Podcast: Brad Greenstein, Principal, Recovery Associates

Transcript

Brian Erickson:
Thanks for joining the Cardwell Beach Recovery Marketing Podcast. My name is Brian Erickson, Chief Strategy Officer and partner at Cardwell Beach. In this series, we’re interviewing senior marketers across industries to develop perspective on what marketing will look like in a post-COVID-19 world. Today’s guest is Brad Greenstein, a partner at Square Medical Group and Principal at Recovery Associates, where he advises behavioral health providers on management, business development and marketing strategy. Brad was also an early employee at Recovery Centers of America. Brad, thank you so much for joining us today.

Brad Greenstein:
My pleasure, Brian. Thanks.

Brian Erickson:
So talking about weathering the storm and it feels like this has been a never-ending storm that we’ve been going through here. So behavioral health providers are considered an essential service during the COVID-19 pandemic, as people close, reopen, close again. And at this time, many Americans are struggling with addiction and mental health challenges for obvious reasons. But at the same time, providers can’t always rely on face-to-face treatment they previously used. So how have you advised your behavioral health clients to adapt to this changing landscape?

Brad Greenstein:
Changing landscape is a great way to put it because even the advice and strategies that organizations were taking right as COVID began have evolved obviously over the last number of months. If you consider the effect of COVID on the behavioral healthcare industry really started probably mid-late March, it’s still going on now. And I think one of the main takeaways that particularly the outpatient providers are facing is they’re realizing that telehealth services alone are not enough. You need to go beyond just providing a technology platform that can offer a virtual visit. And I guess what I mean by that is number one, there’s a number of new tech companies that are coming into the market that are providing pure telehealth services. And when people sign up, they may not necessarily get the same provider each time, the same therapist each time. So providing a consistent presence around who your patients are going to see has become a really important differentiator.

Additionally, there’s a lot of challenges around your drug screening, toxicology that agencies are solving in a variety of different ways. I think they figured out fairly quickly that is a part of treatment, especially outpatient treatment and MET treatment. And lastly, I would say to the extent you’re providing virtualized day treatment, PHP, IOP, the content really needs to be engaging. It can’t just be a televised version of the groups that you used to do. And I’ve talked with some organizations that are doing wildly creative and exciting things to make their IOP programs unique, engaging. And I think that we’ll see the fruits of that for many, many months and years after the COVID epidemic is solved, however it is solved.

Brian Erickson:
It is a different medium, right? The telehealth medium. I mean even being challenged to stay in touch with friends and family exclusively via video call and phone. I mean it’s not the same as sitting in a room with somebody and watching the game, right?

Brad Greenstein:
Yeah, it certainly is. And I think that especially again, on the outpatient side, I’m not sure that telehealth would have been adopted so readily had we not been forced to do it. And now that we are, a recent example, we polled all of our physicians at Square Medical Group. We have a little over 20. Most of them don’t expect that the patients that they’re serving are going to want to come back to in-person services at least regularly, and most of whom would be happy to work from home going forward. And while that sounds obvious, it really isn’t for providers, therapists, clinicians that are used to seeing their patients eye to eye. So for them to adopt this technology so quickly I think has immense consequences for how care is delivered in the future.

Brian Erickson:
I definitely agree that there are some immense consequences on the delivery of care. But I guess on the marketing and outreach side, how have behavioral health providers changed to meet these growing needs for telehealth during the pandemic communications-wise? Have you advised your clients to allocate their budgets differently than prior to COVID-19 as a result?

Brad Greenstein:
Like with any other marketing conversation, it really needs to start with the product and what you’re delivering and how you’re delivering. And then you can take those messages and create a marketing and sales plan. So I think for most of these organizations that are doing well, the very first thing that they decided to do well was protect their staff and their patients. So they came into their next strategic marketing conversation with concrete plans on this is our COVID operating plan, this is how we’re going to keep people safe. This is how we’re going to deploy resources to make sure that happens. This is how we’re going to invest in technology.

And then those organizations can tell those stories, particularly on the organizations that are serving local communities just getting the message out that you’re open for business, seeing patients, whether it’s virtually or in-person or some combination of the two. A lot of referral sources, insurance plans, states, they don’t know who’s open, who’s not open, what hours they’re open, how they’re operating under these conditions. So just being very clear around those things has had a good effect for companies that came in with a strong message around that.

Brian Erickson:
Yeah. Just even having that disaster response plan in place. And I know that Samsung and whatnot have templates and formats. And is it mandated? Is it a state requirement in many places to have that plan in place?

Brad Greenstein:
Yeah. Most, if not all, states would certainly have that at the local state level licensing. Any organization that is Joint Commission accredited knows for sure how much those organizations require around emergency planning, disaster management, et cetera. But also most of the states during COVID have issued pretty valuable guidance to their providers. I live in the Boston area and Massachusetts has really done a fantastic job of educating providers around not just the statewide reopening plan, but also providing guidance to outpatient and inpatient providers on how best to adjust to the realities that COVID brought. There has been a lot of waivers, as you know, federally and the state level to allow for easier delivery of care.

And I think going back to the marketing and sales piece, the organizations that have been able to articulate the strength in which they’re conforming to these guidelines and the care and concern that they have for their staff and patients, have really, at least to me, have shown up as a lot more interesting, inviting and up to date in the times. And then those that have blindly just continued their marketing efforts in a tone deaf way without acknowledging that there’s differences today than there were five months ago. And I think that those that have taken those differences, embraced them and excelled at them, are doing a lot better than those who, like I said, in the tone deaf way, are just continuing on as if nothing has happened.

Brian Erickson:
I’ve seen actually a good amount of that, of just denial. “Yes, everything’s totally normal, come on in.”

Brad Greenstein:
Yes, exactly. Yeah. It’s not a very reassuring message. “Nothing’s changed, we’re still open.” Yeah.

Brian Erickson:
So within the disaster guidelines or plans that you might’ve been privy to working through and seeing, are there communications guidelines in a lot of those? Or is that an area that might go unaddressed in many instances until it needs to be addressed?

Brad Greenstein:
Yeah. I mean there are two. The majority of the communication guidelines tend to be around existing patients, family members, stakeholders and of course, staff, and not so much communication guidelines around the general public. But most of these organizations do have some pretty prescriptive guidance around how to communicate to, again, existing patients, existing staff and the stakeholders that you work with. But in terms of providing communications guidance to the general public, it’s really I think outside the purview of the emergency management type of things.

Brian Erickson:
And obviously, we work heavily within the recovery industry. We also work in other industries. I think one of the things that I was so impressed with is just the response to this crisis. I mean it is a crisis-driven industry, right? On a regular day without a pandemic going on, right? I mean there’s always emergencies that are popping up. But I think the response and planning that I’ve seen across the board has been pretty impressive.

Brad Greenstein:
It is. And I think to highlight one of the things you said in the opening, addiction treatment services are essential services. And the people that work for these facilities are essential workers. And I don’t think we’ve let that register the way that it should, but just like the hospitals that are treating acute COVID patients, we’re treating patients with acute mental health problems, substance use disorder problems. And in this COVID world, those problems have become exacerbated. Everything from just the mental stress of having to live in the current environment with masks and safety, and loved ones that are at risk or maybe getting sick, individuals who have lost their jobs or are at risk of losing their jobs, individuals who are at risk of not being able to pay their mortgage. So there’s been a tremendous amount of additional stress on people for whom there was not a lot of resiliency to begin with. So right now, the addiction treatment industry and the mental health industry is really an important place. And it’s a place that I think we should acknowledge our importance in the larger healthcare system.

Brian Erickson:
Yeah. And I mean you’re already fighting an epidemic and you layered a pandemic on top of it. So it wasn’t like the epidemic went away, it just got multiplied. And additionally even, you have the mental vulnerabilities that are increased by some of the stress. But you also have the physical aspect of potentially a compromised immune system and being a more of an at-risk physical population.

Brad Greenstein:
Yeah. And I think you start to see as successful as telehealth services has been in terms of keeping patients connected and bringing in new patients for whom transportation or other barriers might not have allowed them to access care during this time, you also feel the inadequacy of it when working with some of these patients where in the past, just being in the same room can make a difference for someone in terms of them feeling the support and the efforts that these clinicians that work on the front lines give day in and day out.

Brian Erickson:
So what do you think is going to come next? I know nobody can predict anything that’s been happening in 2020. But I guess how do you envision behavioral health marketing as a whole will change with COVID-19 being a new reality, let’s say, over the next six to 18 months? How do you think that’s going to flow into marketing and communications?

Brad Greenstein:
Certainly, the organizations that benefited the most during this time, and while benefited the most might sound like a not great way to put it, but the organizations that were really in the best position to best serve during this time period had been the ones that are focused on their local communities. It goes without saying that people stopped getting on planes to receive care. And you can question that model in the first place, the so-called flyaway model of people flying across country to receive what’s, for all intents and purposes, medical tourism. But the organizations that have committed themselves to local outreach, local marketing, hyper-local digital search, digital marketing, have reaped the rewards quite frankly.

One of the big changes of course we’re going to see, and no one has a crystal ball on this because unless you work for the federal government or you’re a member of Congress, you might not know where this is going, but there’s been so many waivers over the last three to five months that have allowed clinicians and physicians facilities to see out-of-state patients virtually. We don’t know for how long those waivers are going to be in place. We don’t know for how long some of the prescribing waivers are going to be in place for example. The waving of the Ryan Haight Act, which is used to require a patient seeing a provider at least one time in-person before the issuance of controlled substances for prescriptions virtually. That’s been waived.

It’s opened up markets for providers to see patients over state lines, to see patients in rural areas that would have had to have come in again at least once, if there’s a controlled substance involved in the prescription. That we just don’t know if industry in itself and the regulators are going to say, “You know something? There was so much benefit that we were able to see tangibly during this time that we want to continue these waivers, maybe take a look at the legislation that was prohibiting these behaviors.” Or if they’re going to say, “All right, well time to go back to businesses as usual.” And all of that’s going to have a tremendous effect on who and how you can market your services.

Brian Erickson:
Yeah. Your competitive landscape. I mean there’s a tremendous amount of uncertainty as you lay it out right there, right? I mean are you competing for national business now on a telehealth scale, whether you want to or not, right? Are telehealth providers going to be coming in and competing in your local market? That’s a real consideration. And then how do you adjust your positioning?

Brad Greenstein:
That’s right. And there’s a lot of highly-funded telehealth providers that are coming into the market. And there’s been a number of major acquisitions announced by various health plans that are starting to purchase large telehealth providers. So clearly, they see telehealth as a big part of their future on the payer side. And whether you like it or not, where the payers go, where the providers go, unfortunately, we still live in primarily a fee-for-service world. So the payers really do have a lot of influence on the types of services that are being provided by the organizations and providers out there. So a good crystal ball if you’re looking at it from their perspective, the way they see the future.

Brian Erickson:
So historically, many treatment providers have opted to put all of their eggs in a very small number of marketing baskets, let’s call it. I’m very curious to hear your perspective on any folks that might’ve leaned heavily into the conference and boots on the ground approach previously coming up to this time. And well everybody always in this industry loves PPC, right? And just to hear if you feel that folks will continue to really be super focused on a small number of tactics, or if you see a more diversified approach to reduce and mitigate risks for things that might happen like this in the future.

Brad Greenstein:
What you’re definitely seeing are organizations that relied a lot on what I’d call community relations and in-person relationships, whether that’s attending regional or national conferences or attending lunch and learns or hosting their own events. A lot of organizations have actually gotten really creative around how to continue doing that in a post-COVID-world. I’ve seen tons of virtual open houses. So you’re starting to see people figure out a way to keep that in-person-ness together without having to take the health risks of actually having a number of people altogether at the same time. So it has been interesting to see how people have adapted to all of that. But I think in general, the organizations that have always relied primarily on one form of marketing or another have always been disadvantaged in one way or another, whether they’ve known it or not. And hopefully, COVID will provide opportunities for those organizations to see that a more diversified strategy is likely a more sustainable strategy.

Brian Erickson:
So I think another factor that’s at play here, and maybe hasn’t fully materialized yet, but the unemployment rate is much higher than it’s been in any recent history, whatever the actual numbers are. And regardless of what’s being propped up by stimulus temporarily is how will this be a bigger factor as it relates to people losing their health benefits? Will high-end, mid-tier, lower-end facilities be affected more or less by this trend? What segments of the market a treatment program-wise will have to adapt and revise their approach?

Brad Greenstein:
The high unemployment always correlates with people losing their health insurance. And if those individuals are lucky and live in a state that has a relatively robust Medicaid program, they might be able to fall back on that. COBRA is very expensive as I’m sure you know, in many cases prohibitively expensive for families. So organizations that have relied solely on commercial insurance, whether it’s PPO out of network or HMO in network, or a combination of the two, certainly need to be prepared for that scenario where we have mass unemployment. We’ve experienced a little bit of it. I mean we’ve certainly hit record highs in the last four to five months of unemployment, high double digit unemployment rates. And the treatment industry seems to have navigated that somewhat well. But being able to provide services to Medicaid eligible folks and Medicare eligible individuals, certainly an advantage. Any diversified payer source strategy is an advantage.

The out of network providers, I think they’ve always been disproportionately challenged just because of the few number of PPO plans that are being written. But in the current economic climate, you certainly have to be worried about employers looking for ways to save money. And one of those is always taking a look at employee health benefits and seeing if there’s more economical ways to do that. And oftentimes, one of the answers to that is removing some of the plans that are of options to employees, removing some of those PPOs and only offering the lower cost HMOs. So that could become a problem, but that’s a little bit hard to predict. And I think that’s always been a risk factor for out of network only programs,, one they’re likely always have been aware of.

Brian Erickson:
To sum that up, continue to just diversify on all fronts and payer mix is definitely one of those fronts. So I guess to come back a little bit to, call it medical tourism, right? And travel being severely impacted by the pandemic, do you feel it’s smart to stay focused locally or regionally long-term? Or do you think that’s something that folks are still going to travel nationally and that’s going to come back as well?

Brad Greenstein:
There’ll always be an element of travel. And I think that the travel element with respect to substance use disorder treatment has always been this fallacy that you have to get out of your environment in order to put yourself in the best position to recover. And I think that theory has been debunked somewhat. And I think that the smart, sophisticated providers out there, like my former employer RCA, really develop their strategy from day one around serving the local community. I think that’s served them very well and I think it serves all of the other locally-based organizations well during this time. And if it were me and if I were advising a client or if I were expanding my own business through Square, it would always be to focus on our local community and then reach outwards only after we felt like we were addressing the local needs first.

Brian Erickson:
That’s some great advice. So if you had to give one piece of advice to marketers specifically in the industry right now, let’s say for the remainder of 2020 and to ’21, what would you say is something to keep in mind and to keep focused on on the marketing and communications front?

Brad Greenstein:
My message would be, and always has been, it’s really the product first. It’s the quality of the care that you deliver. It’s the way in which you communicate that care that really makes a difference. But it’s very difficult over any reasonable period of time to successfully market and develop a poor clinical program. So if you focus on the quality of the care you deliver, the quality of the staff that you employ, and then you promote that quality, to me that always has been and always will be your greatest strength.

Brian Erickson:
That’s awesome. I definitely agree with that in any industry. So that’s great to hear. Well, Brad, thanks so much for taking the time to talk with me today.

Brad Greenstein:
My pleasure, Brian. Thank you so much for having me.

Brian Erickson:
Awesome. Well, check out Brad Greenstein on social media and if you need some business consulting, especially early-stage treatment programs, Brad is always around to help. This is Brian Erickson with Cardwell Beach and CB Recovery. Thanks again for listening and please make sure to check back for more senior marketers sharing their perspective on what marketing will look like in a post-COVID-19 world.

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