‘National Health Service Corps: Putting members first drives enrollment’
The National Health Service Corps (NHSC) was started in 1972 in response to the healthcare crisis that emerged in the United States in the 1950s and 1960s. Older; physicians were retiring, and young doctors started to choose specialization over general practice, leaving many areas of the country without primary care medical services.
The NHSC attracts medical students and recent graduates who are committed to helping those with limited access to primary healthcare. It offers scholarships and student loan repayment to providers for their commitment to work at least two years in an NHSC-approved health center or clinic in an underserved community. NHSC clinicians – primary care doctors, dentists, nurses, physician assistants, mental health professionals – also earn a salary from their sites. In 2009, 3,600 healthcare providers were members of the NHSC.
In 2009, the Health Resources and Services Administration (HRSA), the government agency that runs the NHSC, funded FHI 360, a nonprofit social marketing and health promotion organization, to rebrand and market the program to increase its national visibility and recruit 3,300 primary healthcare providers into the program.
Historically, demand for the NHSC exceeded available funding. More recently, with increased attention on the issue of healthcare and a growing primary care workforce shortage, the American Recovery and Reinvestment Act of 2009 provided $300 million to support 4,000 new NHSC providers by 2011. With an influx of funding, this program – which had never much needed to market itself – was suddenly faced with having to more than double its size in just two years.
FHI 360 first conducted a market analysis to better understand the NHSC program, including internal operations, available resources and audiences. The inquiry also sought to examine what HRSA was currently doing to promote, manage and support the program, as well as to learn about the external market environment, including target audiences and NHSC competitors. Activities included intercept interviews with new members; observation and attendance at key NHSC events; key informant interviews with NHSC program staff, partners, ambassadors, alumni and advisors (e.g. National Advisory Council members); a review of background documents and data; an audit of existing NHSC promotional materials; and a consumer experience innovation workshop. These activities were designed to illuminate the current NHSC program’s key strengths and successes, weaknesses and gaps, and opportunities.
The analysis revealed that the NHSC was primarily being positioned as a government-run financial program. This positioning was diminishing the value of the NHSC among its most important consumers – its own members and the healthcare providers it was seeking to attract. In addition to the impersonal and bureaucratic way the program was being defined, the ‘Corps’ in the NHSC did not exist. Once providers learned they were accepted into the program, most said they never heard from the program again, or anyone else in it.
Students haven’t heard of [the NHSC]. When they do, they think it is like uniformed service. They might just equate it with another branch of the government.
NHSC [is] not [a] key recognizable phrase. If I went to the new physician reception in my town they would say ‘what is that?’ But they would know the loan repayment program.
The ‘product’ being sold – membership in the NHSC – was confusing, required navigating a complex application process, and had no values associated with it other than money. Yet, the analysis also showed that, for most current and potential NHSC members, money was just one part of the attraction of the program. Many NHSC members were already working in underserved communities before they applied for the program and most continued to serve beyond their two-year commitment – and had powerful stories to share. Furthermore, the personal values of providers who were most likely to work in communities with a shortage of health professionals had little to do with money. They valued service and social equity, as well as other benefits such as work/life balance, flexibility, meaningful patient relationships, and the opportunity to learn and practice different skills.
In terms of an emotional connection with the brand, input from members and others involved with the program suggested that the NHSC had a split-personality. Many contradictory words were mentioned to describe the NHSC (e.g. ‘cold’, ‘faceless’ and ‘demanding’ vs. ‘dedicated’, ‘genuine’ and ‘caring’). A varied picture emerged of the NHSC depending on participants’ association with the program and their length of involvement in it. This contradiction may have been attributed to participants feeling one way about their commitment to the social mission of the program, and the fact that they are able to do this work, in part, because of the NHSC, and feeling another way about the impersonal way the program was being run.
Some promotional materials did exist, including a website and a wide social media presence, but their effectiveness was undermined by an overall lack of focus, clear benefits, visual interest and an emotional connection. The findings also revealed an incredible opportunity to capitalize on the considerable assets that HRSA had in place for a revitalized marketing effort, including a commitment to program success at the highest levels, experienced and committed staff, and extensive relationships and resources throughout HRSA – including regional offices, and internal and external partners – that could be leveraged to market the program and its benefits. These assets, coupled with the significant goodwill that existed around the social mission of the program, primed it for success.
In order to help the NHSC recruit the large number of providers it needed to bring into the program quickly, and lay a foundation for future marketing of the program, the product needed to be repositioned in a way that:
1- was responsive to member needs and values; and
2- communicated NHSC members’ core values to the target audience in a clear, consistent and authentic way.
FHI 360 created and helped implement a rebranding effort and marketing campaign to:
o Reframe the NHSC – through the voice of its current members – as relevant, responsive, compelling, exciting and more personal
o Begin to build the ‘Corps’ in the NHSC and position this network of like-minded, dedicated professionals as a member benefit
o Develop a suite of NHSC identity products and promotional tools and materials that communicate a revived NHSC brand – both for current and prospective members
o Drive prospective members to register on the NHSC website – the first step to completing the required application (and re-engage those already registered who had not yet applied).
FHI 360 also reinforced with program staff that the current application process was going to be a choke-point for the influx of new applicants expected as a result of a marketing campaign. The process needed to continue to be improved to allow for a smoother entry into the program.
Building on the market analysis, brand elements, messages and materials were developed to achieve the objectives. These brand and materials concepts were tested through focus group discussions with potential members – soon-to-be, and current, primary healthcare providers in NHSC-eligible disciplines – all of whom were either accumulating or still repaying student loans. The research revealed a very low awareness of the program among prospective members, as well as preferences for and questions surrounding various brand elements and messages.
After brand elements and materials were tweaked, FHI 360 fielded an online survey (n=201) with secondary audiences already involved in the NHSC, which aimed to confirm the brand and materials testing outcomes from prospective members; get buy-in for the new brand and materials; and elicit any previously unidentified concerns with the new brand and materials.
On October 13, 2011, a US Department of Health and Human Services pre-release announced that the largest number of NHSC providers in history – more than 10,000 – are providing healthcare to communities across the country. This is neatly three times the number of NHSC providers there were three years ago, and nearly double the number of providers FHI 360 was tasked with helping: to recruit1.
Specific outcomes included:
The key factor in the success of the NHSC marketing campaign was HRSA’s commitment to fix the product, namely the NHSC brand, program and features. Too often, social marketers are asked to promote poorly designed programs or poorly delivered services. Once HRSA began to address the major barriers of NHSC personality, entry and engagement, the program almost sold itself.
Focusing on the ‘consumer experience’ – that is, what did the NHSC look like from the clinicians’ perspective – helped reframe the marketing challenge for HRSA managers.
NHSC clinician members proved to be the best sales force. They simply needed a venue to express their passion, commitment and enthusiasm about the life-changing opportunity offered by the program.
Discuss the difference between market segmentation and targeting. Analyze audience segmentation in relation to the case study. Word count:
Explain the factors that contributed to the higher-than-average response rates and the final results of the marketing effort in the case.
Discuss the marketing mix employed by NHSC, including its merits and demerits. Analyze how the marketing mix led to success or failure in achieving its objectives.
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