Ever since I began consulting, and writing about, then practicing the art/science of marketing, I have looked to the general domain of services marketing for ideas. But one common element of marketing other services has always been fairly rare and difficult in health care, namely what is called “cross- and up-selling”. The intent is to interact with current customers, whether you contact them or they contact you, and describe/discuss added products and services they might buy (cross-selling), or “higher quality”, more expensive versions of those they are already buying (up-selling).

Since sickness care services are needed and demanded almost always in response to unexpected symptoms, signs or events, these both prompt the seeking of such services, and also limit those that make sense for consumers to buy. In some cases, such as pregnancy/prenatal care, cosmetic or bariatric surgery, for example, there may be discussions of options, such as c-section delivery vs. the “natural” vaginal alternative, or different forms of bariatric surgery, as well as other options for losing weight.

Some services are actually “cross-sold” as when women are advised to have their “tubes tied” right after delivery, adding a modest surgical intervention to the maternity experience. Cosmetic surgery patients may be offered the option of having more than one “fix” at a time. But such opportunities are rare, and the services “sold” tend to be determined entirely by the patients’ medical conditions, with not many opportunities to sell others unrelated to the present need. So cross-selling is decidedly limited in sickness care, compared to most other services.

Up-selling is commonly done, though also on a limited scale. Patients may be offered the option of a private vs. semi-private room in the hospital, for example, or potentates from foreign countries may be offered accommodations in the hospital’s “VIP” suite, unit, or pavilion. A surgeon may offer the opportunity for a patient to have surgery in the hospital, or a more luxurious specialty surgical center. But, again, not the majority of patients, nor the majority of service opportunities offer such opportunities, and most patients are routinely served at roughly the same level of service and prices, and their third-party payer mostly decides what will be paid.

With health management services, by contrast, virtually all customers have opportunities to “cross-buy” or “up-buy a wide range of options when they plan their own, or are approached by a supplier thereof. This applies to both “B2B” marketing, where the supplier is dealing with insurance plans or employers, and “B2C” marketing, where the supplier directly serves and charges consumers as individuals.

The movement in “population health management” (PHM) over the years has been toward specialized suppliers of such services to continuously increase the range of health issues they address. “Disease Management” (DM) suppliers have increasingly added to the number of diseases they include in their offerings, even where they may have started with just one. Added diseases may be cross-sold to add to population-based fees that the supplier can get, or to add to the numbers of participants in DM services within a population where charges are based on the number of participants.

Moreover, DM suppliers have increasingly added the prevention of chronic diseases, as well as managing those that already exist in an insured or employee population, since prevention can usually save far more for the payer, though only in the long run, than can after-the-fact management. Many have also added conditions that are more risk factors, such as high blood pressure, sugar, and cholesterol, that are below the “disease” level, but represent high risks for turning into diseases.

When PHM services are marketed to employers, cross-selling is likely to include services aimed at managing behaviors and conditions that are not related to diseases at all, or at least have their greatest impact on causing impaired productivity in employees, more than sickness care expenditures. These may include overweight/obesity, sleep deprivation, poor nutrition or fitness, emotional difficulties, chronic pain, allergies, and similar “non-disease” conditions, as well as behaviors such as smoking, inadequate coping with stress, substance abuse, etc.

When suppliers or consultants are working with payers, there will almost always be cross-selling opportunities. It is common for payers to try out a given supplier with one or two selected PHM challenges first, before adding more, to make sure the initial “pilot test” works well, for example. Or payers who have focused first on only those PHM services that have the most immediate impact, perhaps DM services, for example, may be “sold” the idea of looking toward longer-term options as well.

Up-selling to payers will focus more on making the case that more intensive and expensive options are needed to manage at least some members of the population at risk. Graduating the intensity and prices of PHM interventions to match the risk/reward levels of different population segments, such as low, medium, and high risk prospects, is commonly done, rather than using and charging for a one-size-fits-all approach. This can improve the probability that both the payer and the supplier will achieve a positive and highly satisfying ROI.

The same options may be offered consumers when they pay for PHM services. “Concierge” medical practices devoted to PHM, for example, already include modest programs of basic physical exam plus online coaching that costs participants as little as $20-50 per month. At the other end of the spectrum are practices that charge as much as $100,000 a year. Even “executive health” programs range from one-day programs to as much as a week, with luxury accommodations in a resort or hotel, in addition to the testing and medical consultations involved.

In the PHM case, suppliers would be wise to train and reward their sales force and customer-contact personnel to both cross- and up-sell, as is the case with other industries such as financial services, travel booking services, and most retail companies. While matching these efforts to the unique characteristics, needs, and pocketbook of each customer will be just as important in PHM as it is in other examples, the potential for greatly increasing the range of services bought and amounts paid for PHM is likely to be at least as great as in other services industries.

Moreover, if PHM suppliers learn about prospects and customers well enough, and cross- and up-sell intelligently, they should be able to not only deliver added value to customers in the process, both payers and consumers, and thereby increase their customer retention, as well as their customer lifetime value. In PHM, at least, focusing on, delivering, and demonstrating the value being delivered to customers is both more possible and more important than is the case with most other services.