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 Beyond Hospital Referrals: Gaining Ground With Innovative Marketing Tools

Nursing and assisted living providers seek higher occupanices one influencer at a time.

 

The new world of long term care marketing has expanded the boundaries of where and from whom skilled nursing facilities (SNFs) and assisted living facilities (ALFs) seek referrals, from the old days of working only with discharge planners and social workers at hospitals to the 2010 version, where marketing targets practically anyone influencing seniors’ post-acute care decisions.
 
The federal government says the goal of discharge planning is a “smooth move” to the next care setting, but making that happen oftentimes pivots on provider marketing.
 
Matching the needs of an exiting hospital patient or senior looking to move from home with the care capabilities of a post-acute care provider involves many factors and has seen many new trends emerge in recent times.
 
Marketing, both “inside” the industry and related settings of care and “outside” to the general public, can involve a slew of different strategies for providers to pursue, from physically having a representative working in a hospital with case managers and discharge planners, to tracking data on potential residents via electronic health record management systems, to working on advertising and other outreach campaigns for bolstering the brand and boosting occupancy.
 
Everyone in the post-acute care business knows that hospitals need to move people out as quickly as is feasible, and long term care settings, in turn, need to gauge, sometimes quickly, how a discharged patient best fits into the continuum of care they provide.
 
Caregivers and patients, along with the discharge planning staff at a hospital, all have ideas on what qualifies as a “smooth move.” And, for seniors looking to transition out of their homes and into an ALF, the decision relates as well to what their next residence will do for quality of life.

Reaching All Points Of Access

Seeking access to all sorts of influencers—the people who live with, provide services to, or simply know potential residents—is a growing trend in provider marketing, be it before or during the discharge planning cycle.
 
In addition to senior centers, post-acute providers promote their services among themselves (home care, hospice, rehabilitation, SNF, ALF) and to those influencing seniors: estate planners, clergy, ophthalmologists, Meals on Wheels volunteers, pharmacists, paramedics, and many more stakeholders, says Rhoda Weiss, an international consultant, writer, and educator based in Santa Monica, Calif. “As the numbers of people needing post-acute care moves from seniors to younger generations suffering heart attacks, strokes, orthopedic issues, uncontrolled diabetes, asthma, trauma, and more, the SNFs, rehab facilities, home care, and other providers are expanding their marketing and rethinking strategies, tactics, and techniques,” she says, tapping into her experience as past national chair of the American Hospital Association Society for Healthcare Strategy & Market Development and ex-chief executive officer of the Public Relations Society of America.
 
Weiss relates that her 93-year-old father, who volunteers weekly at a center offering programs for seniors, understands how important referrals are to SNFs.
 
“He sees scores of SNF personnel stopping by with information and goodies in quest for recognition, positioning, and, hopefully, referrals to their facilities,” she says.
 
Patricia Cokington, senior sales trainer for Sikeston, Mo.-based ALF provider Americare, agrees that the old days of SNFs simply making weekly visits to a hospital are over, and for ALFs the net is cast just as wide. “You are definitely seeing more referrals from different people,” she says. “You see lots of influencers in church. The clergy know when one of their elderly worshipers can no longer come to services. Overall, they are very receptive.”
 
The main role clergy fulfill is, of course, is as spiritual guides, making any work they do as a conduit to a provider an informal task, says Father Kevin Walsh, pastor of Saint Anthony of Padua Catholic church in Falls Church, Va.
 
While tending to the elderly in his parish, he occasionally recommends programs he sees that work well for his parishioners. “There is a hospice that has done very good work, so informally I recommend them,” he says.
 
Besides an increase in the number of people receiving at least part-time home care, Walsh says in his 18 years as a priest, the main goal of families continues to be in trying to keep their loved ones with them, or in their own homes, as long as possible.
 
The key for provider marketing and sales staff is to reach out into the community, especially in rural America, Cokington says, noting Americare does most of its business outside of metropolitan areas. While increasing the focus on nontraditional sources of referrals, the best place for provider marketing remains the hospital, be it by placing a representative within the hospital walls or a computer linkup for word on the latest prospective residents.

Physicians Receive Attention

Inside the hospitals, providers have tried more aggressive and straightforward approaches to let doctors treating their potential future clients know that their long term care facilities can offer patients a second professional home.
 
Blaise Mercadante, chief development and marketing officer for Miami Jewish Health Systems, says doctors are tops on their list. “We talk to physicians, and we talk to case managers and discharge planners. Part of our sales force meets with physicians and holds these events in their offices,” he says.
 
The goal is to make the doctor a partner in the future care of their existing patients and others.
“We really want them to feel comfortable,” Mercadante says. “The key message is that their patients will be cared for. We respect the role of doctors, and we will provide the service they feel comfortable with. If they want calls at 3:00 in the morning about their patients, we will do that.”
 
The next level is to work with case managers “to smooth discharges,” which also includes automated links with the nearby Aventura Hospital and Medical Center, he adds.
 
Kindred Healthcare, which has instituted a new marketing campaign under its Continue the Care program (www.continuethecare.com) in Cleveland and Indianapolis (with more target cities coming soon), says amongst all of its varied efforts, the communication with physicians is one of its chief marketing priorities.
 
“We really tell them that they can build a practice [at our facilities]. We make the economic case to the doctors by making the physician aware of the quality outcomes we provide and that we care for them,” says Kindred’s Benjamin Breier, executive vice president and president of the hospital division, as well as the incoming chief operating officer (COO) for the company.
 
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No ‘Bounce-backs’

Dan Benson, COO of Indianapolis-based American Senior Communities (ASC), says his company has personnel right in the hospital “helping to be part of the solution” for discharge planners and hospital administrators, because assessing where to place patients is not as easy as looking up the nearest long term care facility and getting the elderly person there.
 
He says that especially today providers must be savvy in finding appropriate care for discharged patents, to prevent “bounce-backs” from the long term care setting to hospital. “Information gathering about patients really helps to prevent bounce-backs, a negative for reimbursement purposes as well as for patient care,” Benson says. “It is much better to coordinate care with the hospital, to cover the patient’s drug regime and all aspects of their care.”
 
ASC hires nurse liaisons to work at nursing stations to best gauge where potential residents stand in terms of needs, even working on transportation issues. “We go into a marketplace and find the sharpest discharge planners and case managers and have them become employees of ours,” Benson says.
 
Once a possible match for an ASC facility is discovered, the team works back to the facility level to make sure the care can actually be satisfied, he says.
 
“We ask if we can care for this person, are we able to meet this person’s needs,” Benson says, including physical layout of the SNF or appropriate machinery such as ventilators.
 
“It is the folks at the building level that have to be able to focus and see if we can make a good decision.”
 
In the old days, he notes, the decision by families to place a loved one in an SNF might take a day or two to sort out, but today it is usually accomplished in a few hours, with the policy emphasis on moving patients along the care continuum and competition for space.
 
Families can get a jump on research by looking at the Internet, but also viewing marketing materials, like virtual tours, provided by the long term care provider.

Critical To The Care Process

Weiss says as hospitals face higher costs, lower reimbursement, shorter stays, and growing post-acute community resources, discharge planning has become even more of a top priority. This importance translates into more collaboration and partnership with case management and utilization review programs.
 
“The role of discharge planning is growing in importance and respect as a critical part of the hospital’s medical and financial future and its ability to safely and effectively discharge patients to the appropriate post-acute provider, reduce re-admissions, increase patient and family satisfaction, and help lead the critical work of comprehensive continuity of care in their communities,” Weiss says.
 
During the past decade, Weiss says she and others have witnessed an explosion in best practice medicine that involves physicians leading teams of clinicians and support staff who compile, share, and implement best practice plans for scores of medical conditions.
 
“During the last few years, we are seeing more of these best practice care plans integrating discharge planning and discharge planners into the best practice plans,” she says.  

Technology In Play

In years past, discharge planners would spend hours upon hours playing phone tag with multiple referral sources to place patients with the most appropriate after-hospital provider that had the time, space, and staff to accommodate the patient. Now, referrals are increasingly made electronically, securely, safely, and more efficiently, thanks to electronic referral management.
 
This benefits the hospital that can match patient needs to the capabilities, availability, and services of the referral source as well as safely and electronically share secured patient information with the after-hospital provider.
 
One of the main players in the electronic health records (EHRs) business is PointClickCare (www.pointclickcare.com), which bills itself as the market leader in long term care software-as-a-service (SaaS). At the start of this year, some 5,000 long term care centers in Canada and the United States used the company’s software for tracking demographics; managing current, historical, and waiting list clients; and maintaining a physician registry for all care professionals such as attending physicians, dentists, therapists, and consultants.
 
Mike Wessinger, PointClickCare president, says the EHR helps track bed availability and pre-booking assessments in a real-time fashion for often quickly developing discharge scenarios.
 
PointClickCare’s software does this by allowing hospitals to capture critical information on the abilities, capabilities, and resources available from post-acute providers.
 
 “It benefits after-hospital providers with easier and quicker access to patient information, which speeds referrals and patient transfers,” Wessinger says.
 
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Marketing To The Public

There is another kind of marketing of course, and that is marketing to the public through media and other avenues, which is what providers of assisted living and independent seniors housing focus on more than in the discharge planning process.
 
Linda Dickson, marketing director for Redstone Highlands Senior Living Communities in Pennsylvania, says efforts to attract clients for her company’s housing options cover a number of traditional avenues, like direct mail and newspaper ads, as well as new social media like Facebook and Twitter.
 
“Direct mail is one of our best producers,” she says, noting that unlike SNFs, people looking at assisted living are making lifestyle choices rather than “needs-based” decisions.
 
Even through the tough economy, she says, Redstone’s stable of apartments, villa homes, and memory impairment and skilled accommodations have been well-occupied, “95 to 96 percent sold and 93 to 95 percent occupied.”
 
Dickson says one of her marketing successes has been the use of billboards, strategically placed to catch the eye of seniors driving in cars. “I was sort of laughed at when we first did it, but now I think people are envious of our billboards,” Dickson says.
 
She notes that despite the forays into social media, Redstone’s target audience is still newspaper readers, so they do a lot of advertising in that medium. In the end, however, direct marketing brings in the most business.
 
“Direct marketing helped us to zero in on the group of people we are hoping to see more of,” she says.

The Kindred Campaign

At Kindred, the Continue the Care campaign has boosted business in the Indianapolis and Cleveland markets where the program has first been rolled out, Breier says.
 
Besides marketing to hospitals and doctors inside the hospital, he says the two pilot markets have seen an initial round of saturation advertising through print ads, direct mail, aggressive social media, and other outlets to first raise recognition.
 
“The content of the campaign is to build the brand,” Breier says. It seems to be working, as he points to double-digit growth in the pilot markets as a result of the marketing campaigns in what is a “pretty tough market out there.”
 
Kindred plans to expand the Continue the Care strategy to 20 markets in total, gradually rolling out to more cities in 2011. Breier said the company did its homework before embarking on the campaign and stresses that it is important to remember that pre-planning is critical.
 
“The lessons are you can’t be all things to everyone at once. Be careful on what and where you spend the dollars. I mean, we didn’t decide to roll out to 40 states,” he says.
 
At www.continuethecare.com, the public can access information about Kindred facilities across the country, covering long term and acute care, skilled nursing, assisted living, inpatient rehab, home health care, outpatient rehab, and hospice.
 
There are also click-throughs to refer patients, receive a newsletter, and even find employment, with one of the provider’s goals being to attract new and skilled talent through the marketing program, Breier says.

Remember The ‘Smooth’ Goal

Through all of the various ways providers seek to manage their end of the discharge planning process, it is important to remember the factors in play and sometimes in conflict.
 
Discharge planning demands a continual balance between the needs of patients and their families and pressures of managed care and health plans for timely discharge from a hospital—often causing conflicts among nurses, social workers, and professionals who are part of the utilization review and discharge planning process; physicians responsible for each patient’s care; health plans; employers; and post-acute care providers.
 
Medicare defines discharge planning as “a process used to decide what a patient needs for a smooth move from one level of care to another.” But, Weiss notes, discharge planning is not an isolated event—it starts prior to hospitalization once the patient is referred to and/or admitted to the hospital or at admission for unplanned medical events.
 
“The goal is to ensure patients can function appropriately and safely following a hospital stay,” Weiss says. The objectives are to conduct a patient-centered, comprehensive assessment with the most complete data, resulting in the best possible decision making for patient placement. Whether the decision is to send the patient back home or to post-acute care, appropriate and safe reductions in lengths of stay and quick transfers are imperative.
 
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It's A Team Event

Providers note that discharge planning demands close working relationships among all members of the health care team, from both the hospital and post-acute provider.
 
“Discharge planning is a comprehensive activity involving not only medical and physical needs, but psychological; spiritual; financial; and practical and family needs, capabilities, and available resources,” she says.
 
The process is data- and labor-intensive and requires comprehensive knowledge by the discharge planning team of available community resources that best match patient needs and knowledge of how to make the best connections for patients and loved ones.
 
Discharge planners often know as much as primary care physicians about patients as they are typically involved in that care prior to or at hospitalization through hospital discharge to a post-acute provider and follow up, Weiss adds.
 
The challenge for discharge planners, and why providers seek to help in the process or are connected to the process via electronic means, are many, from the hospital and its maze of clinicians, support and back office staff, primary and secondary physicians, and the many parts of a puzzle that comprise such a facility.
 
Weiss says these challenges also have been exacerbated greatly by higher hospital costs, inadequate reimbursement from government payers and health plans that often are lower than the cost of care provided, and enormous pressures from health plans and payers for short stays and early discharges.
 
“Another challenge is identifying an appropriate post-acute provider that matches the patient’s continuing health care needs, requirements for medical equipment, single or multiple diagnoses, the patient’s insurance plan, ability to pay, family budget and availability and age of caregivers, along with their capabilities to care for a loved one at home,” Weiss says. “The emotional distress of the family as well as their ability to accept different levels of post-acute care also play a key role.”
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