From Here to Maternity: C A L I FOR N I A Birth of an Online Marketing Campaign H EALTH C ARE F OU NDATION Introduction increase its use for choosing a hospital for maternity A key principle in current health reform discussions care; and (2) learn which approaches are most is the need to engage consumers in understanding cost-effective for promoting consumer use of health and making health care choices. Over the last ratings services. decade many health plans, nonprofits, and Issue Brief government agencies have attempted to provide Maternity care was chosen for the focus of the resources that consumers can use to evaluate health campaign because childbirth is among the most care providers. More than 200 examples of health “shoppable” of health conditions. Women often quality ratings programs are listed in the Health have several choices of providers, as well as the Care Report Card Compendium assembled by the time and motivation to do research beforehand. Association for Healthcare Research and Quality. As maternity is not often a high-risk condition, personal preferences frequently play into decisions. Though these tools are potentially very helpful, research shows that few consumers make use of The online setting was deemed appropriate them. In 2007, only 23 percent of Californians said for a relatively young target audience in they were aware of rating information on hospitals, regions with high online usage rates. Since according to a California HealthCare Foundation CalHospitalCompare.org is itself an online tool, (CHCF) survey. Far fewer (1 percent) actually used it seemed a logical fit to seek more users through such information and changed their hospital choice the Web. as a result. Strategy and Content How can use of comparative health care The campaign, developed with the help of Behr information be increased? To test various Communications, was conducted from June 9, options, CHCF conducted a pilot marketing 2008 to December 14, 2008 in the San Francisco project focused on maternity services in three Bay Area, with a second phase conducted in regions — the San Francisco area, Sacramento, and Sacramento and San Diego beginning in March San Diego — over a one-year period. The targeted 2009 and continuing through September 2009. A campaign encouraged pregnant women to use range of approaches and mechanisms were used to the CalHospitalCompare.org Web site to assess test and compare cost-efficiency and effectiveness of maternity care at local California hospitals. This the outreach. Unique pages were created within the issue brief describes the project, results, and Web site to capture users accessing the site directly lessons learned. as a result of the campaign. The online media and other strategies included: Why Maternity? Why Online? There were two major goals of the project: (1) Placement/content. A set of display and text build awareness of CalHospitalCompare.org and ads were created to communicate with expectant O ctober 2009 mothers about hospital quality variation and the sites with maternity and hospital content throughout the importance of researching maternity care options. Google network. (See Figure 1.) The ads were designed to engender trust by reassuring people that CalHospitalCompare. Search words. There were “ad word” buys of relevant org is independent and unbiased. They were placed on search words on search engines, so that when the target specific Web sites and via ad networks on Yahoo and audiences were looking for information on maternity and Google and targeted to the three geographic regions hospital issues, they would see the text ads directing them being tested. Placements included news publication Web to the Web site. Search terms in four categories included sites, community participation sites (such as Yelp and the following: Citysearch), and ad networks (Google and Yahoo). The ◾◾ Maternity/pregnancy: baby, maternity, having a ads were also placed via the Google content mechanism, baby, pregnancy, motherhood, child birth, expecting which secured placements on additional relevant Web moms, delivering a baby, breastfeeding, neo-natal care, pregnancy health Figure 1. Sample CalHospitalCompare.org Campaign Ads ◾◾ Birthing: C-section, vaginal birth, giving birth, multiple C-section, caesarian section ◾◾ General hospital reviews: hospital ratings, hospital quality, reviews, and quality of care ◾◾ Hospitals: the name of every Bay Area/Sacramento/ San Diego hospital providing maternity services and listed on CalHospitalCompare.org Branded emails. CHCF used some well-known online opt-in subscriber networks, including Dailycandy. com, Vitaljuicedaily.com, and the San Jose Mercury News. Messages were sent directly to the target audiences through these networks. In each case, audiences were sent an email from (and in the “voice” of ) the recognized brand, and given information about CalHospitalCompare.org. Event. In addition to the online marketing campaign, the project included sponsorship of an event that directly fit the target audience — the San Francisco Birth & Baby Fair. For a relatively modest cost (under $5,000) the benefits included placement on all online and print outreach materials. 2  |  California HealthCare Foundation Results Lessons Learned The online ad campaign had an immediate impact Several important insights were gained from the and drove up visits to CalHospitalCompare.org campaign. They are discussed below. dramatically. Before the San Francisco campaign began, only three of the 25 most-viewed maternity pages on Matching the medium and the message to the CalHospitalCompare.org were of Bay Area hospitals; audience. Identifying and understanding the target after the campaign began, all of the 25 most-viewed market consumer is a critical success factor. The campaign maternity pages (and 33 of the top 35) were in the Bay communicated specific information about the hospitals Area. Furthermore, in the month before the campaign providing maternity services in the target market area; this began, there were 153 visits to Bay Area hospital was highly relevant information to women of childbearing maternity pages; during the subsequent seven months age and pregnant women. of the campaign, there were 1,710 visits per month, on average, to the same pages. This was an eleven-fold Target group diversity. It is important to offer a range increase. Figure 2 shows Web traffic over the course of the of ads given the appeal of different messages to different campaigns, measured in unique visits to the Web site. audiences and to keep the campaign fresh. Individual ads had variable performance from site to site, and each of the ads had at least one site where it generated the highest click-through rates. Figure 2. Visits to CalHospitalCompare.org, March 2008 to August 2009 20,000 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug 2008 2008 2008 2008 2008 2008 2008 2008 2008 2008 2009 2009 2009 2009 2009 2009 2009 2009 CAMPAIGN F I RST PH ASE CA MPAIG N SEC ON D PH A SE [ENDED MID-DECEMBER] (EXTENDED THROUGH SEP 2009) From Here to Maternity: Birth of an Online Marketing Campaign  |  3 Placement location. Understanding where potential Effective wordsmithing. The project did head-to-head users are already seeking information, and coming comparisons of the performance of the different ads. to them is important. There are wide variations in The most provocative one — highlighting significant costs — both in awareness, as measured by cost per C-section rate variations among nearby hospitals —  1,000 impressions, and in use, measured by cost per was the most effective overall at generating traffic to click-through. Google and Yahoo placements had the CalHospitalCompare.org. This ad’s message had a highest return on investment for driving actual use of call-to-action, challenging the consumer to “Find the CalHospitalCompare.org. best hospital for you.” In the test of various words in a search, specific hospital names brought the highest level Cost-effectiveness. Branded emails can be more of interest over more generic words like “C-section,” expensive and therefore less cost-effective than other “maternity,” and “hospital ratings.” approaches. They are used to reach a more precisely targeted audience, since consumers opt in to specific Continuing investment. At the conclusion of the networks when they are interested in its content. Prices San Francisco campaign, traffic noticeably dropped. are set high to reach this group. By tracking the clicks Though it had been anticipated that there would be to CalHospitalCompare.org, the campaign found that residual traffic to the unique campaign pages if users approaching a wider audience through search engines like had bookmarked the site following their first visit, this Google and Yahoo was more cost-effective than using was found to be minimal. Since maternity is an episodic the opt-in branded emails. In some cases, outlets offer condition, the target audience is continually changing, branded emails as a free bonus. with new women becoming pregnant and benefiting from access to hospital quality information. Metrics and flexibility. By measuring results and re-aligning tactics along the way, campaigns can reallocate Questions for Further Consideration resources to online channels and content that are more In addition to strongly affecting traffic in the target cost-effective. This continuous adjustment approach markets, the campaign created consistent traffic maximizes flexibility for the campaign and ultimately flow, avoiding the gradually diminishing returns that achieves better outcomes. characterize some campaigns. The project demonstrated that advertising is an effective way to quickly increase For example, the campaign experimented with Yahoo’s awareness and use of hospital quality reports when the Right Media, allocating an amount to Yahoo and health condition is common, the relevant services are enabling them to make direct online ad placements. shoppable, and the target audience has the time and This technique, known as blinded placement, resulted in desire to research their options. a high click-through rate and low overall cost per click relative to other tactics. The blinded approach resulted in Not all related questions were answered by the campaign an average cost per click-through of $1.14 versus $17.70 research, including: per click-through for other, more direct, approaches. ◾◾ Will other search engines, like AOL or MSN, By measuring throughout a campaign, projects can test produce similar results as Yahoo and Google? marketing channels and tactics and transfer funds to those with the best return for a given cost. ◾◾ Can other campaigns focused on different medical conditions and/or in different markets produce similar results? 4  |  California HealthCare Foundation ◾◾ Will consumers respond similarly to a campaign About the Site promoting a Web site on the quality of other CalHospitalCompare.org is one of the most comprehensive health care choices, such as for physicians or health and frequently updated hospital report cards. Launched in insurance policies? 2007, the Web site provides health care consumers with information on clinical care quality, patient safety, and patient ◾◾ Does a campaign focused on one condition also experience in 241 California hospitals that have volunteered induce consumers to look for information about to participate. It is updated quarterly. The project is the other conditions? result of a partnership between three organizations dedicated to improving health care quality: the California HealthCare ◾◾ For organizations with limited budgets, how can Foundation; the University of California, San Francisco Philip these lessons be effectively adapted? R. Lee Institute for Health Policy Studies; and the California Hospitals Assessment and Reporting Taskforce (CHART), a These questions suggest useful areas for further research nonprofit public benefit corporation. in efforts to get health care quality information into the hands of consumers who will benefit from it. About the F o u n d at i o n The California HealthCare Foundation is an independent philanthropy committed to improving the way health care Author is delivered and financed in California. By promoting Jane Sarasohn-Kahn, M.A., M.H.S.A., THINK-Health innovations in care and broader access to information, our goal is to ensure that all Californians can get the care they need, when they need it, at a price they can afford. For more information, visit www.chcf.org. From Here to Maternity: Birth of an Online Marketing Campaign  |  5