The cycle that your prospects go through to become customers is:

First - Strangers
Second - Friends
Third - Customers
Fourth - Loyal Customers
And Fifth - Former Customers (not the desired outcome)

What is the difference at each level?  The level of permission and trust granted by the customer.

With the high cost of acquiring new referral sources and the even higher cost of loyal customers, the home care marketing professional today must focus on turning as many friends into loyal customers as possible.  This must be done while avoiding allowing loyal customers from becoming former customers.

In home care marketing today the secret to success does not lie in a focus on finding as many new customers as possible, it is the focus on how to extract the maximum benefit from each customer.  Many of the markets that you are working in are saturated and over-saturated with home care agencies.  How the marketer leverages the permission granted by the friend, customer and loyal customer will dictate their success.  You cannot build a long-term relationship without their explicit permission.  The old adage about being able to lead a horse to water but being able to make them drink is all too true.

What is the difference between the home care sales person that is considered a “pest” because they come in to the referral source’’s office once a week and the one that is expected and welcomed once a week?  Permission is the difference.

Where does trust come from?  It starts with familiarity and awareness of your agency and its services.  When the referral source is comfortable enough, and only then, will you get your first piece of business.  What you and the agency do with that first referral will build the structure for building long-term opportunities to earn and build trust.  When you think about those companies that have your trust you will find that you have had frequent and satisfactory encounters with them.  They have not betrayed your trust and have always fulfilled your expectations.

You build a “trust” account with referral sources.  If you build up enough trust, your relationship can overcome a lapse in service or problem.  By handling the problem quickly, visibly and to the customer’s satisfaction will actually add to the balance in that “trust” account.  But if you do not have the referral sources initial trust, you will be just one more home care agency.

Managing these relationships takes time and effort.  It may be necessary to “fire” some referral sources if they are consuming all of your time and endangering your relationships with loyal customers.  If you have too many loyal customers, then it may be necessary to split the territory or otherwise enable the more effective management of these relationships.

Having your customer’s permission to conduct an ongoing conversation with them is something to not take lightly.  Referral sources that have allowed you to become their primary resource for home care will expect you to not betray their confidence.  They should expect, maybe even demand, that you be proactive in making sure that they have all of the information necessary to make good home care choices.  You must be their resource for any information that they need about home care services.

Note: Permission in E-mail communications is especially important.  You should not send any unsolicited or undesired communications to prospects or referrals sources.  Getting permission to have the E-conversation is the only way to really use E-mail to leverage your relationship electronically.

Remember: Permission is Golden.

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One of the biggest challenges facing rural home care and hospice providers is having enough referrals.  Sound familiar?  The principles are the same for selling and marketing home care and hospice in rural America, the stage is just smaller.  Smaller markets typically mean less competition, but for less patients.  Sales people working exclusively in large urban areas tend to covet smaller markets because they wouldn’t have so many competitors.  Those working in rural areas are just the opposite; it’s the case of the proverbial greener grass on the other side of the fence!

Home care and hospice sales people spend a lot of their time in the car in any size market; the primary difference for the rural representative is that they have longer stretches of open road between calls and greater distances between clusters of referral sources.  They must turn these into opportunities!  Learning by listening to CDs on sales can always help the sales person improve their skills and there is no better time than when on the road.  Carry a miniature recorder and make notes of what you think of that you need or want to take action on in the future.  Making challenges into advantages (lemons into lemonade) is one hallmark of great home care and hospice sales people.

People in rural America like to do business with local companies.  Therefore, the agency must look for marketing opportunities to create a local presence.  Billboards may provide an inexpensive way to provide this presence.  Participation and support of local causes is another way to accomplish the local connection.  The sales representative must be visible in the community and the field staff should make sure that they wear their name badges and uniforms in the community.  The key that the referral sources need to understand is that the agency is supporting the local community, the care providers live in the community and the sales person is visibly providing great service.

With the trend being that small community hospitals are closing, there is an even greater need to call on the urban medical centers and hospitals that serve these rural patients.  This brings another group of referral sources to cover into the equation; the case managers, social workers and others involved in the discharge process.  Skilled nursing facilities are another key referral source that may be located in another town but that have patients going home to your service area.  The key selling point needs to be the fact that the agency can serve all of the rural patients within your service area.  Coverage area is a big competitive advantage for the rural agency.  Prepare service area maps with a list of pharmacies within that area.  This provides the referral source with an easy visual aid to determine that your agency does in fact serve their patient’s needs.  By including something of added perceived value, the pharmacy list, you are making their lives easier.

Territory management becomes an important skill set for the successful rural sales person.  Since, by definition, the territory is large and sparsely populated the routing of sales calls is critical to success and to avoid burnout.  The representative should create geographic zones and then first list all of the “A” accounts within the zone.  Analyze which is the best day for the biggest accounts and put that zone on the calendar accordingly.  Then prepare a route list of other accounts or prospects within the zone.  The “A” accounts must be seen at least once a week while the others will be seen every other week or even once a month.  The sales person should supplement these visits with phone calls to check in with the best accounts more frequently.  The inside sales team can support the outside sales team by making outbound calls to these accounts.

This will mean that the account ratings must be adjusted to reflect the market.  It will take a lesser number of referrals to qualify as an “A” account.  The sales person will still need to manage a top twenty or twenty-five list of “A” accounts that they are visiting on a weekly basis.  The key activity driving referrals will always be the number of face to face (f2f) meetings.  An f2f is defined as a substantive conversation with a decision maker about business.  Since there is more driving time involved, each f2f has an even greater value than one in an urban sales territory.  The larger the account, the greater the value of each f2f encounter.

For rural referral sources communication is an important element in determining their satisfaction with the agency.  The sales person must be actively involved in making sure that adequate, appropriate and thorough communication with the account occurs.  For this to happen in a large territory, there must be strong communication between the agency and the outside sales rep as well.  The use of customer relationship management (CRM) practices in rural areas will enable and foster the complete team communication with the account.  If a telehealth solution is employed to manage the patient’s care, then that should be part of the sales process.

The sales person must focus on areas that are consistent with those that the clinical department can staff.  Taking every appropriate referral is central to a strong rural sales program.  By having referrals of patients in same area it makes the clinical department’s job a lot easier.  Work closely with the clinical team to know where patients are needed and those areas where staffing is a challenge.  Don’t push the bounds of what they can staff without their buy-in.  This will come back to the sales person many fold.  Once an area becomes well developed, then the agency can consider opening a branch office.  The sales representatives can and should also assist with recruiting staff in growing areas.

Management should hire sales people that know everyone in the area and that are perceived as being a “home town” product.  There is a real premium on ability sales people that can sell to all types of people as the targets are fewer.  In addition to great sales skills they should be committed to delivering a high level of personal service.  If the sales person makes the lives easier for the referral sources, they will be most successful.  It is an advantage to hire a nurse who can sell in rural territories, but, this should not be the primary consideration.  They must still be able to perform as a top notch sales rep with or without a nursing license.

The agency and the sales representative have to have a longer term perspective.  The relationships take more time to build into “A” accounts.  Most rural doctors have a greater focus on patient care issues, are more hands on and enjoy long term relationships with the patients and their families.  To meet their needs the sales person must communicate with the referral source about specific patients and their care.  This will add to the ability to establish the agency as the only logical choice for home care referrals.

Interestingly enough, technology may actually be an easier sale to the country doctor than their urban counterpart.  As an example, Anodyne therapy was originally developed for use with horses.  I have had sales representatives tell me that country doctors were immediately familiar with this type of treatment, whereas most city doctors have to have the technology and theory explained to them.  Telehealth is more readily acceptable because the doctors can see a real benefit for their remote patients.

Finally, the ability to employ needs assessment selling is essential in rural sales programs.  To over simplify the process, it is the determination of the referral source’s needs and then positioning the agency’s services as the solution.  While I would contend that this is the most important training for all home care and hospice sales reps, it is especially necessary for rural sales people.

Guess what?  Most, if not all of these principles apply to selling home care and hospice in any size market.  Happy Selling and Marketing.

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For every home health or hospice care plan a physician is a key member of the team.  The more you can engage the physician in the process, the stronger the bond.  The agency’s sales people and management should be probing for needs and presenting solutions.  When the relationship with the physician progresses to the point of reliance on the agency for all things related to home health and hospice, then they can become a champion for the agency.

It may take years to gain the required level of confidence and reliance.  The physician that truly values the services of a particular agency typically has had past experiences that have created tremendous trust in the agency.  Usually this means that there have been problems that were resolved to their complete satisfaction.  And, as we all know, trust takes years to develop and only moments to destroy.  Never take these key relationships for granted, assume nothing and stay in close contact with them and their staff.

There are two ways to expand business with a particular referring physician; increase your share of their home health and hospice referrals or expand their use of home health and hospice in their practice.  To garner a greater percentage of their referrals, it is necessary to know the competition and the referral source’s needs / hot buttons.  Then position the agency as the logical solution for their known needs.  The other way to increase referrals is to bring ideas, technology and information to the physician that will have them use home health or hospice for more types of patients.  For hospice that can translate into longer length of stays.  Never assume that the physicians know all of the possible uses for your services.

One way to foment the development of strong relationships is to include the physician and their staff in the development of new programs and protocols.  Pride of authorship is created when the agency involves a physician in developing these protocols and specialty programs.  If the plan of care is created using “their” methodology, they then can take ownership and will be better champions for the programs and your agency.

The other key component of creating and maintaining these key referral relationships is service - make their lives easy and earn their business.  Create service protocols that make the interface with the agency feel customized and you create a significant competitive advantage.  It must be easy for them to work with your agency, because when push comes to shove, they will take the easiest path to complete a referral.  Once you have established the service plan for the referrals source, never assume that there are no changes - keep probing for service needs.

When talking with physicians and their staffs, remember that the patients are THEIR patients not yours.  This may seem like a small semantic point, but it can make a big difference in how they hear what you are saying.  The patients many times have had the same physician for many years and when they are referred to home health or hospice they still feel that they are their patients.

Work to develop strong, personal relationships for best long-term results.  Help them be great champions for your organizations.  Good Luck and Happy Selling!

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