from nonprofit to for-profit, I laugh because we often get, from a consumer perspective of like, “Oh, big for-profit healthcare.” I’m like, “Well, at least we pay our taxes:, right? The acclimation to that hasn’t really been that challenge. It’s just the complexities, right? You go from a completely centralized organization to one that’s got 15 divisions all operating and, to an extent, in disparate ways, but we’ve started to centralize that through a few groups, and our operating model is starting to change a little bit.

What am I most passionate about? I mean, for me, it’s anything that my team and I can draw results on, right? Obviously, a lot of that is enabled by the digital space, my background’s in digital transformation with a tilt to martech, media tech, and media strategy. For me, at the end of the day, I think one of the unique things that the digital space allows us is ultimately connecting those marketing investments back to patient growth. Anything that at the end of the day, we can, we can stop, we can have a beer and say, “This is what we did.” At the end of the day, we moved the needle and we’re confident that we’re adding value to the organization. I always joke that my vision is that marketing is not a cost center, right? Marketing drives revenue.

Alex: You have to prove it. I love having beers and talking about, bro, this is code zero. They don’t allow me to do it near two o’clock or the flock will think even less of me. Director of marketing strategy. Is that over all of HCA, we’ll talk about tracking in a minute, but do you have certain facilities? Is it strategy? Is it marketing strategy across the whole thing like digital and traditional?

Andrew: Yes. It’s the team here in Nashville is new by relative standards. I think that they really started to build out a corporate marketing team, roughly six, seven years ago. In my role, I lead enterprise media and performance for anything that is HCA healthcare-led. As I mentioned, we’ve got a lot of divisions and groups still doing their things. There’s a lot of autonomy and ownership still at the division level. As we continue to centralize work, I help lead out on those things that are HCA healthcare-led.

Alex: I love it. Media performance.

Andrew: Yes.

Alex: I love it. Those are your background. You’d come from the cadets to the medium performance. That makes perfect sense. All right. Let’s talk about performance. We’re having a beer. What are you guys able to track? We’re going to talk. We’re going to say, “Hey, we drove these appointments.” You mentioned revenues. Are you [unintelligible 00:05:04] things all the way back through reimbursement and the, in ethic? What do you, how do you look at success when you’re building campaigns for a service line [unintelligible 00:05:11]?

Andrew: Yes. Yes. This role specifically, I can maybe speak a little bit more broadly to my experience, you know, in a past life. Yes. Right. We’re looking at every dollar invested and we’re matching that all the way to incremental contribution margin at a service line level, which was a really neat space to play in, joining the brand team here, we are embarking on a new endeavor to look at how does brand drive volume. What is the correlation between brand and reputation ultimately to volume growth. We’re very much in the infancy, but that’s what we aspire for. Our legislators and data privacy and data integrity is all playing its part in challenging that vision. I think we play in a world that is evolving every day and we used to be every day. Now it feels like it’s every minute where we have to be very intentional about what we track, how we connect it, using clean rooms, making sure that we have the appropriate relationships, and you joked about BAAs and things like that in place with our partners, Google does its best to try to prevent us from accomplishing that vision. It’s a, hurdle after hurdle, which I laugh, I was a hurdler in college.

I should be used to this for– [crosstalk]

Alex: For [unintelligible 00:06:20]

Andrew: Yes, I mean what we’re doing and versus what we’re aspiring to do are maybe two different things today. At the end of the day, we’re starting those conversations to be able to say, “This is what an investment in brand means”, right? When you think about HCA Healthcare, those who work in the healthcare space may or may not be familiar with HCA Healthcare, but it’s unlikely that consumers are. The majority of our hospital buildings is a facility name. We don’t have a huge brand presence in all of our markets. That’s something that is going to continue to change and evolve is we rolled out HCA Florida Healthcare in 2021 or sorry, 2022, we rolled out the corporate brand, I believe in 2018 roughly, and then, HCA Houston Healthcare.

We’re seeing that shift a little bit because ultimately what that’s going to do is going to enable scale, right now we can’t strategize. We can’t execute at a facility level. It’s just not the best use of our dollars. That’s not how the consumer thinks. They, that there has been a shift over the past, I don’t even know how long that, we have to put the consumer and the patient at the center of what we do rather than put the facility and the doctor at the center of what we do. That may be controversial, but it is something that, at the end of the day, if you want to build loyalty and advocacy with the patient, you got to make sure that they know and feel like they’re at the center of everything we do. That includes marketing.

Alex: At the end of the day, they’re the ones buying, you know, we try to use all kinds of fancy words. It’s a consumer trying to buy a product and that is getting care. It is her story. It is not our story in the facility. I see a lot of brand advertising for the hospital systems here in Atlanta. I won’t call anyone out in particular, but they go, “We’re the biggest, we have the most providers. We’ve been around–” [crosstalk] Dude, tell me about cardiac outcomes or tell me, I like Grady here. They do some really good stuff. Wouldn’t be here without Grady. They use actual patient personas and it’s real people who was through their like innovative cardiac program survived something. I love that kind of stuff. Not to call you up, like what kind cool stuff, what are you most proud of over the last year? Some cool branding campaigns that you guys have run and what have you focused on?

Andrew: Yes. As I, as I mentioned, it’s been a bit of a year of a transition for me acclimating to not only HCA healthcare, but one is complex and largest as we are. While we may in some instances not move at the same pace as other smaller nonprofit systems, we’re still able to do truly innovative and inspiring work. I came in about this time last year and helped support the launch of a first of its kind nurse recruitment campaign. Prioritizing talent acquisition and working with our HR business partners, we’re all in tune with the what’s going on in the nursing space and the shortage that exists, nurses are tired and that’s not something that just came out of COVID. It’s something that COVID pulled back the layers on.

Gave us visibility into just how much nurses mean to the entire healthcare industry. Without them, we can’t function. Yes, providers are important. Yes, doctors are critical to care, but at the end of the day, nurses are, they’re the face, they’re the heartbeat, they’re the hug, they’re often there for life-saving care. We did some extensive research to better understand the nursing landscape, both inward on ourselves, what is it like to be a nurse at HCA healthcare, but what is it like to be a nurse in today’s environment? One of the biggest things that came back was, nurses don’t necessarily, at least nurses today, they don’t want to be considered Florence Nightingale, right? They’re not this higher calling, I’m here, right? They’re just like you and I, they’re here to do a job, yes, patient care, healthcare is important to them.

As we started to do this research and, we did some online anthropology, we were looking at Reddit threads, we’re looking at online comments and things like that. At the end of the day, what we learned is like, man, it is tough to be a nurse in today’s world. We built a campaign fully supporting our nurse talent acquisition efforts. When you think about brand, when you think about marketing, I always joke, like we can say anything in the media space. We can put up any creative, we can have any message, we can tell any story, but how much of marketing brand and reputation depends on the patient experience and how much of that patient experience is directly impacted by good quality nurses who love what they do and who are there to ultimately support patients.

Alex: Once we interact with the most, like the provider comes in for five minutes at the end and gives us a script or says like, “You good? Do you believe what the NPs said? We’re good.” They are the most important, I mean the NPs and the nurses, like that’s who we’re interacting with. That’s also how the business model works. I love it. Guys, what Andrew’s saying here, a couple things to go to rewind back to the beginning, you worked with the HR and talent acquisition people. It’s like, you have to internally network. I keep saying that on this podcast, like as marketers, we don’t work in silos anymore. We’re here to support other functions, whether it’s HR or ops or legal and in recent cases. We’re here to support other functions.

Then you didn’t just start launching “We Want Nurses” campaign and blasting every nurse that matched some ID that a display partner said they had and did a bunch of research to find out who HCA is. How do these people actually feel about being at HCA? How do these people really feel about their job? Then I bet your campaign was awesome because the messaging hit home. It was on point. It was on Fluff Florence Nightingale stuff, but you did the research ahead of time before launching into marketing and people are hesitant to do that these days.

Andrew: Totally. You know what was really interesting? I think at times as marketers, we think we know exactly how to do things and what the message should be. We’re going to AB test that, we’re going to look at these channels. One of the things that we did initially was we socialize this campaign with actual nurses and the creative strategy that we were going to lead with. They hate it. They’re like, “No, that doesn’t represent us at all.” We had to quickly pivot right in response to that, because if that’s the feedback we’re getting in real-time, well, we can’t take that to market. Yes, we just wrapped up the campaign in March. we piloted it in one of our markets in Kansas city where interestingly enough, it’s a challenging market.

It’s hard to acquire nurses. There is a stagnant population growth. It’s not as though you’ve got 10% population increase where you’ve just got this influx of new nurses moving from out of market that you can hire. Ultimately our campaign drove really strong preliminary results. It also exposed a lot of operational opportunities for us to improve, but my biggest takeaway, and this is something I’m, when I talk about results and being able to use results to drive change and strategy, we had a seismic shift of low funnel dollars to upper funnel dollars. We needed to build our brand. I sat with our chief brand officer and I said, “There’s not an employer brand. There’s not a provider brand. There’s not our corporate brand. There’s not our facility brand. There is the brand.”

That brand does mean different things to different people, but the shift in our media mix while infusing incremental budget, it was to better tell that story, that brand story to our nurses, to both passive and active job seekers. In doing so, one of the things that I was in tunely connected with was ultimately what is the impact on the low funnel marketing strategy. At the end of the day, we’re fooling ourselves if we think–

Alex: When the applicants came in?

Andrew: Yes. Not just that, because we know that it’s a, I mean it’s a multiple year cycle. For someone to consider changing jobs, going through the process of, “Where do I want to go? Is this the right fit? Is this the right role?” That’s a, not something that you’re going to accurately account for in a nine-month strategy or a nine-month campaign. At the end of the day, where you can affect is, are we more efficient and effective at the low end by letting that message resonate with those active job seekers? We saw nearly a hundred percent lift in click-through rate and paid search.

We saw a 34% lift in conversion rate. We saw a 35% reduction in cost per click. The narrative there was investing in the brand does add value in that it stretches our marketing dollar at the lower end of the funnel, right? It makes that dollar go further. It’s more valuable. We’re more attractive. We’re more efficient in capturing that volume. I mean the net was, we did see almost a 20% lift in nursing hires through the duration of the campaign when compared to the prior nine months.

Alex: Andrew, I’ve been trying to promote and sell the fact that you have to expand a funnel. We have another t-shirt called the Performance Journey because I’m trying to get our clients out of believing PPC and SEO are the future. The only way that we have to market anymore, it’s really not that the journey is complex. The more you invest, obviously HCA has a lot more capability and bandwidth budget to invest in brand than almost anybody else. That’s what people listening will say. I’ll say for you groups that are starting to hit 50% impression share to budget, you should start expanding out. You’re going to get dimension returns on PPC and SEO. If you’re ranking well, guys, you have to start investing brand.

Andrew, I’m going to use all those stats as the headline for this post. I can already tell that’s the way this is going to go down because I’ve been saying it for a long time. It ends up lowering your CPL, your CPCs come down, your amount of click-throughs you get go up because when you start showing up there, people say, “I’ve heard of that. I’ve seen that. I don’t remember where, but I trust that.” That totally helped you guys incredibly. Also something else you said that was really impactful to me is before you launched the campaign, when you thought you had it figured out, I’m going to do this at Cardinal with something I have going on right now.

Before you launched the campaign, you went to the nurses and you said, “Does this resemble us? Is this–“, and they’re like, “No, bro, there’s no word in my mouth here.” All right, let’s go to hard work and you get paid a lot. Whatever it could have been the messaging, I think that was really cool that you took it. I bet they felt bought in and started referring a bunch of their friends when they said, “Hey, we’re a part of this. They’ve just included us.” I’ve been [unintelligible 00:15:44] referrals all the time. [unintelligible 00:15:46] quite a bit.

Andrew: Yes. Interestingly enough, one of the primary KPIs of the campaign, yes, we had to be accountable for application flow and hires and fill rates and things like that. What we’re, what we’re most specifically looking at too is existing nurse engagement. We just got these results, a big, a big market research firm. We’ve been studying both external perception, but in inward as well with employees. We’re excited to dig into those results. We just closed the study this week and we’ll soon get the results of what was the impact on employee engagement? Because at the end of the day, yes, you’re looking to acquire new nurses, but you can acquire less nurses if you retain more. When you look at that net headcount, that’s ultimately your win right there.

Alex: Yes. Yes. We’re doing that at Cardinal right now. We’re a little smaller than HCA, but it is, you gave me so many good ideas to get them involved in creating the culture messaging. What are we? Who are we? We, what are we going to market with? Please tell your friends and please stay longer. Good tips for me. Hopefully a lot of you all got something out of that. What are you excited about? I know with all of the HIPAA compliance stuff that’s come at us and you all are a big target because you’re so big. You’ve had to really follow the letter of the law. That’s been crazy over the last year and a half for us. I know, I imagine with you guys, are you focused the rest of the year? Still the compliance stuff, you’re excited about any marketing trends that are coming down the pike. What, what are you looking at?

Andrew: Yes, I mean we’re actively having as anyone and their brother is, conversations on how to leverage AI within the workplace, within the way that we strategize, one of the neat things is, how we’re looking at AI in the bedside, both in no capture for nurses, trying to alleviate the documentation burden, introducing virtual nursing for discharge. There’s some trends at the bedside that I think are really interesting that help from a marketing, and a positioning perspective. For me, the biggest thing is consumer trends in healthcare. When you look at the younger demographic and the way that they consume care, you’ve got a lot of people pursuing symptomatic treatment. They wait until they feel bad to go and seek care rather than establishing a regular relationship. This is not news to anybody listening or otherwise.

Alex: It’s a good reminder though, that none of us have BCBs. We don’t know what well visit means.

Andrew: Right. Yes. I know what my blood pressure is. The one time I go in, because I had a cold, and then I don’t check it again for five years.

Alex: Terrible.

Andrew: Do I have a history of high blood pressure? I don’t know. I may have had it at a moment in time, but that could have been from who knows what, probably all the Pig Floyd I’ve been eating. At the end of the day, yes. To me, the emerging trend, you could say data privacy, you could say AI, you could say the MarTech landscape. To me, all of that falls by the wayside, if you’re not developing and strengthening demand for our business, and that starts with the younger generation. What happens when all the baby boomers die, what happens when you can’t maintain volumes? It becomes a market share play. Then it becomes shark-infested waters with mergers and acquisition.

Alex: Yes, race to the bottom. Yes.

Andrew: Who’s buying them and buying, essentially you go buy your market share by acquiring.

Alex: You’re focused on the younger demos. What, like how young are we going? Twenties or thirties and starting to become a patriarch?

Andrew: Yes, I mean, we saw the most significant drop-off in one of our divisions for ER volume was 18 to 34. Then you start to ask the question, “Well, are they at least going to our urgent cares or they just, did they just stop receiving care?” We know that’s the case coming out of COVID that people don’t want to pursue preventative care. They’re like, “Hey, I didn’t get it for three years. Why would I keep going now?” The reality is you have to start to educate and create that need with the younger demographic and to understand how they want to receive care and adapt accordingly. Yes, we can, we can drive demand, but we also have to adapt to meet them where they are. As marketers, we need to be exposing those opportunities to operators, to leadership, to say, the reason we’re down is not because we aren’t spending enough in paid search. The reason we are down in volume is because consumer behaviors are changing and we’ve got to stay on top of that.

Alex: I have spent so much time over the last few weeks diving in. There’s a client of ours in certain higher acuity industry. They’re like volumes down, volumes down, like your rankings are it. Then you start pulling Google search trends up, “Guys, the recession’s hittingm people are spending less money on healthcare, less money on everything. There’s less search demand.” I hate that our generation isn’t going, “I learned a ton. I learned a ton from my PCB. “Hey, listen, you’re coming up on this age, get this checked, get that checked”, and you get a baseline. They check for like, dude, just everybody should be getting their blood checked once a year because you can get a detection of cancer or whatnot. Oh, it scares me that people are waiting that long. It’s once a year, get a physical, get your blood drawn, even if it’s at home, it’s so important. You’re going after, and it’s a big education play, and ACA now has to invest in the education that everyone benefits from, and you hope that you get a piece of the pie a few years down the road for having to spend the money on education.

Andrew: Yes, I joked in a meeting yesterday as I was walking the team through, the traditional consumer funnel, top to bottom, in a perfect world, yes, but we all know that that’s not linear. That people balance based on need, whether they’re caring for themselves, a dependent, a loved one, things like that. I joked, I said, you can move through the consumer funnel in 10 minutes, or you can move through it in 10 years, right? It just depends on your unique circumstance. It’s our responsibility to be there, ready to service any patient in a time of need. Whether that’s, “Hey, I got to go find an emergency room now”, or, “Hey, I’ve had knee pain for the last five years, and I’m getting kind of tired of it. What could it be?”

At the end of the day, the patient, the consumer journey is not linear, and it’s on the health systems, it’s on us to be able to speak to our patients when they need it with a message they’re willing to receive and a modality that they prefer. Ultimately, that’s how you talk about value-based care and things like that. That’s how you ultimately service your patients. That’s how you put your patients at the center of everything that you do.

Alex: Marketing is getting more difficult. Right message, right time, right patient, right modality. Oh my God. Then you have to tell them [unintelligible 00:21:29] [crosstalk]

Andrew: [unintelligible 00:21:30] what, we’re not going to tell you what sites they’re on. We’re not going to tell you what their preferences are. If you don’t have cookies, and if you do have cookies, and it’s making it more challenging to do that.

Alex: I’m glad some of the hospital systems are suing back the government. Oh, I don’t know who they’re, HHS, I think, is getting sued now. It’s like, guys, you took it to the extreme with a blanket, get rid of all cookies and traffic. That actually harms patient care because we can’t get to the right people with the right message at the right time. We don’t know what they’re interested in. Let’s find a balance. I think we’ll get there in the next year and a half because they’re going to get tired of being sued themselves. They’re going to realize they took it too far. Hopefully, we do that. It’s in the patient’s best interest. Marketers don’t have it easy. We’re now technologists, we’re lawyers, we’re ops people, we’re creatives, and all that fun stuff. I love the fact that you say we have to reach the patient how she wants it with the education that she wants.

You never know if or when you’re going to get paid back, but education is the name of the game. It’s not cheap, it’s not easy, but that’s how we prefer to go these days. I’ll leave you with one thing. I want you to leave me with one thing. Anything controversial, opinion, or thing you see not working, or a trend, total waste of time, anything you’re not interested in. Thank you for saying AI or whatever, at the end of the day, it’s about being there when the patient needs you even with all this fancy– Anything else you think is a total waste of time of time or controversial?

Andrew: I mean, for me, it’s you got to go be willing to stop doing things. Be willing to understand, for me, that the cause and effect of the decisions we make every day. For me, A good example of that is paid social. I have a personal disdain for paid social because I think it’s the most overused, over-invested channel that we treat it like another publisher, rather than say, “Hey, stop putting your display ads on paid social.” Stop putting your YouTube ads on paid social. Develop content that people actually consume on social. I think too often we just throw up what we have on a billboard, then we treat Facebook like another digital highway. I think that they’re especially in a changing landscape where downstream optimizations are becoming more and more challenging. Optimizing to true conversions and things like that. I think that Meta’s got a monopoly on the social advertising landscape. At the end of the day, I think it’s a big risk. You got to go be willing to stop doing or change the way you’re doing if you’re ultimately going to get value out of these channels.

Alex: How much do you think Zuckerberg paid Congress to get rid of his only competitor? [crosstalk] Yes, I love [unintelligible 00:23:45]

Andrew: [unintelligible 00:23:46] will see in my bank account.

Alex: Yes, exactly. I’m with you. My takeaway there is develop content that’s content for the channel, not just an ad you took from the billboard saying campaign and start dumping it in there. It really doesn’t work. It’s inauthentic. It’s like, you shouldn’t have ventured into that channel if you weren’t ready to create content that’s native and useful for that channel. Andrew Henderson from Hendersonville. They named the town after him. They’re going to name HCA after him one day soon. Thank you for joining us on Ignite.

Alex: Appreciate it, Alex. Appreciate your time.

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