An Economist article explored the trend of medical tourism in Europe and the United States. Consumers of medical services are going abroad to escape high prices and long lines at home. Hannaford, a grocery chain, and a few intrepid insurance programmes, are exploring the possibility of lowering total employee heathcare costs through incentivising traveling abroad for health care needs.

Physical travel, however, is the tip of a rapidly decentralising (disintegrating?) health care consumer paradigm. HCPs (Health care consumers) also go online rather than travel abroad to find products and services that they couldn’t otherwise access. In doing so, they frequently discover new and innovative products and services that pique consumer interest and fuel further individual (as well as corporate) research.

HCPs find communities of like-minded patients and caregivers and exchange information, ideas and opinions about health care goods, services, even specific providers. They research medications and treatments through forums and health care social networking sites like Trusera and PatientsLikeMe.

HCPs that share languages compare and critique public health systems. They let each other know what’s available where and who or which insurance is willing to fund what. Even institutionally-based medications, once limited to the institution that provided them, can now limit the institution. If a patient can’t access the med that s/he thinks s/he needs locally, s/he goes online and finds a provider that is willing to access the HCP–through the mail, through a network, through travel.

Health used to be geographic. What the next-door neighbor perceived as “health” could be considered standard for the neighbourhood. Now, the community of patients or HCPs determines what is “health” for their community. A patient suffering from dysthymia, a mood disorder, can go online and ask fellow patients across the globe how they best deal with depression. Then that community can advise, support, sympathise and even supply a patient with the products and services that patient wants.

There is a lot of WOM about WOMM these days.

A study published by JupiterResearch suggests that advertisers under-spend on social media marketing. BuzzAgent has been stung by some bloggers for its recent campaigns to “prove” how WOMM works in social media. Advertisers complain that there are too many possible social media and other types of online outlets and no proof that any of these are especially effective.

Social media marketing, online WOMM, etc. is much like any marketing concept. It is an extension, not an alternative, to traditional advertising, market research, and PR. Successful communication with clients and stakeholders, along with customer engagement is as limited in methods of communication as are its customers.

Customers, clients, and stakeholders are online, generating social media as well as other forms of online content, so advertisers and marketers are too. And determining how to listen to and engage with different groups online is as multifaceted as it is offline. Online content and strategic involvement runs the market research and advertising gamut, from online focus groups to online billboards. Social media, however, is something different.

For example:

Synthetron, a neighbour or ours, identifies stakeholders and uses online formats to create targeted stakeholder conversations around an important issue. How? Synthetron first selects stakeholders for a study. Stakeholders must have an interest and a desire to impact a certain conversation. Invitation-only online discussions are then used to create an open forum for stakeholders to dialogue. Individual stakeholders included in a study remain anonymous; their ideas and concerns do not. This sort of online stakeholder forum aggregates and evaluates relevant stakeholder WOM, rather than target individual complaints and concerns. To me, it sounds like an online focus group, one in which stakeholders are invited rather than solicited. It permits incentivized stakeholders to be heard as a group without being hurt as an individual.

BuzzAgent is criticized for soliciting content in the manner of a traditional marketing focus group. As with any solicitation, the individuals solicited do not offer their information for free. They are not concerned stakeholders but paid informants–the information that they offer is rarely given for free. These individual informants want something for their time–free samples, extra influence, or face time with an influencer. This is not a new way of collecting ideas, and it can be quite useful in understanding why people are or are not discussing a particular brand or product. Focus groups can help stimulate conversation and generate new ideas. Holding a focus group online or offline involves parallel benefits and risks. Individuals can fib in person as well as in email.

And then there’s social media. Conversation. Buzz.

Creating a WOMM campaign online is not all that different from creating a WOMM campaign offline. But the means of measuring WOM online are more exact. That’s what the Attentio software targets.

Attentio does not solicit online content. Attentio measures and monitors spontaneous buzz as it emerges online. The tools size a social media conversation and measure it in comparison with other conversations. What generates more buzz, pharmaceuticals or automotives? In which online media are cars more popular, blogs or forums? Within the automotive conversation, do people talk more about Opel or Toyota? Do they discuss car design or price more? Attentio monitors the conversation around certain topics as new government regulations are implemented or tax systems are changed or general social opinion turns from red to blue. These trends show up online in numbers that can be quantified and, with a little analysis, qualified. Unsolicited, self-identified stakeholder/client/consumer/producer conversation filed and displayed for anyone interested in a particular market.

Knowing buzz numbers help a marketer—traditional, innovative, online, offline—plan an effective and efficient campaign. Knowing the buzz from social media lets a marketer know if a focus group might be useful, or a stakeholder discussion necessary, or an offline sale worthwhile. It is not a means of marketing; it’s a means of measuring the market and determining how to best engage.

Buzz Agency is looking to compare (compete?) WOM with traditional media through a “WOM Impact Guarantee” programme. The challenge requires a 300,000 US dollar investment in both traditional and word-of-mouth media. If WOM doesn’t outbase traditional competitors across four brand metrics–brand awareness, consumer opinion, purchase intent and actual sales, BzzAgent promises to refund the marketer the full cost of the campaign.

Maybe its because we’re Brussels based–and what is the EU if not a conglomerate of co-creation and (sometimes over-extended) collaboration?–but we just don’t know if this kind of competition is necessary. WOM and traditional media complement; they don’t compete. Successful media campaigns look to integrate traditional media and word-of-mouth, not to separate or isolate the results.

We measure mainstream media trends at the same time we meausure social media trends here. Comparisons demonstrate the efficacy of both WOM and traditional campaigns, as well as where the interests of both intersect. Analysis suggests which consumer profiles finds which types of media campaign most appealing.

This is the objective of online co-creation and collaboration. Allowing PR firms to create more effective and integrated campaigns that combine both traditional and WOM. Each industry, brand, product, and service requires campaigns modeled to suit the interests of the clients and the consumers–there is no one size fits all marketing campaign.

The concept of the long tail is that more effective marketing money is spent on more receptive markets. WOM is definitely a strong aspect in this, but WOM itself is multifaceted. What creates buzz and generate conversation is never easy to predict, but with the right tools and a little time, PR Agencies use software to analyse what works for clients or consumer and what doesn’t.

A lasting market is an environment in which consumers and producers look to establish long-term relationships. A market is collaborative. Shouldn’t marketing be too?

Paul Dunay, the Director of the Global Field Marketing for BearingPoint in the United States, interviews Adam Lavelle, Chief Strategy Officer of iCrossing here. They discuss the pre-Search and post-Search society and its current transition. Lavelle and Dunay call traditional search engines “reputation management systems”. Lavelle predicts that methods of search for the average consumer are evolving from open-ended exploration to a more established collaborative sharing.

An online Search used to be the map that a searcher wrote herself. The virtual world was wide and uncharted. A self-motivated Searcher chose her terms and clickedthrough to her consequences. Then adwords rewrote the rules, subtly shifting the unchartered territory in favour of those communities with the best technology and technical know-how.

But Search is no longer a lone spot of civilization on the online map. While we haven’t stopped expanding the virtual world, we’ve civilized the territory, erecting our online databases, networks, and communities. We’ve established highways and byways that constrain but also simplify life for the online traveler.

But signposts have been (and are ever being) erected along the highways and byways of the information superhighways.

These signposts are erected by social media. These signposts are the brands, products, services, and ideas that the original searchers carried with them from the real world to the virtual. These signposts now dot the online landscape. Communities cluster around them, discussing, buzzing and bickering about the brands that delight and bug the people back home.

This is what Lavelle refers to when he stresses the changes wrought by social media in the realm of search. Now communities want networks of shared experience to validate the expertise offered by the trailblazing technology of Search. Social media offers this combination of expertise validated by shared experience, making these conversations, this buzz, both authoritative and influential.

Tracking these communities is essential for any successful brand. Its new territory out there and you need to know where your brand stands (or rather, where it’s been stood).

Advertising is changing very rapidly nowadays. To a big extent, this is connected to social media becoming increasingly popular online content. On one hand, consumers have more control over what they want or don’t want to see, not only on TV but especially online – spam filters, pop-up blockers and other tools give internet users the capability to select the content they are watching. On the other hand, the audiences become more and more fragmented due to the variety of media available. Especially for teenagers, internet and social networking sites become more a common entertainment medium than TV.

Because of that, advertising has to become more creative. It needs to offer higher entertainment value and more variations of the same ad, which – to be possible – must go along with lower costs of producing advertising. These points are connected to social media. Social media has already made tools available that allow consumers to create their own content through much cheaper methods than those used by professional agencies (e.g. video making). These users’ and semi professionals’ content is incredibly creative and more and more visible via services like Current TV, which pays users for videos the company decides to air, or Pitch It, which launches campaigns and asks users to create videos about the topic of the campaign.

According to an IBM study, in European countries like the UK or Germany, ca. 35% internet users visit user generated content sites and ca. 10% of these visitors contribute to them. Consumers are not only creating content, they also influence the choices of other consumers regarding which content to view – 32% of YouTube users are watching particular videos because they were recommended to them by their friends.

Marketers have been trying to engage blogs, networks and discussion forums knowing that social media has the biggest power of creating consumer evangelists from all types of media. A recent study compares spending and gain on different types of media collecting these interesting findings:

• The media costs to deliver 500,000 consumers who are informed about a product range from 400K (television) to $200K (print) to $160K (WOM).
• The media costs to deliver 50,000 consumers who indicate purchase intent range from $2M (television) to $300K (print) to $150K (WOM).
• One WOM conversation carries the impact of 200 television ads.

It is of course impressive how much more impact can be achieved at such a lower cost, but the last and most important part of the changing advertising landscape is the possibility to measure the impact of social media campaigns. Using social media monitoring services allows marketers to not only to identify influential bloggers, platforms and the like that should be targeted with the content achieving the most impact but also to measure how responsive they are to the offered advertising content, if they are spreading the ads, and if so, to which audiences.

What can social media show about politics?

It can show that the professional press does not reflect public opinion.

Attentio is measuring and monitoring the buzz around the European Union and its pet policies and problems. Analysis of the project demonstrates the distance the EU has gone to earn popular legitimacy–as well as the distance the EU has yet to go.

Mainstream news is an accurate source of what the EU is up to. The EU elite carefully publicise their efforts through the professional mainstream media. Last week, EU elites at the Commission and the Parliament met to address the issue of illegal immigration and the need for more border security for the Union. As a result of these efforts of the European elite, the mainstream buzz is all about security and border restrictions. (Note the top red trendline highlighting this prominent issue in the chart below.)

Buzz words picked up by the Attentio algorithms (that’s tech speak for the magic that is the Attentio software) include “detain” and “deportation”. Maybe the EU thinks that if it draws a darker circle around all the Member States, the Union will feel a bit more unified, or maybe the elites are genuinely worried about the estimated 8 million illegal immigrants living inside the special European border-free area, the Schengen.

Either way, the political elite are not effectively engaging the public in their concerns. The buzz in the social media, the blogs and the forums created by the unpaid, unprofessional European citizens, is not concerned with non-European immigration to the EU. For the “average European”, the top concern associated with the EU is democracy.

Europeans in the social media are concerned not with the external EU immigrants so much as internal EU integration. Neither the EU nor the mainstream media is reflecting an accurate version of the “average EU citizen’s” opinions. Europe’s population is concerned that the EU institutions are losing touch with the people that they are supposed to represent. This is the difference between mainstream and social media, and this is the distance that the EU elite have to address.

If they are aware of it. Don’t we wish all politicians would pay as much attention to the media that the people produce as the publications produced by the pros?

Addendum from Attentio’s political analyst:

Further Attentio analyst analysis of the data comes up with this short summary: Europe is pretty regional, and the wider the EU grows, the more these regions mix and bump up against each other. The issue for the EU population is not so much European border controls as the lack of internal border patrols. Immigration, for the EU citizen, is a local problem, and it’s the Europeans from other Member States as much as the immigrants from outside the EU that frustrate localised populations. Prior to addressing the regional frustration that is immigration, it might be better for the EU to integrate vertically, then horizontally.

There are two central concerns in online marketing: creating attractive content and distributing that content effectively.  Both factors are dependent upon the industry, product or service and the relevant online market.

Rather, both factors require an accurate Q2 (quantified and qualified) assessment of said market. To address both factors, one needs a Q2 evaluation of the social media surrounding the target market.

Content is three dimensional. It should be visual, viral, and current.

Good content is visually appealing to one’s clients or consumers. The content must be viral in that the information is info that the consumers wish to share–it must infect the individual’s network and not just the individual. Current content is essential. Studies emphasise that WOM (word of mouth) in the chaotic market that is online social media has a “sensitive dependence on initial conditions“. That is, change one letter in the address bar and one’s entire audience is new.  Current content combines the past and the present.  Current content knows the real time concerns and considerations as well as the history of the immediate trends. Current content connects the initial “sensitive dependencies” to the modern market. It is that connection and timely awareness, cleverly and creatively communicated, that makes worthy content viral.  And zing, you’ve just infected a network of interested individuals, aka customers, clients, your market.

But wait.

Content requires effective distribution. Despite the chaos of the online market, or perhaps due to this chaos, esoteric communities and networks specialising in equally valid content remain entirely sealed off from one another. In quantum physics, this phenomenom of multiple realities is called the multiverse. In business, it’s called redundant.

Successful distribution online is also three dimensional.  Successful distribution needs to be authoritative, influential, and proactive. The distributor should have intimate knowledge of her market.  Her authority should be obvious in her engagement with the online community. Distribution needs to be influential. The method of distribution must be broad, connecting several different networks and always searching for additional networks to add to the growing spiderweb of interconnectivity.  This is why all distribution must be proactive, soliciting potential clients to access the content that will influence and create new markets.

I’ve been doing some demos with the software recently, and I’ve come up with a general pitch that seems to appeal to our clients. I want to post it here, hoping for feedback on my powers of communication.

Attentio is a personalised (or rather, industrialised and/or corporate) media manager. Acting as a filing system of all online content, Attentio organises and stores information as it is created in the Internet. It’s one stop-shopping for all the information that you need, organised by source, subject, language, country, etc.

For example, Attentio’s tools note that MySpace is outstripping Facebook in overall popularity in forums and blogs, but Facebook users are more well-rounded than MySpace users. People that talk about Facebook also talk about books, movies, and Facebook’s notorious privacy policy. MySpace posters tend to be less finicky about their privacy policies and more excited about music and cds.

LinkedIn professionals, who prioritise privacy, are increasingly visible in the Spanish and French language blogosphere. LinkedIn’s Facebook tool is also picking up in popularity as the first Facebook generation graduates from socialising to networking. All this Attentio presents in lovely graphs that allow you to clickthrough to access the content that’s been filed for you.

There’s a joke that says the difference between business and economics is that business treats money as finite. The more money one person has, the less others are able to obtain. Economists know money is man-made, just like markets.

Man-made markets are why social networks are online media superstars these days. MySpace, Facebook, LinkedIn and the like have bottled up beaucoups de potential markets. Individuals involved in the networks connect over common interests. These wants and desires are all bottled up online, waiting for some entrepreneurial genie to grant the multitude its mass of group wishes.

The information in these networks is posted for free. The trick, as in any business, is managing the information. Monitoring and measuring the trends and receiving up to date details about what the people in the networks are discussing and why. Market researchers can waste hours every day searching for every article that mentions their markets or potential markets. Or they can use Attentio software.

Where there is consumer will, there is a consumer market. And the success of any market lies in identifying the consumers, letting them know that they constitute a market, and organising their demands to meet your supply. Or is it the other way round?

Either way, this is stuff any economist or business person needs to know.

So when an economy stutters companies want even more assurance when they buy a service there is a keen return on investment (ROI). We care deeply about this of course and want to explain why companies should spend 10,000 -250,000 EURO a year on this type of monitoring and measurement. It goes without saying that this data needs to fit into decision making processes in communications and senior management, we see this more often in Europe now driven by a more social media savvy marketers and an agency network often driven by more “modern” PR companies. For exact ROI of course we need to talk directly to the brands or agencies but below here is our take on the high level drivers for ROI.

1. Campaign effectiveness: Conversation levels are the new metric, compare successful campaigns (benchmarks) with your own campaign and determine if the levels are good, bad, indifferent. This type of measurement enables companies to see what generates the best word-of-mouth and construct more “buzzy” campaigns. The ROI is driven by making more efficient advertising and targeted communication.

2. Digital brand evaluation: The digital brand is the online component of the brand and the same drivers apply, such as,

i. Recognition

ii. Recommendability

iii. Customer sentiment

iv. Cultural/Regional factors

By actually measuring the influence the online brand has in social networks, blogs and forums companies can more effectively evaluate what they need to invest both offline and online. More concretely the word-of-mouth drivers for brands in online are not really being evaluated yet, so companies are actually wasting money on campaigns where they are already getting word-of-mouth support or even worse ploughing money into activities than will never get this warm hand of approval.

3. Insurance against issue that arises in social media first: The analogy - monitoring the news tells you the weather outside, monitoring social media tells you the weather forecast over the next weeks. Companies can also track issues back in time, seeing where the issue arose, by consistent monitoring (and storing) they also build a digital memory that can be anlaysed at any time.

4. Organisational benefits: All companies are now monitoring social media, often this is still ad hoc, done by interns, PR or marketing people. This is a good first step but when the volume becomes too high it is untenable. Would a company trust opinion polling to an internal person? Normally they use outside providers, this is becoming the same for social media (impartiality is important). Social media technology and monitoring enables a distinct process and methodology and if the person who handles this leaves the company then there is a system already in place. I have heard of countless examples were the “guy who had the RSS feeds” leaves and takes a whole process and methodology with him - this is not acceptable anymore…

5. Content strategy: Good well structured, timely content is valuable and expensive to produce, by using monitoring tools companies can see what people talk about really and what information they lack e.g. UK bloggers connect to US bloggers regarding medical issues, company sees this need and provides information site for European web users dealing with different regulation and treatment options. This saves money.

6. Targeting: Simply knowing who is influential can help make a product communication happen faster. This isn’t cynical it just shows that companies are listening to the countless discussions out in social media and trying to speak with the right people. There is a pretty well known group of “A” list blogs but there are 10’s of thousands of other highly authorative people that can be reached and are often interested in new products, content and information. This also has an extraordinary impact on search engine optimisation which further drives ROI.

We have put actual numbers on this with clients and it is normally very easy to explain the value. In my opinion companies will start to have more departments that look like a mix of PR/Marketing and these groups will develop around social media expertise. When this starts to happen the ROI discussion will become more about what tools drive the best ROI not that social media monitoring and measurement drives real value…

Health care today is an individually-consumed good that produces benefits for everybody.

But there is a problem–”health” is subject to interpretation. By the patient. By the doctor. By the nurse. By the judge or the lawyer or the jury or the neighbour or the parent or the secondary school counsellor or the teacher or the boss that sends/does not send the kid home.

Health care consumers know this. That’s why individual consumers are taking ownership of their health care-online. They post and participate in sharing side effects, suspicions, and successes with medications, diets, and treatments.

Online, there are no national boundaries limiting the information about medicines and health care services. Consumers price shop, compare experiences, and exchange advice. But not with everyone. Consumers prefer to talk to each other-consumer trust other consumers, in health care as in all other consumer goods.

Consumers do not trust the professionals-at least, not directly. Direct to consumer (DTC) advertising is despised. Expertise is suspect.

But experience is king. If a pharmaceutical has good word of mouth online, it attracts a dedicated and appreciative following. Consumers are “pulled” to the medication by positive reviews, rather than pushed a drug by DTC.