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.

I63.9, I69.30
Acute Ischemic Stroke
"Intensive multi-disciplinary therapy (3 hrs/day) significantly improves functional independence compared to SNF."

Key Talking Points

  • •United Medical HealthWest offers 24/7 physician oversight, crucial for managing post-stroke complications.
  • •Our stroke-specialized PT/OT/SLP team focuses on neuroplasticity and regaining ADLs.
  • •Higher discharge-to-community rates than local SNFs (78% vs 45%).
Common Objection

"Why not SNF? It's closer to home."

Rebuttal

While SNF is closer, AHA guidelines recommend IRF for better functional outcomes. We offer 3x more therapy intensity, which is critical in the first 30 days for neuro recovery.

Source: AHA/ASA Guidelines 2016
I61.9
Intracerebral Hemorrhage
"Complex medical management of BP and ICP combined with early mobilization."

Key Talking Points

  • •Capable of managing complex medical needs that SNFs cannot support.
  • •Early mobilization protocols to prevent deconditioning while monitoring stability.
  • •Family training program to ensure safe transition home.
Common Objection

"Patient is too tired for 3 hours of therapy."

Rebuttal

We pace the therapy throughout the day. 'Intensive' doesn't mean 'exhausting'—it means focused. Our PM&R doctors manage their energy levels medically.

Source: CMS IRF Criteria
S06.9X9A
Traumatic Brain Injury (TBI)
"Cognitive rehabilitation and behavioral management in a secure, structured environment."

Key Talking Points

  • •Specialized cognitive therapy to address memory, attention, and executive function.
  • •Low-stimulation environment options for agitated patients.
  • •Neuro-psychology support available for behavioral challenges.
Common Objection

"They just need time to wake up."

Rebuttal

Active cognitive stimulation is proven to accelerate emergence. Waiting in a SNF can lead to learned non-use and contractures.

Source: MedPAC Report 2021
G20
Parkinson's Disease (Exacerbation)
"LSVT BIG & LOUD certified therapists to address mobility and speech decline."

Key Talking Points

  • •Medication management optimization by our PM&R physicians.
  • •Intensive gait training to reduce fall risk and improve stride length.
  • •Speech therapy focusing on vocal loudness and swallowing safety.
Common Objection

"It's a chronic condition, insurance won't pay."

Rebuttal

This is an acute exacerbation with functional decline. We are treating the acute drop in function to restore their prior baseline, which meets medical necessity.

Source: CMS Manual: Neuro Conditions
G61.0
Guillain-Barré Syndrome
"Intensive strengthening program matched to the patient's recovery curve."

Key Talking Points

  • •Expertise in managing fatigue while maximizing strength gains.
  • •Respiratory therapy support for patients weaning from vents or with compromised breathing.
  • •Adaptive equipment training to maximize independence during recovery.
Common Objection

"They are too weak for rehab."

Rebuttal

We specialize in GBS. We start with bed-level ADLs and respiratory strengthening. Waiting for strength to return spontaneously delays recovery.

Source: CMS Compliant Condition #10
G95.9
Spinal Cord Injury (Non-Traumatic)
"Specialized bowel/bladder management and adaptive mobility training."

Key Talking Points

  • •Expertise in neurogenic bowel and bladder programs to prevent complications.
  • •Wheelchair skills training and home accessibility evaluations.
  • •Spasticity management via medication and stretching protocols.
Common Objection

"They are bedbound, what can you do?"

Rebuttal

We focus on what remains. We train for bed mobility, transfers, and using adaptive equipment to maximize independence despite the injury.

Source: CMS Compliant Condition #2

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

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

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