HMO uses ad strategies to market its programs

Madison Avenue meets readiness to change

HealthPartners, a Bloomington, MN-based integrated managed care delivery and finance system, has incorporated proven Madison Avenue advertising strategies with the latest knowledge about readiness to change to boost program participation among it 800,000 enrolled members.

In three years a single program, the "Call to Change" telephonic counseling service, has grown from ground zero to 60,000 participants. (For more information on the program’s success, see box, p. 8.)

"We’ve our put marketing and health improvement programs in the same part of our organization, while in many others you may find health improvement on the care and delivery side and marketing on the business’ side," explains Ted Wise, MBA, senior vice president for consumer choice, member health and customer initiatives at HealthPartners.

The art and science of behavior change incorporates a strong body of knowledge in marketing, and influencing people to buy things is a behavior change, notes Wise. "So," he reasons, "we can marry the principles and practices of marketing to [those of] health change."

The marketing process is all about putting benefits in front of an audience that they really want, Wise says. "We tell them how to go about doing it; we help them believe they can do it; and we educate them to be able to do it. Getting someone to go forth and do a behavior is the same process as convincing them to pick a product off a store shelf."

Incorporating the stage of change

HealthPartners’ marketing efforts also hinge on determining where the individual is along the spectrum of stages of readiness to change. There are five basic stages, explains Bill Priest, MS, phone line health educator supervisor. They are:

1. Precontemplative: "I won’t."

2. Contemplative: "I should."

3. Preparation: "I will, or I am preparing to."

4. Action: "I am."

5. Maintenance: "I have, and I will continue to."

"We initially attract attention by talking about the health benefits of doing certain things," Wise observes. "We recognize that within our population there are some people who are very interested in nutrition, stopping smoking, or whatever the behavior might be. We just need to capture their attention, and tell them we have materials or services that will help them do what they want to do."

And those messages are wedded around the growing body of knowledge of change. "People are all at different stages," Wise notes. "The intervention you need differs depending on where you are." In other words, he explains, the HealthPartners message has three components: "Here’s the benefit; here’s where you are; [and] here’s what you need."

Laying the foundation

HealthPartners has laid a strong foundation for its interventions through aggressive, creative mass-media marketing. For example, a couple of years ago, a TV spot focused on an individual member and her participation in the Health-Partners walking program at the Mall of America, and the benefits she had derived in terms of controlling her weight, dealing with her arthritis, etc. "It made a celebrity of her; people recognized her all time, and it has led to a three- or four-fold increase in enrollment in our walking program," says Wise.

Research has played an important role as well. For example, HealthPartners wanted to do an anti-smoking campaign aimed at teenagers. Mall-intercept interviews told them that teenagers were not worried about their health, but it did bother them that smoking causes bad breath. "So, we ran an ad with the tag line, When you smoke, your breath stinks,’ Wise says. The program was so successful, it was adopted by local schools.

Phone line a great success

But it’s the telephonic program that has most successful marketing the stages of change strategies. "We offer courses in areas [as] weight management, stress management, smoking cessation, heart health, diabetes, and soon, back health," says Priest. "Our basic premise is to provide the individual with the core information they need to help them make a behavior change."

Employees can choose to take advantage of a specific program, or they may be referred for counseling by their primary physician. At the beginning of the program, they will receive a set of materials on their specific health issue(s). After they read the materials, there will be a follow-up counseling call to identify their stage of change and readiness to change.

How is that stage identified? Priest gives the example of regular exercise. "The American College of Sports Medicine says we should exercise three to five times a week; so, in order for someone to be in the Action’ stage, they should be doing at least that. Once they have done it for longer than six months, we can say they are in Maintenance.’ If they are not yet there, then they are in Pre-contemplation,’ Contemplation,’ or Preparation.’ This is determined by exploring their thought process towards the change."

The same individual may be at different stages for different topics, notes Priest. "They may be in the Action’ stage for exercise, but Contemplation’ or Preparation’ for low-fat eating, or vice versa."

Once these stages have been identified, HealthPartners can deliver the appropriate intervention. "From a marketing perspective, it’s meeting the consumer where they are at in their readiness to change, and helping them progress along the continuum," Priest explains.

The counselor follows up with stage-matched material. "Sometimes the individual will not move forward, but relapse," notes Priest. "We maintain pro-active follow-up to help them progress." The counselor will call the participant weekly for 8-10 weeks, then every other week or month. "There is a lot of room for individuality," Priest says.

Member feedback strengthens program

The HealthPartners marketing program is further bolstered by regular communications to all members. "As an organization, HealthPartners embraces the stage of change model so strongly that we have taken this message directly to members via HealthPartners publications," Priest notes. "Our Discover magazine is an education/marketing piece mailed directly to members three times per year. It will often carry a theme related to a specific disease state or prevention topic. Included are many tools for members to determine their own readiness to change for specific risk factors followed by more detail on the stage of change model as it applies to the risk factor."

All HealthPartners products and services, including the telephonic intervention, are covered by the basic premium payment, so all members have access at no additional charge. The premiums themselves are determined by such variables as the size of the employee population, the segment of the market in which the company participates, and past health cost experience.


Ted Wise, HealthPartners, 8100 Thirty Fourth Ave. S., P.O Box 1309, Minneapolis, MN 55440-1309. Telephone: (612) 883-5367. Fax: (612) 883-5380. World Wide Web: E-mail:

Bill Priest, HealthPartners, 8100 Thirty Fourth Ave. S., P.O Box 1309, Minneapolis, MN 55440-1309. Telephone: (612) 883-7252. E-mail: