Caring for patients in the home is all in the details, according to leading HME manufacturers. Beyond the wheelchair or the oxygen concentrator, there is a real opportunity to address a patient's all-around health, and providers should recognize and seize that opportunity, these manufacturers say.
This advice comes from experts in several HME specialties, from the makers of home infusion, wound care and incontinence products. As baby boomers age, they say, the push to move patients out of the hospital setting and into the home continues, flooding the home care industry with new patients and their caregivers.
In this ripe market, providers “can create a situation where they're taking care of a customer's overall health by supplying that customer with bath safety products, supplying that customer with wheelchairs, supplying that customer with canes or walkers, scooters, custom-built chairs — all of that,” says Greg Bosco, director of merchandising and marketing for Invacare Supply Group. He points out that every product a provider can offer a patient is “one more reason to keep [that customer] as a continuing flow of business.”
The range of home care products is so wide, experts admit, that it can be challenging for a provider to determine exactly what the company's particular patient population needs. But that challenge can be met as providers learn about various specialties and foster relationships with the makers of niche products. “The key is our knowing their business and their knowing ours,” says Al Ercol, vice president of sales for SCA Incontinence Care.
Manufacturers are making efforts to assist providers in addressing patient needs by collaborating on “goals and strategies” with HME dealers, according to Ercol. The conversation is an ongoing one, but paying attention to detail along the way should ultimately lead to a higher quality of life for the patient — and more profit for the provider.
Home Infusion
The consistent growth that home infusion has enjoyed since the late '90s has much to do with the aging population and the drive to get patients out of inpatient situations, says Richard Bulich, president of Pharmaceutical Buyers Inc. But there are other factors that also are contributing to growth in this specialty niche, which encompasses major therapies including antibiotics, chemotherapy, nutrition and pain management, that will keep it steady.
For one, Bulich explains, “there are more high-tech infusion drugs on the market” because of the continued overall growth of chronic disease states such as hepatitis, multiple sclerosis, cancer and rheumatoid arthritis.
But “even self-injected drugs that don't require a nurse, [where] the patient can do it on their own, are contributing to growth,” he says. This part of the market, known as “specialty pharmacy,” has been considered a mail-order market in the past, “but now we're seeing a huge trend to get involved,” he says.
The home infusion and specialty pharmacy markets are merging to establish a network of local nurses and pharmacies with home care professionals, according to Bulich, mimicking similar consolidation that took place a decade ago. “It's happening again now because of an influx of biotechnology drugs,” he says.
Part D of the Medicare Modernization Act (MMA) will open up “a huge number of newly covered drugs” leading to more consolidation of these markets. “But they won't merge entirely,” he says. “There will still be room for independent home infusion players.”
Toward the future, Bulich says he is optimistic overall about the impact of the MMA, but notes that manufacturers of home infusion products are getting ready for something like a seventh-inning stretch. The market has seen steady growth for six years running, “but we're prepared for a flat 2005.” After significant growth since 1999, “2005 will be a stagnant year because of chaos in the industry from the MMA trickling down.”
Wound Care
In the market for wound care products, manufacturers are sticking to a new mantra, experts say: Heal faster. Reduce pain. Reduce cost.
The market is “growing by leaps and bounds,” according to Michael Lee, president of home care sales for Medline Industries, and manufacturers are answering that growth by concentrating on this set of goals. An influx of wound care patients has renewed a focus on individual needs, with products that are “more tailored to end users' needs. They're not just wet-to-dry products,” says Lee.
He notes that innovation in today's wound care market is driven by the cost of caring for patients. If manufacturers can reduce that cost — while still reducing pain — patients will heal faster and have “improved outcomes with fewer visits,” and providers play a central role in achieving that goal. “[A provider] has to let the referral source know what they're doing. Talk about the programs in place to identify patients that can be healed faster. Talk about outcomes,” counsels Lee, because they can be the key to making sales in the wound care market.
With a patient population on the rise and home care visits costly, providers need to pay attention — and spread awareness — of products that focus on extended wear time, thereby “dramatically reducing costs as well as improving outcomes,” adds Jonathan Primer, president of the DMS division for Medline. “There are so many people with chronic wounds. We're seeing more of these skin care problems than ever before.”
Providers should be focused on how to take a patient to a more advanced dressing, “helping the customer be proactive in identifying products and their use,” says Lee.
Today some advanced products are flexible, longer lasting for extended wear and offer practical solutions to dressing chronic wounds, including the latest in silver-technology wound dressings. In fact, the biggest trend manufacturers report is a return to antimicrobial silver in dressings for chronic wounds. “Silver creates a better environment for healing,” informs Primer. “It fell out of favor with antibiotics, but now many organisms aren't defeated by antibiotics. Silver has come back and become more popular because of this rise in resistance.”
Medline and other manufacturers offer training programs to introduce providers to products and their results, and some also can equip providers with the marketing tools to woo referral services and new end-users. With the focus on more advanced products for improved outcomes, the development of protocols is still needed in this market, Primer says.
“It's critical to successful outcomes. We're taking on part of that responsibility by providing education to end-users, giving them access to expertise,” he says, “but it's a big learning curve.”
Incontinence
For incontinence products, “2004 has been a good year overall,” according to SCA's Ercol, and “retail is picking up, looking very, very positive.
“The aging of America is really making this category blossom,” agrees ISG's Bosco, and the next decade will bring in even more of a baby boomer insurgency. The fact that the boomers are more mobile than their elderly predecessors is having an impact on the incontinence market, which has traditionally focused on brief-type products. While there is still “the need for the briefs, the old-fashioned diaper-type product,” Bosco explains, “what we're seeing now in home care is more of a demand for the protective underwear, which means you have more of an ambulatory patient.”
They key is mobility and quality of life, and HME providers are essential in assuring both for patients, Bosco believes. “Our DME dealers are dealing with customers who want more freedom, and so they're going more for the pant-type product,” he says. If patients aren't bedridden, “they're going to want more freedom. They're going to want a pant-style product, which not only fits more like underwear but is also designed with the ability to tear at the side so that the customer doesn't have to pull them off to change.
“The misconception is that one [product] fits all,” Bosco continues. “You've got to have a conversation with the customer about [his or her] lifestyle. That's the most important thing, because the products made now are really to give the customer more of a feeling of dignity. A [diaper-type product] is not a very dignified product. This is, quite frankly, for the kind of person who is bedridden and doesn't have much of a choice.”
Ercol says the No. 1 growth product in today's incontinence market is protective underwear. “It's the driving force in this market, taking away from the traditional brief business,” he says, adding that people are getting past what some call a “misconception” about incontinence: that a patient needs — and therefore a provider should provide — a product that's going to work overnight.
He explains that consumers are looking for assistance in understanding their options in managing incontinence, a condition that can affect not only the patients but also the lives of their families.
Providers need to address the needs of caregivers, too, many of whom may be making purchases out of their own pocket for incontinence products, Bosco says. “A caregiver is somebody who is taking care of [a patient] — usually a parent — in their home, and they're using their own income to try to take care of that parent. They are not experts in this business. They need help. They know they have an immediate need. Mom needs to be taken care of — now.”
The situation represents a huge opportunity for providers. By educating and helping customers choose the most appropriate products for the incontinence issues they face — whether as patients or caregivers — providers can become the experts on the topic. In turn, these customers will return to the provider for advice and assistance.
Incontinence product-makers also say that too many providers let this business go to local pharmacies. These HMEs are “missing the boat,” according to Bosco. “You're going to buy a wheelchair, you might buy one in that person's lifetime. But [with incontinence products], you're going to have to come in and buy a case a week. Why let that business go to the chain drug? Why let it go to the drugstore? Take that business yourself,” he advises.
In the next three to five years, the incontinence business will continue to grow, Bosco believes. “More people are going to be entering the market. There's going to be less embarrassment. You're going to see older people feeling more comfortable [dealing with incontinence].”
Experts Interviewed
Greg Bosco, director of merchandising and marketing, Invacare Supply Group, Holliston, Mass.; Richard Bulich, president, Pharmaceutical Buyers Inc., Broomfield, Colo.; Al Ercol, vice president of sales, SCA Incontinence Care, Hershey, Penn.; and Michael Lee, president of home care sales, and Jonathan Primer, president, DMS division, Medline Industries, Mundelein, Ill.
