Episode 30: Northwell Health’s Successful Rebranding with Mr. Ramon Soto

In this episode, John Marchica sits down at the table with Mr. Ramon Soto, Northwell Health’s Chief Marketing and Communications Officer. Mr. Soto came to what was formerly known as the North Shore Long Island Jewish Health System after 7 years of unsuccessful deliberations on how to rebrand the system. In the interview, he touches upon how marketing is much more than “what looks good” and using market analytics as a driver to a more consumer-centric health system.

Interview highlights include:

• The mentality behind Northwell Health’s recent rebranding strategy.
• How Northwell Health learned to market its health system to their consumers, the patients of New York, and to their staff.
• Using storytelling to stand out in the highly competitive market of New York.

John:  Thanks for spending some time with me today. I’m looking forward to our conversation, Ramon.

Ramon:  A pleasure.

John:  To get started, tell me a little bit about your journey that brought you to Northwell today.

Ramon:  Northwell is the largest health system in the New York metro marketplace. It’s grown principally through probably through… I’d say probably 60% acquisition and about 40% organic growth over the years.

It used to be the old “North Shore Long Island Jewish Health System”. And as it’s grown, the reality is it wasn’t very good at telling its story. Even the name—its old name, [*rushes for emphasis*] NorthShoreLongIslandJewish Health System—was a byproduct of an acquisition and integration… Really a political accommodation to get the deal done. The old scientific smush method of jamming two organizations together to come up with one name.

The challenge, our organization was realizing, was that in an era where consumers are more informed than ever and our much more customer-centric marketplace, they didn’t have the tools or vehicles to engage with consumers meaningful way—to tell their story, the value they created, why they should be a destination for health care in the deeper service world. And then in the value-based world that’s emerging as well, how do we take the journey differently?

So I had a conversation with our CEO… Oh, lord, that was probably an eight-month dance. One of the first articulations he had was a vision of how marketing could really be a force multiplier driver of consumer engagement. And I’d never heard anybody speak that way about the need to market differently.

It was very attractive to me and my background. I’m a marketer’s marketer. I was born in the agency world. My first job was with McCann-Erickson. Second job was with Young & Rubicam on Madison Avenue. I learned my big storytelling chops there. [I] integrated accounts, big brand campaigns.  I spent a bunch of time at General Electric where they were just experts leveraging a brand to sell product and service, meet customers’ needs. Then I got introduced to healthcare and spent probably over almost eleven years at Aetna in various roles. Ultimately, I became a Senior Vice President there and ran all their global marketing.

It’s been a great 3 ½ year journey at Northwell bringing those skills here, mapping it with the market need, and building a super strong brand in the new marketplace.

By the way, sorry, for the long-winded response.

John:  No, that’s great. I was going to ask you about your background as well.

You started talking about the rebrand. Is it fair to say that was a consumer-driven process? That [customers were] a major factor in the decision to rebrand? And then if so or if not, what are some of the other factors that were driving that rebranding decision?

Ramon:  That’s a great question.

[When] the organization rebranded. I would say the consumer piece was only a piece of the equation. We had various constituencies that really needed to understand North Shore Long Island Jewish in a different construct. I’ll give you a couple examples.

One, North Short Long Island Jewish Health System: It’s seven words—I would argue mouthful of marbles—but has been very successful institution. It’s grown through organic and inorganic process.

The challenge was, we were somewhat landlocked with the name connotation, but we were expanding fiercely into Manhattan, into Westchester, into Staten Island, into Queens, Brooklyn… where the Long Island connotation of the name really outstripped its utility in being able to tell a story about the healthcare journey and how businesses could partner with that organization.

In addition, it started really impacting physician recruitment. If you’re a doctor in Westchester, why do you want to work for a firm that’s Long Island-based? We were hearing in multiple constituencies, “Hey, this thing is really encumbering our ability to go to the markets successfully.”

Once you laid on top of it the need to speak to consumers very differently, it was very clear that we need to go in a different direction with the brand of the organization.

John:   So it’s—I’m going to get some flak for saying this—but it’s my sense that health systems aren’t intuitively very good marketers–

Ramon:   Yeah.

John:   –and that Northwell, just as an observer, has done a really, really solid job in your approach to the rebrand and how you’re communicating the brand attributes.

That said, how do you differentiate the Northwell brand? You’re in a really competitive market. How do you do that?

Ramon:   Great question. So I’ll add to the incoming flak that’s going to come your way and tell you that, from my perspective, I think healthcare marketing, health system marketing, provider marketing in general is terrible.

It’s probably fifteen years behind the times. It’s not very consumer-centric. It tends to be very either chest-thumping, accolades driven, or I’ve seen a ton of selling hope through fear. You know, “Come to this institution or you’ll die.” And I’m not kidding. I’ve actually read copy that read very similar to that.

We purposely chose not to follow anybody in healthcare.

We looked at very consumer-centric organizations that had principally a digital bias. We benchmarked their go-to-market models and their branding approach. We brought in experts from Interbrand and Monigle to help us along our journey. To figure out how consumers make decisions and building a relationship with the health system. Literally did quantitative qualitative analysis.

The quan stuff, we talked with over 3,000 consumers in the New York marketplace and did a drivers analysis that was discrete choice based. We could rank order the importance of different attributes and capabilities that an organization [needed] to build a relationship. And then in the storytelling piece, we strove to move as far away from healthcare as possible.

Interesting enough, Amazon was one of our principal models that we looked to, to understand how they talk about their journey with consumers. Think of the commodities industry that they’re in and how they changed the game on both interacting with consumers and showing their value.

That long story kind of truncates down to a value proposition that’s based on innovation at its core.

By the way, that’s not unique in and of itself in healthcare. But, we found, particularly in New York market, it was the number one attribute that consumers were looking towards to build a relationship. So they’re hoping for better outcomes, right?

Interestingly… Nationally, it’s typically: best doctors, latest procedures. In the New York market. It’s actually innovation, best doctors, latest procedures, in that order, in terms of relationship building. And those are important elements of our storytelling.

Then the question was, how do you do that? How do you tell the story in unique and compelling way? So we go for very heavy digital bias in what we do.

Everyday there’s 175 million searches that occur for health-related terms online. That’s a crazy number. There’s only 320 million people in the United States. So consumers are searching multiple times. Consumerism is here. They’re self-educating. They’re walking into physicians practices more educated than ever. We have to be where they are in terms of that consumption and tell our story in a very relevant fashion.

Then, we really try to change the mechanics of delivering that story. So a very optimistic view of who we are and what our relationship could be. Our messaging is almost populist.

It is, “We’re the health system for the everyday person.” We don’t try to be elitist in any of our messaging. We try to be incredibly accessible with how we brand ourselves. And by the way, that’s populist in the best sense of the word.

Even the graphic look and treatment… We wanted our stuff, our content, to be incredibly arresting, but visually look very different. So we use this parallax affect filming technique in how we developed commercials and put them out in the marketplace.

And then we do incredibly rigorous testing. I monitor a panel of 2,000 consumers each month—where they are in healthcare thinking. We copy test everything. We do head-to-head testing of our ads versus our competitors ads versus other ads in other industries just to make sure we’re having that right balance of tone and telling this breakthrough, compelling story.

The results speak for themselves. We’re at historic highs in terms of awareness. We hover at about 50% market awareness. It’s probably close to 3 times my next-nearest competitor in terms of overall awareness in the marketplace. We think that’s a function of breakthrough messaging and how we message.

My “Likelihood to Recommend” scores are in the high 90s. That’s from a low 80s standpoint when we started. Our net promoter score for tertiary care centers in the 45-47% range. Brand perception is super solid. So we’re in a good place in terms of the overall brand of the organization.

John:  Do you think one of the things that distinguishes you as a marketer is your relentless focus on these metrics?

I talked to a fair number of marketers in your position and I don’t hear them using the same language that you’re using. Do you think that it’s important to measure everything that you do or to measure some specific attributes on an ongoing basis?

Ramon:   I think if you’re not a steward… if you don’t know your customer, if you don’t know how your customer thinks, if you don’t know what your customer thinks of you—and notice that I’m purposely using the word customer, not patient—you’re doing yourself and your organization a disservice.

The reality is, we have to sit at the table of our leadership team and we have to show them how to use the marketing discipline to advance the growth goals of the organization.

It’s no longer in era where… [In the past,] marketing was the place where content went to go get some lipstick put on it and make it look pretty.

[Nowadays,] we have to be a strategic partner to the organization. Do you understand the growth goals? You understand how an organization makes money? Do you understand the implications of payer mix? Do you understand what differentiates your institution from others? Do you understand consumer perception of your organization? Do you measure that over time?

But by the way, those are table stakes. Marketing done well is done exactly that way in other industries.

I think this is where we arc back to my original comment where health care’s about fifteen years behind the time… Where administrative wanted something to look good, so they threw it out there and stuff looked pretty.

We spend too much on it now, and it’s too important when fighting for market share is occurring on a fierce basis. It’s a knife fight out there every day.

How do you maintain your ability to grab that market share and position your institution as a destination healthcare facility? You have to have the right mindset, the right skill set.

And frankly, I’m more change agent than I am marketer because most health systems don’t understand the value of it. So I need to be educating. I need to be espousing, to be evangelizing what the right direction is.

And how do you fight opinion? You fight opinion with data. Right? Every clinician is a super smart person. They have their own body of experience on what works. Well, that’s intuition based or business experience based, but you can steer that in a different direction—and oftentimes a very positive direction—with the right information to guide them.

And that [information is] understanding your customers.

What makes them tick? What makes them work? How your content performs in front of them and are where your competitors going. It’s really… this industry putting his big boy pants on, saying, “Okay, we’re going to do this and I’m gonna do it well, but we’re going to do it for real.”

I’m optimistic. I sit with a number of my CMO peers across the US and I see many of them moving in the same direction because that’s where the business needs them to be.

John:    I was just thinking of something this reminds me of. I used to give talk years ago called Trust-Based Marketing… I believe that at the core of every brand or at the at least part of it is trust, right? I mean, people buy from people they like, and people they trust.

I remember at the time giving talk using pharmaceutical companies as an example. Some of the behaviors that representatives would do, I would say, “Is this building trust with physicians or is it taking away trust?”

So, I’m curious about your thoughts of the role of trust, and if you agree if there are things that you do that as an organization that helps foster trust in your consumers.

Ramon:  I’m going to answer that a little bit different way. I think trust is a super important ingredient, and it’s going to be a component of what I offer, from a content standpoint to consumers, but I think the payoff on that is the experience.

I work very, very closely with our chief experience officer to make sure I’m not over-promising. Like, if I say you’re going to experience something here, are you going to? Is it authentic? Does it ring true?

There’s a case study in marketing. If you went to business school, you probably read it. I can’t remember who the beer brand was, but—bear with me for a second—either Papp’s or Schlitz. They came up with this fabulous campaign and they saw their case sales rise incredibly. It was really breakthrough work, and it had risen to historic heights.

But it was almost this inverted V-shape. They saw the case sales crater almost below where the run rate had been before they started the campaign and you’re going to ask yourself why.

The reason is: the campaign drove people to try the product. At the end of the day, it was still Papps or Schlitz. You know, it was terrible beer.

Now, I can get people to try, but is the product of superior product? And are we delivering what we say we were going to do? To me, that is the trust component—that  what I say is authentic to who we are, and that [when] you come to us, you experience this exceptional care.

By the way, I think that is important, but not sufficient. Because the reality is, in the New York market, consumers have an embarrassment of riches in terms of competitive choices.  New York Presbyterian—fabulous institution, fabulous care. NYU—fabulous institution, fabulous care. Mount Sinai—fabulous institutions, ideal care. On the island, Stony Brook—really, really solid health care. They’re good choices for consumers to make.

So, how do you then differentiate yourself on top of that? And that’s where the storytelling and being a student of how consumers make decisions, applying the science of marketing to marketing.

Most people think marketing is judgment. Like, “What looks good?” But there’s a ton of math behind it and if you do it well, you understand it and you try to execute in that regard.

John:   The new name with well in the name—Northwell.

Ramon:   Yes.

John:   I get the feeling that wellness is something you’re trying to communicate. That Northwell equates with wellness rather than what’s often referred to as sick care.

Ramon:   Yes! Thank goodness you got that that inclination. I’ll tell you a little story about the process of coming up with the name.

Northwell had been trying to change its name for 7 ½ years before I got here. It burned through three chief marketing officers. And it’s a large institution. It’s 23 hospitals and 66,000 employees. It requires a degree of political skill, mapped with a good knowledge base of how to do this, to even have a 50% chance of success.

So we hired Interbrand to help us on the naming side. They purposely analyzed every aspect of our business. And from that analysis, thematically came up with categories that we could go down in terms of naming convention.

We’ve even analyzed historic naming of health institutions in the United States. Turns out there’s like six conventions that are out there in terms of how institutions name themselves. Some are very obvious: religious affiliation, location, benefactor.

And we looked at about six hundred names at the top of the funnel, all these avenues that met a baseline of criteria. We had a high kick-out factor because we applied very stringent legal criteria to the naming process.

Ultimately, we got to about fifteen that were viable. We got to about seven that the executive committee of the board, who was helping me with this process, thought were appropriate for our institution.

Then we did a ton of market research against the seven. Which ones were the right platforms to tell the story? Northwell turned out to be a best of breed.

Remember talking about being consumer-centric and populist acceptable? Coin names tend to be inaccessible. They’re devoid of content, so you have to fill them with meaning. It takes a bit more marketing to do that.

Northwell—out of the gate, two words. One brand.

One concept, North, is born with all this rich storytelling ability for us to use as tools on how to communicate the value that we create. So I can take a journey with a consumer. There’s a connotation of destination, ascension, partnership. Even the concept of kind of true North, like there’s this one direction to go.

John:    That’s what I was thinking, yeah, true North.

Ramon:   And then there’s the second part of the name, which is the “well” piece. Which honestly is a signal to where all of healthcare has to go to–we don’t want people in our institutions. I don’t want somebody to come to my hospital. I want to keep them out of our institution. It’s the signal of taking the journey with consumers in a very different way.

And it also helps that North Shore L.I.J. was our former name.  North is the bridge to the old name and really helped grease the skids on acceptance and understanding in the consumer marketplace with the new name.

And it’s worked incredibly well. We’re doing a ton in the wellness space to make it authentic and bring it life.

One small example is how we’re using as an institution, [the phrase] “food is health”.

We’re the first health system to hire a Michelin star chef as the chief chef of the health system. He’s completely revamped how we prepare foods.

Fresh foods to begin with, a bias for organics, locally grown, partnerships with local farms and manufacturers to reduce the cycle time, and the freshness of those foods into the hospital setting. I hear the lobster ravioli at Lenox Hill Hospital is incredible. And we’ve seen a direct correlation with an increase in customer satisfaction with the changing of the dietary process that we’ve espoused in our health system.

We’ve also revamped how we feed associates because we want them to be nourished as they’re providing care. And we have a huge effort to deal with food scarcity. The fact that, in the New York market, there’s something like 2,000,000 people who don’t have access to adequate food to sustain themselves? Those are all wellness issues that lead to challenges in delivering care.

We have to, as an organization, be much more upstream to get the downstream benefits of those interactions.

It’s an interesting topic too, right? It feels natural to have the conversation. It’s accessible.

I think, for the first time, obesity rates in children have peaked and have been coming down slightly. It’s a place where I think the consumers mindset’s at and it has worked incredibly well for us as a platform to continue to tell our story.

John:   Ramon, what are your key strategic priorities as a marketer, and how do they tie into the broader goals and strategic priorities of Northwell?

Ramon:   One of the first things I did when I got here was—and by the way, I had the benefit of being able to speak the healthcare language because of my days on the payer side. So my years at Aetna really prepared me well to come to the provider side. —But I really tried to be a student of what we’re the strategic priorities for the organization. And then how did marketing support that?

Now for Northwell, scale’s super important. Health insurance organizations, the payers, they’re getting larger, and if you’re not a sufficient size to negotiate with them, you are at a competitive disadvantage. And let’s face it: compensation is life’s blood to an organization.

Secondly, I have never worked for a more mission-driven place. Michael Dowling, our CEO, really believes in putting the people who use our service at the center of everything we do.

We’re a purpose built, 1% margin business because we reinvest everything into the delivery of care into the understanding of science to really advance medicine.

Third, we really need to advocate for innovation that is going to fix health care at its core. And unfortunately, none of that is really coming out of Washington these days. So there’s this belief, institutionally here, that we need to be at the forefront of care—very innovative as an organization from the routine things to the extreme things. How do you reinvent the small? As well as doing those moonshot rocket science projects.

We’re literally reinventing things like bioelectronic medicine, where you attach a computer chip to your vagus nerve so that the body can stimulate the production of chemicals that put whole disease categories into remission. We’re literally the fathers of that science. …Down to really looking at the small touches of how a customer experiences our institution when they walk in our four walls. First touch.

So [we have] a lot of broad goals in terms of our institution.

I boiled all those strategic objectives into three core elements of our mission for Northwell. They’re very simple:

1) To drive consumer awareness and engagement. Michael is going to set the tone of who we are and it’s my responsibility to tell the marketplace who we are. So consumers need to be aware of us. And notice that I said, consumer awareness and engagement, it’s not enough that they just read my ad in the New York Times. We want to interact with them. We want to touch them. We want to have a relationship with them. We want to engage with them in a very different way. Actual engagement is super important to our mission.

2) The second bucket is to drive thought leadership and reputation. That’s both for consumers and for the types of world class physicians and researchers that we’re trying to attract to our organization.

3) Third, to drive volume. The reality is, we have to fill our institutions with those consumers who are seeking services. They have to know who we are, and that we provide superior care in New York market.

And we have a whole host of tactical programs to make sure that our facilities are operating at the top of their capacity.

And that’s it. Super simple. Everything we do is geared towards that. We tell that story to these focused parties: a) at the consumer marketplace, b) towards our peers, c) towards our board members, d) towards those in the philanthropic community, e) to our physician community.

They just come out a little bit differently based on the constituency.

John:   About half of our listeners are in the healthcare delivery world, and then about half are from the pharma biotech world.

I’m curious if you have any thoughts about a health system or large health system relationship with big pharma, and whether there’s room for higher levels, strategic partnerships… And if so, if you’ve made any inroads in that area.

Ramon:   I’m going to answer that from a marketing side and then from business side.

On the business side, absolutely. Think about the populations we serve. Northwell, we provide patient care to two million individuals each year in the New York DMA, the most diversity DMA with DNA in the United States, right? Think of the populations that live in Queens or Brooklyn.

Part of the challenge on the pharmaceutical side is clinical trials testing to diverse populations. So we’ve struck up strategic partnerships.

Harvard is a great example. The birthplace of DNA, literally the father of DNA, started that institution. They do a whole host of clinical trials that ultimately lead to new remedies in healthcare, principally because of the diversity of the patients that we serve and the volume of patients that we serve.

So, I think there’s a ton of room with pharma. They’re interested in our science. They’re interested in our access. They’re interested in the volume of who we serve in the marketplace.

Secondly, on the business front, even new science, things like that bioelectronic medicine that I talked about—Pharma’s super interested because it’s a substitute for pharmaceuticals. It moves us away from pills, bottles, capsules, orals, infusibles… and introduces this whole new schematic of medicine.

And frankly… they have a choice: If they think of themselves as traditional pharma, or in the industry of providing therapeutical remedies. If they take that broader perspective, there’s wonderful opportunities for us to team with them on new solutions.

I would say on the marketing front… Here’s where I’m a little bit more of a skeptic, only because I see a lot of the direct-to-consumer marketing that’s done out there to steer and accelerate usage of particular treatments. I don’t know that that’s always in the benefit of consumers.

It certainly is a way to drive revenue. You know, is Humira the right solution for anybody who needs a biologic? And is that the role of the pharma industry? [Or] should that be the role of the physician? I would debate that pretty hotly.

So, you know, kudos to them. They figured out a model that drives volume and is a bit consumer-centric. I mean, they know their customers very well. I just don’t know if it’s the right place from a systemic standpoint to execute.

I’ll think about it a little bit more. It’s a somewhat provocative question. But we seem to be in different places on how’re communicating and what we’re trying to communicate to consumers.

John:   Yeah, I’m not a big fan of direct-to-consumer. I think that pharma benefits, agencies benefit. But I don’t think I’ve met a physician who says that that they’re necessarily a good thing, that they’re educational. I mean, they’re designed to drive traffic.

Ramon:  And look, they’re smart business people and they do it well. The downstream impact is—at what cost?

John:  Right. Very, very true.

So this has been a treat, Ramon.

Ramon:   Yeah! I’ve enjoyed this conversation.

John:   I value this time. This has been terrific.

Ramon:  Not a problem. Invite me back anytime! The more provocative, the better.

John:   Well, I’m sure that this one’s going to get great reviews. Again, it’s been great and look forward to talking to you again sometime in the future.

Ramon:  Sounds good. Thanks for having me on board.