CDA Hones Its Marketing Image

By David G. Jones

This article discusses the many tacks CDA has taken with its marketing campaigns over the years. The keys to success have been reasonable goals and sufficient funds to make an impact. The current campaign, while underfunded due to budget constraints, carries on the successful theme of positioning CDA and its member dentists as the trusted sources of dental information for consumers, legislators, and health care decision-makers. An accompanying article discusses the proposed ADA national marketing campaign.

Article copyright 1998 Journal of the California Dental Association.
Photographs copyright of the authors.

As the largest and most influential state dental association in the country, the California Dental Association has long been a leader in marketing dental services to consumers seeking high-quality, committed and well-trained dental professionals. The association has boosted public understanding of the importance of good oral health and has solidified CDA's position as a valued source of information about dental care.

The association's marketing program produced exceptional results some years, while in other years, budget considerations have limited its reach. But regardless of funding levels, volunteer leaders, staff, and hired consultants have worked together to produce some pioneering achievements that allowed CDA to be the first state dental association to:

• Undertake a paid multimedia program to promote the dental profession;
  
• Position itself as an advocate of patient's rights through development of the "Dental Patient Bill of Rights";
  
• License its marketing materials to other state dental associations; and
  
• Develop informational materials on AIDS and the dental office and promote them nationally.
  

Those accomplishments can be traced to the late 1970s, well before the association's Communications Committee was born. Eugene Brown, DDS, as the chairman of CDA's Council on Dental Health at the time, was responsible for the association's embryonic marketing program. He explained the program's genesis.

"Dentists wanted to bring in more patients, so we started looking at the busy-ness problem," he said. "We hired an outside consultant who presented a concept to our council. We didn't hire her, but we did go on to address the problem within our existing budget."

That marketing budget had to be approved and renewed each year by the House of Delegates.

Brown said that in the beginning, CDA tried to increase public awareness through free public service announcements and media interviews. The program eventually began to cost more; and in the early 1980s, a yearly assessment of about $100 per member was levied.

"That allowed us to develop some limited television commercials, but it was very expensive," Brown said. "We were trying to make the public aware that CDA members were somewhat different from nonmember dentists."

The TV ads Brown referred to were designed to enhance the image of dentistry, increase public awareness of certain dental educational themes, and increase patient visits to member dentists by setting apart CDA members from nonmembers. Simplistic by today's standards, the $1.2 million ad campaign featured a woman holding an apple and became known as the "Apple lady" ad.

Brown, who became CDA president in 1990, said a survey showing response to the TV spots indicated that public awareness was "pretty high." Gathering data to measure how the campaign affected patient visits, however, was difficult.

"We finally came up with a figure of somewhere around four to five new patients for an average practice over a six-month period," he said. "Of course, some people said they didn't get any new patients."

Brown said that from those early days up to the present, "Members just don't understand communication well. They want a program to put bodies in their chairs, and that isn't going to happen. It's a very hard thing to measure."

In the later 1980s, CDA's marketing requirements exceeded the management ability of the Council on Dental Health, so an ad hoc communications committee was formed to guide the marketing program. That led to formation of a formal Communications Committee in 1988. The committee took over the association's marketing program and developed a three-year plan. Current CDA President-Elect Gene B. Welling, DDS, saw the plan unfold.

"My impression was that it was to increase the busy-ness of dentists," Welling said. "It didn't always work out that way, but I do think it had secondary value in presenting dentistry in a positive light, as a positive resource, reminding people they should have regular checkups."

The new marketing program's official goal was to advance the association's position as a consumer advocate and to bring to the surface issues important to the profession. Those efforts began with establishment of the Dental Patient Bill of Rights, according to Michael Miller, DDS, former CDA president and a trustee when the bill was established.

"When this issue came before the Board of Trustees, I stood up and used words like 'It's embarrassing, unprofessional and demeaning to the profession,' " Miller said. "I objected very strongly to establishing this marketing program and thought it was unprofessional."

The Bill of Rights originally delineated eight -- expanded in 1996 to 10 -- rights, such as "the right to see the dentist every time you receive dental treatment," and "the right to choose your own dentist." Together, they form a way for CDA and its member dentists to provide patients with the most recent information available on dental care, including the quality of treatment they are entitled to, and to help them speak up for it.

Eventually converted, Miller admitted, "It was probably the most effective single thing we did. It was a marvelous program. Various groups I spoke with told me this was very important, addressing their need to ask questions about treatment and fees and to be involved in their own treatment. This was the beginning of the whole patient involvement in health care, and I think we were in the right place at the right time."

Its success provided evidence that dentists such as Miller, who initially opposed the concept, were wrong.

"It pointed out very clearly to me that I didn't know what I was doing," Miller said. "When it comes to marketing that's effective in the public arena, dentists didn't have a clue, and they still don't. We are the worst people to make a judgment about marketing."

The Communications Committee next needed to find a way to encourage business decision-makers to look for and offer employees dental plans that provide the right to choose the dentist they want and not leave that decision to insurers.

"So I proposed the 'Right to Choose' campaign, because this was the start of the patients drifting away from practices because PPOs and HMOs were just beginning," said CDA Secretary Jack S. Broussard, DDS. "I got comments from patients saying 'I want to stay with you but don't have the choice under my new insurance plan.' "

Established in concert with "Right to Choose" was a print campaign to increase awareness of direct reimbursement, dubbed "To Do the Impossible."

"It showed a frog, and a princess was supposed to kiss it and turn it into the prince," Broussard said. "So the frog represented 'to do the impossible,' saying DR could work if we put our minds to it."

The overall campaign's twin goals were to achieve CDA name recognition and promote the right to choose, encouraging patients to ultimately look for a CDA dentist. CDA was the first entity in the country to take on the right-to-choose issue. Broussard said CDA leadership liked the idea but realized it would take extra money and a grassroots effort to implement.

"For the original three-year campaign on the "Right to Choose," the annual budget for primarily radio and print advertising was $745,000," Broussard said.

Funding the campaign cost $50 per member. Added to another $57 in the budget, the total cost was $107 per member for the Marketing Department and the campaign.

"While the project didn't target getting patients into CDA member offices, per se, we were trying to stop patient erosion and also wanted to increase CDA name recognition so we could establish CDA as a valued source of information on quality care," Broussard said.

To measure whether the intended audience understood and remembered the message, "we did the full gamut of testing," Broussard said. "We pretested and post-tested, and found that when these programs were running, six months out of the year, we had figures of 63-68 percent for CDA name recognition, and up to 83 percent recognition for the Right to Choose slogan. When we went off the air, that dropped into the mid-40 percent area. That generally has been the trend through the years."

In 1991, the initial three-year plan was about to expire; and Joe Buchanan, DDS, a member of the Communications Committee, began work on another long-range marketing plan. Under Buchanan, the committee began work on what was to be a five-year marketing plan, which was ultimately presented to the 1992 CDA House of Delegates for consideration.

"So a proposal was on the table at a $124-per-member assessment, which the House approved, so our budget went from around $745,000 for marketing to about $2.8 million," Buchanan said. "It was a major commitment, but it wasn't enough."

When the Communications Committee presented the plan to the House, it actually presented three proposals, small, medium, and large.

"The delegates picked the middle one; and, as you can imagine, when you buy a Chevy and you wanted a Cadillac, you see a difference," Buchanan said. "That was a problem from the beginning of the plan. In hindsight, we should have made only one offering, because what happened was that everyone develops their own idea of what they should do in a marketing plan, and everyone is their own best marketer. But they don't realize it costs a lot of money to do certain things.

"But if you talk to people who are experienced, they said that it's unrealistic to expect the kind of things that many of the members wanted, given the amount of money we were prepared to spend."

What resulted was a strategic plan with a three-tiered approach to marketing. The first leg included radio; print; and, for the first time since 1985, television advertising. The second leg was public relations.

"We hired a PR firm later in the first year to work with CDA," Buchanan said. "This was a new area, and it crossed a lot of departmental boundaries, from Government Relations to the Executive Committee to trustees to component-level issues. So dealing with them was a wonderful learning experience. Their mission was to position CDA's response to the media in a way that PR people do, speaking with one coherent voice."

Before that reorganization, CDA had a variety of responses, some from the component level, some from the councils or committees, and some from the Executive Committee.

The third leg sought to combine the communications program under one umbrella.

"We had one person in charge of publications, another person in charge of marketing, and we had the PR firm. So organizing this as a single entity was a good thing, so for the first time we could develop a program that crossed council boundaries and make the message CDA sent the same for the entire organization," Buchanan said.

In the plan's first year, CDA rolled out its first TV commercial and brochures, developed a contact person for all the media outlets in the state, and dealt with the tough issues of amalgam safety and Kimberly Bergalis, the AIDS patient in Florida who said she was infected by her dentist. Buchanan's committee and the consolidated Communications Department developed a response for those issues, making it a very productive premiere.

Each year thereafter, "We re-evaluated what we had done, and looked at the next year's plan and fine-tuned it based on what we had learned," Buchanan said.

The campaign's result was "about a doubling of the awareness of what CDA was, which was about 24 percent before testing and up to 50 percent after.

"But we learned later that sustained advertising over a long period of time would be most effective," Buchanan said.

A highlight during the second year of the campaign was the Spanish-language test marketing.

"We did some research to determine which ethnic group was under-represented, targeted that group, and ran a model campaign in Monterey County; and from that we learned what it would take to do a statewide Hispanic campaign and also learned about the difference in marketing to a different cultural group," Buchanan said.

Initial results were promising, but the committee finally learned that a separate Spanish-language marketing program would cost too much.

During the course of the five-year plan, Broussard said, dentists were "clamoring" about the "1-800-DENTIST" referral system and wanted a system like that for CDA members.

"We did a major research proposal to establish a referral system like this, and CDA's volunteer leadership made the decision not to go that way, because at that time our leadership didn't want to register CDA as a referral entity with the state," he said. "While we could establish a referral source, and allow all our members into it, each office would only get two to three new patients a month, so it wouldn't be cost-effective because of the dilution of new patients calling in and being referred throughout the entire membership."

In 1995, as the five-year plan began to wane, the Board of Trustees knew that managed care had become a major concern.

Denise Habjan, DDS Communications Committee chair

"They saw the money the marketing campaign had to spend, and while they knew we had objectives for that money, they wanted to add more features, such as a campaign to educate consumers on managed care," said Denise Habjan, DDS, current chair of the Communications Committee. "It was truly a knee-jerk reaction in response to managed care. It was if to say, 'We have all this money, and we're talking to consumers anyway, so let's modify the message and talk about managed care and hopefully influence them.' "

Broussard said trying to stretch funding to achieve goals that were set late in the program was ill-advised.

"The message becomes diluted because we want finite dollars to do more and more," he said. "In the future, we have to try not to dilute those dollars. We need to set our goals, set our message, and follow it through. If we want to add additional campaigns, we have to fund those separately. If we don't do that, a campaign will be mediocre at best."

CDA embarked on a managed care program that included two radio spots promoting a comprehensive informational brochure. In the first two weeks, more than 4,000 people had called requesting brochures.

"Over the next six months, we thought it would lessen up; but requests for the brochure kept up at a high volume," Habjan said. "So around mid-year, we did our first wave of tracking research to gauge program effectiveness. We found that people were hearing our radio spots, but they thought we were a dental plan, because the only other people talking about this in the marketplace were promoting health plans. So those results were disturbing to the Communications Committee, because at worst, they expected our recognition would be low because we had diluted the messages, but it was even worse than that: We were one of 'them.' "

This campaign generated controversy throughout the association. Some members said the campaign needed to be re-evaluated. Some didn't think the Communications Department and Communications Committee were doing anything right, and others thought that too much money was being spent in too many areas. Finally, the Board of Trustees called for an audit of the marketing program to determine its effectiveness and/or need for new direction. The audit began in June 1995 and was finished by November.

"The audit found that to be very effective, we had to spend a lot of money to have year-long television advertising, but we didn't have that kind of money," Habjan said.

A comparison of CDA's advertising to that of the California Fluid Milk Processors Board and their "Got Milk" campaign can illustrate how expensive a successful campaign can be. In dentistry, advertising has to overcome a reluctance of many people who don't want to go to the dentist. The Milk Processors Board uses advertising to increase sales of a product most people already enjoy. Yet CDA spent $2.8 million a year for its total advertising package, compared to the California Fluid Milk Processors Board's $20 million a year, $18 million of it on TV advertising.

The audit also recommended that if CDA were going to spend money, it needed to do it so that all public relations and advertising activities were in one voice.

"The audit didn't say we were off base; it said the organization wasn't working in a coherent, coordinated way to meet its goals in this area," Habjan said.

Using the audit results as a starting point, in 1996 a year-by-year marketing program was developed; and the San Francisco-based marketing firm of Hoffman-Lewis was hired. Since there was not enough money in the budget to do television advertising, the new program utilized radio. It used creative spots in traditional advertising slots and augmented those with traffic report and health program sponsorships. Both were read live by news reporters and disk jockeys, which allowed CDA a lot of flexibility in subject matter.

In the final year of the five-year plan, the Harry J. Krinsky radio advertising program debuted. It is still on the air.

Everyone loved it, save dentists.

"Dentists hated it, but people came into the office; and they talked about it, they heard it, and they remembered," Miller said. "Whether this brings patients into the office, I don't know. But I think it presents dentistry in a lighter fashion than people are used to and opens up conversation between patients and dentists and maybe even breaks down some communication barriers."

The campaign had two purposes.

"The first was to communicate that CDA was the first or primary source of unbiased dental information in the state, no matter who you were, a member of the Legislature, a public employee, a benefits manager, patients, or the media," Habjan said. "And we accomplished this by talking about dental health subjects, like baby bottle tooth decay and components of quality dental care plans. This helped engender the idea of branded identity, to give some meaning to the idea of seeing a CDA dentist rather than just a dentist."

Susan Wall, CDA Marketing Manager

Following the five-year plan, the Communications Committee "proposed a strategy creating a 'trusted source' because while we were talking about dental health issues we knew people were interested in, we also knew that dentistry was interested in making sure the public knew about these issues," said Susan Wall, CDA marketing manager.

The marketing program has gone from a "brief burst" campaign where principally television was used, to a low but continuous wave of media, especially radio.

"This will keep up awareness of the association while keeping our expenditures within budget, but we don't expect immediate recognition or understanding of major dental issues. This will only happen over time," Wall said.

The continuity marketing program has succeeded in maintaining a level of awareness of the association, which translates into people recognizing CDA members as trusted sources of oral health information. One of those oral health areas is fluoridation, one of the seven key objectives identified by the Board of Trustees and adopted at the 1997 CDA House of Delegates.

"The Communications Committee will further analyze those seven objectives, but the one that fits best into our current marketing plan is fluoridation, a dental health issue, and something that supports our mission of being a trusted source of information," Wall said.

She next compared past funding to current and future years.

"In the five-year program, funding was decent, with a guaranteed level for a certain period. When the five-year plan was over, and we needed to ask for continued funding, the organization was faced with a budget crisis, so the program had to take some of the cuts."

In this period of pressure on the marketing budget, and the possibility of a large ADA dues increase if its proposed national campaign becomes a reality, what about the future?

"The committee will propose a program that fits with what we're spending this year, but it has to look at the reality of ADA's proposed national public awareness program," Habjan said. "If that is approved, the question will be can CDA members pay their share of the marketing program and add on top of that the additional $300 to ADA."

Budget constraints have always been a factor in CDA's marketing program.

"I think from the beginning, CDA and its members valued public relations, marketing, and grassroots efforts as advocacy for our patients," Broussard said. "Historically, CDA has strived to do exactly that. If we haven't accomplished what we wanted, it wasn't from a lack of trying, it was for a lack of money."

With the five-year plan, "We looked at options on how to spend money, all the way from $50 as in the three-year plan up to $276 to get everything we wanted with TV in a big way. We went down to $124, so the message was diluted," Broussard said.

Beyond the issue of funding, Habjan said that it is the responsibility of the membership to decide how they want the profession and the association to be perceived.

"It's our jobs as members to decide what we want a campaign to accomplish, and then we turn these objectives over to the marketing professionals to decide the how," she concluded.

Author

David G. Jones is CDA's staff writer.

To request a printed copy of this article, please contact CDA Publications Department, (916) 443-3382, Ext. 4640.