Regional Differences

I remember one of the first thing that healthcare peope used to tell me 10 years ago when I first began working in healthcare.  “Healthcare is local.”  At the time, I took this for granted.  Since then, I have seen all the data that shows how prescription utilization, spend per person, obesity, and many other variables vary by geography.

As I have been traveling, I was thinking about this as I noticed lots of anxillary things that vary dramatically state-to-state:

Boston and some eastern states have Dunken Donuts everywhere.  They went out of business in St. Louis.

In Michigan, everyone drives faster than any other state I have been in.  The other day, I was going 90 in the left hand lane and got waived out of the lane by a minivan and an SUV going about 100. 

In LA, people consider an hour drive nothing.  In some smaller areas, a 30 minute drive wouldn’t be considered for some normal task. 

Yet, from what I can tell, many national companies don’t vary their healthcare marketing and communications per region.  Why is that?  Is it simply a data sophistication question?  If attitudes are going to vary, have you taken that into account?

It makes me think of a project I did with a retailer years ago.  One of their questions was about stocking inventory and how to develop a model to optimize the mix based on location.  They had just gone through a season where some stores had excess shorts which they had to dramatically discount and some stores that ran out of shorts.  At the time, WalMart had just begun their CFAR (Collaborative Forecasting and Replenishment) initiative which created an integrated application for sharing data across stores and with suppliers to optimize mix and maximize inventory turns. 

That CFAR model has now become a default SAP module and created an industry association that uses the model.  Will healthcare do the same?  Not for a while from what I can see.

But, it is critical in communicating.  Attitudes towards preventative care vary.  Willingness to try and exercise and wellness vary.  Perceptions vary.  The most simplistic example I saw a few years back was the doubling of the success of a call campaign when the person calling [into the South] had a southern accent.  People weren’t as responsive without that familiar accent.

The website for Premier (a non-profit hospital association) had some good facts about localization (pros and cons):

“All healthcare is local”: Good for innovation and personalization of care

  • Widespread, local experimentation among U.S. healthcare providers prompts innovation, which as New York Times columnist, Tyler Cowen points out, makes the United States the world leader in new treatments and technologies. Innovations include the development of new drugs and devices and better treatment protocols.
  • The U.S. healthcare system is anchored by community hospitals and healthcare organizations. These local hospitals and organizations are rooted in the community and are able to shape care in accordance with the needs of their specific populations, making healthcare more personal and direct.
  • “Community-based approaches act as a reality check of what is doable and practical: They can provide an actual model of what works; they help identify promising practices in key areas; and they can provide lessons about how to address political issues.”[1]

But local orientation results in variation of care, uneven outcomes and high costs

  • In a national study on quality of care, RAND found that American adults receive just half of recommended evidence-based care services.
  • The National Committee for Quality Assurance’s recent scorecard, The State of Health Care Quality: 2006, reports huge variation in healthcare performance exists in every region of the country and in every clinical area.
  • “Despite the billions of U.S. tax dollars spent on research and the more than a trillion spent on service delivery, movement of evidence-based interventions into communities and health systems is often slow.”[2]
  • Lack of scale and connectedness (“buying clout”) and unnecessary duplication result in high healthcare costs.

[1] Debbie I. Chang, “Applying Lesson Learned in Communities To Programs and Policies at the Federal Level,” Health Affairs 25, no. 3 (2006): w192-w194.

[2] Jonathan E. Fielding and Peter A. Briss, “Promoting Evidence-Based Public Health Policy: Can We Have Better Evidence and More Action?,” Health Affairs, 25, no. 4 (2006): 969-978.

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