How home health marketing can save lives in a COVID-19 epidemic.

U.S. Doctors Historically Lean Away from Home Health

Historically, U.S. doctors have leaned heavily toward inpatient care for pneumonia and respiratory tract infections. This trend could be more than costly if we see a surge in these cases this year. In the U.S., 90% of pneumonia costs stem from inpatient care. Compare that to Europe where 57% percent of pneumonia costs come from inpatient services.1 Guidelines suggest that patients with mild pneumonia and even moderately severe pneumonia can be appropriate for outpatient and community-based health care.2 More specifically, this refers to pneumonia cases with a CURB-65 score of 0-2. Nevertheless, patients with mild pneumonia are often hospitalized, and they account for a significant portion of bed days and costs.2   

Better Home Health Utilization Would Increase Healthcare Capacity

In early reporting, 92% of patients hospitalized with COVID-19 had a CURB-65 score of 0-2.3 (Note: The CURB-65 tool was developed based on historic causes of pneumonia and has not been tested with novel infections.) Consider a report from the Imperial College COVID-19 Response Team.3 The model developed by Neil Ferguson and colleagues predicts that COVID-19 will cause a surge in hospitalization exceeding capacity even with the most stringent of mitigation and suppression strategies. Moreover, they point out that exceeding healthcare capacity in and of itself will cause excess deaths from a number of different diseases simply through reduced individual access to healthcare. While their focus was on critical care beds, it stands to reason that shifting more of the care burden to home health will free acute care resources for severe cases.  

More Benefits of Home Health

In addition to saving lives by increasing healthcare capacity during an epidemic, home health offers other important benefits. Home health costs much less than inpatient options. As mitigation strategies wreck the economy, cost-efficiency will increase in importance. By spreading patients out and isolating them to their own homes, home health is also expected to decrease the risk of hospital-acquired infections and reduce the spread of infection.  

The Role of Home Health Marketing

For the most part, medical journals have not pointed out the underutilization of skilled home health. More than ten thousand home health agencies nationwide are hungry for additional cases and stand prepared to prevent unnecessary hospitalization, facilitate early supported discharge, and deliver skilled care that saves lives. If this life-saving message is to be received by doctors and discharge planners, it’s up to home health agencies to develop and deliver that message, and to deliver that message effectively.

The Message in Marketing Pneumonia Care and Respiratory Tract Infection Management

Our read of the medical journals is finding occasional references to “home infusion” with almost no references to the availability and use of Medicare-certified home health and private-duty skilled nursing. There is likely a lack of appreciation for the difference between home infusion and full-fledged home health in the care of respiratory tract infections. The marketing message should include a long bullet list of the wide range of services nurses can provide, the frequency at which your agency can make visits, and the benefits of home health specific to these types of cases.  

Effective Marketing Requires Repetition

On average, people do not learn and certainly do not change their behaviors from exposure to one marketing piece. Clinicians are no exception to this rule. Just like learning requires studying and repetition, changing referral behavior requires repetition. The classic guideline among advertising professionals is that it takes 12 impressions to change a person’s behavior. This means a doctor who is giving your marketing the normal amount of attention may need to hear it from your community liaison three times, see it in your newsletter twice, and see it on Facebook seven times before the message sinks in. Of course, doctors and discharge planners who are more attuned to your messaging may require as few as three impressions to change their referral behavior.

A Multi-Media Approach to Saving Lives

A paradox of human learning in the marketplace is that people need repetition to learn well, but they tend to actively avoid repetition. Using a mix of media in your messaging increases acceptance of you’re the repetition your marketing needs, and a more diverse marketing mix also increases the sense of credibility. Here are the ways you can deliver this message to doctors.

  • Printed collateral designed for hand-delivery. Rack cards are good tools for describing specific care paths. Plan on roughly $299 for consultation, writing, design, printing, and shipping of your care-path rack card.
    • Ask your doctors if they have easy access to a CURB-65 scoring tool or if they would want one in print. We can print nice ones with your branding on it.
  • Monthly newsletters designed specifically for doctors and discharge planners. Do not send clinicians your patient-oriented newsletters. It annoys them. Only send them newsletters designed specifically for their needs. This requires more effort in the research and writing, so estimate a cost of at least $399 per mailing and plan for three or more.
  • Facebook Referral Source Marketing. In the right hands, Facebook ad campaigns can be used to deliver ads specifically to discharge planners, the right types of doctors, and their staff. For $289 every 60 days, up to 2,000 medical referral sources could be seeing your messages on Facebook and Instagram about weekly.

Timing of COVID-19 Marketing

The time to start is now. The Imperial College model predicts cases surging past normal healthcare capacity in late April / early May almost regardless of mitigation efforts or in late May / early June with full mitigation and suppression efforts. Home health agencies should have three ways of routinely communicating with doctors in regular use (typically sales, mail, and digital). If you do not already have this in place, implementation can take weeks to ramp up. Then effective repetition can take weeks to months longer.

Hedge Your Bets

Lower respiratory tract infections may not exceed healthcare capacity this year. Recent history shows us that early data and the resulting predictions of pandemics can be more pessimistic than what actually happens.3 Avoid making your agency responsible for predictions. Simply present targeted information about how your agency can help. Until we see the healthcare system being overrun in the U.S., use marketing strategies that are likely to increase your business regardless of the degree to which COVID-19 stresses national resources. Fortunately, home health is underutilized in respiratory infections in general. This gives us the opportunity to ask for more mild pneumonia cases from influenza and bacterial infections while also pointing out that agencies have capacity to accept similar cases with novel virus infections. We also know that sales and advertising in general can increase referrals in home health. Monthly newsletters in particular have documented cases of doubling referrals and are associated with a mean and median 30% increase in monthly referrals.

References:

  1. Raut M, Schein J, Mody S, Grant R, Benson C, Olson W. Estimating the economic impact of a half-day reduction in length of hospital stay among patients with community-acquired pneumonia in the US. Current medical Research and Opinion. 2009 Sep 1; 25 (9): 2151-7.
  2. Collins AM, Eneje OJ, Hancock CA, Wootton DG, Gordon SB. Feasibility study for early supported dis-charge in adults with respiratory infection in the UK. BMC Pulmonary Medicine. 2014 Dec 1; 14 (1): 25.
  3. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020 Mar 11.
  4. Ferguson N, Laydon D, Nedjati-Gilani G, et al. Impact of non-pharmaceutical interventions (NPIs) to re-duce COVID-19 mortality and healthcare demand. Imperial College COVID-19 Response Team / WHO Collaborating Centre for Infectious Disease Modelling. 2020 March 16.
  5. Torres OH, Muñoz J, Ruiz D, et al. Outcome predictors of pneumonia in elderly patients: importance of functional assessment. Journal of the American Geriatrics Society. 2004 Oct; 52 (10): 1603-9.