The Costs of Public Healthcare Benefits

Understanding How Healthcare Impacts State Budgets

There is an oft-quoted saying, usually attributed to Otto von Bismarck, the 19th century Prussian leader who became the first Chancellor of the united German Empire, that compares the production of sausage to the process of creating legislation: “It’s better not to see them being made.”

The process can be messy and unappetizing. The end product can amount to an amalgam of disparate contributors and ingredients. And while it might be satisfying when first ingested, there might be some unforeseen side-effects that crop up after the initial passage.

Because many states, including New Jersey, are in the midst of annual State Budget negotiations (with an official deadline of June 30th for passage), interested viewers will have a ringside seat as they get to watch the legislative budget deliberations at their most intense. (Note: Governor Wolf signed Pennsylvania’s FY2019 budget on Friday, June 22, the first on-time budget of his tenure.)

Healthcare Communicators Under Pressure

For healthcare communicators, particularly those who work for public organizations or entities that receive some kind of public healthcare funding, it’s important to appreciate the pressures and influences that often come together during peak budget deliberations.

At a recent meeting of the Health Issues Committee of the Chamber of Commerce of Southern New Jersey, Tom Byrne, Managing Director and Head of Equity Portfolio Management for Byrne Asset Management, provided an overview of the role public healthcare benefits increasingly play in state budget deliberations.

For New Jersey in particular, public healthcare benefits and pensions “are a huge albatross,” said Byrne. That includes the costs of providing healthcare coverage and pension contributions to the many thousands of public employees, including elected officials and their staffs, judges, police, fire and rescue personnel, teachers, superintendents and other personnel throughout New Jersey’s approximately 678 operating public school districts, and more.

Many of these public employees are protected by unions and guaranteed contracts, so there is little incentive for them to agree to shed benefits in the budget deal-making process.

Underfunded Pensions in NJ

One of the key challenges New Jersey budget negotiators face is the past. Over the course of years, budget-negotiators sought to balance the books by underfunding public pension allocations, hoping to make it up at some point in the future when the state’s economic situation became rosier.

Unfortunately, spending on other concerns always seemed to take precedent. As a result, New Jersey faces one of the most dire pension shortfalls in the country. How serious is it? Other states have come out of similar pension problems, but never one this deep, Byrne said.

public healthcare benefits
Tom Byrne, Byrne Asset Management

In March, New Jersey Governor Philip Murphy proposed an allocation of $3.2 billion toward pensions in FY 2019, a 28% increase over last year’s contribution. The proposal noted that this contribution would be larger than the total of all contributions made during the previous administration’s first four years. Even so, it’s only a start to making it whole.

More Funding for Education, Healthcare

In addition, Gov. Murphy proposes increasing state funding for public education, including an expansion of Pre-K and STEM education, Pursuing Tuition-Free Community College, and expanding student aid.

In addition, he has proposed increases in funding for healthcare coverage for low-income citizens, family planning, mental health and addiction services, developmental disabilities services, the Supplemental Nutrition Assistance Program (SNAP) and hospital funding – all worthwhile-sounding investments.

But to arrive at a balanced budget, what’s given out in one area has to be taken back in another – unless the pie is enlarged. That means raising taxes. With New Jersey property owners already paying some of the highest property taxes in the nation, the practicality of continually going back to that well is questionable. An increase in the sales tax is one proposal. Also a “millionaire’s tax” and a proposed fee on carried interest that would focus on Wall Street earnings.

Pushback Expected

Byrne said he expects there to be some discussion about revising public healthcare benefits – incorporating more wellness and in-network programs and requirements as a means to lower overall spending. But such suggestions are only part of the answer, Byrne said.

The fact is, pension and healthcare costs are crowding out a larger and larger share of discretionary spending. And powerful interests with a desire to maintain an existing state program or allotment will be pressuring lawmakers to protect those concerns.

“If you cut eight million dollars from the state budget as a line item, you won’t get eight million thank-you notes from people for saving them a dollar each,” explained Byrne. “But you may upset powerful interests.” That’s something most elected officials try to avoid.

Adding to the uncertainty is the fact that many legislators simply don’t have expertise in public finance, pensions and public healthcare. Byrne said they need to become better educated in order to effect solutions on such complex issues. And soon.

Healthcare will likely be a major component of any solution, but public healthcare reform is not a panacea. There are too many other interconnected variables and links that need to be sorted out before this state budget sausage is fully cooked.

Each year, as annual budget negotiations begin to percolate, healthcare communicators should make the effort to understand how the interests of their organizations line up with pending budget proposals as well as the viewpoints of their allies in the legislature and other influential government officials. Budget negotiations are often referred to as a numbers game. But the number of friendly votes you can count on are often as important as the budgetary numbers themselves.

Juneteenth – America’s Other Independence Day

Patient Experience Relies on Understanding Diverse Perspectives

Americans love their Fourth of July holiday. After all, it’s America’s birthday – the day we traditionally set aside to celebrate the signing of the Declaration of Independence and the establishment of a free nation where “all men are created equal.”

But for many, those hallowed words proved hollow. Hundreds of thousands of slaves throughout the young United States – especially in the South – would need to wait almost another century before their rights to equality were officially recognized.

Another View of History

On July 5, 1852, famed African American abolitionist Frederick Douglass, himself a former slave, delivered an impassioned speech spelling out the irony inherent in the July 4th celebration:

“This Fourth of July is yours, not mine. You may rejoice, I must mourn,” Douglass said. “What, to the American slave, is your Fourth of July? I answer: a day that reveals to him, more than all other days in the year, the gross injustice and cruelty to which he is the constant victim…”

It would take another 13 years, hundreds of thousands of lives, and a Civil War that tore apart the fabric of the American nation before four million African-American slaves would get their own taste of freedom.

Juneteenth – Freedom Reborn

On June 19, 1865, Union General Gordon Granger, military commander of the defeated Confederate state of Texas, read aloud General Order No. 3, telling the populace of Galveston that: “The people of Texas are informed that, in accordance with a proclamation of the United States, all slaves are free.”

Spontaneous celebrations among the newly freed African American population quickly erupted across the South as Juneteenth was born. African-American communities across the U.S. soon adopted Juneteenth as their own holiday, using it as an occasion for celebrating freedom with public events, picnics and church gatherings.

Understanding Leads to Compassion

Once we understand the history of Juneteenth and how it came into being, it’s easier to appreciate why many African Americans consider Juneteenth to be a day to celebrate not only the vision of freedom President Lincoln described in his 1863 Emancipation Proclamation but also the original promise of the Declaration of Independence.

Since our childhood, we’ve been told that America is a melting pot, comprised of people from all over the world, representing a multitude of religious backgrounds, races, cultures, customs, languages and lifestyles.

Healthcare providers face the everyday challenge of understanding how these differentiating factors may affect individuals’ or families’ attitudes toward illness, pain, coping and death. It is important to appreciate why these attitudes are held, because they can significantly influence their willingness to explore various treatment options. Hospice, in particular, can be an especially touchy discussion topic.

For example, according to statistics, African-Americans comprise approximately 12% of the U.S. population, but they make up only 7.6% of hospice patients. Ironically, African-Americans have a disproportionately higher rate of cancer and heart disease, which are among the top hospice diagnoses.

Researchers point out several reasons for this incongruity. As a rule, African-American families tend to be less trustful of the American healthcare system. In addition, because medical decisions tend to be made within the family, there may be a reluctance to consult with a new, unknown healthcare professional or someone outside the home. Finally, statistically speaking, African Americans tend to be especially reluctant to cease life-prolonging procedures such as tube feeding, organ donation, and palliative care in the hospice setting – because extending life is generally seen as something to be preferred.

Honoring Differences

Healthcare communicators need to recognize that their messages may be perceived very differently by diverse audiences and adjust accordingly to ensure positive patient experience.

As the U.S. healthcare system continues to evolve to one that is more population health-oriented and patient-centered, there is a growing need for healthcare providers to educate patients, families and the general public about what they can do to stay healthier, as well as the nature of specific healthcare challenges and treatment options.

Understanding their emotions, how they think, and the reasons behind these different perspectives is vital to helping patients and families make treatment decisions that are most appropriate for their individual situations.

It’s not unlike coming to appreciate the Juneteenth holiday. The better we understand the history and background of our patients, the better we can understand and honor the views and emotions that influence their decisions and actions.

Showcase Earned Media to Demonstrate Your Prowess

Attractively Merchandised Results Can Enhance Client Relationships

As healthcare communicators, one of our primary goals is to deliver high quality deliverables for our clients (or employers) in terms of earned media results: print, broadcast, online and owned media. In addition to simply informing our clients about terrific results, showing the results in a clean, crisp format and as quickly as possible – ideally before they happen to see it themselves – is a powerful way to demonstrate our effectiveness and professionalism while enhancing the client’s brand reputation.

The fact that we are able to achieve noteworthy placements and are willing to make the extra effort to keep our clients informed are critical aspects of any client relationship, and our client’s reputation management. We are continuously reminded that healthcare (and healthcare communications) is a competitive business, so we need to appreciate the urgency of demonstrating proven results – for our own benefit, but also for that of our clients.

Here are some helpful hints to keep in mind when merchandising an earned media result.

In any merchandising effort, one needs to be cognizant of copyright restrictions. For a comprehensive discussion of what is allowed and not allowed, you can peruse the U.S. Copyright Office’s Fair Use Index. Generally speaking, it is illegal to reproduce copyrighted material in its entirety for print, online or broadcast use without the express written permission of the copyright owner.

That said, there is also a doctrine of “fair use” that has developed over the years as a result of various court decisions (See section 107 of the copyright law). Even so, the distinction between fair use and infringement is not always clear and/or easily defined. There is no specific number of words, lines, or notes that may be used safely without permission. Citing the source of the copyrighted material does not substitute for obtaining permission.

Best bet – be selective in what you choose to reproduce. Try to provide a sense of how the story appears in the paper, on TV, or online, and what makes it significant. If the story appears online, provide a link to give the reader/client the opportunity to enjoy the full impact of the story.


For print placements, scanning the article as a JPEG is a practical way to show what it looks like in “real life.” You can use Photoshop (or Word’s “Format Picture” option) to maximize the quality by lightening the background (newsprint generally appears grayish) and adjusting the contrast to minimize any “dirty” background when the article is presented. The photo can then be copied into a Word document for further editing.

Again, be aware of copyright restrictions. Rather than showing the entire article, strategically use enough of it so the reader can quickly get a taste of it. Provide a summary of the story that hits the highlights that are most important to your client. Then link to the full piece on the publication’s website. Make sure the media source and date are prominent, and if possible, provide information about the total circulation, audience, or other key demographics.


Online earned media results can be handled in much the same way. The idea is to provide an overview of the story and its visual significance, along with a link to the story itself.  Whenever practical, we try to reflect the way the story appears online.


Broadcast stories can be tricky to merchandise. Again, the goal should be to give a sense of the story and what it’s about. Keep it to one page. If possible, perhaps insert a handful of screenshots from the broadcast video and laid in an attractive way that help to succinctly tell the story. Make sure to identify the station airing the story, the affiliate, the name/time of the show, the date, and, if possible, the audience reach.

Ideally, merchandising efforts will reflect the same high-quality attention and consideration that goes into achieving the earned media placement itself.  Merchandised placements should be powerfully presented, well laid-out, and legible so stories, dates and media sources are clearly discernible.

Make sure it’s legal. Make it interesting. And most importantly, make it attractive and enjoyable to read.


Your Content Marketing Should Advertise For You

Emotional Appeals, Useful Information Will Help Build Loyalty

There are many avenues to turning consumers into patients, but one of the best is to connect with them through your digital content marketing program. Reaching them on the platforms they frequent, and providing both useful information and content that resonates emotionally can support your organization’s business strategy while building loyalty. Simply put, creating content that does your advertising for you is smart brand strategy.

A recent NESHCO (New England Society for Healthcare Communications) webinar, presented by digital strategists with S/P/M Marketing & Communications, peeled back the layers of a successful content marketing campaign. Like everything else when it comes to crafting a marketing campaign, research, planning and honing your strategy are vital first steps.

Content Strategy vs. Content Marketing

Before launching your content marketing activities, devise your strategy. It was noted that content strategy is based on your research-driven internal communications foundation, and represents your vision and mission. Content marketing, on the other hand, is focused on external communications, should drive consumer engagement, and puts a premium on measurement and analytics. Out of your strategy will come a long-term plan that aligns with your business goals, and  better understanding of what kinds of content will work best for the organization.

Important questions to answer include:

  • What are our goals?
  • Who makes up our target audience?
  • Where to they like to get their content?

Don’t worry about being on all or even most of the the big social media channels; identify those where your audiences are and which will work the best for achieving your goals, and focus on them.

 Content “Buckets” and Mapping the Consumer Journey

It’s helpful during planning to create three or more “buckets” in which to put content. Typically, these would include:

  • Utility – Useful/actionable information that makes life better or easier, presented in an easily digestible way, including factoids and infographics.
  • Emotion – Content that triggers an emotional response.
  • Entertainment – Content that entertains in a clever, humorous or attention-grabbing way.

Under each bucket you’ll ultimately come up with content topics, and, under them, what the presenters called “content franchises.” A content franchise is a series of like-themed posts that prove successful, like patient stories, testimonials, or “expert tips.”

The strategic use of your content franchises will help you shepherd your audience from passive consumers to brand advocates. This consumer journey comprises Awareness, Consideration, Decision, Loyalty, and finally Advocacy.

Public relations, paid advertising, SEO, owned media (including your website), boosted content and word of mouth all play a role in this evolution, but valuable content is the throughline cutting across all of the phases. Compelling testimonials, for example, can move someone from consideration to decision. Powerful patient success stories can build loyalty, as people want content that validates their decision.

Here are some other tips to keep in mind for a successful content marketing campaign:

  • Repurposing a single piece of content for various digital assets can extend its shelf life, but planning for that upfront is key, so you don’t have to retrofit.
  • Use editorial calendars to plan content well in advance.
  • Determine your “voice” (conversational, authoritative, friendly, etc.) and stick with it. Consistency in voice, tone, and style across all your content is very important.
  • Make sure your website is optimized for mobile. Mobile users surpassed desktop users two years ago.
  • Incorporate SEO in your content strategy. Content will impact your SEO, and vice versa.
  • Authentic imagery works better for building connections than stock art.
  • When using video, keep it short (under 90 seconds), and showcase emotion or a service that differentiates your organization.

Creating a content marketing campaign requires legwork up front, and ongoing diligence to ensure your messages support your business goals and are being received. But the payoff both in patient converts and your organization’s reputation is well worth it.