When I began my career in teaching and writing about healthcare marketing, I confess to “borrowing” from other service marketing concepts and applications, until I had enough experience of doing it, myself, to apply personal learning to these efforts. Having been educated in a school of public health, I had no exposure to marketing in my university-based education, though I had plenty in my early career in the marketing division of Michigan Blue Cross.

By the time I got my first executive position in healthcare strategy and marketing, I was teaching and applying marketing as the alternative to management in efforts to get people to do what the organization wanted. This definition was particularly applicable to healthcare, where “patient management” was already the norm, but for physicians, who saw themselves as expert authorities on what patients should do, writing prescriptions and orders covering how patients should respond to physicians. Understandably, the idea of “marketing” to them was a startling and unwelcome suggestion.

This definition also helped with applying early healthcare marketing to healthcare organizations’ (primarily hospitals’) employees and medical staff. While management was the norm when dealing with employees, it was recognized even in the 1970s that employees had to be “acquired” and “retained”, just as customers do. And physicians were even then recognized as the key “customers” for hospitals, nursing homes, home health agencies, etc.

I recently ran across the definition of “leadership” by former US President Dwight D. Eisenhower: “The art of getting someone else to do something you want done because he wants to do it.” (“Smart Quote” AHIP Solutions SmartBrief, Oct 22, 2007] This is essentially the same definition that I had used for marketing, except that “leadership” depends on the individual or group that is the source of whatever means rely on this approach, rather than the usual techniques of marketing.

The theory of leadership that seems to govern most books and articles on the subject is that “true leaders” have to have some combination of charisma, the right mix of mission and values, a sense of the values, wants and needs of those to be led. Add to this the leader’s ability and willingness to “lead from the front” by living out those values so others will be attracted and satisfied with the idea and experience of being led, and you get the right combination of leaders and led.

Like marketers, a leader without the willing led is akin to a marketer without a customer. But clearly, there is room for both marketing and leadership when it comes to health management (HM), particularly employee health management (EHM), where employees have leaders. One of the challenges that makes commercial or government insurance plans’ HM efforts so difficult in terms of achieving demonstrable ROI is the fact that people are not quite ready to be led by their insurance plan or the federal government.

But all prospects and participants in HM are potential customers for marketing efforts aimed at engaging them in particular programs, and getting them to adopt the patterns of behavior relative to their own health that will achieve results desired by payors. The usual form of “leadership” by a recognized and respected individual or group may be absent, but the idea of participants doing something that payors want because the participants want to do it is at least as valid. And marketing, to my mind, at least, is the natural approach to achieving the “conversion” of participants — from hesitant, even unwilling to “adhere” to healthy behavior, to enthusiastic/eager/early adopters and persisters in such behavior.

All the tricks of modern marketers, from “viral” and “buzz” marketing, where peers are enlisted as volunteer or paid “ambassadors” inviting and supporting participants – to tracking and reminding HM participants of what they have accomplished for themselves and for the payor – can be useful in a combination of leadership and marketing. While the labels for HM and EHM both employ the term “management”, it is unlikely that traditional management efforts will work well in either.

While employers can offer incentives and rewards to get employees to participate, and insurers can do the same, these are of limited success and duration in achieving lasting commitments and behavior change, even though rewards and punishments are traditional tools for managers. The problems with both include the fact that they cost money, not just the costs of incentives paid, but the communications used to educate, remind, and otherwise entice people to participate, change, and succeed in improving or protecting their own health.

The art of getting others to want to do something that payors want them to do is likely to require a combination of leadership (for employees at least) and marketing, rather than relying solely on management models. While the term “management” no doubt appeals greatly to the managers who have to be sold on the idea and provide financial as well as other support to HM efforts, it does not appeal nearly as much to participants, who, if anything, would probably prefer that they be deemed the managers when their own health and behaviors are involved.