University Health Publishing Internet Hub Case Study

Publishing in the 21st century is about understanding the big media picture. Successful media empires are built around a brand and encompass a network of products, many of them both marketed and delivered in more than one medium. Companies that began with a single print magazine or newsletter now publish numerous titles, plus books, encyclopedia, one-off bulletins, premium special reports and more. They market these products by direct mail and online, and sometimes deliver them in both physical and digital formats.

University Health Publishing has taken its leading brand—Johns Hopkins Medicine—and developed 26 paid products that it markets to a database of more than 12 million customers. According to Stuart Jordan, chief operating officer of University Health Publishing, his company has overseen a 10-step transformation starting from that core print title to a multi-million dollar media empire.

  • University Health Publishing is an independent company and operates under a license agreement with Johns Hopkins
  • Between 1989 and 1995, UHP mailed 10 million direct mail promotions annually to build its core customer file to 500,000
  • The aging customer base for The Johns Hopkins Medical Letter, Health After 50 presented an opportunity to create and market new products, such as hardcover, consumer reference books and special consumer reports
  • University Health Publishing returned to its partners at Johns Hopkins to develop even more high-end products
  • “We woke up one day and our business had changed,” says Jordan. “We realized we were no longer just a newsletter publisher, but we were a consumer health information publisher—that really changed the way that we thought about the business.”


University Health Publishing is a publisher of consumer health information. It started as a newsletter publisher in 1983, when the company’s founders decided to create a health newsletter for consumers and market it by direct mail.

The newsletter medium was essential to their strategy because the information had to be untainted by advertising. Further, it couldn’t be information about “not being sick.” The publishers didn’t want to market the idea of “prevention,” they wanted the publication to be about “being healthy.”

The company coined the word “wellness” and eventually found a partner at the University of California Berkeley School of Public Health, whose experts continue to edit the eight-page monthly newsletter, The Wellness Letter.

The newsletter defines wellness as “a positive, day-to-day approach to a long, healthful, active life. It includes both highly scientific and practical medicine—from the latest research and most advanced tests to reliable home remedies and common sense.”

By the early 1990s, subscriptions topped at about one million. Today, The Wellness Letter has more than 350,000 subscribers in the U.S. and Canada (plus thousands of readers of its foreign-language editions).

Restless for another product—one with more “juice”—UHP’s owners developed a concept that in 1989 became the The Johns Hopkins Medical Letter, Health After 50.

According to Stuart Jordan, chief operating officer of University Health Publishing, his company has overseen a 10-step transformation starting from that core print title to a multi-million dollar media empire. This is his story, as he related it to an audience of publishing executives at the 2005 Mequoda Summit.

Step 1 – Get a Brand
“The more I do this, the more I believe in the value of the brand when you’re working in direct marketing,” said Jordan.

Johns Hopkins Medicine has been ranked the number one hospital in the United States for 15 years in a row by U.S. News & World Report. Since the 1880s, Johns Hopkins has been credited with developing many far-reaching advances in modern medicine, including neurosurgery, urology, endocrinology and pediatrics. People generally know the Johns Hopkins name and they trust it.

So University Health Publishing began its new newsletter by licensing the John Hopkins Medicine brand, which Jordan characterizes as “both a huge blessing and a huge curse” because of the oversight it imposes on developing editorial content.

“We have this great story to tell about who we are,” said Jordan. “We’re Johns Hopkins, and make no mistake about it, we are the consumer outreach of Johns Hopkins. Everything that we do, Johns Hopkins looks at in terms of how we represent them to the rest of the world.”

Step 2 – Get an Audience
According to Jordan, there are more than 70 million people in the United States over the age of 55, with 36 million over the age of 65. Eighty-eight percent of people over 65 have at least one chronic health condition.

The company already had The Wellness Letter, directed to a younger audience, so University Health Publishing decided to address an aging population of Americans who are 50 or older.

“The young audience and the old audience don’t necessarily want the same information,” said Jordan. “Unfortunately, as you get old, you get sick. So it was just a matter of waiting for the audience to find us. As they get older, and as they develop conditions, a portion of that audience will start looking for health information.

“There are two types of people in this world when it comes to managing their health—the people who go to the doctor and say What’s Wrong? What Do I Do?, and the people who go to the doctor, say What’s Wrong? and then go home and assume active management of their own healthcare. And unfortunately, in this day and age, the need to do the latter has become a lot more important.”

Step 3 – Create a Core Product
UHP began by defining the audience for its new newsletter: Americans over 50 who are interested in getting information to help them participate in managing their healthcare.

The Johns Hopkins Medical Letter, Health After 50, a monthly, eight-page printed newsletter, launched in 1989. It was marketed by direct mail with a $15 introductory subscription price. Within six years it had half a million paid subscribers at $28 annually.

University Health Publishing is an independent company and operates under a license agreement with Johns Hopkins. UHP employs its own staff of editors and freelance writers who write all of the content, which is vetted by Johns Hopkins physicians before it is printed.

As a result, UHP has a greater degree of independence than the Mayo Clinic, for instance, where the health letter staff are employees of Mayo.

Step 4 – Build a Customer File
Between 1989 and 1995, UHP mailed 10 million direct mail promotions annually to build its core customer file to 500,000.

Because UHP is a for-profit organization, it pays higher postal rates than Harvard and Mayo and the other non-profit institutions that publish health newsletters. Those increased costs affect the UHP pricing and marketing models.

Another variable in the equation is the aging audience for The Johns Hopkins Medical Letter, Health After 50. By definition, it’s over 50, but over time, it’s gotten much older. While renewal rates are high, some subscribers eventually expire—literally. Cleaning the list is a special challenge.

Step 5 – Develop Other Products for the Customers to Buy
The aging customer base for The Johns Hopkins Medical Letter, Health After 50 also presented an opportunity to create and market new products.

The first were hardcover, consumer reference items that sold for $29.95 plus shipping and handling. Titles included the Johns Hopkins Medical Handbook, the Johns Hopkins Handbook of Drugs, the Johns Hopkins Symptoms & Remedies and the Johns Hopkins Guide to Medical Tests.

“The way we create content, this is incredibly expensive. Our investment to create one of these books is about $250,000. But it was a way to get the business started into selling more things,” said Jordan.

“But there are only so many of these books you can do, because they’re so darn expensive, so next we started creating other products.”

Step 6 – Develop More Products for Your Customers to Buy
In 1993, University Health Publishing began creating special consumer reports that promised the latest thinking from the Johns Hopkins doctors on a single topic: heart disease, arthritis or prostate disease. These 90-page documents are marketed for $20 annually in a continuity program. Subscribers receive each new year’s report and are billed accordingly until they cancel.

Today, UHP publishes annual reports on 13 different medical conditions. And because so many of its subscribers have multiple illnesses, the company sells an average of 3.25 white papers per customer. That makes each white paper subscriber worth more than $60 annually to UHP. As Jordan explains it, the white papers forever changed how University Health Publishing thinks of itself.

UHP was no longer simply a newsletter publisher. It was a publisher of branded consumer health information products. And they were only just beginning; there was much more to come.

Step 7 – Develop More Products That Focus on the Interests of Your Customers
Next, University Health Publishing returned to its partners at Johns Hopkins to develop even more high-end products. After all, the doctors at Johns Hopkins were eager to get their valuable (read: life-saving) information into the hands of more patients.

By forming an alliance with the urology department, ranked number one in the country for its expertise in treating prostate disease, UHP created the ultimate high-end consumer product containing the latest thinking from the doctors at Johns Hopkins. The report sold for a $195 annual subscription and was updated quarterly.

“And who did we sell them to? Typically, the people who bought the prostate white paper,” said Jordan. “We had an audience built in for it. It was a matter of figuring out what they were interested in. So we started the first bulletin in 1997. It took us two or three years to figure out that this really was a good business. We started the second one in 2003 and now we have four.”

Step 8 – Be Open to Modifying Your Strategy to Reflect the Business Opportunity
“We woke up one day and our business had changed,” said Jordan.

“The business had started as a mass consumer newsletter business. All of a sudden, we realized that we had a consumer health information business and we had a pyramid. The realization was the day we were no longer a newsletter publisher, but we were a consumer health information publisher—that really changed the way that we thought about the business.

“The question always came up, what business are you in? Are you a newsletter publisher or are you an information provider? And when we got to this point, that’s where we really decided, hey, we know where we are, we know where we want to go.”

Currently, Johns Hopkins Health After 50 Publications has 26 paid products.

  • Health After 50 Newsletter: Paid circulation – 225,000
  • Johns Hopkins White Papers: 13 titles, 165,000 paid orders
  • Johns Hopkins Bulletins: four titles, total paid circulation – 7,500
  • Johns Hopkins Health After 50 Books: four titles, 40,000 orders per year
  • Johns Hopkins Cookbook Library: three titles, 15,000 orders per year
  • Johns Hopkins Health & Medical Advisor: Annual desk diary, 12,000 paid orders per year

Step 9 – Build a Customer Database
Jordan says University Health Publishing is still primarily a direct mail business.

After 16 years in the business, UHP has acquired more than 12 million names in its corporate database. It regularly cleans its list against National Change of Address and Deceased Processing files.

In 2005, UHP mailed about 10 million pieces of direct mail promoting its 26 products. This represents a combination of marketing to outside lists to attract new customers, as well as marketing to the various UHP house lists to cross promote products and reactivate old customers.

Step 10 – Expand Your Base
Like most publishers, beginning in the late 1990s, UHP began to market its products on the Internet.

Jordan cited research that show 31 percent of seniors over the age of 65 are online, and that 70 percent of seniors 50 to 65 are online. These same groups are going online for health information 21 and 53 percent respectively.

The 50 to 65 age group identifies the Internet as number one when ranking media sources of health information. Some 37 percent of online seniors are getting drug information online and 25 percent are researching chronic health conditions online. About 34 percent of seniors say they have talked with a doctor about information they have found online.

The research confirmed UHP’s need for an Internet marketing presence.

“Both the newsletters had websites and the products… but we had no Internet strategy,” said Jordan. “We just didn’t really know where we were going.

“We had great information. We knew that we had a brand. We knew that we were prepared to put content online, and we knew that we saw our return on investment in terms of selling the stuff. We weren’t quite sure how to pull it off.”

Following a meeting with Mequoda Group Managing Director Don Nicholas, Jordan says UHP committed to a new online marketing strategy following the Mequoda Method.

Future Online Marketing Using the Mequoda Method

“We’re directly going after the permission-based relationship with our customers, Jordan said. “We believe that they will be interested in getting our information, and we believe that if we share that information with them, they’ll be interested in our products.

“We’re not building a website, we’re building a whole town or village. The center is our hub. Surrounding all those individual sales-based, sales-focused websites are all of our 26 products. We are fast and furiously working at changing that from a couple of circles and colors on the page into real live websites.”

This is a visual representation of what the Johns Hopkins “town or village” will look like. The center is their hub, surrounded by individual sales-based, sales-focused websites. They are working on changing that from a couple of circles on a page into real live websites.

As part of its permission-based, online marketing strategy, University Health Publishing will begin capturing the email addresses of new potential customers by offering free email newsletters, or Health Alerts, on 16 different topics.

UHP is creating a new brand for its Health Alerts, which it characterizes as “a free service of University Health Publishing and Johns Hopkins Medicine.”

With enthusiastic support from Johns Hopkins Medicine, UHP will soon incorporate the Johns Hopkins seal on these email newsletters, as well as its new network of websites. The navigation bar of each site will include a link to the Johns Hopkins Medicine website.

“One of the things that we’re doing with this site is increasing our own brand. The brand here is Johns Hopkins Health Alerts. We want the people thinking about Johns Hopkins Health Alerts as a brand, and thinking about us and the site, and not the (hospital) building in Baltimore, as the focus of their attention.

“We’re basically selling Johns Hopkins Medicine. We can control our message better by what we do with our brand.”

Jordan said the Johns Hopkins Medicine doctors love what UHP does for them.

“Basically, the doctors are the source of everything that we do and our letters are what makes them consumer-friendly,” Jordan said. “We’re making them stars and their departments stars. And it makes a difference. Fundraising works for them and everything else, so they’re happy with us being part of the process.”

Are there plans for any other Johns Hopkins Medicine/University Health Publishing products, such as vitamins or supplements? The answer is, emphatically, No.

“It’s the company policy that we sell information. We’re not in the supplement vitamin business. And quite frankly, we couldn’t be in that business with our institutions.

“We’re very clear in our minds that we’re an information company. And that’s it. We just keep looking for other ways to do that.”


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