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HCCIntelligence™ Webinar Recording: Strategies for ...
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Okay, we are just coming up to the four o'clock hour. Perfect timing. Hello, and welcome to the monthly HCCI webinar and virtual office hours. Today's webinar is entitled Strategies for Growing Provider and Patient Referrals for Your Practice. My name is Danielle Feinberg, HCCI's Coordinator, Education and Research. I will be your moderator for this event. Before we begin, I would like to cover just a few housekeeping items with you. All participants are muted, but please use the chat or the questions boxes located on your screen to submit comments and questions. Questions that are submitted will be answered when we transition into the virtual office hours portion of the webinar. Recording of the webinar, as well as the slide presentation and the transcribed Q&A will be made available on the HCC Intelligence page within several days following the webinar. Today we are joined by Tammy Browning, President, Grace at Home Primary Care House Calls, and Brianna Plensner, Manager for Practice Improvement, Home Center Care Institute. The objectives for today's webinar are describe how to identify patient referral sources, describe methods of recruiting and take talking to potential new patients, inclusive of talking points and scripting examples, and three, review recommended topics of discussion to be used in conversations with providers when reaching out to new referral sources. Without further ado, I'd like to turn it over to Tammy Browning. Thank you, Danielle. Hello, everyone. I'm Tammy Browning, and I'm excited to share with you marketing strategies to help grow your practice. I know there may be representation here from many different practice types, be it a startup or an established practice looking to grow or change your focus in these crazy changing times. So, at first, I recommend that you start by answering a few questions for yourself. What is your own or your company's skill set and strengths? And what services are you really focusing on delivering? There are many different avenues you can take from a true home-based primary care model, perhaps partnering with an insurance payer to provide mostly annual wellness exams and help gather HCC information or a strictly palliative care practice, as mentioned in the slide. And then finally, after you decide where your strengths are and who you're targeting, you have to do a market analysis. This is a very important step that some people like to leave out. You need to establish what the need is for the services that you'll be providing within your specific community or service territory. Who else is providing similar services? Who's your competition? You should look at things like population density, who are the insurance carriers within your area, what the reimbursement types are, how many miles will be covered within your service territory, and the availability of hirable staff, providers and support staff alike. And then you need to understand your target population. So are you a true longitudinal home-based primary care practice, who will serve the older frail adult, multiple comorbidities, complex patients who have trouble leaving their home? Will you perhaps focus solely on assisted living facilities or domiciliary-based residence? You may be working with an accountable care organization or an insurance carrier and therefore be focused mostly on high utilizers, frequent ED visits, recurrent hospitalizations. In general, you need to have done your homework and have a clear and concise plan on who you will serve and the skill set and delivery model which you will utilize to meet those needs. All right. Generating those referrals. So there are many ways to generate referrals. We've listed several here and I'm going to go into some details and some examples. In my particular practice, we are a longitudinal home-based primary care practice and the assisted living facilities, home cares, home health cares, and hospice companies are our bread and butter. In your assisted living facilities, it's all about forming a relationship with the management of those facilities. Consider hosting a family night or an ice cream social for the residents. The more you can form those relationships with the executive director or the nursing director at those facilities, the better you'll be. At home health and hospice agencies, think about how you can help make their job easier because they can certainly make yours easier. Form alliances and make sure that if they make referrals to you, when the time is appropriate, you're referring back to them. For example, home health company refers to me and the patient is active with that home health company at the time they make the referral, but the cert period ends, the patient's skilled need resolves, and that home health company is no longer involved. But six months later, they have a change in their health status and they need home health again. It's important that I make sure I refer back to that same home health company that referred to me originally. So make sure you're following that detail and tracking it and then returning that patient back to that same home health company. Coordinate with your local council on aging or senior service centers. There are always opportunities for health screenings or health fairs you can volunteer for or other similar type opportunities where you can actually be in front of the groups of patients that you may be most attracted to. Contact your local hospitals. Talk with their emergency room discharge planners. ER staff knows exactly who their frequent flyers are, and they will be happy to make referrals to you if you can limit the needless visits to their emergency room. And hospital discharge planners as well are very interested in speaking with someone who will help manage their home limited or homebound patients, especially during transitions of care. If you can reduce their readmission, both 30, 60, and 90 days, they're going to want to send you those patients. So make sure you're making yourself available to them. And don't forget your community-based ambulatory primary care providers. Here's some others to think about, non-skilled home health agencies or I call them often aid and attendance companies, group homes, your linkage organizations, linkage programs, or your Medicaid-based programs, to name a few. Be prepared to articulate and provide documentation related to, okay, so make sure your target audience is clearly identifiable from your literature. Your mission and goals should be clearly reflected in who you or in who you approach and explain your why. Whys are important. Why are you in business? Why are you serving the population that you are? Why are you better than the next guy? Make sure it's relatable to the need that that particular referral source has. Know your referral process. Make it as easy as possible. Do you need just patient demographics and insurance information or are you going to ask for additional information such as the full medical history, medication list, and that sort of thing? The more complex the process is in making that referral, the less likely you're going to get repeat referrals. So make sure you know that process. You can clearly and concisely relay how that process is to unroll and make sure it's as simple as possible. And set clear expectations for your follow through. How long is it going to take you to confirm that that patient can be accepted? I'm sorry, Brianna. You can go to the next slide, that's fine. Make sure your team members all know your mission statement and that they're making it a part of their regular talking track. It will help define to your referral sources who you are. Another thing that is one of my little caveats is never over commit yourself. Only promise what you can actually deliver on. I tell my team members all the time, for multiple reasons, but specifically as it relates to intake of new patient referrals, always close the loop, meaning communicate back to your referral sources regarding when the patient is going to be scheduled, especially if there's any problems in contacting the patient or communicating with them or getting them scheduled for that first visit. Don't ever leave that undone. Close the loop, communicate back. That's something they'll appreciate and they'll refer to you again because of it. Next slide, all right. Growing is hard. You need to be realistic and take many things into consideration. Growing too quickly can be as detrimental to a home-based primary care practice as not growing at all. So communicate appropriate expectations with your referral sources. You should start from the very first phone call they make to your office or if they're faxing by making a phone call and letting them know you received their fax. It's not just to start in the first provider visit. Your onboarding staff and your intake staff should be spending an appropriate amount of time explaining your services as well as setting expectations with both the referral source and the patient or family member on that first phone call. Make sure you're touching on important facts like how quickly can you actually get the patient seen, how should the patient reach you or how quickly should they expect you to be returning phone calls or voice messages and train your providers on those first visits not to rush the patient. The first impression is so important. It sets the tone for an entire relationship. If a provider tries to rush through that first visit, they're setting a very negative tone and it will hamper the building of mutual respect and trust from the very beginning. Thanks, Tammy. This is Brianna and I'm going to jump in here a little bit too about these practice considerations and why they're important to also consider if you're ready and when is the appropriate time to grow if you're an existing program. First and foremost, you always want to be thinking about some sort of growth just to offset the turnover. Due to the complex aged population that home-based programs care for, you're going to have a lot of turnover at the end of the month whether it's due to deaths or a transition to a higher level of care. If you don't have that consistent incoming referrals every month, you're not going to be able to even sustain and especially grow your practice. From a service delivery standpoint, you want to make sure that you're ready to provide really excellent care to these patients. If you're not able to offer timely appointments or if your patients have to go through an extremely long phone tree before they're able to reach a live person in your office and your caregivers aren't getting timely responses back with medical advice, all of those things are something that needs to be looked at first before you can truly tell that you're ready to grow. Some practices even choose to limit panel sizes for their providers and their clinical staff to help with bandwidth. Tammy started to talk about how important it is to arm your front office or your back office, whoever is going to be answering the phone and talking with patients and caregivers. You really want to help them to be professional, confident, and successful. If they don't have some talking points or some scripting, they're going to be less likely to be able to have those conversations. Phone etiquette is really important. Sometimes that's not as natural to some people as it is to others. Make sure they really understand how they're making patients' and caregivers' life easier, especially with home-based care being interdisciplinary teams. Emphasis and language on that team approach is really important, especially if you have a practice that is largely advanced practice providers who are making those visits. You don't really want physician-centric language that's going to make your patients question this team-based approach or who's going to be seeing them and why. If you set that expectation and you explain that team approach from the very beginning, your after time is going to be a lot more successful. Also, when you're talking to new patients, your intake staff should have some sort of checklist, and whether that's a form or something within your EHR, there's things that these patients need to know, and especially when it's a transition to a home-based practice. Oftentimes, when I was previously working in a practice, I was originally surprised that sometimes these new patient conversations would go on for days and days because they had anxiety or discomfort with giving up that long-term PCP relationship that they've been seeing for 20-plus years. They need to know how to reach you and what your after-hours coverage is. When are they going to call you, too? Make sure that if they're sick, that they know they don't just have to wait for you to come back to their home. How do they reach you in between visits? Are you going to be the ones refilling their medications so that they understand that they're not calling that previous primary doctor and you don't have a continuity of care concern? You want to help them remain at home, make sure they know how your scheduling process works, and how they'll be notified for when you're coming back. All of those things are hugely important. Again, you're going to have talking points for referral sources and for patients and family members, but you really want to encourage them to be a part of their care team, especially with the caregivers and the families. You want them to have trust and confidence in you and be able to know that they're a part of your team, that you want to hear from them, and that you're going to work closely with them and any other community-based providers to make sure that they're getting the care they need. And so beyond talking points, it is helpful to have a script, and you could even, if you're new, have your intake team or your front or back office, whoever's answering the phones, practice with each other. Now, you're not going to be reading from a script, but when they're talking to that new patient that may be a little uneasy, if they're able to explain, we're able to come to your home so you don't have to leave. We're going to bring all the medical care that you would get in the office to you. During that first visit, our provider, they're going to evaluate your needs. We're going to be able to make recommendations and refill any medications. We'll make sure you're connected with any other resources or home health and hospice agencies. We'll be that line of communication, and we're going to be available for you 24-7 and make sure that if you need treatment at home, oftentimes, we can order in-home x-rays and ultrasounds, and we want to work with you and your family to keep you healthy. So you can see how I kind of modified that a little bit, and if you get your staff really comfortable in speaking like that, these conversations are going to go a lot further and a lot more smoothly. Yeah, I agree. Yeah, I agree, and my office has often used scripting, where we actually type out the script for, especially for new employees. This is really important because they're not comfortable with what they're saying. So even if they read it, the first few times they'll read it, but they'll quickly adapt and they'll make that their own. It just gives them a great place to start from. So I encourage you to actually have a written out script, whether you use it on the routine or not. Talking points for referral sources. I did want to make a note here. I personally, and we talked a little bit about getting referral sources or referrals from ambulatory primary care physicians, and I just kind of hinted to that. I wanted to talk a little bit more about it here because when I first started in practice 10 plus years ago, I met with a lot of resistance from primary care physicians. They did not want to make referrals to me because they felt like I was going to infringe upon their own practices and steal their patients. So I would tell them, look, I want your sickest of the sick. I want the patient who come in, you know, on a gurney by EMS transport or their family members are pushing them in in a wheelchair. They've got a med list a mile long, a problem list just as long, and they take up three to four appointment slots and they just really clock up your day. Give me one or two of those patients and let me see how I do with them. I will send you copies of every visit note. You can still see them once a year. We'll send them back to your office and you will have notes from me on what's been going on with them the whole time. You'll know the whole time what their progress is. And if you have any information or any suggestions for their plan of care, you've known them longer than I have in the interim. Here's my phone number. Feel free to call me. And they love it. And by the time they send you their first, second, third patient, and they realize how beneficial this is to their practice process, they're going to want to send you all of their patients that are these more difficult to handle patients. So that would be a great place to start with ambulatory PCPs, in my opinion. Yeah, that's a great point, too. And I think building those relationships, like Tammy said, is really important. And especially if you happen to be a practice, too, that is part of some sort of provider network or even part of an ACO, you kind of might already have that warm relationship or in-the-door kind of opportunity where you can think about a proactive referral approach. So some strategies that I know for new programs that have been part of a system is targeting no-shows. So giving those outpatient PCPs a list of their really high no-shows, or even if you're not, encouraging them to think about that. And then just have them look at their list. They know their patients. They can probably identify if they understand the services that you provide, when that would be beneficial, and that you're really there to partner with them and to help them. And Tammy mentioned earlier, those ED and those discharge planners, you know, in my experience too, they have been great partners. And once they really see the success that you have, that can really, you know, boost your referrals by quite a bit as well. Absolutely. And Brianna, one of the other interesting things that we have done locally is partnered with a hospital organization's outpatient transitional care management program. So they have a TCM program that they refer to, but they still have to go into an ambulatory office. And so we have frequent no-show or they had frequent no-shows and they called us and said, hey, you know, could you help us with these? And so we've really partnered with them and that's done an amazing job at helping those patients that were failing to show for their transitional care management appointments. With them, we've been able to take on and see in their home and they've been much more successful at reducing readmission rates. Yeah, absolutely. That's a great example. And, you know, I think transitional care management programs, we're starting to see that a lot. Even if you're, you know, I actually know one home-based program that's all TCM, you know, that's all they do, but they have enough referrals where, you know, their patient length of stay is not all that long, but they're able to sustain a whole practice, really doing great transitional care management for a vulnerable population. Absolutely. And I'll pass it back to you, Tammy. Okay. Well, you do a great job of kind of capturing things here, but getting that first referral is never the ultimate goal. Getting many referrals from a referral source should be your goal. So once you start getting referrals, that's only the beginning. You have to feed those established relationships. You need to check in frequently. For our practice, we do quarterly meetings with our assisted living facility team members. So the executive director, the nursing director, and we go in quarterly and we take typically a patient care coordinator, a nurse, support staff, the provider who's covering that facility, and sometimes either a chronic care management employee or even the marketing representative from our company or account executive. We have a list of everybody that is a patient of our group within that facility, and we kind of do just an overview and make sure that we're all working on the same page and we are identifying any problems, any communication disconnects, and that does a huge thing in keeping us grounded, and it makes that assisted living facility really feel like you're their partner. Additionally, during this same sort of networking process, you can meet regularly with your home health agencies or hospice agencies. Again, there's going to be problems somewhere along the way. Make sure you're readily available and they know who to contact when there's a problem. I always tell my home health agencies, please, if you're not getting what you need, call me and tell me. I can't fix a problem I don't know about, and they know because I respond very quickly when they do call that when there is a problem and they're not getting what they need, that I am going to fix it. Update your website with provider or team information. Consider social media usage. We're currently doing a meet our team, and each week we post, every two weeks I guess, we post a new team member with a little bio, and sometimes we'll throw in some comment that a patient or a family member has said about that particular team member and how impactful they've been in helping to deliver care to their family member or to themselves. That's really nice. It can get a lot of mileage for your practice. Make sure that if you're utilizing social media that your referral sources are liking you, following you, and that you're doing likewise with them, and then a big thing is tracking your data. Make sure that you know how you're impacting readmission rates, that you know the referral sources that you're sending referrals back to, and that you're able to utilize that in conversation, both networking and when you're speaking with those referral sources. And so we talked a little bit about this already too, but again, especially if you're going to take on a big growth, maybe you have an opportunity with a payer, you really need to make sure that you're ready and that you understand the workflows of your staff. You know, outcome metrics are so, so important, but sometimes we need some operational metrics to help us along the way too. You know, what's your call volume and how long is your staff on the phone? You know, if they're not able to get back to patients timely, is there some sort of staffing challenge or service delivery model improvement that you can help prepare your team for so that you don't get yourself in a situation where you do have growth, but you're not ready for it and you can't proceed with the same quality that you would normally? Absolutely. It's really important to consider your current staffing when you consider growing and make realistic decisions. If you can't take on new clients, then you need to be aware of that. Staffing limitations have affected my practice in multiple times. There is an ebb and flow, both with staffing as well as referrals. So just make sure again that you're being realistic and that you're able to provide the services that you're marketing for. In my patient, I think Brianna mentioned earlier the high turnover of your actual patient volume. Sorry, Brianna. No, go ahead. We do have, we lose 50 to 60 new patient or new, not new, we lose 50 to 60 patients per month on average. So if we are not exceeding that number in new patient visits per month, we're actually losing, we're losing patients, we're losing total volume. So it's very important to know your numbers and to understand what growth you can tolerate. So we try to add about 90 to 100 new patients per month. So that's making up for a loss and then actually growing as well. Yeah, absolutely. I think that, you know, constant flow is just really important. And, you know, if you're looking for ways to really kind of take a pulse on your practice too, the other, you know, suggestion that I would offer is just do some observations, you know, sit with, you know, have someone on your team, the appropriate leader, you know, either go on ride alongs with your providers if it's an efficiency concern, how can you make their lives easier? How can you help them provide great care? And then also make sure you understand the workflows that your front office and your back office is doing and that there's not duplication and tasks and that everyone's able to really work to the top of their licensure and that you're reducing that provider burden as much as possible so they can focus on great clinical care. Absolutely. Some other, before you move on to the payers, and you don't have to go back to the slide, but trackable data is really important. And a couple of years ago, we did a transitional management stint where we fastidiously tracked readmission rates and through our transitional care management program for about 18 months. And we were amazed ourselves to see the numbers. And it's so nice to be able to present that in hard form to people when we're talking to them, to referral sources. So know your outcomes and have trackable data that you can actually present to them. That's a great consideration for referral sources. Absolutely. And so we wanted to spend a little bit of time too about the payer opportunities, especially with all the kind of exciting movement. And Tammy, I'd love for you to kind of talk, kind of start us off about kind of how you've started to think about this. Yeah. So it's never too early to start thinking about opportunities for growth, even if you're a brand new practice. But certainly after you've hit the two-year mark, the five-year mark, even at my stage where we're past the 10-year mark. And so recently, we've joined an accountable care organization, which focuses on the geriatric post-acute care patient. It's a better fit for our practice than a traditional hospital or healthcare system-based ACO. But that certainly has provided growth opportunities for us, as well as marketing from tracking data and that sort of thing. But Brianna, I think you were going to talk about some other opportunities as well. Absolutely. Yeah. So we're continuing to see a push towards value over volume and a lot more payment reform. Many of you are probably familiar with the new alternative payment models, like primary care first and direct contracting that are going to be starting in 2021. All of these things are supporting care in the home. And they're realizing that even insurance payers, that they really need to meet patients where they are. We're seeing people like Humana and Optum purchased home-based or post-acute care services because they realize that it's the right thing to do. And it's also what they have to do to get the outcomes and to be successful with their member population. So I'm going to talk through each of these in a little bit more detail, but this is kind of the sequence that you want to think about. And like you said, Tammy, it's never too early. Maybe you're not ready to go knock on someone's door right now, but think about your product, think about your cost, your audience, who are going to be your allies, and then really understanding a clear and concise pitch that shows value to the person that you're speaking with. And we're going to talk more about that. So it's a little funny to think about your product as being essentially your practice or your clinical delivery model, but that's really what it is. You as a home-based provider have a solution for complex, you know, aid or age patients that improves outcomes, has really high patient and caregiver satisfactions, and overall is a lower total cost of care. And, you know, we're going to talk about this over and over again. You have to measure, you have to be able to show that data and be able to kind of back up what you're saying and focus on that you're doing that with the sickest of the sick and what kind of population you're able to do that with. And so those measures that suggest competence, to give you a little bit more specifics too, you know, advanced care planning is a big one, you know, making sure you're getting that annual documentation of patient preferences, that's actually an independence at home measure. So is medication reconciliation within 48 hours of a hospital or discharge visit and follow-up within 48 hours, you know, those annual pneumococcal, but don't also forget about those patient and caregiver satisfaction surveys, you know, really making sure that you're understanding and that also allows your practice to respond to feedback. And in my experience, I mean, home-based practices have tremendous, you know, usually in the 90th percentile because you do so much for your caregivers and for your patients. And also, HCC scores, especially if you're going to talk with a payer, that's directly tied to the premiums they get for as a Medicare Advantage plan and they get, you know, higher premiums or higher dollars paid to them when they care for a sicker population. Now, HCC scores, just to talk a little bit about it, comes down to accurate ICD-10 coding and quality documentation. So that falls on you as the practice and the providers to be able to help with that. I think a lot of people don't realize that the actual ICD-10 guidelines tell us that we have to code to the highest level of specificity. So if your documentation is supporting, you know, hypertensive heart disease, but you're still using that, you know, I10.9 for just unspecified hypertension, that's an area of opportunity. You know, think about using more specific diagnosis codes, especially with, you know, diabetes due to chronic kidney disease, all of those things. Even some of the kind of odd HCC scores or if your patient has an amputation or colostomy status, you have to report every condition they have at least once per year. So annual wellness visits are a great way to do that. And then the other quality measure that we're starting to see more recently is days at home. You know, payers care about that costly hospital admission, and those are all things that you're able to help and improve your competence for. And when you think about cost, and this might be a little bit of a difficult one if you don't have, you know, some financial or some analytic support, but if you can eventually gauge your average cost per patient month, that's really helpful to do. And knowing it from at the start for a new patient, that's probably, you know, a little unstable and needs a lot more intervention than a patient that's been established with your practice. To give you kind of some cost figure examples of practices that have shared data, you know, for an interdisciplinary team, a home-based primary care model that really has that full, you know, continuum of care on average might be around $500 per patient per month when they're new, and then they might be closer to 350 or 400 for established. And if that's not realistic for you, there are other ways to think about cost. You could also think about ICU stays within 30 days of death or hospital admission rates within 30 days of death, because what those measures are showing is that you're able to provide really high-quality but low-cost care at the end of life. And Tammy, jump in if you have anything that perks your interest as we're going through this. But also, you need to understand your audience. So, you know, so far in this presentation, we've talked about how you talk to the patient and caregiver, you know, how you're going to talk to your potential referral sources, and now how you're going to talk to a payer, and those are all very different audiences, and you need to think about, you know, approaching each of those conversations very differently. And from an insurance company, do your research. You know, how are you going to help them with their medical expense, you know, and their revenue? Again, the HCC scores are directly tied to their premiums. And look at their existing programs and goals as a health system, and what are your easy wins or your easy conversation starters where your care model is really already aligning with what they're doing? And then as far as allies, you know, do your research. You know, chief medical officers or, you know, clinical delivery, anyone on the quality or risk adjustment teams, too, is really going to understand the value that you can bring. So do your research, you know, make connections with people. Even LinkedIn can be a great way to kind of network and really find your allies and who might be able to just start a conversation or help you get their foot in the door, even if they're not the right person. And when you are making your pitch, you have to speak to their priorities. Yes, you know, you have a product, you have a solution for them, and a lot of times these payers, you know, they know the population that needs it. They know their membership, who can care for, you know, who would need this model of care, but they don't have the providers. So if you're coming to them and rather than them, you know, having to start their own medical group or hire providers to do home-based care and to capture HCC scores and to help with their HEDIS and STAR measures and quality, you're able to do that, you know, that's going to be a win for them. But you also need to be prepared to kind of respond to feedback and maybe be flexible. Maybe exactly what you thought you walked in the door with isn't what they need, but is what they're offering enough aligned with your mission values and goals that you can still, you know, have a win-win situation when you're making that pitch. A couple creative examples, too, that we wanted to share with you, you know, I know actually a hospice and palliative organization that has contracted with the Medicare Advantage plan in their area to do in-home annual wellness visits, largely because of that HCC scores, but they're being paid to do those. And Tammy mentioned the ACO. You know, you want to keep your autonomy and your mission and your vision, but also that gives you an opportunity for some data and for infrastructure that you might have not had previously. And I think you can look at the framework for all of these, you know, alternative payment models that are coming out, and it'll kind of give you almost a roadmap for how you can prepare your practice. You know, if you go to CMS's website, if you just, you know, search their innovation center, they have one for primary care first, they have one for direct contracting, and it really gives you an overview of their model. And it's a great way to kind of start thinking about it, and certainly if you're participating in MIPS and receiving that shared savings and already, you know, producing and monitoring those outcome metrics, you're in a lot better position to kind of be prepared to have those conversations. And the last thing I would say too is just make sure you don't get yourself in a situation where you're taking on risk until you're really ready for it. If you're offering a risk-based contract, generally you need to have a really large patient population in order to be successful. So you want to keep that in mind as well. And the reason I left others on this slide too is if any of you on the phone, we always love to hear, you know, what people are doing and maybe there's something we haven't heard of. So feel free to share that in the Q&A. We'd love to hear from you as well. Tammy, any other words of wisdom that you want to add? No, not right now. It's, you know, it's an adventure. You need to just know who you are, know your why, and keep true to your own mission and vision. And look for other opportunities. There's been a lot of opportunities, I think, with the current situation, COVID, and being able to do telemedicine now and bill at a higher rate for telephone check-ins. So these are exciting times. Yeah, absolutely. I think especially with the COVID-19 pandemic, remote patient monitoring, telehealth, you know, providing those virtual services. And I think it's been a great opportunity for the field too. I think we're getting more attention that, you know, you have to meet patients where they are and that bringing healthcare home is really the right thing to do. So I think we're going to see a lot of exciting opportunities in the future as well. Absolutely. It's a great time for growth. So with that, I want to pass it back over to Danielle. Excellent. Thank you so much to Brianna and to Tammy for sharing just great knowledge with us today. We are also joined, as we transition into our question and answer portion, we are joined by Dr. Paul Chang, HCCI's Senior Medical Advisor. We do have some questions that have been submitted during the presentation, as well as prior to the presentation. We will get to all of your questions. The first one, our HBPC is a newer service line within a predominantly hospice organization. We've been trying to make partnerships with senior living organizations, but have found that this market, at least in our area, is saturated with concierge physicians. Any recommendations or thoughts on how we might work through around this challenge? Well, I'll jump in, Brianna, if you don't mind, and certainly if you have other ideas, feel free to interrupt. I would just say that there's always opportunities within that, those assisted living facilities for choice. First of all, the assisted living facilities are typically paid out of pocket or by insurance, long-term care insurance. And so our services are paid for by Medicare Part B or health insurance coverage. And so for that reason, there's always choice. And I like to approach it as, okay, I'm thrilled that you have this concierge physician in your organization. They're doing a good job for them, but would you keep my information for additional patient choice? And then the other side of that is just making sure that they understand the difference between your practice model and a concierge practice. Concierge practices typically have some upfront costs and they're not necessarily billing just insurance. I don't know what specifically your practice model is, but in my practice model, we don't charge a travel fee. We bill insurance, Medicare, Medicare replacement plans, and other insurances, private insurances, and we take what they pay. So it can be a very economically advantageous practice model compared to a concierge practice. Brianna, do you have any other? Yeah, I would agree with you. I think just remembering that a lot of referral and networking is relationship driven and sometimes it happens over time. It's typically not one conversation. Can you keep in touch with that executive director or that chief nursing? And I think, I'm sure Tammy, you would agree, once you get in the door and once you even have one or two patients that are able to share the value and how great your practice has been, those patients and those communities talk. They're going to be in the dinner hall and word of mouth through the patients is going to get out about the care that you provide. And we also, in my old practice, saw a lot of opportunities with new facilities. If your community and all of those other referral services are really aware of you and then a new senior living, even if it's not assisted, maybe it's a group home, kind of opens up and is doing their research and you're really searchable and they're able to find you, or if you're proactively monitoring what new facilities, see when you can get the foot in the door would probably be the only other thing I would add. Absolutely. And piggybacking on that, I mean, you're driving around all day, every day anyway. So make sure when you see a new building coming up, I'm constantly writing stuff down, doing some research, finding out where those new buildings are originating from. They hire the staff months and months in advance, especially your executive team. So make sure you're contacting them as early as possible. And what Brianna said about relationship building is absolutely key. Even if you just have one patient, two patients in there, make sure that you're making yourself available to their staff on the regular basis. When you go in to see that one or two patients, make sure that you're stopping in and checking in with the nursing staff and then checking out with them after your visit to give them an update on your assessment for that patient. I see a lot of other practices who will come in, do their work, write an order and leave, and they really never speak to anybody. The more you ingratiate yourself to them and try to be personable with them, the more they will enjoy having you in their facility, in their community, and talk to the other residents too. Just because they're not your patient doesn't mean you can't be cheerful and greet them. Absolutely. Thank you. Yeah. How do you tackle PCP issues when HHA refers a patient to you? When the home health agency refers a patient to me, if they have an existing primary care physician that they're able to get to, I will not accept the patient because I don't want to step on their toes. If I step on their toes, they're not going to refer to me and that's going to ruin my reputation. Reputation's everything. I will kind of fetter out that information as part of my intake process before me as the provider ever gets there. That's my intake department's responsibility. Yeah. I think I would just add too, when your intake staff is explaining services to patients, there's a balance. If the patient really is, they need to do enough of a screening that your provider's not getting there and it's a patient that's still driving and is getting out. That's really not typically the services that you're providing. Take care of the patients that truly need it, but also make sure that your scripting and those talking points we spoke about earlier are not too harsh. I remember conversations with patients where we're like, no problem, we'll send the first note to your PCP and we'll stay in communication with them. But once they realize that you're their partner, they're not getting out and seeing that PCP. You don't have to be so harsh with your language in the beginning, but you also want to make sure it's truly a patient that actually is going to benefit from your service. Right. What are your thoughts on direct to consumer, i.e. patients and families marketing? Which forms, if any, are effective? Do you have tips to avoid the ambulance chaser marketing appearance? Brianna, do you want to start on that one? I have very strong opinions, but I'll go first. I'm very interested in your opinions. Yeah, I mean, I think you can certainly, you know, I think if you want an approach that comes to mind, that's, you know, truly, I think a good approach is even if you're any of your providers are on local boards or councils with the, you know, local senior services or area on aging, you know, sometimes referrals come up there, you know, your faith communities too, if you're involved in a religious group or a church, you know, making your services to support that kind of community could be another appropriate angle. You know, again, you're there to help the people that truly need it. So if you're taking a networking opportunity, that's, you know, with a community or, you know, even a patient, you know, and caregiver gathering event where you're going to be able to support them. You know, I don't see that as a negative thing, as long as you're doing it in the right ways at the right times, but Tammy, I'm interested in your opinion. Yeah. So I feel like as long as you're providing some value of service in those particular marketing ventures that will be appreciated, whether you get a referral or not, great, do that direct to consumer. But typically they're always in an environment that isn't necessarily just direct to consumer. So if you're talking direct to consumer marketing, that is TV ads or print literature, that's mass mailed to a demographic. I don't believe in that. That is in my estimation, kind of the ambulance chasing approach. But like Brianna alluded to, if you're working with a senior living or a senior community or an Alzheimer's group and you're presenting at an Alzheimer's group meeting, support group meeting, you're providing a service, you're educating, if you're doing a health fair, then you're providing a service that whether you get a referral out of that or not is meaningful to the people you're providing the service to. And in doing so, it shows your heart, it shows your why, and you're going to get referrals. So absolutely do the right thing and the rest will follow. Yeah, absolutely. I couldn't agree more. Can you speak to your practice's personal growth, applying these strategies and how it's translated to your business growth? Absolutely. And that has to be for me because, well, I don't know, Brianna, you can speak to that. Oh, go ahead. I'd love for you to start. I mean, I think, I mean, Tammy, I know you probably won't embellish yourself too much so I was, but I mean, you started out all on your own and I'm pretty sure you cover almost the entire state of Indiana now. I mean, you really have shown through the value and the care that you provide how this is really possible. Thank you. Yeah. I did start a little right at 10 years ago, a little over 10 years ago, 10 years ago this past October. And I started as a single provider out of my living room, praying for patients. And within 10 years we have, we carry about 2000 active patients. We make over 15,000 visits a year. And we do that with about 16 or 17 different providers over most of the state of Indiana, a large portion of central Indiana. It's been, it's been an amazing journey. There've been tears, there've been hard times. There's been wonderful stories that have come out of it. But you heard all of my marketing, not all of my marketing, but you heard a good portion of my marketing strategies here today. It is looking for the opportunity and not looking for the opportunity for a dollar, but looking for the opportunity to make an impact. And if you do that, in my opinion, the rest will follow, the money will follow. So again, know your why, know what your skill set is, know who your target audience is, deliver a good product every day. Make sure you're communicating, make sure you're revisiting. How could I do this better? How could I do this better? And you'll be successful. Yeah. And I think the only other thing that I would emphasize too, is what we talked about earlier, you know, don't put all your eggs in one basket. You know, you can never rely on just a few referral sources. Really try and be innovative, look at your community and the care that you're providing and how you can help. And also you have to stay connected. I mean, you heard about, you know, Tammy, how great of relationship management she does with her referral sources. That's something that you need to be tracking too. You know, how many referrals are you getting from where and are you doing quarterly meetings with them all? Are you meeting with your home health agencies about patient cases and your hospices or other, you know, your hospital discharge planners, all of those things. You need to be taking the time to do those activities and continue that relationship and always be looking for ways to support each other, ultimately for the good of the patient and the caregivers. Right. How do you get referrals for patients with cognitive decline? So I believe the question, so a lot of in the home, and Tammy jump in here too, I think what they're asking is, you know, many of these patients have memory or, you know, cognitive status issues. Oftentimes you're talking to their caregiver or their POA or their family anyways, as they're the responsible party that's getting them set up for services. So again, just don't forget how important that that family member and that caregiver is and, you know, taking every opportunity you can, you know, elevator pitches, you never know who you run into and just making sure, you know, that they know you're a resource for them to help them care for a loved one. Absolutely. And you can reach out to your local Alzheimer's association. There have got to be Alzheimer's support groups in your area. That's a great way to start with the caregivers. And additionally, we have many physicians that are in the area that do geropsych evaluations, cognitive assessments, and that sort of thing. We've reached out to all of those physicians and said, Hey, we understand your importance and your role, and we want to come alongside you and we want to do the day to day. You know, you're going to see the patient in the office, you're going to do the initial evaluation, you may see them once or twice a year and follow up. We want to manage everything else in consultation with you to manage their geropsych issues. And that's been very helpful as well. Can you speak to how you've established relationships with assisted living facilities? And has that changed or evolved during the public health emergency? Tammy, you want to start? Yeah. So certainly we have, we have in excess of 42 different assisted living facility communities that we work with. And so there are different degrees of relationship with the different communities. Some communities, we see the majority of their residents. Some communities, we only see, you know, a handful of their residents. Some communities we have a medical directorship agreement with. Even though an assisted living facility in the state of Indiana isn't required to have a licensed medical director, a lot of these facilities want them. And that's a whole different topic and a whole different discussion. But I will tell you that specifically during the COVID crisis, we have come alongside a lot of our assisted living facilities, the majority of them, by giving very early communication on how you should be preparing for the COVID crisis. They were saying, close your doors and no more. We were saying, limit your, limit your community access, check temperatures, have a hand washing station at the front door, make sure everybody signs in, you know, we were communicating with them via email and kind of setting the tone on, this is how you should proceed. We stayed very in touch with the state board of health in our community, and we acted as a source of guidance for our assisted living facilities during this COVID crisis. And it certainly has strengthened our relationships. We've additionally agreed to write orders for testing their staff and oversee that. And we have managed severe COVID outbreaks within memory care units and assisted living facilities within our community, unfortunately. I think the community will tell you that they couldn't have asked for a better partner. And that true, that too has been very, made very clear because we talked with the regional and then even the national organization, the ownership of a couple of different assisted living facility communities about kind of our protocols and helped them put protocols in place that they've been used across their own facilities nationwide, not just in the state of Indiana. So we have time for one more question. And then we will just wrap up. The last question is, can you share your practice's mission statement or how you describe your practice to patients? So, and Tammy, you can feel free to share yours. Dr. Cheng, I don't know if you want to talk a little bit about home care physicians at all, or kind of how you approach, you know, talking about your practice. Just a couple of comments. Number one, I think throughout this webinar, I think the word relationship came up over and over and over again, how important that is. Relationship with payers, relationship with an assisted living, relationship with patients and their loved ones. That is such an important part of what we do in home-based medical care, especially when we are taking care of complex patients, chronically ill, and supporting them at home. So I want to remind, I'm reminded by listening in this webinar, how important it is. Yes, we need to know metrics. We need to know our numbers. We need to know our strength and how we can market ourselves. But having those relationships and sustaining them and building them are so important in doing what we do. Home care physicians, we're a house call program outside of Chicago. We're part of an academic center of Northwestern. And we've been taking care of chronically ill patients at home for the last 20 years. Our mission is to support, give them wonderful, terrific care of our seriously ill patients at home, finding out what's important to them and supporting their caregivers, minimizing the transportation and the logistics that are necessary. It's related to caring for those with chronic multi-comorbidities. And that's the mission of what we do at home care physicians. Yeah. And the formal mission statement too that you'll see on the website in case it's helpful is really compassionate, comprehensive, primary medical care at home. There's some research out there about eight word mission statements if you're really trying to draft a formal new one for your practice. And also one of the things that I personally like about Dr. Chang's practice is they focus on that team-based care. Tammy, I love what you said too about the meet the team. I think anytime you can give patients especially like welcome packets and panel cards or have that on their website where they see the providers and the whole team's faces and are really able to kind of feel like they can get to know them, I think that helps as well. Yeah. I agree. And our mission is just to foster graceful aging through the delivery of exceptional healthcare outside of the traditional medical setting. I love that. I do want to take a moment to thank our presenters again for joining us today. As we move to the end of our presentation, we're just at about the five o'clock hour. I want to remind you of our HCC Intelligence Resource Center. There's various outlets for you to connect with our subject matter experts as well as our monthly webinars and virtual office hours. You are able to contact us via our hotline as well as our downloadable valuable tools and tip sheets. Next month, we do have our upcoming webinar every third Wednesday of the month. This is Intersection of Faith and Community Organizing in Advanced Illness Care During COVID-19. This is presented in collaboration with our partners at CTAC. After this webinar, we will be sending out an email to all of our attendees today with a brief survey link as well as the information to register here. I want to thank everyone for joining us today. This has definitely been, and I've seen positive feedback, that this has been a fantastic webinar. So thank you all for your time. Please stay safe and we'll see you next month. Take care. Thank you, everyone. Thank you.
Video Summary
The webinar titled "Strategies for Growing Provider and Patient Referrals for Your Practice" discussed various strategies to increase referrals for healthcare providers. The speakers, Tammy Browning and Brianna Plensner, shared their insights and experiences. Tammy emphasized the importance of understanding one's strengths and target population, conducting market analysis, and establishing relationships with referral sources such as assisted living facilities, home health agencies, and hospice companies. They suggested hosting events, forming alliances, volunteering at health fairs, and contacting local hospitals to generate referrals. Tammy also advised being clear about the referral process and setting clear expectations for follow-through. Brianna discussed the importance of assessing readiness for growth, ensuring timely appointments and responses to patient inquiries, and having scripts and talking points for staff to provide consistent messaging. They also highlighted the potential opportunities for growth through payer partnerships, direct-to-consumer marketing, and focusing on cognitive decline patients. Both speakers emphasized the importance of building relationships and providing value to referral sources and patients. They shared personal experiences of their own practices' growth, and the impact of relationship building on their success. Finally, they encouraged tracking data, staying connected with referral sources, and adapting to changing circumstances, such as the COVID-19 pandemic. Overall, the webinar provided valuable insights and strategies for healthcare providers to increase referrals and grow their practices.
Keywords
webinar
strategies
provider referrals
patient referrals
healthcare providers
referral sources
market analysis
relationship building
COVID-19 pandemic
practice growth
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