Referral Marketing for HME with Disease State Management

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Referral Marketing for HME with Disease State
Management

• Presented to
• AmerisourceBergen
• by
• Jack Evans
• Global Media Marketing
• www.retailhomecare.com

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HHCs Upcoming Obstacles to Growth

• 1.Accreditation
• Mandatory for all Part B Medicare providers
• Sept. 30, 2009 deadline
• 2 4 month process
• 2500 to 5000 min. cost/3 yrs.
• 2. Surety Bond
• 1500 for 50,000 bond
• Oct. 2 deadline
• 3. Competitive Bidding

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Americans Affordable Health Choices Act (H.R.
3200)

• Exempts pharmacies from DME accreditation that
  supply diabetic testing supplies, canes, and
  crutches
• Contact your Congressperson now!

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Target Referral Sources

• Make a list of all current physician referral
  sources.
• Make a list of all other healthcare professionals
  who refer patients to you.
• Categorize this list by specialty area or disease
  state.

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Target Referral Sources (cont.)

• Create an A list of referral sources within a 3
  to 5 mile radius of your location who refer over
  half of your patients. Visit these monthly.
• Create a B list of potential referral sources
  within this area who do not currently refer
  patients. Visit them monthly for 2-3 times to see
  if you will begin to get their patients.

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Steps for Referral Marketing

1. Call Referral Source to introduce yourself and
   explain that literature will be mailed.
2. Mail literature with a cover letter outlining
   what you can do for them.
3. Call back one week later to verify that the
   letter was received and set up an appointment.

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Cover Letter
Dear Healthcare Provider, Welcome to Family Home
Health Care. We offer a complete selection of
home medical equipment and supplies. But service
is our real niche. All of us at Family HHC are
professionals who are dedicated to providing you
with the home health care answers and information
you need. We have the largest showroom in the
Los Angeles, featuring the most comprehensive
selection of equipment and supplies for virtually
any home treatment or rehabilitation program
prescribed for our customers. And we pride
ourselves on being specialists in medical
equipment for the home. Family Home Health Care
is recognized for achieving the highest level of
care that exceeds all State and Federal
regulations, having been awarded accreditation
with commendation. Rentals. Sales. Repairs.
Patient Education. Product training. These are
the services we provide beyond the sales of home
healthcare products. We have been meeting the
home healthcare needs of our community since
1983, and our pledge is to continue doing so each
and every day. Please dont hesitate to call us
whenever you have a question or need concerning
home healthcare.
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Steps for Referral Marketing (cont.)

1. Learn as much as possible from your contact or
   online about this referral source.
2. Meet with referral source to present your HHC
   offering and learn about their home healthcare
   needs.
3. Mail a thank-you note for meeting with you.

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Referral Marketing Program

1. First Visit Present your business card and
   brochure specific to their patient base. Question
   and learn about their patients home healthcare
   needs.
2. Second Visit Present a catalog or sales folder.
   Demonstrate your complete product and service
   offering. Set-up an inservice in their requested
   area.

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Flier

• Introduce your new HHC business to referral
  sources
• Ask what products and/or brands they prefer for
  their patients

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Referral Marketing Program (cont.)

1. Third Visit Present an inservice with the
   respective vendor rep and include breakfast or
   lunch.
2. Remember to send thank-you cards after each
   visit!
3. Call your contact at the end of every month to
   find out how their patients like your program/
   products/services.

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Marketing Tools for New Referral Sources

• Fliers
• Brochures
• Sales Folders
• Catalogs
• Videos
• Sample Program

• In-Services
• Seminars
• Direct Mail
• Open Houses
• Disease Management Programs

Does your vendor coop program include these?!?
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Creating Sales Tools

• Request new product information from vendors,
  trade magazines and distributors.
• Catalog literature by disease state.
• Copy onto your own masthead.
• Take copies of all information on one specific
  topic/disease state whenever you call on a
  referral source.
• Become a home healthcare resource for your
  referral sources.

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Sales Presentation Folder Left Side
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Mobility Products Homecare
Bedroom Bathroom Safety
Compression Therapy Respiratory Therapy
Insurance Coverage Our
Service
Sales Presentation Folder (Right Side w/tiered
sheets)
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Tiered Sheets
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Open Houses

• Focus on a category and/or disesase state.
• Plan a luncheon or after-work wine-and-cheese.
• Invite vendors to display and demonstrate their
  products. Charge them for tables to defer food
  cost.
• Offer raffle and door prizes.

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Open Houses (cont.)

• Invite a local hospital/medical/ insurance
  executive to present a brief keynote talk.
• Send formal VIP invitations with RSVP cards. Call
  to follow-up.
• Invite local newspapers.
• Invite a radio station to broadcast live.

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Diabetes Open House Flier
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Primary HHC Disease Management Programs

• Asthma
• Cancer
• Congestive Heart Failure
• COPD
• Diabetes
• High-risk Pregnancy
• Hypertension
• Obesity
• Sleep Apnea

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Top Diseases Named as Drivers of Health Care
Costs

• Diabetes
• Heart Disease/ Hypertension
• Asthma
• Cancer
• COPD
• Obesity
• (U.S. Dept Of Health and Human
  Services/Emory Univ. study, 2004)

• Diabetes
• Heart failure
• Hypertension
• Dyslipidemia
• COPD
• Asthma
• (Top 10 Part D MTM
• Chronic Conditions)

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Positive Outcomes

• Overall Goals
• Improved Quality of Life
• Fewer hospital and ER admissions
• Fewer unplanned physician visits
• Greater independence

• Interrelated Components
• Education
• Medication
• Rehab
• Post-acute care
• Self management

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HHC Disease Management Program Outline

• Patient diagnosis by disease state
• Patient evaluation (intake assessment)
• Treatment plan
• Patient Education
• Medication compliance
• Related HME
• Self-management plan
• Referral source education
• S.O.A.P Analysis
• Monthly monitoring utilization review
• Quarterly evaluation and report to referral
  source

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Medicare ReimbursementPart D

• Medication Management Therapy (MTM)
• Patients with multiple chronic diseases such as
  asthma, diabetes, hypertension, congestive heart
  failure, or high cholesterol
• Patients with high annual drug costs of over
  4,000/year
• Medicare Part D PBMs specify requirements for
  reimbursement (i.e. 60 per 30-minute session)
• Presented by pharmacist or other qualified
  provider
• http//www.cms.hhs.gov/PrescriptionDrugCovContra/D
  ownloads/MTMFactSheet.pdf

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MTM Program

• 2010 CMS will require ALL covered patients to
  receive MTM.
• Proposed Standardized MTM model
• 1-hr initial pharmacist assessment
• 6-hr patient education program (3x 2-hr group
  sessions)
• 3 pharmacist follow-up visits
• Maintenance visits every one to three months
• Physical assessments to include blood pressure,
  foot exam and weight

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Medicare ReimbursementPart B

• Diabetes Self-Management Training (DSMT)
• Individual or group setting
• 30-minute intervals
• 10 hours of initial training
• 2 hours of follow-up training annually (group)
• ADA must recognize program for Medicare 3rd
  party reimbursement (www.diabetes.org)
• Presented by pharmacist, registered dietitian or
  nutrition professional
• http//www.ihs.gov/generalweb/webcomponents/docume
  nts/HLDB/1831-200206031027173.pdf

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Patient HHC Continuum of Care

• Market educational programs and related products
  to referral sources
• Inservice their staff on above
• Educate patient referrals
• Document how you ensure patient compliance for
  physician
• Have patients sign-off and date sheets
• Fax or drop off at referral's office

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Asthma Program

• Following are an outline and sample worksheets
  from an asthma management program.
• Each item would be initialed and dated by the HHC
  staff person who reviews the information with the
  patient.
• Individual worksheets would be completed, signed,
  dated and then faxed to the referring physician
  to document your efforts in achieving patient
  education and compliance.

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Asthma Program Outline

• Establishing a Partnership to Manage Asthma
• Asthma Learning Record
• 1 What is Asthma?
• Basic Information and Resources about Asthma
• 2 If you have Asthma and You are Pregnant
• 3 If You Have Asthma and You are Over 55
• 4 If Your Infant has Asthma
• 5 Resources for Patients and Families with
  Asthma

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Asthma Program Outline

• Developing a Medicine Plan
• 6 What you Need to Know about
• Medicines for Asthma
• 7 Asthma Medicines for (Name of Patient)
• 8 Beta2-agonists
• 9 Theophylline
• 10 Cromolyn
• 11 Corticosteroids

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Asthma Program Outline HMEs Take Note!

• Correct Use of Inhalers and Spacers
• 12 Correct use of a Metered Dose Inhaler
• 13 Spacers
• Use and Care of a Nebulizer
• 14 Use and Care of a Nebulizer
• Home Peak Flow Monitoring
• 15 How to Use a Peak Flow Meter
• 16 My Weekly Asthma Symptom and Peak Flow Diary

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Asthma Program Outline

• Developing an Asthma Management Plan
• 17 Warning Signs of Asthma Episodes
• 18 Personal Asthma Control Plan for (Patient)
• 19 Summary of Steps to Manage Asthma
• Identifying and Reducing Asthma Triggers
• 20 Asthma Trigger Control Plan
• 21 Find Your Asthma Triggers (for Children)
• Managing Exercise-Induced Asthma
• 22 Plan for Staying Active Adults
• 23 Plan for Staying Active Children
• 24 How to Set Appropriate Guidelines for Your
  childs Activities

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Courtesy Pacific Seminars, Kahului, HI
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Asthma HHC Products

• Core Products
• Nebulizers
• Compressor/Home
• Handheld for School/Sports
• Peak Flow Meters
• MDIs
• Pediatric

• Related Products
• HEPA Air Cleaners
• Allergy Control Products
• Pillows
• Sheets
• Bed Covers
• Dust Mite Sprays
• Vaporizers
• Humidifiers

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Referral Sources for Asthma

• Pulmonologist
• Allergist
• Physician
• Pediatrician
• ENT

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Diabetes Program Outline

• Identify the Diabetic Patient
• Patient Evaluation
• Evaluate Drug Therapy
• Prescriptions
• OTCs
• HME (Leg Health)
• Referral Source Loop
• Diabetic Educator
• National/Local Associations

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Diabetes Program Outline

• Patient Education
• Glucose Control
• Blood Testing
• Foot Leg Health
• Blood Pressure Monitoring
• Written Self-Management Plan
• Monitor Evaluate Treatment Plan

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Diabetes Standards of Care

• American Diabetes Association (ADA)
  www.diabetes.org
• American Association of Diabetes Educators (AADE)
  www.aadenet.org
• National Institute of Diabetes Digestive
  Kidney Diseases (NIDDK) www.niddk.nih.gov
• National Diabetes Education Program (NDEP)
  www.ndep.nih.gov

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Basic Training 101

• Blood Glucose Control
• How to obtain a blood sample
• How to test a blood sample with a blood glucose
  meter
• How to record the test results
• How to maintain quality assurance with control
  tests
• How to care and maintain the glucose meter
• How to store and use test strips

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ADAs Link! for Health Care Professionals

• "Make the Link! Diabetes, Heart Disease and
  Stroke" Program
• Health care providers talk to their patients
  about the link between diabetes, heart disease
  and stroke.
• 68 of people with diabetes do not consider
  cardiovascular disease to be a serious
  complication of diabetes.
• 60 of people with diabetes surveyed do not feel
  at risk for either high blood pressure or
  cholesterol problems.

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ADAs Link! Educational Materials

• Diabetes Cardiovascular Disease Review
• Issue 1 Redefining Diabetes Control
• Issue 2 Hypertension in Diabetes
• Issue 3 Diabetic Dyslipidemia
• Issue 4 Nutrition, Diabetes and CVD
• Issue 5 Coronary Heart Disease in Women with
  Diabetes
• Issue 6 Peripheral Arterial Disease in Diabetes
• Issue 7 Promoting Weight Loss in Patients with
  Type 2 Diabetes Importance and Strategies
• Issue 8 Prescribing Physical Activity for the
  Management of Cardiovascular Disease and
  Diabetes www.diabetes.org

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• Other Titles
• High Low Glucose Levels
• Physical Activities Diabetes
• Healthy Eating Diabetes
• Medications Diabetes
• (www.homediagnostics.com)

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Courtesy Molina Healthcare, Albuquerque, NM
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Program Outline 1

1. Diabetes Overview
2. Diabetes Self-Management
3. Hypoglycemia Hyperglycemia
4. Insulin Therapy
5. Oral Diabetes Meds
6. Eating Healthy

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Program Outline 2

1. Physical Exercise Weight
2. Cardiovascular Disease
3. High Cholestorol
4. Foot Care
5. Eye Oral Care
6. Smoking Cessation

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Diabetes Category

• Related Products
• Blood Pressure Monitors
• Shoes, Socks Foot Care
• Compression Stockings
• Skin Care
• Oral Eye Care
• Sugar/Alcohol-Free Foods, OTCs Vitamins
  Minerals
• Identification Products
• Pressure Management Surfaces Seating
• Erection Aids

• Core Products
• Control Supplies (Insulin, lancets, syringes,
  test strips and glucose)
• Blood Glucose Meters

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Diabetes Destination
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Beyond OTCs
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Beyond OTCs
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Referral Sources for Diabetic Care

• Physician
• Diabetic Educator
• Podiatrist
• Endocrinologist
• Dietician
• Retinal Specialist

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Outside Salespersons Responsibilities

• Call on local referral sources and document these
  sales calls.
• Attend local meetings of healthcare
  professionals.
• Inservice and train referral sources on available
  HHC products/services.
• Assist in insurance coverage decisions.

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Conducting Inservices

• Educate and inform first, then sell
• Demonstrate how to care for patients at home
• Bring food or imprinted give-aways

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Sales Contact Record

• Maintain records of every contact, call and visit
  to maintain continuity.
• Use automated programs such as Goldmine or Act.
• For manual records, chart date of call/visit,
  contact person, product/ service discussed,
  requested action, date of follow-up and action
  taken.

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Sales Contact Record TopReferral
Name Address Telephone Fax
email Key Contacts Titles

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Sales Contact Record Bottom
Date Call/Visit Contact Person Product/Service Shown Follow-up Requested Date Follow-up Action Taken





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HHC Market Qualifier
Market Buyer Product Payor Revenue Source
Acute Hospital Basic Institution 3rd Party
Surgery Ctr. Basic Institution 3rd Party
Post-Acute
Institutional Nursing Home (SNF) Basic Institution 3rd Party
Rehab facility Basic Institution 3rd Party
Board Care Basic Institution 3rd Party
Assisted Living Better/Best Individual Insur. or Cash
Retirement Communities Better/Best Individual Insur. or Cash
Homecare HME Good/Better/ Best Individual Insur. or Cash
Drug Store Good/Better/ Best Individual Insur. or Cash
Mass Mkt. Good/Better Individual Insur. or Cash
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Hospitals

1. Never say No!
2. Any willing provider?
3. Hospital-owned HME?
4. HME chains w/in-hospital desk?

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Case Managers Discharge Planners

• Refer to the sales rep, not the Company
• Depend upon the person, not the company (value
  personal relationships)
• HME salesperson is the Point Person to oversee
  patient from hospital to home
• Count on Reliability and Accessibility
• Know they can have HME waiting at patients home
  when discharged
• If not possible, know they can reach HME rep at
  all times so rep, not them, can resolve any
  problems

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Case Managers Discharge Planners (cont.)

• Overall need
• Tell us how to better care for patient at home.
• Tell us what new HME is available to better care
  for patients.
• Tell us what we should recommend to patients for
  their respective medical conditions.

• Needs at discharge
• Qualify patient
• Order equipment
• Deliver equipment to home
• Educate patient on equipment usage

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Long-term Care Facilities (LTCs)

• Nursing homes (SNFs)
• Rehab facilities
• Board-and care facilities
• Assisted living centers
• Retirement communities

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Independent Assisted Living Facilities

• 81-year-old female resident
• Private pay!
• Majority need help with min. of 2 daily
  activities
• Bathing
• Dressing
• Transferring/Toileting
• Coordinate visits with social director, not
  nursing director

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LTCs (cont.)

• Questions to ask
• Who is Administrator?
• Who is Supervising Nurse?
• Is purchasing local, regional or national?
• Who pays for products?
• Who is weekend supervisor?

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LTCs (Cont)

• First visit to Administrator
• Write/call repeatedly to get appointment.
• Be brief
• Emphasize you are a local company servicing your
  community.
• Request approval to return and meet with head of
  nursing.

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LTCs (Cont)

• Second visit to Dir. of Nursing
• Introduce your company, products and services
• Determine their product/service needs
• Set up an inservice the following month based
  upon above
• Wheelchair seating
• How to use concentrators
• COPD mask compliance

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LTCs - Ongoing

• Contact Maintenance Supervisor.
• Offer to pick-up and service wheelchairs.
• Focus on parts, repair, and cleaning.
• Offer an annual program for preventative
  maintenance (similar to auto).

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Visiting Nurse Associations Home Health Agencies

• Determine sources of revenue, i.e. Medicare,
  workers comp, private insurance.
• Make appointment with the supervisor.
• Find out who currently receives HME referrals and
  why.
• Determine primary needs, i.e. closed door
  pharmacy, enteral feeding, custom fit wheelchairs.

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VNAs HHAs (cont.)

• Request permission to attend their monthly
  meetings. Offer to provide refreshments.
• Bring a doctors bag of professional tools such
  as stethoscopes, scissors, sphygmomanometers,
  otoscopes, pen lights, nurses kits.
• Leave samples for a week with pricing. Request
  samples from vendors to use. Place your business
  stickers on every piece.

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Hospice

• Standard package bed, overbed table and beside
  commode.
• Oxygen 1 HME service requested.
• Other top HME shower benches and wheelchairs.

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Hospice (cont.)

• Per diem rate vs. flat fee
• Three levels patient care acute, respite and
  residential.
• Reliability as key benefit HME ready to deliver
  or pick up equipment at moments notice