Simione™ Healthcare Consultants

DON’T GET LEFT BEHIND: Industry Changes Require Sales Action and Bring New Opportunities to Grow Home Care and Hospice

Patients’ health care needs are being impacted by a cascade of changes in policy and regulation, payment methodology and provider practices. While every home care and hospice agency is working to adopt better ways to operate among these many challenging factors, their sales and referral management teams have enormous opportunities to make home care and hospice a bright spot for patients, providers and payers alike.

In fact, Kara Osborne, Director, Simione Healthcare Consultants, contends that sales teams will be key to help their organizations capitalize on the shift to community-based care.  Sales teams will need to embrace the growing focus on chronic disease management and an emphasis on care coordination and transitional care in the coming years to develop and excel in an era of more accountable care.

"Industry changes driven by the Accountable Care Act will place greater value on home care and hospice's role in population management," Osborne says, "and the IMPACT Act will bring post-acute definitions and standardized reporting of outcomes through the use of data."   Related factors within the industry include health systems scrambling to mitigate losses from readmissions and value-based purchasing penalties, the development of the Patient-Centered Medical Homes, and programs for home-based primary care and promoting independence at home.  

Home Care

Within home care alone, changes are plentiful – from the Face-to-Face regulations and Medicare cuts through 2018 (rebasing and PPS rates) to new Conditions of Participation, ICD-10 (October 1), and the threat of co-pays that continue to show up in the budget. 


Hospice changes are abundant as well, with reimbursement refinements, greater scrutiny regarding eligibility, new part D requirements, and determination of diagnosis and related or non-related medicines.  “Hospice leaders are working to correct dementia diagnoses, update Notice of Election, involve their medical directors in more activities, and stay focused for triennial surveys,” Osborne explains, “and the rate of change is accelerating across hospice and home care, requiring closer scrutiny over operations and infrastructure to increase efficiency and improve patient care.”

Palliative Care

Palliative care is another area ripe with change now that we can expect the announcement of demonstration agencies for the Medicare Choices program, more private pay, and continued expansion of palliative programs under the Medicare home health benefit.  “We see this area as a great opportunity for sales teams, in that agencies can work with many providers to develop palliative care in hospitals, ambulatory settings, and based in the home,” Osborne says. 

So, what should sales and referral management teams be doing in the face of all this change?

“Agencies are seeking increased revenue to thrive in the new healthcare landscape, and many are asking the question about whether they can survive.  They are awash in a sea of Medicare and Medicaid cuts, increasing mergers and acquisitions, and ACO activity.  Sales teams must strive to differentiate their agencies in these times of higher stakes,” Osborne adds.

In the face of this uncertainty, Osborne emphasizes the triple aim of home and hospice care:  improving the patient’s care experience, including quality and satisfaction; improving the health of populations; and reducing the cost per capita of health care.  

“It’s not enough to just compete with other agencies.  You must strive for world class sales success, partnering and developing strategic alliances on one level, and having clear goals and key metrics (such as cost per admission) in daily efforts to secure referrals and admissions,” Osborne says. 

Keys to Sales Success

Osborne suggests a four-part focus to achieve greater success in home and hospice sales and referral management:

  • Do more with less – set quotas based on incremental growth, improve accountability, monitor sales/marketing cost per admission, use dashboards to stay on top of metrics, release underperformers (bottom 20%)

  • Elevate the sophistication of the sales team – develop the sales management function, hire the best, invest in onboarding, provide consistent and continual training, assign key accounts

  • Protect key account relationships – determine success by the number of “A” accounts, develop platinum account service profiles, grow admissions in “A” accounts, develop top down/bottom up approaches to engaging health systems, ACOs and payers

  • Be part of the solution – Understand and serve both internal and external customer needs, making everyone’s job easier with a high level of involvement and attention to service

Redirecting the Flow of Healthcare

Sales teams possess a wealth of opportunity to earn more business when they deliver a strong and tangible value proposition to their many customers.  By focusing on patients’ health needs and understanding the practices of their agency and other providers, they can translate quality outcomes that will align with each “buyer’s objectives”.  “Agency-based sales forces will be key in contributing to growth as health systems focus on greater utilization of home care and hospice,” Osborne explains, “Right now, most agencies are straddling two worlds at the same time – fee for service and value-based population reimbursement.  The future will embody more of the latter, and sales professionals have a unique position to create value resulting in greater use of home care and hospice to manage populations more effectively.”

Share This