How three HME providers connect with customers
by Colette A. Weil

The fuel that feeds the home medical equipment engine is referral development and retention. Referrals direct patients and consumers to HME businesses. Business must develop programs, services and products to engage referrals and deliver on brand promises.

Businesses can encourage health professional referrals, commercial referrals and consumer referrals with strategies that might include outside and inside sales people, advertising and promotions, social media, websites and more.

No two firms are alike in how they encourage referrals. But the common denominator in getting and keeping referrals is building a relationship. From the cold call to the long-time connection, referrals require constant care and feeding. Here is how three top providers do it:

1. No more lunches—just comprehensive programs

Advanced Home Care business mix
Managed Care/HME Contracts: 40 percent
Infusion/Respiratory: 30–40 percent
Medicare/Medicaid: 12–15 percent
Private/Retail Pay: 5 percent

Advanced Home Care (AHC) of Greensboro, N.C, is a hospital-affiliated, nonprofit firm that provides home health, HME, infusion and respiratory services to more than 30,000 patients throughout North Carolina, South Carolina, Tennessee and Virginia. But the AHC does not assume that being hospital-affiliated guarantees referrals.

AHC has a robust, sophisticated sales and marketing team to encourage referrals. Outside sales people are called “transition to home specialists.” They implement a comprehensive, targeted sales strategy developed by marketing professionals for calls on health professionals, health systems and more. 

“It starts with our marketing product line leaders,” said Kim Brummett, vice president, contracting and reimbursement. Product lines include areas such as negative pressure wound therapy, respiratory and specialty wound care. These leaders take hands-on responsibility for their areas.

“They develop complete programs, which include product line details, formulary, process, support tools,” Brummett said. “These programs may also include educational programs with CEUs for nursing and pharmacy professionals. The product line leaders then train the sales personnel on the programs and tools to use on calls to practice groups, payers, etc.”

But they don’t do lunches, Brummett said. “Our sales personnel have a regular call plan, and their focus is education, the patient and outcomes. Their incentive plan is based on the product line programs. We don’t use customer relationship management software but maintain an extensive contact database.”

AHC has a compelling story to tell on a cold call: size, depth, clinical outcomes, clinical personnel and community involvement. The company has been active in the community since its founding and provides community rooms and support for a large charitable golf tournament. But like every firm, AHC cannot afford to take the market for granted with the growing reach of competitive bidding. A potential 32 percent cut is tough to take.

More than two years ago, AHC launched its commercial accounts team. The manager and sales team have developed different revenue populations to include skilled nursing, doctor offices, dentists, group living, juvenile and adult jails and EMT groups.

“We have thousands and thousands of referral touch-points, but we can’t afford to become complacent,’’ Brummett said. “Our focus is now on the whole patient and to communicate to referral entities that we can support the patient and whole family with preventative, recuperative, rehabilitative and palliative care.”

2. Making calls outside your box

Black Bear Medical business mix
Complex Rehab: 48 percent
Supplies: 22 percent
Retail: 23 percent
HME: 7 percent

Black Bear Medical (BBM) is among the foremost HME retailers and certainly the largest in Maine with two showrooms. Jim Greatorex, CEO, has built his firm’s strong retail expertise since 1994 by appealing to the health care consumer through print and TV advertising. His firm keeps a database of purchasers and reaches out to his customers regularly through customer service representatives, open houses, trade shows and infomercials.  Having two of the largest showrooms certainly helps communicate his brand position. But it is the follow-up that makes the difference. His firm is an innovator in trying new consumer products and letting people know.

BBM was founded in 1988 and grew to the largest wheelchair and rehab chair provider in Maine. Of the seven certified Rehab Technology Supplies in Maine, five are with his firm. This side of his business grew naturally through the years as hospitals and rehab facilities became aware of BBM services, and their choices decreased. Typically, facilities invited BBM for a visit, and BBM received the tougher cases.

Still, Greatorex suspected there were other health care needs not being satisfied. Based on the success of their walk-in showrooms, he said he knew that building awareness among health professional audiences on product lines in pain management, supplies and HME could only be a win-win situation. BBM needed to make direct personal contact with the referral audiences. Calls on physicians had not been particularly productive. But education of nurses and office staff proved more valuable.

“This year, with the hiring of a new outside sale rep, we developed a concerted referral development and sales call plan which includes the hospitals, wheelchair clinics and rehab facilities, apprising them of our rehab expertise and additional products and services,” Greatorex said. “We can’t assume they know our products. Our sales contact plan also includes other ancillary referral entities, such as home health agencies, pain management clinics, physical therapists and occupational therapists.  Our ultimate goal is to get them to our showrooms.”

Greatorex said he has learned he must not take a relationship for granted, even if it is established. Sales calls are now made to existing referral sources one to two times a week along with cold calls. Greatorex personally participates in the sales calls, particularly with large groups or facilities. The referral sources appreciate meeting the owner and the personal commitment. The regular contact has also unveiled what Greatorex calls the “warts.”

“Rehab staff turnover requires that we stay in the hospital and rehab facilities doors on a regular basis,’’ he explained. “With regular contact, we can identify quickly when a situation is not going as smoothly as we thought and determine solutions. Complaint management is a crucial tool in the relationship.”

Greatorex continues to think outside the box for his business. With the launch of a new retail pain management product, BBM marketed to chiropractors for referrals. Chiropractors were interested in co-promoting, and Chiropractor Awareness Days were born at the showrooms.

“Things will never be the same as yesterday,” Greatorex said. “Don’t assume relationships stay the same, which means we need to be out there regularly and always with new products and approaches. That’s the excitement to our business. Everyone wants solutions for their health care needs.”

3. Everyone is a salesperson

Advacare Home Services business mix
Medicare/Medicaid: 4–6 percent
(Medicare/Medicaid before competitive bidding: 12–14 percent)
Managed Care/Contracts: 62 percent
Sleep Labs: 16 percent
Private Pay: 10 percent
Retail: 6 percent (not including add-ons to insurance

Advacare Home Services (AHS) has four locations in Pennsylvania. With competitive bidding on the horizon in 2006, AHS began redesigning and adding showrooms with a focused retail strategy in three locations. In Round 1, AHS won oxygen. But on the Round 1 Rebid, it won only walkers, and the company declined the contract offer. It subsequently made the hard decision to subcontract to an out-of-state provider who won the oxygen bid.

While AHS has taken many big breaths stomaching the 32 percent cut, it adopted the changes and reset its course. The company launched a new product line, CPM (Continuous Passive Motion), and set a new long-term strategy course to incorporate education into their referral sales plans—thereby improving sales call professionalism, efficiency, quality and success.

“Salesperson is probably not the exact correct term for health care,’’ said Tammy Zelenko, president and CEO. “Our purpose is to make referral sources and consumers aware of the offerings that will improve life so that consumers may be comfortable in their home.”

Advacare has three outside sales people. But they view every employee as a salesperson or awareness builder. Everyone has goals—service technicians, respiratory therapists, customer service reps, retail store personnel, management, warehouse and the receptionists.

“Our education strategy has driven our referral strategy,’’ she said. “The two main components, one of which is Advacare University where we provide CE training for case managers, social workers and other health professionals along with CME training for physicians. We also provide a series of Lunch ’n’ Learn Programs for office staff, new employees and new referral sources, on such topics as Travel with Oxygen, Safety with Oxygen and How to Determine the Correct Mode for Oxygen.”

The second component of the education strategy is the Product of the Month. A monthly calendar schedule is developed for featured products. “We determine the manufacturer’s specifications on the product, and create a sales flier with the product information and the items that it may complement,’’ Zelenko said. “We share the product of the month with all the staff so that they are aware of it.”

Salespeople have a regular call plan. When they make a cold call, they have the tools to show they can train referral sources at their convenience, help them with their continuing education and provide the professional support they need. Once a new referral is engaged, the first in-service is on Advacare. The salesperson then lays out a calendar of training activities, events, product focus and support. Before you know it, they have six months scheduled.

“For existing referral sources, these tools maintain the relationship,” Zelenko said. “When there is a change in referral personnel, we are there with training. We offer an in-depth PowerPoint presentation to referrals on competitive bidding and all of the changes that would result from it. We also bring in new home health agencies to our showrooms for training, and in hospitals, their new respiratory therapists will shadow ours.”

AHS uses OnBoard Communications for fleet tracking and has added specialized features to include drop down menus for sales personnel to identify the call type (Lunch ’n’ Learn, Advacare University, Cold Call, Prospecting, etc.). All referral sources are in a master database. Weekly meetings are held to discuss new business prospects, referral activity, competitive landscape, successes and challenges.

“There are more and more roadblocks,” Zelenko said. “Besides a hospital’s in-house HME, more and more hospitals are requiring HMEs be credentialed by VendorMate ( This has placed a middleman between us and the hospitals and another way to make us pay to get into hospitals. We spend a fair amount in radio, TV, billboards and the website to make consumers aware they have choices and of our services. We encourage consumers if they are happy with our services to tell their physicians and health plans of their interest in switching.”

Zelenko believes in the basics when it comes to encouraging referrals: timely response and follow up, and helping make their jobs faster, easier and more enjoyable with an honest, consistent relationship.