Succeeding in a managed care environment
Hospital designs program around market demand
When managed care representatives said their clients wanted chiropractic services, but the payers didn’t have a way to provide them, the staff at HealthSouth Mid-America Rehab Hospital set up an affiliation with a chiropractic group.
When the hospital was locked out of a large managed care plan, the marketing department found out that the managed care organization needed behavioral pain management services, set up a program, and got a contract for all the pain management services in the metropolitan area.
Understanding your market and tailoring services to meet market needs is crucial for survival in today’s managed care environment, says Janell Moerer, administrator of marketing and development for the Overland Park, KS, hospital.
"Market-driven means you build and design your services based on surveys and focus groups to find out what the market wants. That doesn’t mean that providers can’t come up with programs based on new technology and program services. We still design the program, but we design the program after we have done a thorough assessment of what the market will need," she says.
Mid-America runs a survey or focus group at least twice a quarter. "But we don’t spend a boatload of money on formal focus groups. We do a lot of informal focus activities. I’ve yet to find a payer who wasn’t very upfront. They don’t have time to sugarcoat. If the quality of care isn’t good enough or the price is too high, they’ll tell you," she says.
Her office collects feedback from all the marketing people to see what payers and referring physicians are interested in. "Our whole marketing approach is that when we go out to the marketplace to sell our services, 90% of what we do is ask questions and listen," she says.
For instance, one often-stated need was for rehab-focused oncology services. As a result of this feedback, Mid-America staff talked to payers, oncologists, oncology independent practice associations, oncology nurses, cancer support groups, and the American Cancer Society.
She made sure to get input from all types of people and organizations. For instance, an oncologist in an individual practice looks at things differently than an oncology group, she says. The marketing staff showed them the general design of the program and asked how it should be changed to fit their needs.
As a result of the market research, Mid-America is setting up a rehab program for cancer patients who are terminally ill but still have a substantial life expectancy. The original concept for oncology rehab was an inpatient program. But based on input from the groups surveyed, the program will have a lot of outpatient components, she adds.
Mid-America calls its program "pre-hospice" because using the word "terminal" makes payers and referral sources uneasy, Moerer says. Payers, and even physicians, initially balked at the idea of rehab for terminally ill patients. "We could see the doors shut when we used the word terminal.’"
Mid-America is not going to set up every conceivable piece of the continuum by itself. "Our focus is to affiliate and partner with diverse groups. There ultimately may be merger opportunities, but this way, the players have a chance to start working together," Moerer says.
Several years ago, Mid-America set up a managed services organization (MSO) to provide post-acute services in the area. The hospital initially contracted with a group of outpatient therapy providers and an ambulatory nursing group.
However, managed care plans, looking for "one-stop shopping" for post-acute care services, wanted the network to provide more ancillary services, she says. "Rather than decide what we thought we should add, we asked the payers." MCOs told Mid-America that their members were demanding chiropractic services, but the payers didn’t know how to handle the services. As a result, the Mid-America MSO carefully screened and contracted with a chiropractic group. That affiliation was a boon to both parties, Moerer says.
Mid-America’s management service organization had the ability to get managed care contracts but needed to diversity its services to serve customer demand. The chiropractic providers’ network could provide the services but did not have the ability to capture managed care contracts because it did not offer the kind of wide range of services available through a rehab hospital.
Mid-America required that the chiropractic network comply with the hospital’s quality improvement and credentialing procedures and that they meet National Committee for Quality Assurance standards. The network manages itself, with oversight from the MSO.
"Obviously, chiropractic is not our core line of business. Our MSO allows us to affiliate with multiple and diverse groups of compatible service providers," Moerer says.
The moral of the story is that when Mid-America found itself locked out of a large managed care plan, staff didn’t give up but devised a niche program custom-designed for the payer that ultimately may lead to an expanded contract for more services. It is a pattern that bears repeating.
"We heard from other payers that chronic pain was a problem. We went back and asked them about their difficulties in finding programs for their chronic pain patients," she says.
Mid-America representatives took detailed notes about the problems the payers were having, what it costs to cover chronic pain, and what kind of program they would like. Then the hospital designed a program model to fit the payers’ needs and ended up carving out all the behavioral pain with several payers for the metropolitan area.
"We used the template we have found useful for many types of chronic disability management. It took 60 days of very dedicated work. Now we are talking to them about other services," she says.
[Editor’s note: For more information, contact Janell Moerer at (913) 491-2477.]
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