Transitions Care CEO: Hospice Marketing Doesn’t Work in a Vacuum

When marketing his hospice business, Transitions Care CEO Jim Palazzo makes it personal.

Palazzo established Illinois-based Transitions Care in 2007 as a portfolio company of the Transitions Group — which also holds skilled nursing, home health, medical equipment and therapy assets. Since then, the company has expanded its footprint to cover four additional states: Indiana, Michigan, Pennsylvania and Ohio.

Most recently, the company acquired Cardinal Hospice in Michigan for an undisclosed sum, and, in October 2022, licensed a de novo in Ohio.


Palazzo became interested in health care during his college years while working as a caregiver for a friend’s 87-year-old family member. He later began his career as a health care professional in the skilled nursing space.

Palazzo spoke with Hospice News about what it takes to market and grow a hospice business, with an emphasis on building relationships with referral sources and families.

Transitions Care Transitions Care
Transitions Care CEO Jim Palazzo

How does marketing a hospice program differ from other types of businesses?


Marketing hospice — this is a very personal thing. You’re really selling yourself when you market hospice. Families and referral sources need to believe in you, and the ability to deliver what you’re actually offering.

It’s definitely different than selling oranges or cars. It’s really a connection with people, and then really having a sense of belief that we’re going to deliver.

How do you cultivate that sense of belief?

It’s important to be true to who you are. There are definitely differentiators among hospices. I think it’s really important from a leadership perspective to provide education and training to your staff on what we can actually do and how we do it.

You really need to put your money where your mouth is. If people go out and preach the heart and soul of the organization, then as a leader you have to ensure that we live up to that expectation. That’s truly the difference.

When we talk about marketing, are we speaking primarily about the referral sources? Are we talking about educating patients and families?

The hospice landscape has definitely changed. Understanding who the decision makers are in the market is important, and, yes, a big portion of that is our families.

We ensure that our regional hospice coordinators have the ability to connect with people and have the empathy and foresight to actually understand what the families really need. And I think that’s really the key when it comes to our referral sources.

Whether it’s hospital discharge planners, whether it’s placement services, whether it’s physicians’ offices, you really need to understand what they need from us and be able to act on the referral quickly.

If somebody requires hospice, they probably needed it weeks ago or months ago, so it’s really important to be able to do an admission in two hours and have everything set up for a family and get the medications and equipment and supplies.

I think the biggest thing is knowing your market, understanding what you can expect as far as those decision makers and researching your competitors presence in the marketplace — creating advertising and marketing campaigns that spread the word about your care model.

Have you seen a change over the past few years in terms of referral patterns?

I think that certainly the traditional hospice referral sources have remained in place, hospital discharge planners, skilled nursing facilities, physicians, primary care physicians or patients and families contacting you directly. Those are all there through the pandemic.

There was a change among the skilled nursing facilities. They had been decimated with COVID, and so hospices that were really heavily invested in skilled nursing really struggled through that two-year period.

We’ve always tried to keep a heavier balance between our referral sources and have spent more time in independent living and assisted living facilities.

For us, the majority of our patients are home patients. So we actually grew significantly through the COVID years, primarily because the acute care providers were looking for home-based alternatives instead of placing patients into institutional settings.

What are some methods you’re exploring for increasing those referrals?

Really our strategy is to solidify the value proposition for our agency and highlight the differences. I think your identity matters. I think a lot of hospices are very similar to one another. I think everybody in hospice is caring. Everybody in hospice is passionate. But what are the differentiators?

I’ve always wanted to make sure that differentiators are black and white. I don’t think that going into a facility and saying, “We’re nicer than the other guys. We care more,” is a differentiator.

For us, about 18 years ago I wrote a tagline that said, “It’s about living.”

For us, it’s always been about helping someone live as well as they can until they die. It’s not about the finality of death. It’s about celebrating that person’s life. I feel that we’re a lot like cruise directors. Our job is to give a patient what they need to live better at the end of life. That’s what matters to us.

I think the other big differentiator is that — every time a patient’s family calls us 24 hours a day, 365 days a year — we immediately do a visit.

What are some strategies that you’re using to boost your census?

There’s no question that we are seeing an uptick in acute care admissions, and those patients tend to be very short length of stay and very intensive.

But I think as a hospice organization, you have to be balanced enough to be able to manage the acute care patients and manage the longer-term diagnosis patients. You need to be really nimble and to be able to make changes within your organization.

As an organization grows, a lot of times you’re slower to pivot and do the things you need to do. For us, we’ve tried to keep the management very small at the top and make sure that decision makers are in the field at the patient level.

A business development plan sets the goals for the particular market, a good market analysis, understanding the niche in the market, understanding the competition and referral sources in the market space. That is generally the foundation of a marketing plan.

From there, I think it’s a matter of consistent and strong interactions with referral sources, and then understanding what is going to work within a particular market. You have to ask if there are other things than direct marketing to referral sources or social media that make a big difference in that market. Does print make a difference in that market? Do TV or radio make a difference in that market?

I think that you need to have that all solidified before you can go look at another market.

Then you have to make sure that you have measurable goals within that marketing plan so you can keep pace. If something isn’t going well, then you need to have the ability to go ahead and make the change for the market. It’s not definitely not something that you can do in a vacuum; everything’s fluid.

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