Agrace CEO Lynne Sexten: We Market to Consumers Directly

Locals in central Wisconsin have likely at least heard of Madison-based Agrace Hospice & Supportive Care. The nonprofit routinely advertises in local media and other forms of direct-to-consumer marketing in addition to relationship-building with referral partners.

Lynne Sexten, president and CEO of Agrace Hospice & Supportive Care, recently sat down with Hospice News to discuss how the organization has been shaping its marketing efforts to reach patients further upstream, as well as the ways providers can collaborate for mutual support.

Agrace operates four locations, with a fifth coming in January, 2022. Agrace offers hospice and palliative care (or supportive care) to patients in their homes and in skilled nursing, assisted living or community residential facilities. They also provide grief support and have an inpatient hospice facility with a memory care suite.

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Earlier this year the provider became a founding member of the Wisconsin Hospice & Palliative Care Collaborative. The five member hospices share best practices, negotiating power with payers, quality initiatives, diversity programs and staff education and volunteer management opportunities. Several years in the making, the collaborative’s combined geographic footprint covers 80% of the state.

Agrace has developed a strong marketing presence in south central Wisconsin, running local TV advertisements and billboards throughout the area. How would you characterize your messaging to consumers?

Our marketing team does a great job of doing their homework, [and] our outreach is never done off-the-cuff. It is well-researched and thought out. The real focus is to educate throughout our market that we actually are bigger than just hospice. We have this array of services for people who are aging, ill or dying. The narrative throughout all of these marketing spots is to build awareness and confidence in storytelling. It’s not just about promoting the benefits of hospice, but we’re also also trying to show people this care can help them stay at home, or that their family can come and go and visit them in facility-based care. We’re educating and laying the groundwork through positive associations with what matters to our audience.

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How does this kind of direct-to-consumer marketing complement traditional sales practices oriented toward referral partners? How do you compare these and decide where to pour your resource bucket into?

We’ve always marketed and advertised ourselves, but as we expand our services our goal is be the solution for people who really want to remain in home but might not be able to do all of their daily care if they’re not hospice eligible.

We have our age at-home, non-medical home care for folks who are not hospice-eligible but they have chronic conditions and just need some help. We also have our palliative care program and our adult day program, where maybe they’re not hospice-eligible but they’re struggling with cognitive decline and they want to be engaged during the day.

What we’re trying to do is build the services that really help keep people in their homes, where they want to be. We market out to consumers directly. We’re trying to make Agrace top of mind, but also educate health care decision makers about the benefits that we can bring, but in a very relatable way.

When our referral partners mention Agrace, we want consumers to already have heard about us so that it feels familiar and gives them confidence that we can help them. We have that kind of a marketing approach, and then we have our sales team that’s also out there carrying that same kind of message when they’re interfacing in all kinds of ways with referrals.

As we’ve opened other types of services, there’s a halo effect of our reputation where people come to us because they know Agrace is going to do a really good job. That reputation is all wrapped around hospice. We’re trying to always walk that fine line between leveraging our great reputation, which is so wrapped around hospice, but also have people start to really think about us more than just this so they’re not fearful when they hear the word of Agrace. Agrace could mean any number of things, not just the end of life.

How are you measuring the success of your marketing efforts?

There’s a couple ways. On a longer term basis to develop our long-range marketing plan, we do consumer research surveys every few years in all of the markets that we serve here in Wisconsin. That helps us track brand awareness, preference trends, and it shows how our marketing has been moving those trends in recent years. That’s one way that we measure.

Another way is through the insights we get from social media; the demographics of the people that are engaging with us, their engagement behavior, etc. We also use Google analytics and we use a tracking pixel on our website that helps us measure conversions, such as whether someone has clicked to download an educational piece, submitted an inquiry, or clicks to contact us.

We use marketing data to understand our top referral sources and how we can meet consumers earlier in their journey. We also ask patients and families how they’ve heard of our services. This question isn’t rocket science, but documenting their replies is really helpful. These could give us some qualitative insights into what marketing efforts spoke to them and why.

In March Agrace opened an adult day service center with clinical services for aging, chronically ill and dying populations and their families in Madison, Wisc., and surrounding areas. Was this the first expansion of your service lines beyond hospice or palliative care?

We developed a long-range growth plan a couple years ago. It envisioned a handful of services that we felt would be instrumental in helping to keep seniors at home that would then in turn make Agrace an attractive partner with health systems, [accountable care organizations (ACOs)], and for payers who provide Medicare Advantage. Certainly among these services was palliative care, non-medical in-home caregivers, [durable medical equipment (DME)]. Adult day was the most recent one that we did.

We’re trying to develop a relationship with a potential future hospice patient, but we want to get to know them earlier in the trajectory of their aging process. These kinds of services really help us move upstream, but not in a way that competes with our really important partners. We’re not competing with the health system and we’re not competing with the long term care facilities. We’re trying to thread the needle and develop services that are really complementary and not competitive. These are very important aspects for outreach in the community.

In what ways does the adult day services complement your hospice and palliative care business?

A really good example is when we have a program like our adult day or our palliative care — which we call supportive care — a lot of those clients and patients come to us without advance care planning documents completed. They haven’t had those discussions yet, and what an advantage to be able to get those discussions going and make those necessary decisions before it’s a crisis.

Another good example is that we have really close relationships with geriatricians in the community, the Dementia Alliance, as well as the Alzheimer’s Association. A big chunk of the folks that are enrolling in our adult day center are people with cognitive decline. We also have one of the country’s few inpatient memory care units dedicated for hospice patients. Our hospice memory care unit is a very nice way to help provide a little bit of a continuum when someone’s needs have moved beyond adult day and they are now hospice eligible, and the burden of caring for them at home is just too much.

How is the Wisconsin Hospice & Palliative Care Collaborative progressing since its launch in February? What has been the top priority in pooling the collective powers of the hospices involved?

There’s five of us in this collaborative, and we have literally been working together for almost 10 years and that’s been a wonderful structure into where we are now. For years and years, we’ve benchmarked quality, we’ve streamlined a lot of our regulatory required forms, and we’ve worked on coming to a consensus around eligibility determinations. A ton of work has just been in the nature of collaborating with one another over the years.

Then you flash forward, and the [value-based insurance design (VBID)] demonstration is announced, and the five of us are looking at one another knowing none of us have a wealth of experience in negotiating care contracts. It’s just an inconsequential part of our business right now, and in order to position ourselves well for that, we need to develop a provider network that can then go in contract with plans.

While the collaborative can do and is doing many things, the first and foremost is the provider network. Our collaborative covers just about the whole state of Wisconsin. Right now we have contracts with two insurers, because the VBID has not been rolled out in Wisconsin yet. That’s going to change next year. Counties in and around the Green Bay area will all be through Humana [(NYSE: HUM)] that’s grabbing that area.

Our contracts we have now are entirely focused on supportive care in their per member per month to start. Then year two is let’s see how it went and refer back to the data. Does it make sense for these to flip into value-based contracts? We’ve completed two of these, and they started in 2021. Then we have another one that we’re hoping to sign by the end of this year.

That’s our main focus now, but at the same time, we have a lot of other benefits going on from the collaborative.

What do you expect to see from the collaborative in the long term? What are some additional areas of focus in terms of scale, back office costs or other benefits?

We have some back-office agenda going on. Years ago before we even had a structure to work under, we went together and purchased all of our patient care supplies together. We experienced a nice decrease because of the purchasing power of the five of us.

Now in the collaborative, we’re asking ourselves questions about what other things we can do and pool that we can maybe experience the same kind of discount with the five of us buying together that maybe individually we wouldn’t get. For example, what can we do with pooling our patient medical supplies or office supplies across all organizations? Or is there a path to purchase some or all of our benefit packages together? It’s a part of a larger process to learn where we have more latitude. The work is ongoing right now as to what resources we’ll be able to invest elsewhere because we’re paying less for others.

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