Set your agency apart with specialty programs and disease management

Choose specialties you already may serve

"We do a great job. Everyone loves our nurses, and our outcomes are great."

You may feel this way about your agency, and it may be true. But is it enough to make your agency stand out from the dozens or hundreds of agencies with which you compete? The challenge in marketing a home health agency is that every agency sounds the same, says Alison Cherney, a marketing consultant with Cherney and Associates in Brentwood, TN. "Everyone offers the same basic service 24 hours each day, seven days each week," she says. "A home health manager needs to find a way to differentiate his or her agency by providing the service in a way that is better and different from competitors," she says. "Nordstrom is a retail store like many other retail stores, but people choose to shop at Nordstrom because the customer service is better," Cherney explains.

"Just as Nordstrom offers personal shoppers and friendly employees, a home health agency can offer an intake process that is easier and more efficient, an assessment process that is more thorough and includes better communications, and a discharge process that results in patients who are better prepared to manage their conditions on their own," she points out.

Another way to differentiate your agency from other agencies is to develop a disease management program, or to promote a special expertise your agency has, Cherney suggests. One way to succeed in today’s health care market is to specialize, she says. "Many agencies may already have a specialty, but it isn’t packaged and promoted as a specialty," she says. For example, a home health agency may provide services for a large number of diabetic or wound care patients by using employees with extra training to handle these patients, Cherney notes. "If you already provide the care, you just need to take a few steps to make sure you are meeting the needs of the special population, and then promote yourself as an expert," she says.

An advisory board that includes physicians and other experts related to the disease management program can give you some good ideas about features that are important for a successful program, Cherney says. "Package your service by medical specialty, such as respiratory or heart, or by disease such as diabetes," she adds.

To find the right service for your agency, look at your current patient population, says Amor Bango, RN, BSN, director of clinical operations at Visiting Nurse Association of Central New York (VNA) in Syracuse, NY. Two years ago, Bango and other managers noticed that more than 20% of their new admissions were for cardiac-related reasons and about 33% of all of their patients had cardiac disease even if it wasn’t the reason for admission to home health. Congestive heart failure is the strongest reason for readmission to the hospital for VNA’s home health patients.

Therefore, the agency management developed a team to focus on heart patients and improve monitoring and education for this group, Bango says. The program was launched in February 2003.

"We developed a cardiac team and named the program Heart Smart, says Diane Nanno, RN, BSN, clinical nurse manager for VNA. But the agency did more than just create a name. "We chose nurses for the team that either have a strong interest in cardiac care or a background in cardiac care," she says. All of the nurses are also experienced home health nurses, she adds. The Heart Smart nurses, who were chosen from existing staff members, underwent intensive training to learn more about cardiac disease, diagnosis, and medications used to treat cardiac disease, Nanno explains.

The education continues on a monthly basis as Heart Smart team members meet to discuss the program, patients, and new articles or research that relate to their patients’ condition, she adds. "We also look for inservice opportunities using outside experts that can increase our knowledge," she says.

In addition to equipment such as pulse oximeters and scales, the agency developed a teaching guide that serves as a written record of the patient’s daily status as well as a reference guide to support patients when the nurse is not in the home, Nanno continues. There was no need for a large financial investment to develop the program because it did not require anything that they weren’t already doing, except the specialized education for the nurses, she says.

The benefits to the agency include a more positive relationship with referring physicians and a new relationship with a local hospital that has set up a program for patients with advanced heart failure, Bango says.

Sometimes, the specialty doesn’t relate to clinical issues, as discovered by the staff at Wellspring Personal Care in Chicago. "When I joined this agency, I was struck by the number of our clients who came to us after exploitation by a family member or other in-home caregiver," says Gwen W. Watkins, MSW, LSW, director of marketing for the agency. In addition to the medical issues of the patient, Wellspring staff members were dealing with emotional issues related to the patient’s experience following financial exploitation by people they previously trusted, she says.

The agency’s reputation and record of responsiveness had created a group of attorneys and bank trust officers that would call upon the agency when a case of exploitation was discovered or suspected, Watkins says. Although the agency didn’t purposely choose to specialize in this type of case, she realized that it was important to define the process to make sure the patient was protected.

Allowing victims to stay at home

"When an older adult falls victim to exploitation, a nursing home often is considered the best place to protect them from further exploitation," Watkins says. "We wanted to provide a service that enables the person to stay in the home," she points out. The program includes a "SWAT" team that sees the client within 24 hours of a referral from an attorney, bank trust officer, physician, or even another family member who suspects abuse. "We go into the home to evaluate the patient’s health and assess the home environment."

Because staff members are trained to recognize signs of both physical and emotional abuse, they are able to recognize and document any indication that there may be something going on, Watkins adds. Marketing of the program includes educational articles related to elder abuse as well as presentations to groups that might come in contact with victims, such as bank trust officers and attorneys, says Watkins.

The signs of financial exploitation can be as obvious as a request to change a will or a power of attorney to someone not known to the family or to a family member who has not been involved in the care of the senior. Or it can be as subtle as a caregiver isolating the senior from contact with others, she explains.

Both Wellspring and the VNA programs were willing to change traditional approaches to meet the needs of the clients. "A willingness to change processes or organizational structure is important to create an effective disease management or special expertise program," Cherney points out. "Nothing is worse than saying you have a program specially designed for one group, [and] then providing a service that does not differ from every other service you offer," she says. Also, make sure your intake, billing, and other administrative areas of your agency are doing their jobs well, Cherney notes. "Even if your clinical program is excellent, if referral sources can’t get through to send you patients, you won’t succeed," she explains.

Now that the Heart Smart program is established, staff members at VNA are looking at other groups of patients that might benefit from a disease management program, says Bango. "We are developing a wound care resource team, and we’re evaluating the use of telemedicine to enhance the cardiac program as well as support other patients," she says.

While development of a disease management program or a special focus may give you a marketing edge over your competitors, Bango says it is also a natural move for home health agencies today. "I’ve been in home care for over 30 years, and for most of that time, you had to know a little bit about everything," she says. "Today, home care patients are more ill, their care is more complicated, and they have less family support, so home health nurses need to know more about specific conditions, Bango adds. "Nurses appreciate the opportunity to become experts, and they are rewarded by seeing the impact they have when they can focus on one type of patient."

For more information, contact:

Alison Cherney, President, Cherney & Associates, 9719 Concord Pass, Brentwood, TN 37027. Phone: (615) 776-3399. Fax: (615) 776-3492. E-mail: Web site:

Amor Bango, RN, BSN, Director of Clinical Operations, Visiting Nurse Association of Central New York, 1050 W. Genesee St., Syracuse, NY 13204. Phone: (315) 476-3101. Fax: (315) 477-9378. E-mail: Web site:

Gwen W. Watkins, MSW, LSW, Director of Marketing, Wellspring Personal Care, 125 N. Halstead St., Suite 303, Chicago, IL 60661. Phone: (312) 648-1565. Fax: (312) 648-1569. E-mail: