Managed-Care Ads: Rx for Image Ills?

Managed-care companies, smarting from resoundingly low public approval ratings, are attempting to repair their tattered image with a technique long used by the oil industry, auto makers and others beset by a bad rap: an ad campaign.

A coalition of health plans and industry trade groups will spend $11.5 million on print, broadcast and Internet promotions by the end of the year. Unlike the multimillion-dollar lobbying and public relations efforts that the industry is hoping will stave off proposed new state and federal health-care regulations, these 30-second spots and full-page ads are aimed at the general public.

The idea, industry leaders say, is to convince Americans that managed care has changed--that it is no longer “focused on cost,” as one ad says, but on taking care of patients. The campaign is meant to provide what Madison Avenue types refer to as “push-back,” a competing voice to counter the tide of managed-care horror stories told by neighbors, family doctors and the news media.

It won’t be an easy sell.

The industry’s own polling efforts show that 76% of primary-care doctors and 45% of the general public hold negative views of health-maintenance organizations, the most restrictive form of managed care, in which access to specialists and some medications is carefully controlled.

“It’s pretty obvious that the managed-care industry needs help with its reputation,” said Patrick Garner, a senior vice president of Wellpoint Health Networks. “Everything that people read about or hear about managed care is negative. Someone has got to say that there are some positives. And who else better to say that than the industry?”

The ads, which feature interviews with doctors who profess to like managed care, were viewed with skepticism by consumer advocates and some health-care experts.

“You don’t overcome image problems by advertising,” said Diana Bianco, the lead health-care advocate for San Francisco-based Consumers Union. “You overcome image problems by action. . . . I’d like them to spend that money on patient care.”

This is not the first time that the managed-care industry has attempted to improve its image. In 1998, a group of six companies spent $6 million on a series of television ads, but they had little impact.

This year the group, which calls itself the Coalition for Affordable Quality Health Care, has 10 of the largest managed-care companies and two trade associations as members, and has committed to a campaign that will last at least three years.

“We decided to upgrade the level of the campaign,” said Roger Bolton, the group’s president and the chief of public relations for Aetna U.S. Healthcare, the nation’s largest managed-care company. “Last year’s spots looked more like political commercials. This is quite different.”

Bolton said the group has raised $10.5 million so far for this year’s campaign, which debuted briefly over the summer but will gear up in earnest in the fall. The group plans to continue raising money through the end of the year.

In one ad, a doctor from Kansas City, Mo., says that whereas “old managed care was focused on cost, new managed care is taking an active role in managing a patient’s health.”

“Should patients feel less secure with managed care?” the physician, Elizabeth Gallup, asks in the ad. “Absolutely not. If anything, patients should feel more secure, because doctors and managed-care companies are looking out to make sure that the care they receive is appropriate.”

In another spot, a doctor says that while some physicians were skeptical of managed care at first, they are beginning to warm up to it. “Change is always frightening,” the doctor, internist Jill Broffman of Los Angeles, says.

In choosing doctors as spokespersons, the coalition was relying on market research that showed that most consumers are well aware of doctors’ gripes about managed care, said Jim Palumbo, president of Waylon Ad Inc., the St. Louis-based firm that designed the ads.

The television spots were deliberately shot simply, using an interview format, in order to avoid appearing too slick, Palumbo said.

“As we talked to them in focus group research, we heard consumers say, ‘When I hear from my doctors that managed care is getting better, then I’ll believe it,’ ” Palumbo said. “We’ve found that doctors have a high degree of credibility and respect.”

But while it is true that advertisers have frequently relied on doctors to lend credibility to health-related products, there’s a possibility that this time, the technique might backfire, said Lawrence Wallack, who specializes in mass media and public health issues at UC Berkeley and Portland State University in Oregon.

If the ads spark outrage or strong disagreement among managed care’s critics, such as consumer advocates or professional organizations representing physicians, these groups could launch counterattacks, Wallack said. The result could be a rash of anti-managed-care ads or stories in the news media that question the content of the ads.

Already, the California Medical Assn. has weighed in heavily against the use of doctors in the ads. “These advertisements do not reflect the actual mood of the profession of medicine,” said Jack Lewin, CMA’s executive vice president.

Far from becoming more comfortable with managed care, doctors and health plans are in a state of war, he said, adding, “There is increasing dissent, distrust and frustration among physicians about the attitudes of HMOs and the . . . policies of HMOs which adversely affect patient care.”

But health-care executives say that their side of the story needs to be told--and they see the ads as the way to do that.

Managed care, industry leaders said, should be praised for providing better preventive care than the old fee-for-service system, in which insurance companies only paid for doctor visits that were prompted by illness.

Today’s HMOs and other managed-care plans pay for childhood immunizations and general checkups, and offer disease management programs that are changing the way doctors treat chronic conditions such as asthma and heart disease.

The industry has also loosened the restraints on some medical procedures and access to specialists, and has offered new types of insurance plans that, while more expensive, offer greater choice.

Failure to get this message across could be disastrous, from the industry’s point of view. Already, some big corporate buyers of health insurance have begun to balk at paying the higher premiums demanded by most plans for next year. And in at least one poll, voters said that health reform was the most important issue for candidates to address in the 2000 elections.

If the general public had a better image of health plans, the theory goes, there would not be so much pressure on politicians and employers.

“If you continue in an environment where all that individuals hear is horror stories . . . it leads to skepticism, which leads to legislators initiating legislation and regulators initiating regulations,” said Karen Ignagni, president of the American Assn. of Health Plans, which is backing the ad campaign.

The new rules, she said, “may be wholly inadequate to address the problems that are inherent in the health-care system.”

There is some question, however, as to whether an advertising campaign alone will achieve the industry’s goals.

“I think that it would take more than $10 million to get the public’s trust back,” said Linda Bergthold, a health-care consultant in Santa Cruz. “If I were an HMO I would hire a really crack team of ombudsmen and really put my money into the front-line telephone staff, because they have the lowest-paid and least-trained people at that level.”

Kaiser Permanente, for one, is doing just that. The nonprofit managed-care giant applauds the ad campaign, but is not participating.