Hopeful Hospice Marketing: Reimagining End-of-Life Care with Alysha Wilkins-Smith, Medical Services of America

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Alex Membrillo: Hey everybody, I hope you’re not driving right now because I just scared you and you’re going to veer into something. We are going to have some fun today. I’ve got Alysha Wilkins-Smith with me. What’s going on?

Alysha Wilkins-Smith: Living the dream. I’m living the dream.

Alex: Hey, when everybody is here. I came home last night and my wife said, “Hey, did you have a good day, Alex?” I was like, “That’s such a complicated question right now.” [laughs] Every day-

Alysha: That could be a loaded question for a lot of people.

Alex: -that someone is happy and healthy, alive. Yes, it’s just listen. You know what I said, I said, “Babe, the kids are healthy. Everybody’s healthy. It was a good day. Every day above ground is a good day.” Not to be morbid because we’re going to have some fun today. Alysha has been in a home health and hospice game for quite some time. I can’t wait for her to tell you about the background. It is so cool working in healthcare marketing.

I always say medical marketing is marketing that matters because you find some zealots like Alysha that actually love the cause and connecting patients with care and making difficult times in people’s lives tolerable. That’s the one thing, Alysha, I love about healthcare marketing. You find people that actually love it. It’s not like we’re selling shoes. I’ve done that before. That’s fascinating. Tell them about where you hail from in Tobaccoville. Where do you work?

Alysha: I work for Medi Home Health & Hospice. It’s often known as Medical Service of America, but our little umbrella is Medi Home Health & Hospice. My background started in nursing and oncology, so I guess that’s morbid as well. I worked in the cancer field as a nurse, but I started out in nursing. I see patients a lot and I’ve been making some very hard decisions and having to come with the term that they were not going to live, they were not going to survive the battle and what were they going to do next?

Whether it was going to be go home with home health and try to get a little bit of strength or were they going to go home with hospice? I decided that I wanted to be a part of the go home. I wanted to be a part of them living their journey the way they wanted to. That led me into home health and hospice. I started out as a bedside nurse. Then I quickly decided that I wanted to go to the bedside for the hospitals, the facilities and the doctors’ offices to help them figure out what to do to come home because a lot of patients don’t want to be in the hospital. They want to be in their environment where they feel comfortable.

That guided me to being in home health and hospice all together but hospice is definitely my passion. I think death deserves as much beauty as being born. To be honest, it’s their journey. That’s the only thing we’re guaranteed in life is to be born and to die. I think it could be just as beautiful as the beginning of their life as well. Being a part of that has– I’ve been a part of it with my own family. I’ve helped take care of them and make the decisions with them and had hospice involved and being a part of that journey is something. It does something good for the soul. It makes you feel good.

You’re with those people in a very delicate time of their life. Just to be a part of that does something for you as a person. As long as you’ve got the heart to do it and that strong faith, being a part of that journey does something for me personally. I know it does stuff for my staff and I can see it on their faces. It’s hard, but it feeds the soul to know you’re doing something good for people.

Alex: I love it. I love it. From nurse to marketer and everything in between. Alysha, I can’t think of a single time that I’ve interviewed someone that was actually in the medical space providing care that has come over to the marketing side. You had the fun job but now, “Okay, whatever.” I think that nursing is so tough like a true hero. That’s awesome. I’m sure the bond is incredible. When you walk into the house and that family is dealing with that, they’re trusting you with the most important part of that person’s life because the baby doesn’t remember being born.

I agree with you. I think it can be beautiful. I told my wife, “Throw a party and nobody is to cry. I know y’all will be happy, but throw a party and talk about all the fun that we did.” I hope that you’ll carry some of that through. Very cool. Tell us, so home health and hospice. Hospice, I know they give you a couple of names. Hey, you should check these out in the hospital. Tell us about the marketing difference between the two tactics you roll out, stuff like that.

Alysha: Home health is easy. That’s the easy sell for anyone because you’re giving those therapy services, PT, OT, speech therapy. You’re marketing that tactic of they’re getting better. You want to keep them out of the hospital. You want them to do so well. You want them to thrive. Then in hospice, you’re going in and you’re saying, “You’ve got six months left to live and we’re going to go home. You’re going to be the driver of this bus and we’re going to make this journey as beautiful as possible. We’re going to let you live your life however.”

The marketing tactic is very different because the home health is the positive thing. You’re getting better. You’re going to do better. You’re getting therapy. Then the hospice is the sad thing. I’ve had doctors later in my life come in and talk to these people. They’ve six months left to live. Here you go. Take it. As the families are standing there, they’re like, “What did he just say or what did they just say?” You take the crash of it all.

In North Carolina in particular, and I’ve marketed in a couple of states now, South Carolina and North Carolina. The market in North Carolina, you have a certificate of need so it limits how many people can be in a certain area. You have to own a certificate of need for that area. That limits how many companies can be involved in hospice and in home health. In South Carolina, they’re an open state, so you can have however many there is.

When I was there was 80 different hospices and you were up against this beast of trying to rush in a mad dash to get to that patient to give them what they need. In North Carolina, it’s not that way. North Carolina is an easier market in a whole because you’ve got your big players that come to the table because they own that certificate of need. It’s an easier sell in North Carolina than it is South Carolina. I’ve had to sell both. I’ve sold non-profit and for-profit. I’ve sold the different aspects.

That is a whole different ballgame when you start talking to patients about non-profit hospice and for-profit hospice because everybody thinks non-profit is this great thing. It can be but it’s not always. It’s really a tax write-off for that company. It doesn’t really mean anything for the patient necessarily. I’ve done so much and had to filter the waters of different things and different sales for people. You really just pull apart your sales tactic to who you’re up against, what your competition looks like. Are they for-profit? Are they non-profit? You just break it down to however you need to market that. It goes different for home health and hospice [unintelligible 00:06:34].

Alex: Very much so. I appreciate you saying sell. That’s what we’re in the business of doing. We want to connect the patients with our care because we know they’re going to be better provided for. Thank you to alluding to all of the non-profit sketch balls out there. It doesn’t mean anything. It just means they don’t retain the earnings. They can take it all home as a C-level. On the home health side, do we do any of the digital marketing type stuff? That’s not just referral out of hospital. Is there any?

Alysha: Our marketing tactics are more face-to-face education where you’re in front of people but I take it a little bit further. I share on my social media, my Facebook, my Instagram, my LinkedIn. I like to share it. I have seen people making TikToks. I’m not the TikTok guru, but I do put my staff, my AEs and stuff sometimes in there. A lot of our marketing tactics are face-to-face, taking pictures, being a part of your facilities and your staff, and then taking it and promoting it on LinkedIn and Facebook and Instagram and posting it to your company pages and stuff.

That’s one thing that I tell my account executives under me right now, “Take these pictures, post it, sell yourself.” Showing that you’re involved in these communities and being a part of these partnerships it’s very important to being a part of the community. The community is a big part of selling yourself and being a part of that sale because that’s how– The geriatric population, they don’t have TikToks. They don’t have Facebook and Instagram.

Some of them do, but not all of them. Being a part of the community sells yourself. Then for the people that do have the technology side of things, putting it up there, promoting it, they’re just going to go back and tell their families, “Hey, look, I’ve seen this on there, or I’ve seen them being a part of this community thing.” Veterans is a big thing to be a part of. Being a part of people that serve our country and being a part of those events so you promote that. That promotes you to those other veterans’ organizations. Alzheimer’s walks, being a part of all of that and promoting it on social media in every way that you can, it’s just as important as face-to-face selling as it is being on those different platforms.

Alex: No replacement for the in-person and the online stuff accelerates everything. When you walk in there and they see you, they’re like, “Oh, yes, Okay, I’ve been seeing your content. You do care.” I know you care about personalized care quite a bit, patient-centered care. you keep showing patience. How do you get that across? You’re really trying to convince everybody we care more than the next person, the next caregiver. How do you always–

Alysha: I share patient success stories where we’ve done something really, really good or that I know something went really, really right. I do track them on a personal level. I do tell some salesmen don’t get on a personal level with their referral sources or their partnerships but I find if you do, you don’t have to be all personal. If you know some personal things about them or you share some personal tidbits of where you’ve had hospice involved or you had home health involved, that brings them to a place of connection with you. It makes them feel like they’re a part of your story and you’re a part of theirs.

Patient testimonies are phenomenal for guiding that patient-centered care and selling yourself different than others. My company in particular, we have phenomenal nurses and staff. They use our company for their own family and that sells itself. If you’re selling your service and you’re willing to use it for your own family, then that sells that service. That says that they’re not selling a lie or they’re not putting something that they wouldn’t put their own family in. Our staff use our company. It’s phenomenal because we’ve been a part of a lot of their stories. That says a lot to people that we will put our own family with my company.

Alex: That says a lot. Sometimes not taking the patient also says a lot. I know you believe quite a bit in that as well.

Alysha: I have giveaway referrals or business because it was what was right by the patient. If I can’t provide it, I’m okay with saying that I can’t because I wouldn’t want someone to do my family that way, my husband, my grandmother. Doing what is right pays you back in the end. You’re going to get so much more from doing right by a patient and giving them what they need so you always get it twofold. I have give and lost business. I’ve lost bonuses because of giving business away.

At the end, my next bonus was even better. It’s like good karma. You put out good karma you get good karma back. I believe in that wholeheartedly. Doing what’s right by the patient is the most important thing at the end of the day. Not me, not my bonus, not my commission, though that’s important. To my bills and my family, at the end of the day, I wouldn’t want someone to sell a whole pie to my family or me when they’re going to get a piece of it. That’s not okay with me so I’m okay with walking away if it’s what’s right by the patient.

Alex: Put yourself in the patient’s shoes. I also believe in karma when someone offends me or does it wrong by me. I’m like, “Bro, I’ll be watching you and something is going to happen to you in the next. I almost feel bad you did that because now you’re just going to wake up one day and have your car towed on for [unintelligible 00:11:24] like I did last– I don’t know what I did that.” Karma is that and I guess I deserve it somehow. Wow do you stay efficient? Do you have any tech that helps you zone in on where do you spend your time? What do you do there?

Alysha: I use a Trello calendar. It’s also known as Playmaker. It’s the Medicare claims data system that report where Medicare patients and volume goes. Hospitals, skilled facilities, assisted livings, all are using it now. It tells home health and hospital data and where they’re spending their Medicare business and the different insurances. It helps guide me to the accounts that I sell to where I know those good payer sources are. I can dive into that data. If a hospital looks at me and says, “You’re my number one choice,” but am like, “Really? Let’s pull it up and look at it.” They’re like, “Okay, let’s see how I get out of this.”

Alex: They’re like, “No, let’s see how I become your number one choice.”

Alysha: It doesn’t always make for the best of friends right off the bat but if I can prove to you that you’re not telling me the truth, a lot of times it makes for better friendship on the back. I have done that, but I use it, my account executives under me use it. It has a calendar that you can plan your day, your week. You can log your calls, see who you’re talking to, who you’re making these sales calls to. I love it. I live by it.

It has been a big component in my job and I sell it to everyone. I’m like, “Pull your data up, look and see where this is at. If they’re telling you number one, you need to be number one on that list.” It gives you readmission rates to the hospital. Those top diagnoses that patient pop back into the hospital for, what’s hitting their readmission rate and stuff like that. In a sales world, that data is important. I can’t say it enough of how much you need to be looking at that.

You really need to be guiding yourselves from it because somebody can tell you all day long, “You’re my number one or my number two.” If you’re not, you’re wasting your time, you’re wasting your money, you’re wasting your resources if you’re not going to ever move up on that list because you think you’re top and you’re not. I think having that data at my fingertips really guides myself to where I’m at.

It also helps me guide my selling to those referral sources because if there are a lot of advantage plans and a lot of plans that are something that a lot of companies want to take, I know I can bargain with them and play with that. “Hey, I’ll help you with some of this bad if you help me with some of the good and we can have a good partnership.” Trying to help you guide your selling also.

Alex: You have 10 liaison offers after this gets published. That’s a Medicare play to check the data. Any other trends you’re seeing with commercial insurance? Anything that you’ve noticed?

Alysha: I’m seeing a lot of advantage plans which is your non-traditional Medicares. They’re your advantage plans like your Humana, your Aetna, your Cigna, your UHC. Those plans are hard in the world of home health and hospice because some of them do not have hospice benefits and some of them are not a good payer source for your home health companies. Those patients that get locked into those advantage plans don’t realize that they don’t have the top choice as a traditional Medicare or a good payer source.

My grandmother was a victim of that as well. I looked and I was like, “Please don’t switch to this advantage plan.” They’re selling that you save this money every month in your premium but what happens when you go to the hospital, you need a skilled facility or you need home health or you need something. You’re not going to have everybody fighting for your referral or your business. They’re actually going to limit you to who you can get. I actually got her switched over.

I was like, “Please stay traditional Medicare.” She has and she’s lucky to be married and have the VA benefit as well. She’s very, very lucky. These advantage plans make it hard for home health. Hospice companies because they don’t always pay, they try to find the loopholes to get out of paying if a clinician doesn’t document a certain way and they’ll come back and home health loses money on the back end because they’re not going to pay.

When we go to get a referral from this company or this hospital or skilled and it’s got this advantage plan, a lot of home health look at it and they say, “Mm, that bit me last time. I don’t want that referral anymore.” That patient is limited on their choices because the insurance companies are trying to crack down and not pay or try to get out of pay. These patients suffer in the end because these companies are trying to get out of pay.

Alex: Our system is so messed up. Then it’s your grandma that pays in the end. Not cool. The good sign to being in health care and marketing and sales is that we connect patients-centered care. Then you see the flip side where good people don’t get the care they need. That’s really tough to watch. Any other big trend you would want everybody else to hear about that you’re going to start embarking on? How are you feeling about the rest of ’24?

Alysha: For me, I think the trends that I want to see is, and you said it before, is patient centered care. I want patients pushed out of the hospital and not know where they’re going or not know what is happening to them. Patients are getting pushed out quicker and more serious. They’re coming to home health and hospice higher acuity. I want to see a trend in hospice where it’s not so much a– I guess I want the verbiage change. That’s what I want. I don’t want it to be hospice anymore. I want it to be serious illness management.

I see legislation and stuff going through and they’re wanting to change the name because hospice comes with a stigma. It comes with a stigma that you’re going to give me a hospital bed, morphine, and I’m going to die. I’m going to die tomorrow. That’s not it. We want patients to have that six month expectancy, have good quality time with their patient or their family. I would like it labeled as serious illness management because we are taking that serious illness. We’re managing it and giving them quality of life for six months of their time.

I don’t want the Black Reaper coming to get me type mentality that you’re going to get a bed and morphine. I’d really like some of the stigma around hospice to change and it’d be highlighted for what it really is and be highlighted for its good benefits, not morphine in a hospital bed. I’ve been referred to as a nurse, as an undertaker coming to get them. You’re the undertaker walking through the door coming to take me.

It’s not that way. Hospice is not scary. It’s not meant to be scary. It’s meant to be a wonderful thing. I would really like some of the stigma took off of it. I would like to see that push. I know a lot of hospitals are not referring to DNRs as a do not resuscitate. They’re referring to it as a golden rod because it’s a yellow piece of paper that hangs on your door. It’s called a golden rod so it’s not scary anymore. I know doctors are referring to it as serious illness management and different things now to try to take some of the scary out of it.

I would really like to see some of that change. Even the verbiage would change because back in the day, older people would be like, “Hospice just kills you. They’re just going to kill you.” That’s really not what we do because you come on hospice and we get to take care of you. If you get a cold, we treat the cold. If you get a UTI, we treat the UTI. We treat the patient as a whole and it’s not scary. I would really like to see some of that push for that to be changed.

Even on the home health side, I would like to see the patient-centered care where they’re not getting shoved out of the hospital with nowhere to go or not knowing what happens. I’d like to see a good partnership with everybody across the board in taking care of these patients and giving them what they need because in my world, competition is real. Every home health company and every hospice is trying to steal the other one from somebody else.

I’d really like to see it to be a partnership. If they can’t utilize me, let me give it to you and you do what you need to do with it. Don’t see me as I’m trying to take all your business. See me as a partner in this business. I keep my competition close. My best friend works for my competition. Me and her have such a great professional relationship. I know that if I can’t give a patient what they need, she’s going to try her best to give them what they need and I’m going to do the same for her.

We’ve been competition for each other for a while. We’re best friends and we work for competitors. It works so well because we respect each other. I don’t see her as trying to take my business. She doesn’t see me that way. I would like to see sort of that come together and that collaboration to be a part of a team. We’re not just there to steal each other’s business. That would be so nice. That’s probably a pipe dream at this point because everybody’s like, “Let’s get all this business and have our bonus checks,” so it may be a pipe dream.

Alex: Maybe, you’re a nurse, more people need to have more empathy for what that business is and what the revenue is. That’s like the person I can tell you being handed three hospice companies names in the hospital. They’re like, “You need to go figure it out.” It’s very scary. You’re coming from a place of empathy. Guys, if you want to find Alysha Wilkins-Smith, that’s how she has it on LinkedIn. You might see her at the Capitol changing stigmas, changing the way we view hospice and serious illness management. We came here. We got educated. Alysha, thank you.

Alysha: You’re welcome. You’re welcome. I enjoyed it.

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