Relationships, not marketing, still key to diabetes

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Wednesday, April 30, 2003

Scene I: A provider of diabetic shoes contacts a referral source, such as a podiatrist, and tries to persuade the source that he should refer his patients to the provider. What should he say? According to vendors, the provider’s No. 1 selling point should be having trained personnel on staff.

Scene II: A provider of diabetic supplies contacts a referral source, such as an endocrinologist, and tries to persuade the source that he should refer his patients to the provider. What should he say? According to vendors, the provider’s No. 1 selling point should be taking a disease state management approach to diabetes.

Referral sources hold one of the keys to the more than 11 million people in the United States who have been diagnosed with diabetes. (Another 6 million people have the disease, but they are unaware, according to the American Diabetes Association.) Through referral sources, providers can tap into the estimated $680-million diabetic shoe market and the $2-billion to $3-billion supplies market. The Medicare program alone spends about $600 million on diabetes products each year, according to CMS’s Office of the Actuary. It’s one of the four largest product categories within the program.

But how can providers of diabetic shoes and supplies win referrals?

If the shoe fits…

For diabetic shoes, vendors say, one of the answers is having trained personnel on staff. That could mean an employee who has completed a vendor-sponsored training program, says Jeffrey Alaimo, president of Acor Orthopedic in Cleveland. Numerous vendors travel the country conducting such programs, often one-day, multiple-hour affairs. It could also mean an employee with an allied health degree or with a background in health, such as a licensed physical therapy assistant or a licensed practical nurse. Or it could mean an employee like Alaimo, who is certified in orthotics and prosthetics.

“This way, you’re going to do a quality job, and when you have a conversation with a referral source, it’s going to be an intelligent one,” he says.

Because of Medicare’s increasing scrutiny of the diabetic shoe market, however, some vendors think providers should take things even further. The Region A medical director recently issued a bulletin that restricted the provision of diabetic shoes to podiatrists, pedorthists, orthotists and prosthetists. The bulletin was later retracted, but if it had gone into effect, it would have eliminated DME providers from the diabetic shoe industry. Incidents like that have convinced Stephen O’Hare, president of Pedors Shoes in Marietta, Ga., that providers should seek partnerships with industry associations like the American Orthotics and Prosthetics Association and the Pedorthic Footwear Association. They might even want to seek accreditation from them. O’Hare says professionals like podiatrists often don’t want to fit diabetic shoes, preferring to focus on more lucrative services, so DMEs might be doing them a favor.

“If DMEs want to stay in the footwear business, with the direction things are going in right now, they’re going to have to form a collective entity with these professionals and associations,” he says. “They need to get qualified, go out there and boast their shoe programs to referral sources.”

Alaimo says providers can also win referrals with marketing tools, including “introductory letters” on company letterhead that explain how many people have diabetes and answer frequently asked questions about Medicare’s shoe bill. Other tools include newspaper ads and television ads.

Providers can also win referrals by being visible in the community and raising awareness about diabetes, says Glenn Strickman, v.p. of sales for Apex in Teaneck, N.J. They may want to attend health fairs sponsored by local chapters of the American Diabetes Association or by local hospitals to educate people about the disease and how it can be treated.

Then there’s what Alaimo calls the “old-fashioned” approach to winning referrals: “Just pound the pavement and talk to [referral sources],” he says.

O’Hare does have a few words of caution for providers, however: They should focus on winning referrals from sources like podiatrists and general practitioners — and not end-users. He says DMEPOS supplier standards state that “a supplier must agree not to initiate telephone contact with beneficiaries, with few exceptions allowed. This standard prohibits suppliers from calling beneficiaries and soliciting new business.” Some read the standards as prohibiting providers from sending out ticklers and telling patients when they’ll be eligible for a new pair of shoes.

“Everything you’ve learned at business school in terms of what to do in marketing, you have to throw out the window,” O’Hare says.

Combining supplies, programming

For diabetic supplies, vendors say one of the answers is taking a disease state management approach to diabetes. In addition to providing quality products, providers want to be able to tell sources that they hold events like demo days and clinics, says Carol Quitmeyer, a product manager for TheraSense in Alameda, Calif. At these events, providers can show diabetics how to use blood glucose monitors correctly, for instance.

“You want to show that you’ll spend time with the patient, because physicians have so little time to spend with patients these days,” she says.

Suegene Levin, product manager for Invacare Supply Group, a distributor in Holliston, Mass., agrees.

“The crux of what a provider can do to increase their referral sources is to manage the disease, not just go out there and say, ‘We have this many patients, and we put this many strips out,’” she says. “It’s not just the product you provide — it’s the program.”

Providers can use their programs to differentiate themselves from mail-order supply companies like Liberty Medical and Diabetes Supply USA, which often have the large coffers needed to target end-users through television ads. Though these companies often develop custom software that tracks supplies and maintains patient specific shipment schedules, providers believe the companies can’t replace local service and delivery.

Vendors say providers can also win referrals by carrying the most up-to-date and technologically advanced products. Since diabetics have to test their blood sugar levels by pricking their fingertip, which can be painful can be painful, carrying products that provide alternative site testing are especially important.

“You want to be able to tell a referral source that you offer products that will be less painful for their patients,” Levin says. “These products will increase compliance, because a patient won’t have to prick only their finger anymore: They can also use alternate sites for testing. It gives a provider more credibility with the referral source.”

Levin says providers need to be careful not to tout high-tech products that don’t really replace current technology or that aren’t reimbursable, however.

“You don’t want to go over board,” she says. “Then you lose credibility.”

Providers can also win referrals by offering ancillary or companion products, says Lynne Brown, director of U.S. sales for Home Diagnostics in Fort Lauderdale, Fla. Those products include insulin and syringe cases, socks, foot creams and heel cups. That way, a referral source knows he can send his patient to the provider and have all of the patient’s diabetic needs taken care of.

Worth a provider’s time

Whether it’s for diabetic shoes or supplies, it’s worth a provider’s time to woo referral sources. Both the diabetic shoe and supplies markets are poised to grow in the future. The Centers for Disease Control announced recently that diabetes was the sixth leading cause of death in 2001. And the increasing rate of obesity has ensured that the rate of diabetes will continue to grow, according to the Journal of the American Medical Association.

Even the Bush Administration and the Department of Health and Human Services have taken notice. For the fiscal year 2004, Bush is looking to secure $125 million in funding to implement a disease prevention program, concentrating on obesity, diabetes and asthma. The Department of Health and Human Services supports the plan, saying it also wants to conduct experiments with insurance companies to improve coverage of preventative care. Both diabetic shoes and supplies fall into that category.

“Diabetes is an epidemic,” O’Hare says. “The philosophy should be a prophylactic or preventative one. (Those) who are at risk for diabetes should be in therapeutic footwear. We need more people out there willing to provide the service.” HME
Category: Diabetic shoes, supplies

Key referral sources:

General practitioners, podiatrists, endocrinologists, pediatric endocrinologists, certified diabetic educators, discharge planners, nutritionists, screening clinics, hospitals

Effective marketing techniques:

- Having well-trained personnel on staff

- Using marketing tools, such as letters, and newspaper and television ads

- Being visible in the community and raising awareness

- Having a disease-state management approach to diabetes

- Providing up-to-date products, as well as ancillary products

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