Strategic Guide

Market Intelligence & BD Playbook

A data-driven system to track referral behavior, quantify leakage, and build precise targeting routes for United Medical HealthWest.

Core Objectives
1

Track physician and hospital referral behavior for IRF-appropriate patients in Orleans, Jefferson, and St. Bernard Parishes.

2

Quantify IRF leakage to SNFs and out-of-area IRFs by hospital, service line, and physician.

3

Map referring ZIP codes and build a ranked list of high-value ZIPs, hospitals, and physicians.

4

Translate insights into a weekly playbook: target lists, routes, talking points, and volume goals.

The Data Engine

CMS Provider Data
National IRF & Hospital Data
Provider Data Catalog (IRFs)

Identify all competitors in LA/MS and pull public quality/volume metrics.

Post-Acute Care Utilization

See IRF volume/payments by geography to quantify the total market "pie" vs United Medical HealthWest share.

Hospital Service Areas
Acute Care Volumes
Medicare Inpatient Hospitals

Identify acute hospitals serving the parishes and pull discharges by DRG (stroke, brain injury, ortho).

MedPAR + SNF MedPAR

Distinguish discharges to IRF vs SNF vs Home Health by DRG and hospital.

Physician Mapping
Doctors & Clinicians
Physician Compare

Master list of physicians by specialty (neuro, ortho, cardio) with practice locations and hospital affiliations.

LAHIDD (State Data)

All-payer discharge data to track Orleans and Jefferson Parish residents going out-of-area for care.

Clinical Pathways

Neuro PDFOrtho PDFComplex PDF

High-impact talking points, value propositions, and objection handling for key service lines.

S72.001A
Hip Fracture
"Accelerated mobility protocols to prevent DVT/PE and pneumonia in elderly patients."

Key Talking Points

  • •Daily physician rounds to manage comorbidities (diabetes, CHF) often present in hip fx patients.
  • •Pain management protocols that balance comfort with participation.
  • •Fall prevention training in our ADL apartment.
Common Objection

"SNF is standard for hip fractures."

Rebuttal

For patients with comorbidities (BMI > 50, age > 85), IRF is compliant and safer due to daily physician oversight and RN staffing.

Source: CMS Compliant Condition #5
Z96.652
Bilateral Joint Replacement
"Simultaneous rehab of both limbs requires the higher nursing acuity of an IRF."

Key Talking Points

  • •Managing safety for transfers when both weight-bearing limbs are compromised.
  • •Intensive pain management to allow for early ambulation.
  • •Faster return to home compared to staged SNF stays.
Common Objection

"Surgeon prefers home health."

Rebuttal

Bilateral replacements have high fall risk. Our 10-14 day program ensures they are safe for home, reducing readmission risk.

Source: CMS Compliant Condition #12
T07.XXXA
Major Multiple Trauma
"Coordinated care for polytrauma (ortho + neuro + wound) in one setting."

Key Talking Points

  • •One team managing weight-bearing restrictions across multiple limbs.
  • •Wound care specialists for road rash/surgical sites.
  • •Psychological support for PTSD from the accident.
Common Objection

"Too complex for rehab right now."

Rebuttal

We are a hospital, not a nursing home. We handle IVs, wound vacs, and complex pain meds while starting therapy.

Source: CMS Compliant Condition #11
S88.111A
Amputation (Lower Extremity)
"Comprehensive pre-prosthetic training and wound management."

Key Talking Points

  • •Stump shaping and edema control to prepare for prosthetic fitting.
  • •Phantom limb pain management strategies.
  • •High-level balance training for single-limb mobility.
Common Objection

"They don't have a leg yet."

Rebuttal

The pre-prosthetic phase is critical. We prevent contractures and build core strength so they are ready for a leg as soon as the wound heals.

Source: CMS Compliant Condition #4

Core Analytic Views

1. IRF Opportunity by ZIP ("Size of the Prize")
Market Sizing

Goal: Prove to liaisons that there is sufficient volume. Extract all IRF discharges for Orleans, Jefferson, and St. Bernard parishes.

Deliverable: Top 20 ZIPs List

  • CoreWithin 25 miles of Gretna
  • Growth25–50 miles from facility
  • Stretch>50 miles (repatriation targets)
2. Leakage Map (SNF & Out-of-Area)
Leakage Analysis

Goal: Show where IRF-appropriate patients are going instead of United Medical HealthWest. Identify SNF-heavy hospitals and out-of-area IRF leakage.

Leakage Flags

  • SNF-heavy hospitals (above national norms)
  • Out-of-area IRF leakage (East Bank competitors)
  • Low United Medical HealthWest share hospitals

Deliverable

Ranked list of "Top 20 Leakage Hospitals" with estimated annual IRF dollars leaving the parish.

3. "Bring Them Home" Campaign
Repatriation

Goal: Identify New Orleans metro residents going to acute care facilities and then taking rehab at competing IRFs outside our service area.

Key Insight

"If United Medical HealthWest captured just 25–30% of these out-of-parish rehab cases, that equals X incremental ADC and Y incremental revenue."

4. Physician Segmentation
Targeting

Goal: Convert hospital & ZIP-level patterns into named physician targets. Overlay physician directory data on leakage maps.

Neuro/OrthoStroke, Brain Injury, Joint Replacement targets
Cardio/VascularComplex medical & debility targets
HospitalistsKey referral nodes in large groups

Have a new strategy idea?

This playbook is a living document. If you find a new pattern in the field, let us know.

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