Full episode transcript.

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Kris (00:01.074)

Hello and welcome everyone to the NoNormal Show brought to you by BPD. This is where we leave all things status quo, traditional, old school and boring in the dust and celebrate the new, the powerful, the innovative, the future, all related to how brands can lead the way in health. I am Chris Wickline. am the SVP of strategy at BPD and I'll be your host for today. And in this episode, I'm joined by my two co -hosts Desiree Duncan

VP of Health Equity and Inclusion and Stephanie Weirwill of EVP of Engagement. my gosh, Des, it's been a while since we've all been together. How are

Desiree Duncan (00:41.454)

I'm doing well, living my best life, biking all over Chicago. How are you? Stephanie, the three of us, we're

Stephanie Wierwille (00:48.433)

But we're all back together again and Chris is hosting. I'm super excited for this. This is great already, Chris. Happy to be

Kris (00:55.446)

God, it's nice to see you. I think it's literally been months since we've been together. We've been ships passing in the no normal website.

Stephanie Wierwille (01:06.077)

That's right. There's been lots of fun stuff happening here at BPD that have kept us really busy. So I think we've done a lot of sidebar episodes, but the official crew is here, ready to go on a really important

Kris (01:17.668)

Yes, and that important topic is we're gonna be talking about some of the unique challenges facing rural health consumers and what it means for those of you who are trying to reach and serve them. So I'm excited about this conversation because I think we all have a lot of personal experience and also a lot of passion around it, but perhaps we should just maybe set the stage a little bit for kind of how we're thinking about this.

No surprise, it is a really tough time in healthcare. Is that surprising to you, Desiree or Stephanie?

Desiree Duncan (01:53.6)

No, it's the chaos, it's the life that we live.

Kris (01:56.72)

It's the chaos, but for all of that chaos, and it's kind of the ethos of the whole idea of no normal, for all of that chaos, there is opportunity. And that's what we're gonna talk a little bit about today, the opportunity that we see in rural healthcare. So consumers in general, of course, as we know, are feeling the challenges of healthcare. And they're all the same things that we've been talking about for some time and that have been exacerbated in the post -COVID years.

And it's sometimes I think easy as you know, we are in healthcare day to day and so are the clients that we work with to accept some of these things and just feel like, God, it's overwhelming and it's kind of helpless, right? But what are those things that we see consumers getting really kind of frustrated about at a level that I don't think we've ever seen before? So things like access and wait times, which of course are a function of workforce shortages

consumer frustration with affordability, things like insurance, inflation, and some of the financial pressures people are feeling day to day. Of course, in general, we're seeing chronic conditions and health issues become more significant across the country. And then things of course like mental health and the impact of physical wellbeing.

And all of these things impact rural populations at a much more significant level. And I think, and in various episodes, we've shared some of our perspectives and I think we've kicked it around the agency. I know the three of us have specifically talked about it. It feels like that consumers generally have a much more frustrated feeling toward healthcare in general with a lot of those factors coming together. So what do you think about that, Stephanie, as we tee that up as

backdrop for our convo.

Stephanie Wierwille (03:51.271)

think you summed it up perfectly. mean, these are the issues that have been coming to a head for several years now, but they're really hot right now. I mean, I think of course the economy is the number one topic in the news and the headlines of the election. And that affects healthcare significantly because as we saw a couple of years ago, people put off care when they can't afford it. And what does that lead to? It leads to increased...

know, sickness and issues that are just even worse than they could have been if folks got care. I think the other one, which is a whole sidebar topic, is the increase of chronic conditions, which is just, the stats are just absolutely mind -numbing. And we'll get into some of those in regards to rural care. But, you know, this year it feels tougher than ever regarding people's day -to -day healthcare needs.

Kris (04:43.336)

Yeah, and Des, what do you have to add to that? Do you have any added thoughts? Because I know that we've had the opportunity to work on a lot of clients together where we've seen some things and you've personally done some research digging into this as

Desiree Duncan (04:55.01)

Yeah, mean, there's not a lot of things at play. But I think about just that sense of just that reputation and how people perceive actually more so perception of the brands that are out there, who's out there, what kind of experience, the fact that they're talking to each other. I don't know, just more about what the kind of consumers are doing to share more info about what they're experiencing.

Stephanie Wierwille (05:23.483)

Does you make a really interesting connection there, which we'll get into more about perception and brand reputation. But I think, you know, we'll put our consumer hat on for a second. These macro issues that you just threw out, Chris, a lot of those are issues that are happening because of a variety of societal and political factors and cultural factors and all these things coming together. But when I'm, you know, average average Joe public, I guess, as we like to say, consumer, I'm going to blame my local health care organization.

I'm gonna maybe blame my local hospital, my local doctor for things like wait times, not realizing that it's a much larger issue that's really complex to be solved. So as we think about rural healthcare today, I think that's an interesting connection is, know, it's what can healthcare organizations and brands do? What can we control and not control given the macro environment?

Kris (06:16.958)

Yeah, and I mean, again, the challenges are real everywhere, but felt even more so in rural areas because all the things that we've talked about are even more pressured, right? Fewer providers, people having to travel longer distances, meaning even longer wait times. Again, financial pressures because poverty levels are higher in rural areas, that's a fact. Chronic conditions and comorbidities are higher in rural areas. Aging populations, I mean,

all of those dynamics come to a head, right? And people are feeling urgent. And again, the general dynamic, it's feeling like it's kind of coming down on them. So I think it's right, Stephanie. And that's where I think we see some of the things that we'll talk about in a little bit in terms of the opportunity, right? It's really what can we as healthcare and marketers and communicators do to kind of understand where consumers from these areas are coming from and regardless of where we are and how we're trying to help them.

kind of consider that as we reach out and engage them. So I think that's fascinating. let me, know, tell me a little bit about kind of what kind of personal experiences do you have in this environment, whether it was here, you know, professionally at our work at BPD or in your own personal lives.

Stephanie Wierwille (07:36.679)

Yeah, I'm happy to jump in. So I think I have maybe two eras of my life where I've been either living in or tangentially in or near rural areas. I think I'll just share some of these stories and maybe we can go back and talk about the stats as well, because what's interesting is we started comparing and combining our stories we realized and just connected it back to the stats that the majority

of Americans have had some kind of experience in these areas. And actually there's a lot more folks in rural areas than we think. But back to my story, I grew up in East Tennessee. So in a small town that is surrounded by very, very, very small towns. And it's about 45 minutes to the closest academic medical center. So not terribly far.

But in terms of healthcare, there's really one local hospital in the area, which folks from the surrounding rural counties come into as well. And so, you know, just from a healthcare standpoint, it was sort of an interesting landscape of if you were really, really had a complex issue, you would drive to your AMC, which is could be 45 minutes, hour, hour and half, two hours in some cases.

But for the most part, your local emergency department might be anywhere from 30 to 45 plus minutes. Now, that said, also had an experience. I lived a couple of my summers in very rural Northern Iowa, which was an hour plus drive to the local Walmart and closest grocery store. So that was really rural. It was in the corn fields. It was living on a farm. And the closest

besides the home I was in was a mile down the road, right? So you're in a farm environment and it's not just about living in a local town, you're not even in a town. You're not even as part of a town. So I think there are many shades of rural that we started realizing as we started getting into this discussion.

Kris (09:42.324)

Yeah, I mean, I can definitely relate to that. I I grew up a real kid. my God love my mother. She's like I call her a one percenter. She's like 81 and she's like the one percent of people who are just exceedingly active. And she won't pull her bike out for less than about 20, 25 mile ride. She's crazy. But she also she lives in an area where she's got access to health care, but she doesn't feel really great about it. And, you know, so therefore and there is a critical access hospital.

who I think has done a great job when my family has utilized them. But at the same time, she commits to driving an an hour one way just for a primary care appointment or specialist. And the poor bird, she keeps losing her primary care doc because it's a revolving door. And this gentleman now moved an hour further. So she's gonna start trying to drive two hours just to see the gentleman.

because she really created a relationship with physicians. So the challenge is real and the challenge is definitely felt. I think that we all look at that and we all say, geez, how can we continue to support people despite some of the constraints that we see in the environment? So get that, but Des, you have a little bit different experience. What's on your mind when it comes to

Desiree Duncan (11:07.266)

Yeah, I I grew up in the city, but spent a lot of time in smaller rural communities, like in college and then in more recent years. And I've always been really intrigued by some of these smaller communities. So I know we when you think of rural, you think of like, this town that has like one stop sign and like this general store, what have you. So yes, there's that. But then there's also these kind of micro -political hubs that

have been growing over the last decade or so. I know a lot of folks during the pandemic who had that flexibility to work from wherever and were maybe looking for better cost of living, started to flock to some of the smaller cities, smaller areas. But in the town that I'm thinking of, a lot of this was already starting to happen long before the pandemic. So I'm thinking of just that opportunity that arises. there's like, yes, there's

all of the critical care access issues you have for these really small rural areas. But then there's these hubs that are really actually kind of growing. But despite that, across the board, and when talking to friends and thinking about what hospital offerings and health system offerings that are there, a lot of them, much like what you all have shared, prefer to travel to the other larger cities to get the critical care needs.

They'll take care of any day to day, regular visits, what have you, but if there's something serious, they feel like they just need to go somewhere else. And a lot of this has to do with past bad experiences. Depending on the specialty, the trust differs. Like if ortho might be pretty bad, but their heart care might be really good. Also hearing about just what you had mentioned before, Chris, around the financial struggles and some of the decisions that need to be made to kind of

keep it going. So some of these specialties might be contracted out, like emergency departments might be contracted out. And so it's a completely different entity. And depending on what kind of patient experience they're giving, if it's good, bad, what have you, it doesn't matter. But it affects the overall reputation and experience that folks or perceptions that folks have of the hospital based off of those few times, especially when you're younger and have not as many of the comorbidities.

Desiree Duncan (13:29.816)

you're only going for those emergency moments. And that is a lot of times kind of how people base their loyalty to a system.

Kris (13:39.89)

Yeah, you know that for sure. mean that, you know, and we've talked about this before, I know at different times as well. mean, personal experience is one thing, but again, sometimes those perceptions in smaller areas, you know, have a legacy life of, you know, generations, right? And they're kind of a shared history among families, you know, the perceptions of care providers. And at the same time, it's so fascinating because

even those critical access hospitals. And I know my dad was cared for in a critical access hospital and they did a great job caring for him with the resources that they had. I don't have any complaints about the level of care, but I think the reality is those hospitals are required to keep communities going. mean, without them, healthcare is really the lifeblood of a community, but at the same time, Des, as you mentioned,

people may be reluctant and when they have any opportunity, sometimes can still want to look beyond and drive further than staying local.

Desiree Duncan (14:43.778)

And I will say there's something that's good to be said about just having that extension to maybe even the larger hospitals and that triage, that experience. Like when something happens, you need to get some work quickly and either they can take care of it there or they have a really great system for triaging it and you too, another specialist. But I know that in some of those emergencies where you just, you have to go to this place that you would have never expected yourself to.

but that you're also, there's that opportunity to be surprised by the quality of care. Because you think about a small hospital, you just kind of instantly write it off. But then when push comes to shove and you're just really in that deep need of care, and they actually come through, that really has an opportunity to kind of shift the perception. And how do you get more of those stories out

Stephanie Wierwille (15:37.735)

Yeah, and I think the other factor here is the key factor of relationships. Like in many areas, healthcare is the local health system or hospital is the largest provider of jobs in that area. I mean, that's a very, very common thing.

If there is a hospital nearby, then you know someone who works there, or you know someone who's been there as a patient, or you've had a baby there, or you've been born there. All of that relationship factor plays in. Then I think getting even down to the smaller towns and areas, the family practice is so key. And that's where a lot of this access issue is coming from is, as Chris, you mentioned with your experience and your family's experience, the primary care providers kind of dwindling

more and folks aging out of being a PCP or moving to another industry or moving out of the area. that sort of just puts even more strains on access.

Kris (16:37.406)

I mean, and that is just, I mean, that is so tough and we get it, we understand it. I mean, within healthcare, right? If we can't keep providers, we can't keep providers and we're doing our best to keep them. We're doing the best to recruit, retain. I think at least the key thing is if you get above all of it, the whys and the what fors, the idea is that people are still seeking that relationship that you two have both touched

So the question becomes, you know, as marketers, I think, my goodness, we have the opportunity and that's one of the key things that we do is we have the ability to foster connection and relationships. So to me, it still comes down to kind of, you know, how do we help people feel that despite whatever, despite whether it's a care transition within a system, despite whether it's a handoff to a partner system that, you know, that, that we might partner with on another specialty. I mean, I think those are just great examples

you know, how are we thoughtful in those circumstances to engage consumers and make them

Stephanie Wierwille (17:36.219)

Yeah, and I might just throw out, you know, just a starting place here, which is in discussing and prepping for this episode, you know, we discussed a few of the stats and I think while they're not surprising, they're still good to be reminded of. So I'll just read a few of them out because I think the first thing for healthcare marketers to be thinking about whether you serve a rural health system or you don't, either way, it's helpful to think about the context here. And

80 % of rural America is medically underserved. And it's because of all the factors we've been talking about, but 80 % is key. Now take that stat and put it in a context of this next one, which is nearly 20 % of the American population live in rural areas. So 46 million Americans, a pretty large percent of the population, 20%, is in what is defined as a classically rural area. Now that's not even considering the things that we're talking about that are sort of in the shades of gray here, right? Like the micropolitan areas.

So 80 % of 20 % is medically underserved. no. Yikes. And the population has increased since the pandemic as folks have kind of shifted where they live and the aging up has continued to happen. And add on that that rural residents live two years less in terms of lifespan and longevity than those in metropolitan areas. So what we haven't really even dug super deep on is all the other factors here that

beyond, you we've talked a lot about access, but there's a lot of factors like food deserts and just, you know, health literacy and quality of life. And as you touched on earlier, Chris, you know, high incidence of chronic conditions, including heart disease and cancer and strokes. And so I guess I just start there to say, keep these stats in front of you on a day to day basis. I think that's a good place to start. And secondly, how do we, you know, as marketers always have our ethnography hat on?

and know the people around us, whether we serve a metropolitan or a micropolitan or a rural area, what are you doing as a marketer to get out in every single one of those places and talk to

Kris (19:42.292)

Yeah, no, I think that's great observation, Des, you were gonna jump

Desiree Duncan (19:47.564)

Yeah, kind of tying that into, you know, with these communities, you know, lot of folks know each other. They've grown up together. They talk, like you just mentioned, a lot of folks work there. And so there is that opportunity for these employees, these colleagues to be that ambassador, that mouthpiece for you. But that also connects to when you think about what people talk or complain about the most, a lot of times it does have to do with the patient experience. Sometimes it is the care.

A lot of times it is a care, for the most part, they're talking about what was the actual experience. So how can we grow from within is what I know a lot of rural hospitals are looking at, of how do we grow our staff? And that also because there is such a deep, knitted community, there is that opportunity

those clinicians that come to town to kind of make a name for themselves, to really get involved. Like for example, I know that there was a urologist that was highly involved in various community groups. And because of the work that I did, I was always kind of had the pulse of what was going on and I would meet him. it's all about the relationships as you all had said before. And it's because of, if there are those folks that you have built a connection with or seen them out in the community,

it might give you that second pause of like, actually, maybe I will consider going to this hospital. But again, it ties into that, where are you showing up in the community? Like where are you, Stephanie mentioned, like how are you understanding how people are experiencing you and then making and then implementing those changes, but then also where are you showing up, especially beyond ads?

Kris (21:30.334)

I mean, I think that's so fascinating because I know we've had many conversations with clients around, you know, how, you know, older physicians have unders, you know, and making some sweeping generalizations, but older physicians by and large, you know, a lot of even specialists, right? Their referrals were based on relationships that they had, relationships within the community and others. And that younger generations of doctors and oftentimes many employed doctors,

haven't had to work that hard. And again, this is just a generalization, but haven't had to work so significantly in building those relationships as a path to referral. So it might not quite seem as natural, yet in rural areas, relationships are everything. I mean, I remember when my dad was in the hospital, you're a so and so, you're a Johnson, are you related to, right? And it's like everybody, that's no such thing as six degrees of separations, maybe two at max.

when you see those relationships, right, you're also extending your presence in the community. Because I think that's the other dynamic we often talk about is that everybody's an insider, like it or not, right? Everybody in a small community is an insider because as Stephanie mentioned, you know, in most rural communities, hospitals are the single largest employer in the area and even in some good size regional communities. you know, it's so critical

there's some understanding of that connection

Desiree Duncan (23:00.982)

And also as people have been shifting and may continue shifting or looking for like smaller communities to live in, know, connecting with those new folks that might not have been succumb to the past histories, reputations or stories. Like I almost think like get to them first in a way, not that you all have bad reputations, but that opportunity to connect like right out the gate, especially once they're moving there, they're looking to find

a new doctor, a new pediatrician, what have you for their families or themselves. Those are those opportunities for you to show up and create a new memory for a community

Kris (23:41.918)

Yeah. What else, Stephanie? Any, do you have any other thoughts kind of on, you know, some of the important things to consider as we think about consumers?

Stephanie Wierwille (23:50.873)

Yeah, I think that it is to show up in the community as a brand and do something for the community. To me, that is key. And that's not just true of rural. That's true of suburban areas and metropolitan areas and micropolitan. I mean, that's just probably a good practice in general. But I think about, you know, if I put myself back in the shoes of East Tennessee, and again, there are many different shades of those communities, right? We've talked about that a

But there's a lot of different things that matter from community to community. So step one is knowing them. I think step two is what are you doing for them? So I'll give y 'all a little test, and this is just from my vantage point, but what brand or organization or, I'll just use the word brand, I suppose. Des, know East Tennessee pretty well. What do you think would be a beloved brand in that area?

Desiree Duncan (24:45.402)

I, Mastercraft just came to mind. Just because I've never been in the works there. And probably mostly in Oxford I would think about the university, like UT as a brand.

Stephanie Wierwille (24:48.953)

Okay.

Stephanie Wierwille (24:56.657)

Yeah, yeah, definitely the university. But you know, I'm thinking there's, you know, the local Mayfield, there's, but then here's one is Dolly Parton, right? So I was just, yes, the patron saint of East Tennessee. So her brands, plurals, are all over the place, but she is a brand. The reason why in that area, at least, she's a national global treasure, but in that area why she's so beloved is because she's done so much for the community.

Desiree Duncan (25:07.484)

our patron saint.

Stephanie Wierwille (25:25.765)

I mean, she's given scholarships, she's created improved literacy through her imagination library, she's created many jobs. So no, we don't all have Dolly Parton size budget. That's not what I'm saying here. But I'm just saying the best way to create authentic connection is to get out and do something, go beyond advertising. And a lot of health systems, this is part of who you are. You're out in the communities, you're improving health.

Maybe you have partnerships with schools or local sports leagues or whatever it is, and are certainly talking about your internal relations and jobs. I just think that's the best and most authentic way to show up, no matter the size of the community.

Kris (26:08.584)

I mean, I think that's awesome. And I think, know, I bet the responses, but we do all that stuff, right? But guess what? A lot of times, what is it? We do all that stuff. We do the sponsorships and we show up with a logo on a banner and, you know, and we're done, right?

Stephanie Wierwille (26:21.893)

Right, exactly, exactly. Because the best, so how do you promote the fact that you partner with schools? It's not an ad on the side of the road, although that might be part of it. But what are the bigger stories you can tell? I mean, again, if I think about, you know, the lovely Dolly Parton, there are no ads, there's no communication promoting the Imagination Library. It's the fact that every single kid who grows up in that area gets a book once a month. That is the promotion. And

And so how can you do that on a smaller budget? How can you do, you know, what are the scalable ways to make that type of difference that people never

Kris (27:01.564)

No, I love that. Again, that whole adage of people remember how you made them feel, right? And those activities are way more than a logo. It's actually kind of what kind of authentic connection did that create with the community? That's great. Des, any other thoughts or examples from your point of

Desiree Duncan (27:26.303)

Yeah, guess I think about the, and this might not have to connect directly to like rural in a way, but some of the fastest growing smaller communities have been in the South, right? And that's where there are the larger populations of black and brown folks, but especially black Americans.

And as we, not to get political or anything like that, I'm just stating kind of what we're seeing. I think I've always kind of said like, there is an opportunity for hospitals, health systems to connect to black Greek organizations as a way of connecting more with this growing population, right? And we're seeing, we're going to see more of this with the vice president.

Kamala Harris and her connection with the the AKAs, right? I feel like this is a little bit of prediction, but I feel like more people will become to know that opportunity of where these large Greek organizations, that opportunity to connect directly to a community. I know this is like completely like off topic, but just look more for where you can have an authentic connection other than just that that brand at the festival that

Stephanie Wierwille (28:46.846)

Yeah, what I love about that, guys, is it's the affinity groups. What are the affinity groups that people are really leaned into in the area? And they are vast and there are many. And maybe it's faith -based groups, maybe it's sports -based groups, maybe it's, to your point, Greek life. It could be all varieties. And I love just thinking about

That goes back to my earlier note, which is step one, understand the population, their interests, what keeps them up at night, what makes them really excited to get out of bed, and what groups they're part of. And that's a really good starting place.

Kris (29:29.108)

Yeah, no, I love it because it is all about making an authentic connection. And the authenticity and the connection created with that is again, just so much different than seeing an ad on a billboard or the 40 % of people who may not have an ad blocker up to see a digital ad, right? I mean, these are actual things that people care about. And that's the important thing.

Desiree Duncan (29:53.43)

And one more thing around that, I know we always talk a lot about like the physicians getting out there in the community, but that day to day face that you or a loved one is seeing is the nursing team. And part of me just thought about like, you know, could there be more of a coalition of like supporting your nurses getting out there in the community, that kind of being that public ambassador and understanding the huge role that they play in the care that's delivered there.

Kris (30:20.488)

mean, all of this is about activating your brand, right? Activating your brand and making it real and unique in different ways. again, so special that this couldn't be done at any health system, anywhere, regardless of the market. mean, honestly, these are just the kinds of things you could all be doing to connect, but in those rural areas, even more important. So I think,

Stephanie Wierwille (30:41.659)

Yeah. Can I offer one don't? I have a, we've given some dos. I have a don't and that is don't slice your budget so far to do so many things that nothing actually works because one of the challenges, let's say that you're a health system and maybe your headquarters is in a metropolitan area, but you have facilities all over and you serve all sizes of communities.

Kris (30:47.186)

Yes.

Stephanie Wierwille (31:12.037)

So, you know, it might seem like, okay, I wanna really market and be super, super local. And there's a time and a place for that. But I think what's key is understand the different populations and their needs so that then you can figure out what are the similarities and now what's the most impactful thing we can do across the board. And then what can we do at each local area that's really authentic? Because it could sound like we're recommending sponsor a bunch of groups and...

you know, do all kinds of different advertising. And I think that's just not possible with today's marketing budgets. So I think I just wanted to make it clear. We're not saying slice your budget in a thousand ways. Please don't do

Kris (31:51.688)

Yeah, no sage advice as always, Stephanie. So, all right, this has been a great discussion. Let's wrap it up there. I just wanna say thank you so much. It's been lovely to be with you two ladies again. Thank you so much for today. And really appreciate you all being here. If there's something you want us to cover on the NoNormal show, shoot us an email at nonormal at BPD Healthcare.

Make sure you share the show with friends and colleagues and give us a review and rating on iTunes and Spotify. All of that would be appreciated. And until next time, don't ever be satisfied with the normal. Push that no normal y 'all. Talk to you next week. Thank