This article is sponsored by Homecare Homebase. It is based on an interview that took place during a live Q&A session with Amanda Overmyer, CEO of Overmyer Healthcare Consulting, and Jon Higginbotham, VP of Business Development for Homecare Homebase at the HSPN ELEVATE conference in Chicago held on October 21, 2021. The discussion has been edited for clarity.

Hospice News: We’re going to talk with Amanda Overmyer and Jon Higginbotham from Homecare Homebase about growing your agency with CRM. We will also discuss data and analytics, and sales strategies in home-based care. Jon, give a quick introduction of yourself, then we’ll turn it over to Amanda.

Jon Higginbotham: My name is Jon Higginbotham, I’m the VP of business development at Homecare Homebase. I think of myself as like the Homecare Homebase hype man, but really what I do is I help organizations evaluate what’s going on and figure out how we can intervene with technology. This encompasses not just their EMR, but all of the partners they need to connect to as well. That’s me in a nutshell, I’m a nurse too which is exciting from a different perspective.

Hospice News: Thanks, Jon. Amanda?

Amanda Overmyer: Hello. My name is Amanda Overmyer. I’m also a nurse with a law degree in health law. Recently, I started my own consulting firm because my career has taken me into the sales realm. I have worked with numerous companies across the nation in helping build their sales team and put training mechanisms in place to grow hospice. That’s what we are all trying to do here.

Hospice News: Thanks, Amanda. Jon, you’ve had a big picture view in your role. Tell us a little bit about what you’ve seen over the last 18 months.

Higginbotham: There’s been a big change in hospice because COVID has had a significant impact on length of stay. 18.7 days was the median length of stay, and our customers, which represent 40% of the hospice market, have been under 10 days length of stay on average. It’s coming back, but we’re nowhere near the 18-day length of stay.

That along with access to facilities have been really tough, especially with the vaccine mandates and turnover impacting the industry as well.

Hospice News: Interesting. Amanda, during our prep call, we discussed your expanding lens with almost 20 years in the industry. Seeing how it has evolved, what’s been your perspective over that period of time, what’s changed and what has not?

Overmyer: When I was reluctantly recruited into hospice in 1984, the policy was pre-Obamacare. When we were selling hospice, we went to the facilities because that’s where the elderly population was. We called them nursing homes. That’s a taboo or these days, you can’t say that.

When Obamacare happened, we started tracking those hospitalizations to keep patients out of the hospital — that’s what made that post-acute boom happen because they started pushing all of the patients to home.

Looking at the different diagnoses of patients, historically, we thought of that Alzheimer’s patient because that’s what the hospice patient looked like at the time. Now we’re looking at the full depth of all diagnoses. The hospice offering is the same, but the industry has changed and the type of patient we need to go after has changed. This is why even the small percentage of patients who qualify are not getting the services, or getting them late. Now we’re looking into physicians’ offices and going direct to patient to change the perspective of what a hospice patient looks like and redefine what a hospice is.

We all know the word hospice is one of the most dangerous things for a sales strategy, so we have to change that perspective and talk more specifically about the Medicare qualifying guidelines for every diagnosis that we didn’t have lined out in the beginning. When you go to school in the healthcare industry, they don’t give you a semester on home health, hospice and Medicare qualifying guidelines.

If you don’t work in it, you don’t know it. It doesn’t matter what city I’ve worked in, it’s the same across the board. There is such a huge misconception of who these hospice patients are and who qualifies. Most physicians and nurses do not understand that COPD patients and CHF patients are the ones we really need to target because so many of these patients are missing out on a benefit that they’ve already paid for. Hammering that home to the physicians is paramount to growing this industry.

Hospice News: The panel earlier today talked about the H-word and the D-word and the taboo around that. Part of that panel talked about some transitions. Jon, how have you seen the importance of these transitions from home health to hospice come into play today?

Higginbotham: I think palliative care becoming a necessity and a private duty is the biggest impact we’ve seen as an industry. Transitions are key to the continuum of care. Also, as technology has gotten better, we’ve implemented predictive tools that enable us to identify a patient is hospice-eligible from their home health information.

I think we have this mindset of CMS, 6-month length of stay. These are terrifying things. We need the patients on the right level of care, and figuring out a way to get them on hospice as soon as possible is going to impact families after the patient passes. The bridge is so important, but identifying at-risk patients who need to be pushed to hospice is important as well.

Hospice News: Amanda, what are your thoughts on that transition?

Overmyer: It is absolutely a necessity, and that’s where we got the frequent flyer term. You would have the patient who calls 911, goes to the hospital, gets their three-day qualifying stay, goes to the SNF, ends up on home health, comes off of home health, then repeats the cycle. As hospice providers and salesmen, we have to educate the physicians and the specialists.

Physicians and specialists have the greatest need for education. They need the most help pulling referrals and identifying those types of patients before they fall into that cycle. We also need to educate patients because this is the first time many of them ever heard the word hospice. They’re going to freak out because the patients we’re looking at are fully cognizant up until the day they pass. As a sales team, the initial conversation with those patients is very important.

Hospitals can’t do anything for you that we can’t do in the home. Instead of calling 911, you call us. I think there is a huge need for that. So many of these patients want that, but they don’t affiliate that experience with the word hospice. They affiliate hospice with death as we’ve said all day.

Hospice News: Sticking with the sales and marketing topic, how have the CRM conversations changed throughout your career? How do you view the CRM for tomorrow?

Overmyer: Salesforce is actually a good CRM for hospice. In my last job, I had the opportunity to help build out a platform to go direct to patients and direct to patients’ families. You can also utilize a CRM to pull leads from online marketing campaigns. Even 10 years ago, the elderly population wasn’t necessarily using iPhones and other devices yet. Now I’m seeing all of the patients with tablets and iPhones, and they use social media as well.

They’re at home with nothing to do, so they’re on social media with their families. Getting those people engaged online and tying that engagement to your CRM for lead gen is where I see us in the future. Since we’re not able to get into the facilities and some physicians’ offices, we are going straight to the home.

Hospice News: Yes. Jon, talk to us about some of the big picture sales and marketing trends you guys see coming through the system.

Higginbotham: One of the biggest things people don’t realize is that hospice sales are beginning to follow the trends of sales in general. You need 10 touches before you get a referral source to give you referrals. We manage our sales teams just like any other organization — that’s number one. The second thing we don’t talk about enough is that we need market data to get referrals. We have integration with Trella, LexisNexis and all of these different market data options. The key is figuring out what referral sources have your market share and attacking in whatever way possible. If I’m a hospice agency, I want to take as many patients under my care as possible.

It’s about identifying part B information and saying, “Okay, how many of these physicians have COPD patients? What are their main diagnosis categories from a physician-level?” That’s how you target referral sources because everyone’s getting kicked out of facilities and vaccine mandates are forcing people out.

Another thing we don’t talk about is that 50% of health care providers outside of physicians are refusing vaccination. Now I have to differentiate my sales team and say, “Okay, you have to be the ones that focus on these facilities because you’re vaccinated.” Again, the COVID impact is lingering, but your strategy for attacking referral sources is also unique. The Trella data is really killer for our customers.

Part B data is something that is so underutilized and I know we have some folks from enquire here. I know PlayMaker has integration with market data. If you have a CRM, you’re almost limiting yourself if you don’t have market data access in your CRM tool. Homecare Homebase has a proprietary CRM from which we can pull data too, but you have to be empowered with data. Even things like Muse predictive analytics and predicting hospice patients — if you’re not using data, you’re going to fall behind the curve.

HSPN: They don’t teach a lot of data at nursing school. Do they?

Overmyer: No, no.

[laughter]

Higginbotham: They do not. No.

Hospice News: Earlier, we were talking about your interest in the M&A market. How would you look at your role as a sales and marketing professional in hospice today with an eye towards M&A?

Overmyer: Obviously in M&A, the whole point is to grow. Over the years of selling hospice in all of the different cities, the methods that I implement focus on hammering home that we replace the hospital. It’s not that you can’t call 911. It’s that you’re not going to need to. When you’re talking about hospice, it’s always been “, You can’t have this, you can’t see your specialist, you can’t have this medication.” It’s “you can’t.” We have to focus on what people can gain and change how we talk about it

Higginbotham: I will just add that one more trend we’ve seen is a lot of consolidation in the market, which leads to a higher valuation if your market share is increasing quarter after quarter. There has to be a focus on organic sales, not just M&A. Act like you have to do both to get the highest valuation.

Hospice News: Talk to us about how you’re viewing the positioning for value-based care in your role.

Higginbotham: This is the biggest question in our industry. It’s transforming home health as we speak. Right? The exciting thing is understanding the trends that happen in home health and applying them to hospice and value-based care. Again, it depends on the reimbursement model and the impact on your percentage boosted, or not boosted, taken away by your value-based care.

You have to be able to provide quality of care because if you just focus on quality of care, everything else falls in line. So stop focusing on the things that aren’t important and focus on bringing great quality of care to the patients and families —everything will work itself out.

Hospice News: Amanda, how do you feel about the quality of care versus the reimbursement model, and what’s your point of view, especially as a nurse?

Overmyer: Quality of care is paramount and ultimately, the federal government is going to make more cuts. I also come from the DME world, and I feel like this is going the same way. I don’t have an answer yet.

Hospice News: Amanda, what advice would you give to smaller organizations looking to revamp their sales and marketing strategy as we come out of COVID?

Overmyer: In the physicians’ offices and the specialist offices, the reps used to go out and do lunches and present—now they can do it on Zoom. One company I was working with had three different physicians from three different towns at once. You can actually hit more people by doing those meetings, and it boosts the conversation between local physicians when they come up with questions about hospice.

Hospice is home hospital-like, and the physicians in smaller communities have been more receptive because they’re open to new ideas and having reps come in. It’s your larger physician groups in big cities that are harder to get into. It takes a little bit longer, but that’s definitely the way to go.

Higginbotham: Yes, and just to add on to that, I think there’s also some strategy in play in the areas that you’re in. For example, if I have a health system-based-hospice, they are going to get their referrals from the health system. That is what it is, but if I am not that health system-based hospice, who do I need to target? Do I need to target the health system and try to overtake their share? Well, you can try, or you can just target the rest of the hospice referral sources out there. I think, again, there is a strategy based on where you’re trying to grow your business.

Overmyer: Yes, and the hospitals that have smaller hospice companies might be out there in virtual land. We’re not going after the patients that you naturally refer to your hospice, we’re helping you identify the patients that wouldn’t necessarily be identified before. We’re partnering with you to ensure that the community as a whole is getting these benefits that they qualify for as soon as they can. That’s the best way to get past that.

Hospice News: Looking at sales and marketing strategy going forward, how do you view risk management with privacy and data associated with trying to grow these hospice referral sources?

Overmyer: Moving forward, if utilizing the CRM for lead generation, direct to patient might get a little wonky because– there will be more steps. If the patient is giving you their information themselves and asking for a hospice assessment, the staff will have to stay in compliance with that, which is not common on the sales side.

That’s the only place where we would need to pull the reins on the sales team to make sure we’re following proper process.

Hospice News: Jon, how about your perspective on data privacy and trends these days?

Higginbotham: The biggest roadblock we have seen is the ability to get information from the health systems. I still don’t understand why we’ve been talking about this for 20 years, and why it is hard to pull information electronically from the health systems. It has to do with the health systems not being on the same version. I could go to Kaiser and they might have 12 different versions of Epic. I can’t just build one spec to Epic, because I have to build it 12 different times.

Privacy is not as big of an issue as access. I feel like any home-based care providers are handcuffed by the inability to get data from the health systems, and if we’re talking about hospice criteria, we’re talking about the prediction of hospice eligibility. If we were able to pull an HMP from the health system from three months ago, it might be insightful as to whether or not someone is hospice eligible.

Overmyer: Reps are still on foot going and getting paper copies.

Hospice News: A lot of what we’ve talked about today is raising the awareness of hospice, not only to those in the profession, but even outside the industry. How do we go about raising that awareness with sales staff?

Overmyer: It comes from your sales leadership or a consultant, and their grasp of the Medicare qualifying guidelines. They are informing the reps and making them stronger, because a smart sales team knows where the patient has to be, with all of their diagnostic tests, what their oxygen levels are, what their ejection fraction is, etc.

They need to be able to speak that language because when you’re going to direct a physician or specialist, you’ve got to know what you’re talking about. Whether it be a pairing of the sales leadership and a nurse teaching this to the reps, you need to beef up their knowledge of pathophysiology.

Hospice News: Jon, how about you?

Higginbotham: The biggest thing is changing the perception of hospices. Hospice is not end-of-life care, hospice is forever life care. The patients and the families have to live on after the patient passes. It’s more about, “How can I have the best end-of-life experience for everyone involved now and into the future?” I think training your sales staff to have a different mentality of what they’re selling is the key.

This article is sponsored by Homecare Homebase. Homecare Homebase was started by industry veterans in 1999 to tackle the real-world challenges of nurses on the front lines of home health care. With the steady growth and evolution of services, we’ve expanded into a comprehensive and innovative platform to empower exceptional home health and hospice care used by virtually all the top players in the industry. To learn more, visit https://hchb.com/.