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BETTER UNDERSTANDING YOUR PERSONAL CARE MARKET
Originally presented April 2012
SPEAKER BACKGROUNDOver 20 years in home care35 years of experience in planning and
marketingMBA from the Sloan School of Massachusetts
Institute of TechnologyPresident, Healthcare Market Resources, a
market intelligence providing customized market research to home health agencies and hospices, including MD/facility referral trends
AGENDASize Your Market
Physician Targeting
Hospital Discharge Patterns
SIZE YOUR MARKET-PERSONAL CARE
Determine the number of individuals living in your service within the various age groups
Determine how many within each age group will need assistance
Determine how many are candidates for services @ homeNumber of nursing home beds & assisted living beds
Determine % of families with sufficient income levels
Determine number of individuals living alone
NUMBER OF LIMITATIONS TO DAILY LIVING (%)
Age Group Total None 1 2 3+
65+ years 100.0 94.3 (0.13) 1.4 (0.06) 1.2 (0.05) 3.2 (0.09)
65-74 years 100.0 97.1
(0.11) 0.7 (0.05) 0.6 (0.05) 1.6 (0.08)
75-84 years 100.0 93.9
(0.21) 1.4 (0.10) 1.2 (0.09) 3.5 (0.16)
85+ years 100.0 82.2 (0.62) 4.7 (0.33) 3.4 (0.28) 9.7 (0.49)
SIZE YOUR MARKET-MEDICAID WAIVERDetermine number of dual eligibles in your
county/countiesMultiply by the proportion of your service
areaMultiply by % of dual eligibles receiving full
Medicaid benefits
MEDICARE DUAL ELIGIBLESTATE: YOURSTATE
COUNTY CTY # ELIGIBLE MGD CARE % PART B DUALS
BATH 18050 2,186 12 0.55 170 102
BELL 18060 6,522 190 2.91 335 201
BOONE 18070 11,139 1082 9.71 854 512
BOURBON 18080 3,241 204 122
BOYD 18090 10,854 160 1.47 786 472
PHYSICIAN TARGETINGProblem is knowing which MD’s to call upon
Largest practicesMost patients on home health
Head nurse or office manager may be the key referral source
Type of patient may vary by specialtyShort term vs. long term
HOME HEALTH PHYSICIAN REPORTFirst_Name Last_Name Specialty 1 Specialty 2 Primary Specialty Address City State
JUAN BERNAL
Physician - Internal Medicine - Cardiovascular Disease
Physician - Internal Medicine
Cardiovascular Disease 2700 10TH AVE S BIRMINGHAM AL
PARKS PRATT
Physician - Internal Medicine - Rheumatology
Physician - Internal Medicine Rheumatology 4300 W MAIN ST DOTHAN AL
PARKS PRATT
Physician - Internal Medicine - Rheumatology
Physician - Internal Medicine Rheumatology 4300 W MAIN ST DOTHAN AL
DAMIAN COLLINS Physician - Internal Medicine Internal Medicine100 MEMORIAL HOSPITAL DR MOBILE AL
DAMIAN COLLINS Physician - Internal Medicine Internal Medicine100 MEMORIAL HOSPITAL DR MOBILE AL
DAMIAN COLLINS Physician - Internal Medicine Internal Medicine100 MEMORIAL HOSPITAL DR MOBILE AL
DAMIAN COLLINS Physician - Internal Medicine Internal Medicine100 MEMORIAL HOSPITAL DR MOBILE AL
HOME HEALTH PHYSICIAN REPORTDeciles
Overall Overall Overall Hom Hlth Hom Hlth Hom Hlth Hom Hlth Hom Hlth
Zip Phone Fax PracticePractice Specialty Hom Hlth Neuro Hemonc Cardioresp EndoDiabet Ortho
35205 2059390139 1 1 1 1
36305 3347939564 3346718907 8 9 1 1
36305 3347939564 3346718907 8 9 1 1
36608 2513422641 2513439507 5 4 7 6 5 6 6 6
36608 2513422641 2513439507 5 4 7 6 5 6 6 6
HOME HEALTH PHYSICIAN REPORTHom Hlth Hom Hlth
share_MD Agency
100
ALACARE HOME HEALTH & HOSPICE
50
MID-SOUTH HOME HEALTH AGENCY, LLC
50MID-SOUTH HOME HEALTH
8.6
10.8
TENDER LOVING CARE, AN AMEDISYS COMPANY
16.1
AMEDISYS HOME HEALTH OF MOBILE
HOSPITAL DISCHARGE PATTERNSUnderstand to what sites of care does a given
hospital discharges its patientsHome health, SNF, Rehab hospital,
Community(No care)By DRG
Is there a bias to use in-house resources?Transitional care units tend to have shorter
lengths of stay than freestanding SNF’sImpact of healthcare reform
PATIENT PROTECTION & AFFORDABLE CARE ACTMedicare Re-admission Penalties
Three DRG sets subject to potential penalties in FY2013, based on FY2012 results Acute Myocardial Infarction(AMI) Pneumonia Chronic Heart Failure
Additional DRG sets in 2015 Chronic Obstructive Pulmonary Disease(COPD) Coronary Artery Bypass Graft(CABG) Percutaneous coronary intervention(PTCA) Vascular Procedures
Hospitals judged by all hospital re-admissions in thirty(30)day period following discharge, regardless of hospital
PATIENT PROTECTION & AFFORDABLE CARE ACTMedicare Re-admission Penalties
Worst-case Scenario 1% of ALL Medicare re-imbursement in 2013 2% of ALL Medicare re-imbursement in 2014 3% of ALL Medicare re-imbursement in 2015
Penalties based on prior year results
PATIENT PROTECTION & AFFORDABLE CARE ACTAccountable Care Organizations
Limited initial interest; too much upfront $$Medicare accommodated thru different modelsMoney will be made thru reducing or eliminating
services or substituting lower cost servicesPost Acute Bundling
Limited scope of servicesInitial offering oversubscribedMONEY IS IN PREVENTING HOSPITAL RE-
ADMISSIONS
HEALTHCARE REFORMKey Concepts
Value-Based Purchasing“Tearing Down the Silos”Outcomes-Based ReportingPost-Acute Integration
HOW CAN YOU OFFER VALUE?
UNDERSTANDING YOUR KEY ACCOUNTWhich DRG’s are important to me?
Where does the hospital tend to send these patients by site of care? Which specific facilities/agencies?
How do they compare to their region/state and best practices?
Do they have a length of stay issue?How elderly is their patient population(80+)?
HOSPITAL RE-ADMISSIONS
Quartiles will compress over time
PROMOTING PERSONAL CAREDoes the hospital have a re-admissions issue?
Are they participating in an ACO or post-acute bundling demonstration project?
How do you prevent re-hospitalization?Falls programMedication managementPhysician visit assistance
SELLING @THE C-LEVELOutcomes orientedLimited access; fewer times at bat; more at
stakeMultiple agendasCommunicating and getting feedback more
difficultNeed to work thru several layers of the
organization; implementing decisions can be lengthy
CONCLUSIONSKnow your market to set realistic expectations
Target the “right” physicians to maximize sales rep productivity
Plan your key account strategy to optimize your face time opportunities
Position personal care as a complementary tool for healthcare reform
CONTACT INFORMATIONRich Chesney
President, Healthcare Market Resources
215.657.7373
215.657.0395(f)
www.healthmr.com
