Building Referral Relationships

1. Building Referral Relationships Dell MosleyPrincipal

2. Overview • Setting the Stage – Market Dynamics • Marketing Assessment • Online survey • Center team interviews • Findings and Recommendations • Phase Two – Kick Off

3. Market – 2016 • Uncertainty rules • The healthcare provider environment is changing – reform • Population has increasing needs • Leaders are cautious – What will be expected? What resources will be available? Needed? • Competitive forces remain • Growth more challenging • Retention even harder • Everyone asked to do more • Often with the same or less resources • Requires integration of marketing/referral development into daily work flow

4. Marketing Assessment – Objectives • Assess current efforts • Understand Center needs – growth • Review results on prior efforts • Provide recommendations for future plans • Define roles • Consider all customer groups • Physicians/office staff particularly • Patients and families • General consumers • Host facility employees

5. Study Approach • On-line survey • Capture insights on brand, marketing, referral development • Participation from nearly every Center • In-depth telephone interviews • Deeper understanding of perceptions • Recognized strengths; uncover challenges • Participation from nearly every Center Admin; sometimes along with Medical Director and/or Education Coordinator • Review current resources and tools • Current intranet • Website • Develop a marketing toolbox – strategic and tactical recommendations

6. Key Findings – Brand Position • Current and preferred brand strengths • Clinical excellence • Full continuum of service • Solid reputation with local community and patients • Patients would give lower ratings to Centers’ customer service and recognition as local diabetes leader • Improve perceptions of referring physicians

7. Key Findings – Marketing • Directed toward volume growth through awareness building • Considered to be most effective • Physician referral development • Media/community relations • Broadcast (radio, tv) advertising • Health fairs, screenings, educational programs • Payer issues another significant barrier • Hard to capture “out of pocket” patients

8. Key Findings – Marketing • Only 30% of interviewees satisfied with efforts and results • Unsure of dollars and efforts made • Nothing allocated • Allocations spent and nothing else remains • Greatest efforts are around Center launch – limited ongoing marketing attention • Jayken Solutions national campaigns would benefit local Centers

9. Key Findings – Competitive Landscape • Most compete with services offered at other area hospitals • Competitor brand strengths mirror those of most centers • Competitor advantages – current PCP referral relationships • Competitor disadvantage – lack organized approach as comprehensive diabetes care facility, i.e. Jayken Solutions model

10. Key Findings – Physician Relations • Gaining new referrals and expanding network are top goals • Some inside their network; some focused outside of network • Smaller markets need not be as targeted • Centers believe they • Offer superior clinical expertise • communicate well with physicians • Education offered as “test” service • New PCP relationships • Manage potential paranoia • Access greatest vulnerability with referring physicians • Patient wait times • Telephone volume • Lack of EMR connection

11. Key Findings – Physician Relations • Believe more face-to-face visits needed • Endocrinologist when he/she already known • Center staff • Endocrinologist is less familiar • Existing negative perception of Endocrinologist • Sharing clinical outcomes also important

12. Key Findings – Customer Service • Interviews explored “lacking” areas further • Suggested infrastructure improvements needed • Host hospital scheduling process a barrier • Appointment wait times – particularly endocrinologists • Navigating patients in Center during appointments • Post visit communication with patients • Referral process paperwork

13. Recommendations • Jayken Solutions implements national marketing campaigns • New marketing collateral templates • Made available by Jayken Solutions to Affiliates for customization • More current look/feel • Develop specific plans to improve infrastructure barriers • Collective efforts between representatives, Center leadership, host facility leadership and marketing team • Address appointment scheduling and telephone improvements • Staff scripting – particularly for payer issues • Assess Center signage, ambiance, patient flow

14. Recommendations – Beyond Center Launch • Capacity Limitations • Review current patient mix – direct efforts only on those desired • Create more on-going communication tools • Volume building • Identify target audiences • Referring physicians/staff 4. Employees • Patients/Families 5. Hospital-discharged patients • Community/New movers 6. Employers

15. Referring Physicians • Ensure solid customer service practices • Dedicated telephone number • Various treatment options • Consistent patient follow-up communication • Identify targets • Who is and is not referring • Who has the desired patient mix • Build proactive relationship building effort • Define specific roles and obligations • Nurse educator visits “X” number of physicians/month • Medical Director conducts “X” number of educational sessions/quarter • Establish tracking mechanism to assess progress

16. Developing Sustainable Preferred Referral Relationships • Know how physicians think • What do referring physicians want? • Use the 80/20 rule to focus your efforts • Understand how the medical social network can help or hurt • Overcoming barriers • Other referral opportunities • Future trends

17. Physician Viewpoint Drives Physician Behaviors

18. What Do Referring Physicians Want? • Creating a mutually beneficial relationship • Patient is at the center of our work together • Advice and assistance on managing a referred patient • Keep me informed and help me integrate that with other care I provide • Knowledge that will help me manage other similar patients • Work to “put yourself out of a job” • Be easy for my staff to work with

19. Red Flags • Patients share something that can be construed as criticism • Not returning the patient soon enough in the care process • Not accepting after hours calls • Delays in returning calls – there is a reason they are calling you • They perceive tone or message content as condescending

20. Earning Referrals • Physicians refer to other physicians they know and trust, not to organizations or brand names • Establish a mutually rewarding relationship • Meet with them at their office – individually not whole groups • Know a few “facts” about them in advance of meeting • Ask how you can help in caring for “their” patients • Make them important in the care process • Actively maintain the relationship • Report regularly on patients you are co-managing • Personally communicate changes in standards of care • Stay in touch through your staff as appropriate

21. Be Selective in Forming Preferred Referral Relationships • The 80/20 rule • 80% of your referrals will likely come from 20% of your referring base • It is easier to get more referrals from a high referring physician than a low referring physician • Who has the potential to be the 80%? • What type of patient does the Center want/need more of?

22. Physician Social Networks • Naturally occurring social network • Training • Common experiences • Referral network • Call coverage • Altruistic intent – healing • Social

23. Three Degrees of Influence Physician Leader Physician Physician Physician

24. High Transitivity Connected

25. Social Network • High transitivity gives rise to collaborative thinking and new ideas • Highly connected individuals disperse new ideas • Leverage physicians with high transitivity and/or highly connected individuals in influencing peer physicians to refer to you

26. Barriers • Legacy referral patterns • Establish and maintain a professional relationship • Inappropriate treatment by referring physician • Educate the referring physician on standards of care • Referrals coming from “bad” physician • Meet individually with the referring physician to consult on alternative care approaches • Competition from other endocrinologists • Be a better resource

27. Additional Referral Opportunities • Hospitalists referral relationships • Support their care of inpatients • Non primary care affiliated patients (15%) • Urgent Care Centers • Emergency Room • Nurse Practitioners and Physician Assistants • Independent Practice for NPs • Post Acute Care practices • Convenience Clinics

28. Future Trends • Patient-Centered Medical Home • Become part of the Neighborhood • Coordinate Care with PCMH • Common EMR or data reporting • Participate in care planning • Accountable Care Organizations • Population Health Management • Team based care for high risk/high risk patients • Crisis prevention

29. Putting It Together • Become an expert in establishing and maintaining professional relationships • The relationship is the priority • Focus your time and efforts • On the source of 80% of referrals • Use the physician social network • Address barriers when they occur • Also consider non primary care referral opportunities