see it. I can do it. Never mind. I got it. Yeah, I didn't. You got it. I got it. Okay. All right. So this is the part of the afternoon where Amanda and I really stopped talking at you. And we're gonna make you guys be interactive with us whether you like it or not. We do have some more marketing and branding content that we can cover that we, you know, we talked a little bit in economics. We don't sometimes depending on how timing works out, we don't always get to that. So that's the only really structured content that we have to go over today. But also, this is where if you had any burning questions, or you want to talk about your practice model or your challenges or anything that comes to mind that you want to kind of have a group discussion or ask us questions about that's what this time is for. And we can use it however is most beneficial to you so that you leave here feeling like you got the most out of this and you got your questions answered. That's that's really our goal for the segment of the afternoon that you're with us. So do we would you guys like to start with any burning questions that you guys want to start with or otherwise we can kind of talk a little bit more about marketing and branding and then go from there. I'm gonna I'm gonna close my door. That's that's got me but someone just walked in. Nobody's here on Fridays. I mean, no one's here a lot of the time, but in case I'm bugging someone, no worries. All right, let me exit. Sorry, let me pull my slide deck up here. Once I'm at Amanda had a really good thought to before we totally dive into kind of the structured content that we have for you guys. I think it would be really if you guys are willing to share helpful to just kind of go around and talk about what makes your practice unique. Like we talked a little bit yesterday about unique value propositions are kind of, you know, how would you describe your practice or or what makes you unique? What are you? I'm so sorry, I'm selling points if you will, for your care model. Anyone have any thoughts? And you can put it in the chat if that's more comfortable for you too. That's completely fine. So, um, I come from, like I said before, primary care practice where I'm the only provider that does home visits. I've been doing, doing them about 21 years. I do. So I only work two days a week, because I faculty at nursing. And, you know, kind of one of the, I can just float along like this until retirement my two days a week, seeing my patients, I do about five assistance. And then I have a, you know, a good chunk of people that are basically homebound. And I've limited, limited it primarily do the guidelines, but also for my own sanity to really, you know, meet the need of the people that most need it, instead of people that just don't have a ride to the doctor's office, which is something that, you know, we get a lot too. What I'm really trying to build here is kind of dovetailing off, I had the HRSA grant where we did, it was called geriatric outreach and training. Oops, sorry about that. Geriatric outreach and training with care got care where we had about 260 interprofessional learners, and about nine faculty members, and we, we did training each semester. And then we brought the groups out to older adults who were in their homes who we would ordinarily either be doing primary care on, we kind of worked as more of a specialty service, where we did a comprehensive geriatric assessment, we taught the students, you know, the, the, you know, the specifics about geriatric care. And then after the fact, we looked at, well, while we were doing that for our grant, we had to look at patient satisfaction, we had to look at look at some population health parameters, we didn't have to look at cost of care, and we had to look at provider satisfaction. So we would provide, it was basically almost like a consult service where we would provide the primary care provider, a list of risks for the older adult to be hospitalized or institutionalized, like the Oasis risks that come from the home care model. And we had a nurse navigator that came from home care, and she would help us after we, you know, gave our report, almost like a consultation report, she would help to navigate the care, and then we would follow up with the patient. So it was really a teaching model versus a care model. However, we've been able to go do some secondary analysis on the patients we saw. And, you know, we've had tremendous reductions in ED utilization, like 36%. You know, and then we look at cost of care six months pre and six months post 12 months pre and 12 months post, just with the short little intervention we did where we did like a geriatric consultation in the home, we, you know, we found that it saved the system a lot of money. But me twice a week doing home visits, you know, I don't, I have leadership that believes in the value of it, which is good for me. But when you look at and I liked Amanda's comment yesterday about, I think it was Amanda, or maybe Brianna, I'm not sure, comparing, you know, sheets of, you know, looking at people's balance sheets and what they've brought in month to month, you know, that can be very divisive, I think. And, you know, when you're doing this type of work, there's a lot of value to the system that's not shown in those sheets. And so, you know, I'm trying to kind of capture that for not only, you know, establishing what I'm already doing. I'm not getting pushback so I can keep doing this probably as long as I want. But if I want to grow it or and or make it more interprofessional, and or bring students in, you know, I kind of got to show more about the value of it. And as value based care comes forward, I think, you know, we're behind the eight ball and looking at what the future is. So that's kind of where I'm coming from. Yeah, absolutely. Thank you for sharing. I like that. It's really interesting. I love that how you kind of started with the HRSA grant and the teaching model. And I think early, you know, as much more we can get early graduate medical education, or take students out and get them exposed to home based primary care is so important, because otherwise, we won't have a workforce. I'm sorry, did you have thoughts? I saw you unmuted. Oh, yeah, I mean, that that's awesome. And right, like, so I think, I mean, you, you have it all, you're sitting on it all, it's just, you know, coming up with the five bullet points of how much money you save, what was your hospital, you know, reduction, and, and what was your provider satisfaction. So if you I mean, I think you're sitting on those pieces, it's just being able to kind of rattle them off and say them over and over again. And what I find, when you're when you're trying to negotiate, whatever you're trying to negotiate, I completely agree with myself and with you, that when people continue to look at the P&L may just look at these things as expense only, it just does not tell that whole story. So you have to you have to drive that revenue component. But yeah, I think, I mean, I think you you have so much value that you've already kind of studied, incidentally, you know, because of the teaching work that you really have some opportunity to expand. One thing I will say, though, is as part of larger systems, even if and I go back to this, and this is where sometimes you never actually take off the launching pad. Even if they want hospital admissions and readmissions reduction, because of penalties, and they say they want it. Many don't really want it. And that's where you just get just circular lip service about the situation. So you know, it's one of the things you could, you know, you may need to pick have those in your back pocket. But you may need to pick other, you know, cost mechanisms that are that are of value, that maybe make maybe a little more sense. You know, some of some of what I think about is, if you know, your health system is going into a contract, or they have a contract today, you just show up with that information and say, Hey, I'm not coming for all your patients. I'm coming for you that new Medicare Advantage contract you just signed. Here's the total cost of care, I'm going to have you switched in dollars from from from hospital, and we're going to switch them over to primary care. And, you know, and then the whole system is going to save us some money. And so it kind of if you take smaller bites sometimes of like where you know people are feeling pressure points, that can kind of help. And from a quality standpoint, again, pick some maybe different quality measures other than readmissions, because that can be threatening, depending on who's in the room or who you want to be in the room eventually. Yeah, we've heard about the the value of ED visits to the bottom line. And so you know, if we're trying to erode that, but, you know, I'm waiting for Medicare to say, you know, we can't be doing this. This is this is ridiculous, primary care in the emergency room. So yeah, I mean, I don't know, like, beyond CMMI pushing where they pushed, and then this kind of what I'm doing is a little bit of a step back to take some of these programs offline and kind of reevaluate. Like, I don't think Medicare is going to come out and say that I you know, I think they're going to keep it's like they're taking like a passive aggressive approach. You know, well, by this date, we're gonna have this many people in value contracts, it doesn't really address that you're moving them from non you know, value programs. And so, you know, I think you at some point, you know, you have to kind of go after them. And again, there are some things that they're probably holding some contract value. And it's so funny, you say that because behind closed doors, they'll say, yep, we need those hospital admissions, boy, but you're not gonna find a CEO in the United States is going to get up and be asked on a panel that says anything like that. Hey, we got a we got a lower readmissions, we got to transform healthcare. You know, again, alignment, synergy, partnership, a bunch of buzzwords don't mean much. Yeah, I think the only evidence you're going to find that they support, you know, is what they've done to support TCM from a Medicare fee for service standpoint, because actually, like I pulled in the advanced coding handout, some of the language that CMS used around why they've, like, they give a little, they always give some rationale that's buried in, you know, their mumbo jumbo of why they're increasing the payment and the revenue for TCM when all the other EM services are kind of at risk of taking a hit. And it was because, you know, we've looked at patients that are admitted to the hospital who have qualifying conditions and what their readmissions are. And we know there's more like these services could be built more than they have been. And we believe that would prevent so that's the only way but I agree with, you know, of course, everything you're saying, I think maybe, maybe you know, or maybe you can have some conversations like, hey, what are some, what are our other priorities? Or what are our what's other, you know, is advanced care planning important to you? Because that's, you know, becoming more or is, you know, HCC important to you because of a value based contract, you know, what are other things that you can do that might show your value in other ways? Yeah, we're actually so we're working with the age friendly health system. Okay. You know, and so, but that's all in patient right now. But I'm, I'm on one of the committees, you know, just from my experience and whatnot. So as we're building what we want to do, going forward, we're using actually the, you know, we're using the five M's within our assessments, because what we had built before was really like a huge, the comprehensive geriatric assessment, which can be, you know, huge, and each discipline kind of did their own thing. And now we're really focusing it on the five M's, and kind of targeting our assessments to those so that our outcomes align with those. We're building a logic model with that right now. So, you know, and making sure that all of our outcomes are those that are of interest to the to the hospital. So that's kind of, I'm actually working on this with the Director of Community Development, who's an MPH for the hospital, and she worked with me on the other project. So we're, we're kind of doing this, you know, once a week, we meet, we're building this, and we're not quite ready for primetime yet. But this was an important piece, all of these threads that you guys are sharing. So this is very critical for me, and I appreciate everything that you're sharing with us. And I think you guys said you're going to share the slides? Yes, they are going to be available on the HCCI Learning Hub. So you'll receive another follow-up email from our team after that, but you should have received, that's also where you'll claim your CME credit and do the evaluation. But all of the materials, I was assured that specifically all of these non-clinical track slides will be made available on there for you. Yeah, because there's like, I've got my camera, I'm like, I'm going to take a picture of that. But I haven't, I'm like, I know they're going to give them to us, because they're really like, you can't keep all this in your head, you know? No, no, not at all. And we would never want to expect you to. Yes, it was funny. I was on a phone call with someone the other day, and they showed me, it was like a one-off conference we did. And they were like, look, I brought this from my vacation reading, and they like showed me an HCCI workbook. And I was like, that's awesome. But like, you got to find some better vacation reading. So like, we got to, we got to find some other time to mix in some of this content. But like, they are really valuable, you know, when you have the time or when something comes up to refer back to. Okay, thank you. Thank you. Anyone else want to share the value of their program or anything else they're kind of struggling with? Otherwise, we can dive into some content and maybe some questions will come up. This is your time to tell us what you want to hear. Be brave. All right. So like I said, you know, we talked a little bit about marketing and branding in the economics session. Amanda and I kind of wanted to talk a little bit more about market analysis and and what you can do because before you do anything, and especially for, you know, the Carolina Caring folks on the call, and even Geriatric Solutions, if you're thinking about expanding, you got to think about geography first. And so how do you really evaluate the market in your area and what tools are available to do that? And so this, you know, the map that's on the screen was actually a new program where they were saying, okay, the orange is our target area, the green is things we might consider in the future. And the, you know, they didn't want to travel that far. Initially, they would obviously have to have different service lines or different providers. But they looked at population data, and they looked at where there was competition and where there was lack of community service models, and where they felt like patients had the greatest, you know, risk of access for care and things like that. Has anyone done that? Or, you know, even mapped out the senior living communities, you know, made a map of what assisted living facilities, what group homes, what, you know, big congregated areas are nearby your target market? And do you know your target market versus where you might consider in the future? Yeah, Brianna, I did that not too long ago, and shared that with our growth and sales team, just, you know, we're, you know, pretty healthy organization and been in the area for a long time. So they kind of have majority of these relationships, but there's some that we don't. So I thought that would be helpful. And then, you know, there's a lot of retirement communities like our active, you know, retirement communities popping up, which, you know, may or not be a successful strategy for us. But I imagine there's probably some pay, some residents in there that could fall into, you know, the home based primary care need category. And a lot of those communities, you know, target or market themselves as concierge type services, you know, and, you know, what better than, you know, bringing primary care to your home, I think that falls right into that concierge category. So we're starting to, those are starting to grow in popularity down here. So I met all those out. And actually, we've got a meeting next week with the growth and sales team now that we have a nurse practitioner on board to really start, you know, getting out there and promoting the program. Yeah, two things I would say, or go ahead, Amanda, you jump first. Nope, you go. All right. The especially when you're first kind of your sales team or your business development team is having those initial meetings with some communities, they may or may not already have some traveling doctors or a doctor that's there, but they have to give patient choice. So, you know, don't, don't, you know, say, well, would you keep our information, you know, this is what sets us apart, or, or maybe there's patients that need kind of more comprehensive services that we might provide that this doctor that's here once a week doesn't, they do have to give choice. So don't, you know, let that discourage you. And then the only other angle I've heard for the retirement communities, like you mentioned, is the annual wellness visits, like comprehensive Medicare annual wellness visit is generally like a pretty good sell for retirement communities. I have other thoughts on patient choice, but it is not, it's not, it's not the time. So I'm going to skip by those. We'll see, I was gonna say, oh, I was gonna say, we just did this work. And we mapped by county, Medicaid patients. So because that's all public. So you can usually go and find how many who's on public programs by county, maybe, maybe people break it up other ways are, you know, maybe it's by city and other areas, but ours is by ours is by county. So that's what we just did here. That's great. I can't say there was a great, like, yeah, I don't know. Do you have like a good mapping system for this kind of thing? Like we kind of, we're trying to kind of build our own. Yeah, I mean, I don't know that I know that there's a lot that you can like buy, you know, we'll do this for you. And actually, you know, you know, there's a lot of different kind of things under the way with with research services. But there's a lot of public information data to like I said, the Census Bureau, but not like mapping like that, like, like you kind of have to do your own if you do have like a larger organization, though, like, I'd be surprised. I've seen a lot of homegrown, like you mentioned, you're trying to build your own. But like, if you tap the right people in analytics and it to see what they can do. I've seen some really neat map heat maps and geo heat mapping, scheduling and all sorts of really high tech, fancy things that just individual, you know, programs and organizations have been able to develop. Yeah, we've certainly I mean, we definitely did the free one for all of the, you know, we went online and did all of the senior housing in the state and took those and translated those and put those in like a Google Map. So we could get a sense of, you know, by by county again for us. So yeah. Okay, thanks. Oops, did I switch? So kind of building on the neat, unique value proposition, and, you know, what problem are you trying to solve for? And like, what's unique to your community? Or what's the benefit for different audiences? And especially, I think what we didn't really get into, which I think is important to is, yes, your elevator speech, yes, being able to communicate it. But like, how are you going to explain this to patients and caregivers, you're going to have a different sales pitch, like when you're Patrick, your point when your business development team is meeting with the elves, and you're understanding that, but like, how are you going to talk to vulnerable patients and caregivers? And what's, what's that sell? Or what are those just two or three bullet points that aren't in, you know, salesy medical language on how you can help them. And, you know, again, if there is competition in your area, or if they know of other services, why you and I have to adjust my window here really quick. But, you know, understanding your different audiences, and really trying to kind of dig deeper into what's your messaging for each? Anyone want to share what they've thought about? Yeah, our organization just set in on a marketing conference, conference, and the, you know, the subject matter expert talked a lot about I just put in the chat claim pain gain, claim pain gain. So, you know, what do you and your organization do differently than the competitors? You know, what are the pain points for the consumer that you're going to help solve, you know, and what are they going to gain by choosing you over the next person? So I thought that was, that was really cool. And so, you know, as far as promoting the practice, you know, verbally, but also kind of, we're actually going to probably overhaul our website. We went in kind of a deep dive on our website as well. And it looked, we thought it looked good, but it was pretty weak when we used their criteria. So Yeah, I've also heard of like, I think it's the five P's of marketing, and there is a lot of stuff. But if you challenge yourself to compare it to like your own materials, you know, sometimes too, I really love this is kind of a sidebar, too. But I really love seeing the entire care team on practices websites, you know, sometimes it's just the physicians, but like, I've been seeing a lot more of like, here's our care navigators, here's our IMAs, you know, I mean, depending on how big your team is, you can't have, you know, five, you know, 50 people on there. But like, is there a way to kind of introduce that? And really, like, I think, pictures and faces, and especially when they're new, kind of does a lot for people to and I really like seeing the entire care team kind of being featured, or at least explained, you know, if you depending on the size of your program, it might not be realistic to have everybody on there. And for us with this value proposition, you know, as you know, you know, what problem are you trying to solve for? Or, you know, how do you distinctly market your services or talk about the service you're providing is this value, I can tell you, we're in an interesting spot where now we've been around for, I don't know, 1819 years. And, you know, what we're seeing is we will do something and it might take a year or two, and then the other groups will do it. And so we're you know, like you have this, this constant innovation wheel. And as technology and time and focus for the competitors has gotten, you know, faster and better, essentially, like their processing time to implement something we're doing is, it's a lot shorter. So like, you know, like, we're the largest geriatric practice, we have really specific areas, we would like to grow, and some really interesting things we would do across all service lines, but especially in the home based medical practice, and, you know, they're just nipping at our heels. And so like, we're just trying to figure out, you know, what is the thing that we already to kind of take us to the next level of that, you know, of that, that game, I think that game period, so as Patrick said, you know, claim pain game, you know, I think a lot of stuff that's happening is being sold as solving people's pain. And even if it doesn't, at least when they say it does, it drags out the time for us to be able to come in and do something helpful. So that's, that's where we're trying to figure out is we are really stuck on the game piece, because the competition is becoming so stiff. Yeah. Yeah. That's new. I didn't have that problem five years ago, which is weird. Like I had different problems. Yeah, that is interesting. I know, too, like if there's ever like a really good patient story, depending on like, like you have to, obviously, you can't do this with certain patients. And I don't know that I'm necessarily recommending this. But I, you know, I haven't seen practices that have had really good value in getting a media consent signed by the patient and then being allowed to take some photos or do a little story or short, you know, video clip or something on them to kind of use because again, we talked, there's a lot of value in data, but there's a lot more value in like real life, relatable patient and caregiver experiences and stories. So, you know, this is just kind of building on this, this was just a general example, but you, you have to have scripts for your front office team or whoever's answering your phone, three to four bullet points, you know, how are they explaining to a new patient what you do? You know, we're going to send a provider to your home. We're going to manage all of your medical needs. You can call us anytime there's an acute problem. We're here for you. You know, we're not going to come physically visit you on the weekends or after hours, but you can reach us for medical advice. We could coordinate other, you know, services or like your medications and equipment and other needs, you know, just very general things, but really making sure, you know, you have your kind of script and your talking points. Cause also the other thing that I was surprised about when I first started working in a home-based primary care practice, I felt like sometimes I was convincing patients. I was like, oh my gosh, like this is exhausting. Like I have like a couple different phone calls of a patient that the hospital is blowing us up. Like, why have you not seen this patient? But they've been with that office PCP for so many years and they just don't understand our care and they're, they're so hesitant to have a new provider, you know, come into their home. And I think sometimes just taking the time to kind of understand why the patients feel that anxiety or the caregiver has that anxiety and kind of really just walking them through. You know, you're not some sales person walking in the door. You're there because they clearly have a need that you want to help them solve, but just being able to be comfortable and be explaining because if whoever is taking that intake phone call can't kind of handle themselves in those difficult phone call situations where a caregiver might have some really specific questions or is really unsure, then that's going to affect your business model and overall your practice as well. That's kind of, I'm trying to give different kind of spins on this than we've talked about so far. I'd welcome any other thoughts that anyone else has or experiences. There, I was new. I was like somewhere there is an, there's a slide for the elevator speech and I just like the little animated thing. But again, you know, just keeping it very, very simple. You know, hi, I'm Ron from Senior Care Clinic, Medical House Calls. You know, we do medical visits for the homebound elderly seniors, you know, or, you know, something that you're going to say, you never know who the person standing next to you is or kind of how you're going to describe your services and, you know, one very easy, succinct sentence. And this, not saying this is like the standard, this is just to really give you an example of what we mean by an elevator speech. I like doing this at staff meetings too, especially if you're a new program or even every so often as you're kind of, you know, maybe you're looking at your mission, vision and goals. And, you know, have you had a staff meeting where you do kind of a little bit of almost like role playing or going over different questions and just making sure that everyone really understands what services you provide and how to describe it. And I would say, you know, you don't kind of have a couple of versions. You never know how many floors you're going up and they all kind of start the same way, right? We do medical visits for homebound elderly seniors. Great. Next, next thing should be something why you're special, like a nondescript reason why you're special. We accept, we're the largest practice in the area. We excel at, you know, personalized care, individualized plans, or, you know, working with families. Okay. And then I think the next sentence should be something specific, right? Like, you know, we do X every time. So, you know, you kind of plan out your sentences and see how far they'll let you go to. But yeah, I, I agree. I always try to figure out how to describe my company first and what makes us special and then a specific of what makes us special. And really everything that comes out of your mouth should be why you're special. And the bigger the room, you get, I think you, you start kind of big and you eventually kind of narrow to, to, to specifics. I think rooms are starting to get smarter than they've ever been. I think we're starting to see, oh, you can't just use the term patient centered. You actually, you know, or accessible. What does that actually mean? Or even diversity? How are you going to prove and back that thing up? So I think that's, I think those, those are the things now we have to really kind of, you know, hit home. Hey, we do home medicine. Second sentence, we serve the most diverse population, you know, the most diverse population in this area. Third, you know, 90% of our patients and our providers are people of color. Great. Yeah. Great. We've gotten, you know, boom, boom, boom, whatever it might be. Okay. Thanks. Yeah. I think that's great. It's like, how long have you been hearing access? It's like the, you know, the primary goal, like standard pitch to everything, right? Like access, access, access. Like I liked, you know, focusing on like independence and we're here for your caregiver. And, you know, the, but the person centered is, is another interesting thing. CMS still uses it all the time, but I don't think they'll ever give it up. All right. So, and I know Laura in the last session had brought up a really good point too, about getting patients directly from health plan referrals or ACO referrals. I'd be curious to think, to hear, oh, I do have payers on this list, apparently just not the other side. Where else are you thinking about getting patients? Patrick shared the retirement communities. I think that's another great angle. Is there anywhere else that you, you know, maybe have surprised you that you found patients from? I think someone in one of the previous sessions made a comment that was really good, that I jotted down was being a temporary, potentially a temporary provider. It may or may not turn into a long-term relationship, but there's folks that are coming out of the hospital without a PCP and that are very complex and sick and need a little bit of help. Maybe until they get established with the PCP. Then it may or may not evolve if they potentially become more home-bound or just don't recover as well, then we could be their long-term provider. I thought that was a great concept and idea. There was one other one on here. Yes. The clinic PCPs, I was having a conversation with a geriatrician in the community. She was actually leaving the community, was maybe interested in coming on board with us, but I took the opportunity to ask her, if she were staying, would she think our practice would be competitive to hers? She said, yes and no. She said, yeah, if you're setting up a straight primary care, not targeting the elderly or the complex patient just wanting to do full-blown primary care, internal medicine, she said yes. She said, but no in the sense because as my patients are getting older, I'm having to utilize EMS sometimes to bring my patients into my practice, which is just so resource-heavy on everybody. The EMS, the clinic, the caregiver, as you said, those are great opportunities where we could collaborate and partner together and you see those patients, or we co-manage those patients. I thought that was really cool. I think that opens up a lot of opportunities for us with some of the other physicians in the area where we can target them and promote our practice as collaborative for some of those patients, just like she described. I thought that was really cool. Yeah. It's interesting that you bring up the collaborative point too, because I do know some practices that as much as we talked about, especially in a discharge situation that don't like to go in saying they take over as the primary care provider, they like to position it, and I think especially as being collaborative, I can't think of who it is, but that is literally like their market temperatures. They're willing to collaborate with other providers. They're focused on more palliative or whatever the case may be. But I think too, when you're talking with clinic PCPs, what I've heard, there's another partner of ours that does a great job talking about this and she's like, that's what I ask them. I say, who are your patients that are coming in on gurneys or calling EMS, or you're getting those calls that says, I just can't see you, or you're struggling and your office staff is trying to find non-emergency transportation and you can see how exhausted they are when they walk in your clinic front door. That's who I want to take care of, not any of your other patients. I think you just have to approach it in the right way, so that's a really good point. Then Mary Lynn shared in the chat, it might have been Julie, I'm sorry, if I didn't give you credit, Julie, about Meals on Wheels and Churches. Actually, HSCI works closely with CTAC. I'm not sure if any of you are familiar with the Coalition for Transforming Advanced Illness Care. They have been really big on bringing faith-based professionals into the healthcare field, and how can we better partners. Really with the thought process of people of faith trust their church, and may go to them when they need care or family members need care, and they don't know where else to turn, and do they even know what medical resources or community resources exist in their community? I think that's an excellent point. I know local church groups, even that home-based primary care practices will reach out to do social visits for their patients when they can't get to church and things like that. That's certainly another angle. Yeah, the Meals on Wheels and any community services, how are you connecting with those kinds of people? Any other thoughts? It was Julianne. I'm sorry, I didn't give you credit. You and Mary Lynn, I know we're together, but it was Julianne that sent the comment. We talked about adult daycare programs. I think we talked about this too. What about private duty and caregiving agencies? Anyone has done networking with them or found that effective? I appreciated the comments that came up earlier in our discussion about not only just networking with these programs, but having a resource inventory that's somewhat vetted. You know quality because there's so much, especially in the home care space of these agencies out there. Again, you want to give your patients choice. Yes, you want to be a good partner, but do you get any feedback on the experience of care at their survey? I know Megan mentioned health fairs and things like that. Obviously, because of COVID, I haven't heard of that in a while, but yeah, I mean, definitely those kinds of events and things. I don't know, Amanda, you have any other creative thoughts? I'm trying to think of anything that we haven't talked about yet. I mean, boy, we've, I don't. That's okay. You don't have to have a magic answer to everything. Usually you do. I just had to give you more credit. Yeah, usually I do, but I just don't. I'd say that's a good group. So we're kind of done identifying, right? We've thought through where you're going to find your patients, who you're going to network with, thinking a little bit more about how you can prepare yourself to articulate those questions. Prepare yourself to articulate those conversations when you're thinking about partnership opportunities. Yes, obviously the mission, vision, and goals of your programs, but, you know, what is your enrollment criteria? What are the benefits that you're going to offer? And what do you need from your partner? I think the last square is the hard part, right? Because you're trying to build a relationship and get your foot in the door, but also like what do you need from them or what expectations are you going to start with a partner before you go down that road? And I'd be curious if anyone has any, oops, sorry, boundary setting or kind of criteria that they've come up with on what they're looking for in a partner. Kind of twist this. How many of you, anyone have any trouble, like, with their assisted living facilities that you were able to kind of resolve, like, you know, really struggling to care for their patients or to get the information that you needed from them that you were able to kind of overcome through some conversations? One thing in particular that some of the assisted living facilities Josh and myself ran into is state regulations and their understanding or interpretation of them mainly regarding hospice. Because that affects their, whenever it comes to that role of life in transition, it seems like some of them are afraid of state regulations because they think it's a, something that they're not supposed to do versus some will take it on and there's just no worry, so that seems to be the ever-growing problem, let's say, in Alabama. Like they don't, they're afraid to have patients on hospice in the facility, is that kind of what you mean there? Yeah, some of them are all on board and they understand the interpretation from their state regs side versus others are afraid of it'll lead to an audit because when a state comes in, they look for anybody on oxygen or some kind of DME and then they do a reverse tracer from there, kind of like they do in a hospital setting, so it's just a scare for them. Yeah, no, absolutely. In those facilities. We had a conversation that didn't go so great, talk about, we had, like I said, we've been really on blast from competitors and there was kind of nothing we could do from a facility standpoint that didn't kind of right the ship when the other group was promising them everything, you know. And I didn't exactly come true and they've come back, but boy, it really stalled negotiations and discussions and we just kind of, yeah, we just kind of couldn't, we couldn't, and that was kind of a hard lesson for me to learn early in negotiations of like, sometimes you do your absolute best and you really offer a superior product or you're really trying to get information across it and there's just, there's not the, the information was received in a totally different way or it's just not the value you think and yeah, that was tough. Yeah. I think you have to think about that too. I was talking to a practice the other day that was a little worried because their partnerships were getting a little frayed, similar situation, actually because of COVID regulations and how much, you know, the provider had concerns, but she was like, that's 80% of my business. If that one facility pulls out, you know, my practice is in trouble because my partnership, you know, then you think about how you diversify and kind of go from there. So, I mean, it definitely is a push-pull relationship, but, you know, you also have to, the previous practice, we had to pull out of a couple of facilities. We only had like less than five patients there and it just wasn't worth it for like the constant, not calling us, sending them out to the ER, not getting the care that they needed, you know, just wasn't a good situation for anyone. Well, they need it. I mean, you do need enough volume on site for everybody to care, you know, and they have such turnover in facilities that, you know, you really, really need to be able to have volume, have some, you know, continuity of education and learning as they transition people. And you don't just, to your point, you know, with five patients they leave. And so that's, we were in the same, but we certainly have just exited over things like that too. But yeah, I think that kind of more of this will continue to bubble up, is people on the receiving end in the community who haven't ever had these services before, at least from like maybe systems like assisted living or an independent living that we're going into, they're going to, it's like anything else, they're going to need to be watered a lot. You know, my problems are usually with groups that I totally wrote off as like, are totally fine. You don't ever have to hear from me. And then something pops up out of nowhere. It's like, we haven't been giving me enough attention. So, you know, that regular, my advice on the partnership is, you know, set an expectation of when you're going to communicate back and just do it, right. I'm going to check in with you twice a year. I'm going to check in with you every month until we fix this problem. And then you just give a call. So, hey, so, you know, I'm here. It's all, everything good. What can I do differently? Yeah. So, I think we talked a lot about internal preparation already. I'm going to kind of advance this because I'd like us to kind of have some more discussions on this too. But thinking a little bit more tactical, does anyone know, you know, how timely their patients can receive an appointment? Amanda, I know you were talking earlier, like, what are we doing with all these phone calls? I mean, I've had to pull phone call volume record because we found out, you know, when we were trying to advocate for more staffing, the practice was getting over 100 phone calls a day. And the length of those phone calls was like close to five minutes. And then you look at the FT that's answering those phones and everything else they're supposed to be doing, and it gets unmanageable. So, you have to be thinking about, you know, phone calls, how timely access to care, you know, even your caregivers and what kind of responses are they getting, our messages. You know, you can pull EHR in-basket message reports or have a supervisor look like are things getting addressed that should be before close of business? Or how much is really sitting there and how long is it sitting there for? You know, and how long does it kind of take for those kinds of things? You know, how long is your typical visit? You know, if you have one provider that's constantly spending so much more time, maybe their patients are just more complex or do they need help, you know, with an efficiency that kind of a shadowing from a more experienced provider or supervisor could help with. And then really just making sure. I'm always surprised. And this was even a learning for us sometimes. Like when we asked people, you know, how we were doing or what we could do better, like sometimes just a more simple explanation of how we worked with our other community partners was appreciated and needed. And then it was like, well, we need to do a better job on our patient and caregiver education and kind of thinking about those things. Anyone monitor anything like that or how you structure that within your team? Oh, let me see the chat. We just asked for the medical assistants to listen to voicemails before leaving for the day and check for the lights left on. Yeah, absolutely. You know, depending on what kind of voicemails you have set up too is like how often do they really need to check that, you know, or what kind of messages are left there that are, you know, left unattended too? Because you would hate for, you know, to get a, gosh forbid, which shouldn't be a voicemail anyways, but sometimes you get that voicemail and you're like, oh my gosh, this should not have been something that was going to wait. So definitely. We used to put some medical assistant checklists like on every, we had a little issue for a while. So on every door walking out the building, like a reminder in the face of like, you know, hey, did you plug in the thermometer? You know, did you unplug the car charger? Did you, you know, put the vaccines that were unused back in the refrigerator? You know, like literally little stop signs everywhere trying to remind people of things before they left for the day. Talking points, I'm going to kind of move us along. CARE was kind of those office-based providers, you know, the mile-long med list. Also, especially from the health plan angle, you know, the patients that they're really at risk for that you have a really good solution. And maybe you're going in even, I'd be curious if anyone has ever used the medication management angle or like complex medical, you know, medication management, or if anyone's kind of thought about that and proving when to be effective. Anyone have really good relationships? We've talked a lot about kind of ED partners with our local hospitals, or have you tried? How's that gone? If I could get a relationship where I could just send my patients that they just need fluids because my patients get dehydrated a lot. I don't need a hospital, say, I just need fluids. Yeah. Because a lot of the home health, or the home infusion companies require a five bag minimum. We find it really difficult to, you know, and especially in an urban area, you know, with with so many different hospitals and so many different people on call, I mean, to kind of get any attention, you know, that's it's just that's where we kind of hit a little bit of a track as we just get stuck. The home infusion thing, like have you tried any like pharmacies directly sometimes or like I've heard of and it's very slim and far between, but I was trying to remember where it was, but I had heard of one program that was kind of like a partnership that the pharmacy had for IV fluids, but it was it wasn't like your typical it wasn't like a Walgreens. It was like a more, you know, complex pharmacy. There are some hospital at home programs popping up now. So if it was a hospital had that, you know, and it's interesting. Like I don't know if anyone's heard of like the money follows the patient like the sniff to home model. So like we're starting to see a lot more of those pop up. So I would just kind of be aware if any of that's in your area. But yeah, I mean if home health won't do it. I mean definitely, you know home health for the for the IV fluids or the infusion services other than like a compound pharmacy partner that you know has some access at home would be my only ideas. I don't have anything like that in Alabama. Everything is a maybe Huntsville or Birmingham, but there's two companies that cover Central and North Alabama called Continuum and I can't remember the other one right off, but they used to be a one bag where they would do a one bag order for fluids. Now it's gone up to a five bag minimum. So that kind of the fluid. But yeah IV infusions for antibiotics. That's still I can order, you know, one thing of Lasix IV. I can order Solumetrol Lasix if anybody's in some kind of storm or stuff. That's no problem. It's just the fluids. The fluids. Okay. I actually know one nurse practitioner that was like her model like she did home infusion and a bunch of other you know things but again, I you know, there's few and far between and it wasn't you know, you know in between but yeah, I mean she that was really how she got a bunch of partnerships was that was what she really loved to do that and kind of like healthy more alternatives to pain management. What about social media anyone, you know had any news coverage or media or done anything? I think it's really interesting. I've seen a lot of practices using that to advocate advocate excuse me for covid vaccines and the lack thereof and home-based practices, especially the independent practices. I don't know if you guys have seen the scene, but I've seen a lot of positive media coverage advocating for the need of vaccines for homebound patients. Amanda, I know your practice not that it was necessary advocating you are actually advocating in a different respect about the importance of getting vaccinated or wasn't your practice. It was magic is the video. I'm thinking of yeah. Yeah, I was so in Minnesota the local AGS and the AMDA and kind of informally a HCM since they don't have state branches that I'm on the board of that group. And yeah, I mean, I think social media since we've gone to covid like social media has continued to be an important space for us. And again, it's not necessarily that we I can tell you we're driving patients from that, but I think it adds to a level of legitimacy. We know when I started at Genevieve it was we didn't even have a website and I was like we have to have a website again just so we look legitimate and now we're getting to the point where you know, I'm not in any personal social media, but the amount of news that is created by social media is becoming a legitimate entity and is of itself you have to be able to show that you're creating content of value for consumers almost regardless of who they are. And so that that part has been kind of an interesting learning for me. So yeah, we we did we Genevieve has started some social media presence and we do try to make posts, you know couple times a week. We have worked pretty hard whenever we do anything on press releases and who we're going to talk to and I take media interviews. I then have from kind of a networking getting it out. I typically try to do like four speaking engagements and I sometimes will actively search out speaking engagements. I've signed up facilities who want to be in our ISNIP because I spoke at a conference, you know, and I just had even no idea or whatever and then Magic again our combined AGS or AMDA and depending on your state you probably have these groups, but you know, they put our quality goals and they put out they did a video on getting a vaccine and we put that out and did a big push and send it on social media and actually our State Department of Health tweeted it out. Which which drove a lot of volume to to our organization and then you go to the Magic website and there you see all the listed organizations including ours. So, you know what I see the kind of tentacle spreading of what is it? SEO search engine optimization stuff happening and it's not where I'd spend all my money right now, but it's certainly we're trying to keep a little door open there. Yeah, something to think of. Yeah, I mean, yeah, I mean you guys like you guys jump in if you do anything better than me on that, but that's we're just starting there. What a contracting pay. I know I was going to say Amanda this is your time to shine here. I would love to hear your best pitch to payers or your contracting 101. Yep. It's a sneak peek of the advanced. Yep, I do. We go in we go in kind of a bigger bigger in-depth, but my my piece is always trying. I always try to say you have a problem and I'm your only solution and you know, we've talked a lot about those pieces. But again, I spend a lot of time looking up what they're doing. What's their mission? How are they spending their money? If they're nonprofit what are what forms are publicly available? What their County structure is? I do all this research going in and I say, okay, and then here's kind of a piece of what you want to do. I we got a nice enough two years ago. We signed with a local payer here to do an institutional special needs plan for long-term care and assisted living and memory care. So two of those are all right. Well, at least two of them are home-based medical practice. We've met memory care is mostly a L here for us. And so we got in with this group and it was right at the time that cost plans were exiting the state and we used it almost exclusively we pitched to them. This is how you release an innovative product to stay innovative right now. And it really I mean it really worked, you know, so I you know, I think you try to figure out what you know, what problem you're going to solve and then who to talk to and we talked a lot about this in the advanced course too, but you know, if you go into a health plan your health plan account rep has zero power. They have no power. Sometimes they have enough power to pick up the phone and talk to you and sometimes they have enough power to get you a contract that they probably are drawing up legals drawing up. So like just absolutely no power at all. So you got to figure out and it takes many months to set up who's the right person to talk to and then and then you bring your data. Here's how big we are and my dad has changed. So I never had a competitor data until covid hit and then we all band together all the geriatric practices and we're like well just in case it gets really bad. We'll all submit our data and see how we're at what locations we're at. Like what what if something happens with an assisted living and we need to be in that spot. We're like, okay, this is a great idea and for the first time ever we got competitor data of size and we realized we were the largest health plan every single PowerPoint every single email every single phone call I have even if it's talking about something totally benign I say and as you know, we're the largest geriatric practice in Minnesota. So I just plant seeds all over and then I try to kind of connect them together. Sometimes I have long range plans of how I want to connect. So, you know, this is one of my favorite slides again. We go we go in a little bit more but you know, what are you selling? How much does it cost someone or what's it going to save them? So it's cost less savings who you're going to talk to who else do you need with you and how do you do that elevator pitch piece? And I don't we've buried that guy. I don't need to keep bringing him up, but that's that's a good list. Anyone else I'd be curious to is anyone have any like Medicare Advantage, you know contracts or payer partnerships or anything they want to share that they feel like has worked really well. Haven't even stepped into anything like that yet. Yeah, and Chris so you're I mean, are you you mentioned earlier you said you're not fee-for-service, but you are it's Medicare Advantage plans or like is it Medicare beneficiaries or who are your patients Medicare Blue Cross? There's there's finally two insurance types that we don't accept. But it's mainly just because they're not accepting new providers. Got it. Okay coverage areas that are at that time, but they are like Medicare beneficiaries just through whatever. Okay. I just want to make sure to because a lot so the G codes. I thought that we were talking about a little bit yesterday. I wanted to make sure you had a caveat. Those are like Medicare code. So sometimes but if it's a Medicare Advantage plan, they should cover it. But sometimes there's caveats. I just want to make sure you weren't, you know, completely commercial or under like a capitated arrangement. Sometimes they can bundle those services in your payment. Oh, no, there's there's people in Birmingham, Alabama and I sit in larger cities also that they use the concierge service. Hey, we will you pay us X amount of fee either quarterly monthly or yearly however, they set it up and say how you get 24 7 access to us and we'll direct admit you to hospitals and all kinds of stuff like that. There's other things like that going on that we're combating against also. I don't know how they're going to be able to pay for it. Is it like you think about the patients and it's a target population that Democrat that wants preferential treatment. Yeah, but if you you know, so if you have a you know, a couple major payers and you have original Medicare anything you would do from a value standpoint under original Medicare, you know takes a little bit of putting together but from a payer standpoint if you have some serious volume, I don't know if you're if you're saying you did or didn't have Blue Cross, but if you had like a Blue Cross if if they're Medicare patients with Blue Cross, they're at risk. They're absolutely a risk you could go to them. You're ready like you have a program. It's working. You know what you're selling you go to them. It's going to take you know, 18 months to kind of, you know, really get in the door and kind of generate that value. But you know, you are saving them money for sure that I think where I've been stuck is you know, where what do we do with the patients who aren't in any other type of Medicare Advantage and we just are doing original Medicare like what's the right original Medicare track but for everybody is not it and there are so many and Brianna's really an expert in that but that's where we're really exploring now, but for anybody who's not in original Medicare the health plans making money when you when you do your work. Yeah, another thing we've I mean, it's rare but people let's say losing jobs or losing things like that where they lose their coverage. We've developed a basically a cash per visit and we try to you know, say yeah, we can help you with this and this is how much would be you know per visit and it's a smaller fee. I think it's something like $80 or something like that and we try to focus on those types of things where it's like the Walmart $4 list or the free list, you know, some pharmacies so, you know get them hooked up with good RX things like that. So that way we're still capturing those people also. Yeah, that's great. I mean the under uninsured especially right now more than ever, you know, I know some programs that can sometimes have like through foundations patient assistance programs or financial assistance programs and kind of kind of bundle that in. I think if you can do that, that's great. But yeah, even just an affordable self-pay rate, you know, if you don't have insurance absolutely, you know that you can you can set that cost structure. Yeah. Anyone else? Go ahead. Oh, I was going to move to this slide because I you know, I want to make sure that you don't you guys don't feel like we're saying the same thing over and over again, but I you know this define your product this like clinical model is really interesting. Millicent was saying earlier that they built their model off of the IHI 5Ms or you know, I guess health and aging 5Ms or the 4Ms off of the IHI and that's really powerful. So Genevieve has always had a model and I'm trying to pivot us into using that model. You know, we're already doing some of the things I'm trying to say. These are tools for a base infrastructure and that's a model that not everybody is using today. And so just saying like hey, we're using a nationally recognized model of care and we're taking that and we're applying our own tools to accomplish these goals and that's why we're going to be better. I think that's I think that's a future of where clinical model goes. I think what we think sometimes is the clinical model is how the provider or nurse interact with each other or what the nurse does or how our nurse answers the triage. Those are all tools. That's not a model of care, right? Your values and your philosophy become your model of care and you build the tools on top of that. And I think that's where we maybe don't spend enough time because that is like a philosophy buy-in piece that I think we could do a better job selling as if I'm making sense or I've just completely gone off the deep end. No, and especially I'm glad you brought that up too because especially since you guys have been with us in the non-clinical track, I know there's a handout in the workbook. If you look at the patient assessment form, it kind of has a HCCI form with the 4Ms framework and the 4Ms, you know, they kind of bundled the 5M multi-complexity into each one of them. So it's like we're still considering the 5Ms, you know, it's just under the John A. Hartnert-Furr Foundation. They like the 4Ms with the 5M as kind of a component of it, who's a, you know, a big supporter of HCCI. So that's why we say the 4Ms, but it still is 5. But if you look at some of those handouts that you would have missed because they covered that in the clinical care session, it's kind of interesting to see how you structure it. But I think, you know, especially even like I have heard of it now as like a way, especially for new providers that are like getting overwhelmed with how sick these patients are and how much to do. It's like a strategy that they do during onboarding and training. Like, hey, here's how you prioritize your visit. You think about the 4 or the 5M framework. And then this is kind of how you break that down actually into a progress note. And then what needs to be followed up on or, you know, what are you going to address next time? Yeah, we just included the, you know, the 5Ms distinctly because of Mary Tenetti because she's the one that kind of puts in that and she's in our state. So we're, you know, we're like kind of bound to following what Mary Tenetti says. I love all the Ms. They're all welcome. But yeah, I know it's interesting when people are like, we've gone back and forth too, but she was saying 4Ms, but now it's like 4Ms with 5. Yeah. Yeah. And I'm part of the Harford Foundation. So I, you know, like want to follow, trying to follow what the national guidance is. And I think that's probably like because of my academia stuff, we have to kind of have these theoretical models and frameworks and make sure we're following all the national standards. And I just, I think that's really important because, you know, if you follow something that's developed, rigorous, has been tested, you're not going to go wrong and people are going to recognize it rather than just trying to make something up. And that's kind of what we did when we first launched, you know, we're making things up like, okay, this is good. We do this in practice, you know, here's this from this journal, here's that and, you know, we know this is good and these are the tools we're going to use. But as geriatrics evolves and becomes more standardized, I think in the important metrics that you're looking at, such as the 4Ms, you know, I think the more we follow it, the more efficient we get and we're focusing on the things that really matter. I know that's an M, but that's not what I mean. You know, the things that are driving bad outcomes like the med lists and, you know, in our training program, we had a patient we saw that was on 47 medications, like not doses, 47 medications, including supplements. I mean, you know, it's like half the PDR and, you know, just pulling him off. And, you know, that's the thing I think all of us do in geriatrics. You know, first thing you do is look at the med list and start cutting it and, you know, figuring out how to optimize what is most important. And, you know, following these frameworks, I think will keep, will help us, you know, show the outcomes that we want to, that we need to show to move forward. And I think, Millicent, to your point, when you define it that way of, you know, and that's why I love the four or five M's, right, is this is the base structure. We put tools to accomplish our goals and our values within these things. And then we can freely test our tools. You know, we have something that we do here and we do it with every patient that we have. And, you know, and it's a pretty intensive meeting. And, you know, we do many things that many people do or lots of meetings. We do it all at one time. We call it our family conference. And it's been kind of untouchable because it's the thing that we do. And I'm like, when you think of the family conference or anything else, fill in a clinical pathway as the model, you never touch it again. But when you have a model that you're testing tools based on a set of outcomes that you'd like to see, nothing becomes untouchable. The tools can change. You can redeploy teams. You can change how you're thinking about your structures, your processes. And it really, you know, it kind of depersonalizes the work and the attachment to the real focus. So I just think, though, that we as a community have a long way to go around this clinical model piece. And again, getting that foundation right of who we want to be, what tools we're using, and proving out then these measurements of the tools are working and I'm getting it all the right things. And you who's hearing my pitch are hearing me say, I know what the real problem is. I'm going to tell you what the real problem is. My tools get to these things and boom, here, I'm showing you that. Could anyone tell us, like, do any of you know the average HCC score of your patient? Does anyone feel like that comes down to your ICD-10 diagnosis coding, unfortunately, and making sure that every chronic condition that your patient has is reported at least once a year? Because in the eyes of risk adjustment, they're reborn every year, and they don't have any conditions that they had last year. There's also some peculiar ones like toe amputation and respiratory failure and using, you know, congestive heart failure combination codes. Your EHR, a lot of them have that now, too. So that could be even something you look into if it identifies which diagnosis is risk-adjust. Keeping your problem list up to date and not using unspecified diagnosis codes. And then using, I've seen a strategy where you use annual wellness visits as kind of that opportunity, right? You're not going to spend that kind of time in every kind of visit. But maybe during your annual wellness visits, you're spending a lot of time really getting specific and making sure you code every condition that the patient has so that that's being reported appropriately. All right. First for our non-managed care population is 2.49. Wow. Anybody? That's good. I mean, over, you want, in the risk tiers of like the payment models, you want like over two is like, you know, your highest risk generally. This is our entire, it's not broken down by service line. It's any patient attributed to us. So absolutely any patient attributed. Yeah, we're going to get a lot of the home base, but we're also going to get some long-term care in that number, unfortunately. Yeah. So a lot of these measures that like we talked about, this was kind of just grouping them and like what shows quality, what shows revenue and what shows expense. And then kind of thinking about to Amanda's point, like who your partner is. And, you know, especially for the kind of more integrated practices that we have. I know a few, several of you, you know, also have, you know, maybe hospice or palliative service lines and that, you know, sooner attribution to hospice and referral time and things like that. And that can be kind of an angle for you guys. But the advanced course, we go into more detail on HTC coding too, but it really does come down to your ICD-10 diagnosis coding, not using those unspecified codes and then having a really good strategy, even if it's just once a year, annual wellness visits to really report every chronic condition and patient that the patient has. I think we've talked through a lot of this. I want to have just some kind of general question time. So I'm going to kind of, you know, skip ahead just a little bit today. Amanda, do you have any thoughts you want to, as far as preparing? I think we touched, I don't want to be repetitive, so I'm going to skip over some of this. Yeah, no, no, keep going. Let me make sure I don't miss anything in the chat here. Okay. So clinical track. So we are getting ready for our break. I think we talked about, you know, making your pitch. Any other creative partnership examples that anyone wants to share that we, that we didn't think about or haven't talked about, whether it's in this discussion or another one? Are there any other, if not, that's okay. If you think of them, throw them in the chat. Any other burning questions? We're getting ready to take a break and then transit, we're going to be transitioned back to the larger group for the rest of the day. So anything else that we want to talk about in this setting or any other questions that you want Amanda and I to chew on for you? I can't think of anything. It's the second day afternoon and my brain's just, I don't want to keep. Yeah. I want to just like QSR break a little early, but I also don't want to, I want to be respectful of all of you here. So, all right. You have a break until 3 20 PM central time. Sorry. So, and then you'll be sucked back into the main room and we'll go from there. It was fun playing with you guys in this. Thanks for hanging out with us. Yeah. Energy drink. Thank you.

marketing

branding

home-based primary care

value proposition

target markets

elevator speeches

patient sources

collaborations

networking

health fairs

HCC coding