Putting on the charm: Insurers try a new tack to sell themselves

Health plans are on a marketing mission. They "want you to know" how to "thrive" by turning to them for "guidance when you need it most" because "it's time to feel better," and their business is "helping people live healthier lives."

The business imperative behind these advertising slogans -- in order, for Aetna, Kaiser Permanente, Humana, Cigna and UnitedHealthcare -- is increasingly tied to health plans' own ability to thrive.

Health plan executives and the people who study managed care say that with further government regulation, reform looking likely in the next few years, and the individual market for health insurance gaining importance, insurers must reposition themselves as care managers and providers of medical navigation.

If they fail, the transition to a role of trusted adviser will stall, and health plans could end up as the emperor without clothes, analysts say. Even plan executives are believing that the public and elected officials must feel health plans do something besides make money, or plans will be out of the health system reform process.

"The new way of doing things for insurers depends on engagement," said Humana spokesman Tom Noland. "A consumer will not engage with his or her health plan if he or she doesn't trust the health plan."

David Shore, PhD, associate dean at the Harvard University School of Public Health, in Boston, is founder of the Trust Initiative, which is part of the school's continuing education program. He wrote the 2005 book The Trust Prescription for Healthcare: Building your Reputation with Consumers and edited the 2006 collection of essays, The Trust Crisis in Healthcare. Shore is scheduled to speak to health plans at the annual business forum for America's Health Insurance Plans in November.

"Trust is at historically low levels," he said in a phone interview. "Trust is a lubricant for business, and in health care, and particularly in the health insurance industry, there is a trust deficit."

The successful plans, Shore and others say, will first change the way they do business, then turn up the volume on messages of trustworthiness, friendly guidance and caring.

For physicians frustrated by health plans, the slogans not only contradict reality, but they also send a message that insurers are the first, best stop for health information, said J. James Rohack, MD, AMA president-elect and a cardiologist from Temple, Texas.

"What they're doing is saying, 'Trust us,' " Dr. Rohack said. "They haven't said, 'Don't trust your doctor.' But the implication is pretty much, 'We're here, we can provide all this stuff for you, come to us first.' "

Health plans have to sell the public on trust because surveys show they haven't won any. For example, a 2007 Harris Interactive poll of 2,565 adults found trust ratings for health insurers were similar to those of such perennial corporate boogeymen as oil and tobacco companies. Health insurers and managed care companies, which Harris put into separate categories, were deemed by the public to be among the least trustworthy, and the most in need of increased regulation.

Experts say years of health insurers stepping in between doctors and patients -- highlighted by anti-HMO rants that started appearing in popular movies in the late 1990s -- have either contributed to, or are reflective of, that lack of trust.

Shore said insurers also face a problem most industries don't. While the public might support a company such as General Motors making money, health plans can be seen as greedy and self-serving.

Kent Grayson, PhD, professor of marketing at Northwestern (Ill.) University's Kellogg School of Management, said there is another challenge: As for all health care professions, the complexity of medicine means the public requires a greater degree of trust in the people with expertise in health care, whether they are physicians or health plan representatives.

The patient seeking care generally knows less about the options than do the people and facilities offering that care. That "information dissymmetry" puts the patient on edge.

And that, Shore said, leads people to use proxies, or substitutes for real measures of trustworthiness. For example, a patient may judge the quality of a physician's care by the cleanliness of the waiting room or the age of the magazines.

The most common proxy, Shore said, is the degree of warmth, empathy and genuineness (which marketers call WEG), a person feels when dealing with the company or person in question.

Getting warm and fuzzy

To overcome the mountain of reasons people may have to distrust health plans, the companies have rolled out ad campaigns wrapped in WEG: The photos accompanying the slogans show couples and families embracing, children playing, families walking on the beach, and intelligent, thoughtful-but-not-confused people looking at laptop computers. The campaigns are not necessarily new, but companies are pushing them harder than ever.

Humana began using its "Guidance when you need it most" slogan in 2002, after extensive research to find out what people really thought health plans did and what they wanted them to do, Noland said.

He said Humana has backed up its slogan and marketing with work to address the big problems in health care, citing as examples pilot programs in Michigan and Florida that have reduced costs in localized areas. In addition to being a good idea, those projects do have a public relations component, he said.

"I don't mind acknowledging that," Noland said. "There are two messages: That Humana cares, and the second message is, 'We are part of the solution, not part of the problem.' That goes a long way to counter arguments you probably hear a lot, like, 'All they're doing is making money at people's expense.' "

In 2003, the country's largest nonprofit plan, Kaiser Permanente, began putting up billboards that barely mentioned its name, but featured people doing healthy activities with the slogan, "thrive."

More recently, Aetna's "We Want You to Know" follows a theme of helping patients cut through the complexity of the health system, while United pushes a role as an able assistant in its slogan, "Helping People Live Healthier Lives."

Cigna's new campaign, launched in July, takes a slightly different tactic. It directly references the impending elections and heightened debate over health care reform.

"It's Time to Feel Better" offers the same messages of assistance and wellness as other campaigns, but also includes a component meant to show customers that the company is engaged in the health system debate.

Derek Weiss, Cigna's vice president of strategy and marketing, said the company has been working to improve its business relationships for the past three years, and the last step is to tell the public what has changed.

Cigna wants to move from being a managed care company to a "health services company," he said.

"You don't have to be ill to work with Cigna," Weiss said. "We have services and information that help you maintain your health."

The other part of the campaign includes a discussion of Cigna's own work to address cost and access to health insurance, and refers visitors to reform proposals put forth by the health plan trade group America's Health Insurance Plans.

Going beyond words

But even the best slogans, warm, empathetic and genuine, don't automatically draw trust. Grayson said companies that polish their messages without changing the way they do business get in trouble when the reality and the advertised idea clash. So plans face a risk if the public doesn't believe they are warmer and fuzzier, nor the partners they need to ensure better health.

"There's a saying, 'Nothing kills a bad product faster than good advertising.' Everybody goes to the store and realizes it stinks," Grayson said.

Dr. Rohack compared the insurers' catchy slogans with the tobacco advertising of the past. "The tobacco industry for years used advertising as a mechanism to say, 'Here's a product that's actually harmful to your health, but we're going to make you feel better about it.' "

It makes good business sense for plans to market heavily to the individual, given the reality of a declining market for employer-sponsored insurance and the possibility of an individual market bolstered by tax credits -- a plan advocated by the AMA to reduce the number of uninsured -- or an individual mandate, Dr. Rohack said.

"Strategy-wise it make s a lot of sense for them to say, 'We need to really ratchet up the individual market, and get the individual to be loyal to us from cradle to grave,' " he said.

"But what frustrates us at the AMA is, I know the money isn't coming out of the CEO's bonus to pay for that marketing."