Campaign Design FINAL-EDITED-11.30.15

Medical NutritioN therapy R429 Public Relations Campaign Plan

Created and Presented by: Taylor CraddockSydney Kayman

Chelsea KatzMegan Schmidt

Lindsey Silva

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Table of ConTenTs

Executive Summary 3

Situation Analysis 4-6

SWOT Analysis 7

Campaign Goal 7

Publics in Relation to Target Audiences Chart 8

Key Messages Overview Chart 9

Target Audience 1: Spouses and Guardians 10-11

Target Audience 2: Potencial MNT Patients 11-12

Target Audience 3: Medical Care Providers 13-14

Target Audience 4: IU Health Employees 14-15

Implementation 15

Tactical Implementation Timeline 16

Campaign Evaluation 17-18

Appendix 19-35

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This proposal recommends methods to solve the issues expressed by Indiana University (IU) Health’s Medical Nutrition Therapy (MNT) program. To better address the needs of MNT, the campaign focuses on furthering the success of the Bedford program as it is more closely related to IU Health (see Appendix B) and, based on the transitive nature of the methods presented, can be used in the future for the Martinsville program.

Medical Care providers in Bedford are not referring patients to the newly available MNT program (see Appendix B), which results in patients not receiving the benefits of the program. This campaign will outline potential solutions, goals, tactics, and evaluation to help remedy this issue.

In order to increase the number of referrals to the Bedford MNT program, this campaign focuses on the two most crucial target audiences: Potential MNT Patients and Spouses and Guardians of Potential MNT Patients.

A main objective of this proposal is to increase the number of successful first time appointments completed in the Bedford MNT program. Tactics for these two audiences will focus on communicating directly with them through mailers, pamphlets, and a special event.

Bedford Medical Care Providers are also a crucial target audience as the gatekeepers to the refer-only program. The MNT campaign proposal team would like to recruit more providers to be enablers of the program. To accomplish this, the MNT campaign team proposes to offer a referral-based incentive program and to communicate with providers through the IU Community Health Liaison and a local pediatrician.

Evaluation for campaign tactics include before and after surveys, exposure surveys, and continuous tracking of appointment and referral data. The MNT campaign team invites you to learn more about our strategic plan to increase the success of the Bedford MNT program.

"If you have a family really interested and willing to do what

it takes, it is easier to refer."

- Amanda Pruett (Appendix D){ }

exeCuTive summary

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Problem sTaTemenT

Medical care providers in Bedford and Martinsville are not referring patients to the newly available Medical Nutrition Therapy program, resulting in patients not receiving benefits of the program.

CurrenT siTuaTion

The Medical Nutrition Therapy program has been least successful in Bedford and Martinsville, meaning that very few patients in these areas are being referred to the program. This is most likely due to low awareness among providers in these areas, and because of the fact that MNT Bedford is a new program.

Specifically, medical providers in Bedford and Martinsville may not have ample knowledge in the program details, the registered dietitians’ credentials, and the cost of the program and insurance that covers it. Another problem is that some providers prefer to cover all aspects of treatment themselves.

baCkground

The Indiana University Health Bloomington Hospital Community Health Department runs Medical Nutrition Therapy, in which registered dietitians provide nutrition counseling for children and adults, in individual and group settings. The program also consists of registered dietitians commuting to different regions in south central Indiana to provide outpatient nutrition counseling. Patients in these regions gain access to the program through provider referrals.

Patients are then able to see registered dietitians for appointments from a half hour to a full hour where they can learn how to maintain good health and weight by applying healthy nutrition habits and participating in individualized meal planning. The program also offers therapeutic services for patients with diabetes, high blood pressure, high cholesterol, hypoglycemia, cancer, food allergies, high-risk pregnancies, and other conditions.

There are four registered dietitians in the Medical Nutrition Therapy program who travel to external locations. Patients are referred to them through the patient’s primary care provider. The dietitians report back to Samantha Schaefer, who reports to Carol Weiss-Kennedy at the Indiana University Bloomington Hospital Community Health Department. Competitors, such as the St. Vincent Bedford Diabetes Care Center and St. Vincent Bedford Community Health and Wellness Center, are well-established threats that offer similar programs.

siTuaTion analysis

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Program deTails

The program consists of four main stages (see Appendix F):1) Assessment of client’s nutritional needs and overall health2) Development and implementation of individualized nutrition plan using evidence

and research-based guidelines3) Monitoring client’s progress over extended period of time4) Follow up and evaluation

Patients must receive a referral from their primary care provider in order to see a registered dietitian for Medical Nutrition Therapy. Appointments can be made on Thursdays between 9:30 am and 5:00 pm at many different hospitals, including Indiana University Health Bedford Hospital and Indiana University Health Morgan County Hospital. The initial appointment is one and a half hours long, with each follow up appointment being half an hour long, scheduled as needed.

key PubliCs

Medical Care Providers in Bedford and Martinsville who have not referred patients to the Medical Nutrition Therapy program are a crucial public to this communication plan. In order to participate in the Medical Nutrition Therapy program patients must first receive a referral from their medical provider. While there is currently another Registered Dietitian in Bedford at the Southern Indiana Physicians Clinic as well as a Diabetes Center, the IU Health’s Medical Nutrition Therapy program can be used to treat a wide variety of medical problems.

Patients in these two cities who have not been referred to the Medical Nutrition Therapy program or have been referred and not used the program are also a main focus. Patients who have not been referred may deal with problems such as cost issues, insurance, lack of benefits, patient readiness, time, etc. It is crucial that the Medical Nutrition Therapy programs expand their aid to those that may run into these problems so that everyone can receive proper and necessary treatment. It is also important that those who have been referred, but have not used the program take advantage of the help and services they could receive. By spreading awareness about the advantages of these programs, IU Health can further educate patients and make them more willing to accept the referral.

IU Health Employees are also crucial enablers and producers to the Medical Nutrition Therapy program and are a priority of this communication plan. As an expansion of the benefits that IU Health and IU Community Health provide to Indiana, Medical Nutrition Therapy needs the support of the employees in order to build a positive foundation for the program. Because of the lack of marketing tactics and information sent out to hospital employees about Medical Nutrition Therapy, this crucial public is currently unaware of the impact their employer and coworkers could be making. This public could be unaware of the Medical Nutrition Therapy program all together. By informing them about Medical Nutrition Therapy, the benefits to the patient, and the benefits to IU Health as a whole, IU Community Health can increase the internal awareness about the program through word of mouth, fliers, and other communication tactics.

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signifiCanCe of The issue

Patients in Bedford and Martinsville are not receiving benefits of the Medical Nutrition Program because medical providers are not referring them. The ultimate success would be to create enough awareness that medical providers would not only refer more patients, but also that patients could become more independent and seek out referrals from their providers on their own. Additionally, the program could grow, expand and improve. If the problem does not get solved, the issue will remain at a standstill.

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sTrengThs

• MNT can be altered to treat a large range of medical problems• The RDs have already sent out letters to providers introducing themselves, increasing awareness among providers• The Morgan and Bedford programs can look at the Bloomington and Paoli hospitals as a basis for their model• The MNT program only hires RDs, which requires high levels of training

Weaknesses

• Limited appointment opportunities for patientsin each external location• The Morgan County Hospital has been slow togrow their MNT program• Marketing materials were slow to be created anddistributed• No show rates are high at the new facilities• Eligible patients may live far from the MNTcenters• Patients must have medical provider’s referral forMNT

oPPorTuniTies

• Create a program that provides educationon recent trends in nutrition and can betaught in group settings• Making the physicians more informed willhelp showcase the benefits of the program tothe public• Expanding appointment hours could in-crease amount of patients seen• Appealing to patients can increase dis-cussion and awareness of MNT program inprovider offices

ThreaTs

• High cost of program if there is a lack of insurance or non commercial insurance plan (billed in 15min increments)• Morgan County mainly has a Medicaid population making insurance an issue• St. Vincent Bedford has diabetes care center with RD• St. Vincent Bedford Community Health and Well-ness Center has nutrition counseling for women, children, and potential parents at low cost

sWoT analysis

CamPaign goal

Through the implementation of this campagin, we intend to increase the overall number of referrals by medical care providers in Bedford to the Medical

Nutrition Therapy Program.

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PubliCs in relaTion To TargeT audienCes

Spouses and Guardians Secondary Potential

MNT Patients

Medical Care

Providers

IU Health

Employees

Potential MNT Patients Primary

Medical Care Providers Primary

IU Health Employees Primary

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key messages overvieW

Spouses and

Guardians MNT can help your loved one combat or live with their health problem in a positive way

Your loved one needs encouragement and positive reinforcement to succeed

These health problems are severe and potentially life-‐threatening

Potential MNT

Patients It is easy to manage your health problems through MNT

MNT is non-‐invasive, treating certain health problems through diet and nutrition

Dietitians and nutritionists are not the same

Medical Care

Providers MNT is individualized and can adjust to patient readiness and enthusiasm

MNT dietitians are well-‐qualified and knowledgeable about many health problems

Medicaid covers diabetes-‐focused MNT

IU Health

Employees Families are a good communication tool to use to access patients

MNT should be a primary treatment option for patients with appropriate health problems

Talking about MNT increases awareness of the program’s benefits

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Members of this target audience are very close to the issue, since they are related or married to a patient. They play a key role in whether or not the patient asks their provider about MNT, schedules an MNT appointment, and goes to MNT sessions. Spouses and guardians of potential patients are a secondary audience to potential MNT patients. Shared methods of communication include local newspapers in Bedford and Martinsville, flyers and pamphlets available in provider offices. Demographics of this group vary drastically. Geographically, this target audience is located in Bedford. Typically, members of this audience are working adults who are married and/or have children. Most members of this target audience are homeowners or renters.

key messages:

• Your loved one needs encouragement and positive reinforcement to continue to use MNTand receive all possible benefits

• These health problems are severe and potentially life threatening• MNT will help your loved one combat or live with their health problem in a positive manner

aWareness objeCTive

To have an effect on the awareness of spouses and guardians in Bedford, IN; specifically to increase their knowledge about the services of the MNT program (50% of the spouses/

guardians of those diagnosed in Bedford between January 1 and April 1).

sTraTegyCommunication: Provide members of target audience with information on how MNT works

and what the benefits of the program are for potential patients.

TaCTiCHave RD hold open forum at the Bedford Public Library for potential patients and providers

who have questions or want to get more information.

TargeT audienCe 1: sPouses & guardians

“It’s hard with kids, the parents have to be on board, and if they’re

not, then just forget about it.”

- Amanda Pruett (Appendix D){ }

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aCTion objeCTive

• Non-invasive program for health problems that can be managed through diet

• Dietitians and nutritionists are not the same• It is easy to manage your health problem with Medical Nutrition Therapy

To have an effect on the action of spouses and guardians towards their family members who are potential MNT patients in Bedford, IN; specifically to help reinforce the potential patient’s interest and concern with their own health and wellbeing (60% of the patients who come to appointments have a family member in the waiting room as support between January 1 and April 1).

sTraTegyCommunication: Provide members of target audience with information on how familial support

can impact the success of MNT program.

TaCTiCCreate pamphlets that include statistics about how familial support can improve healthcare success,

specifically with the MNT program and distribute them to urgent care facilities, Bedford school offices, assisted living offices, and medical care provider offices.

TargeT audienCe 2: PoTenTial mnT PaTienTs

These are the patients suffering from diseases that could be directly and significantly abated through their participation in the Medical Nutrition Therapy provided by IU Health Bloomington. These patients are a primary audience. Shared communications include newsletters, brochures available in physician waiting rooms, emails, etc. Demographics for this group vary drastically, but all members are suffering from a disorder that can be managed with the aid of dietary adjustments. They include both males and females who reside in Bedford. These patients are between 19 and 70 because outside of that age range, their guardians become the more crucial audience (see previous Audience).

key messages:

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aCTion objeCTive

To have an effect on the action of potential MNT patients in Bedford, IN; specifically to increase the number of successfully completed first time appointments (10 patients in Bedford, IN by April 1).

sTraTegy

Action: Deploy the RD who travels weekly to Bedford to talk with various local support groups.

TaCTiCs1) Create informational video about MNT including patient testimonials to show at open forum and

support groups2) Request permission for RD to speak as a guest at various support groups in the Bloomington and

Bedford areas, including adult and adolescent eating disorder support groups, teen pregnancy support groups, and more. The RD will hand out information pamphlets on the program and how to get referred.

3) Have RD hold open forum at the Bedford Public Library for potential patients and providers who have questions or want to get more information.

sTraTegyAction: Mail out postcards to MNT patients who have set up an appointment that include an

emphasis on important and perhaps unknown facts about MNT.

TaCTiCCreate postcard with reminder about upcoming meeting and information about the importance of

attending appointments that will be mailed to patients with appointments scheduled.

aWareness objeCTive

To have an effect on the awareness of patients in Bedford, IN; specifically to increase their knowledge about the services of the MNT program. (50% of patients diagnosed in Bedford between January 1 and April 1).

sTraTegyCommunication: Provide potential patients with informational documents focusing on how MNT

works and what the benefits of the program are for potential patients.

TaCTiCEmail informational documents explaining the program, benefits, costs associated with the program,

success rates, and all other relevant information, including information about the open forum.

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For the purposes of this campaign, we want to target Medical Care Providers (MCP) outside of IU Health who are either primary care physicians or providers that focus on the specific conditions treated by the MNT program. With the exception of those providers who are currently referring patients to the MNT program, MCPs fall into two categories: apathetic and latent. We have tailored our key messages for this audience to fit both categories. MCP are the only people that can refer patients to the MNT program, so informing this primary audience about the benefits of MNT is crucial.The demographics for this audience include: 25-years-old to retirement age providers, working in their own private practice in the Bedford area. As providers working for hospitals or large treatment facilities are more likely to have a long standing treatment option in place and are less likely to take advantage of MNT. Shared sources of communication include the IU Health South Central Region Physician liaison, trade magazines and Bedford trade newsletters, and patients.

key messages:

• MNT dietitians are well-qualified and knowledgeable about many health problems that canbe managed with diet

• Medicaid covers diabetes-focused MNT• MNT is individualized and is meant to adjust to patient readiness and enthusiasm

aCCePTanCe objeCTive

To have an effect on the acceptance of Medical Care Providers in Bedford; specifically to increase positive attitude toward MNT and the qualifications of RDs involved (40% by April 1).

sTraTegyCommunication and Action: Employ a local, respected medical care provider who has referred

patients to MNT to be an advocate for the program.

TaCTiCs

1) Communication: Employ a Bedford provider to send emails to various medical care providers in the Bedford area about why she refers patients to the program and why they should as well, including patient testimonials.

2) Action: Hire a Bedford provider to speak at the forum held by the Bedford RD at the Bedford Public Library.

TargeT audienCe 3: mediCal Care Providers

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aCTion objeCTive

To have an effect on the action of Medical Care Providers in Bedford, IN; specifically to increase the amount of patients referred to the MNT program (20 patients in Bedford, IN by April 1).

sTraTegyAction: Create incentive for medical care providers to refer patients

TaCTiCs1) For every 5 patients referred to the MNT Program by an individual provider, the Bedford RD will

hold a complimentary nutrition education session at the practice. 2) MNT Liaison will meet with Bedford area providers to tell them about the incentive.

Employees are close and near to the issue because they work for the organization. They would be considered a primary public due to automatically being involved with these issues upfront. Shared communication involves pamphlets or fliers located in the building, and employee newsletters that would regularly get sent out reinforcing important information and messages. Demographics for this group consist of working adults ranging from 25 to 65 years old that live within the Monroe County area, all maintaining similar IU health insurance plans and benefits.

key messages:

• MNT should be a primary treatment option for patients with these diseases• Talking about MNT increases awareness of program benefits• Families are a good communication tool to access patients

TargeT audienCe 4: iu healTh emPloyees

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aCCePTanCe objeCTive

To have an effect on the acceptance of IU Health Community Health Department Employees; specifically to increase their positive attitude toward the MNT program (75% between January 1 and April 1).

sTraTegyCommunication: Provide information about the benefits and success rates of MNT to employees.

TaCTiC1) Post flyers about MNT around IU Community Health.2) Submit article including the benefits and successes of MNT to IU Community Health employee

newsletter.

Tactical implementation for this plan takes place during the months of January, February, and March of 2016. Most tactics have a combination of one-time actions, indicated by stars on the timeline, and continuous actions, which are indicated by arrows on the timeline. The majority of one-time actions take place in January in order to kick-start the flow of information between IU Community Health and the target audiences. The chronology of tactics was designed to enable the plan to be as effective as possible.

The Key for the Tactical Implementation Timeline can be found in Appendix O

imPlemenTaTion

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imPlemenTaTion: Timeline

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sPouses and guardians

To evaluate “the awareness of spouses and guardians in Bedford, IN; specifically to increase their knowledge about the services of the MNT program (50% of the spouses/guardians of diagnosed in Bedford between January 1 and April 1).”

Metric: Record the number of people who are aware of MNT through surveys distributed to all medical care providers in Bedford, IN.

To evaluate “the action of spouses and guardians towards their family members who are potential MNT patients in Bedford, IN; specifically to help reinforce the potential patient’s interest and concern with their own health and wellbeing (60% of the patients who come to appointments have a family member in the waiting room as support April 1).”

Metric: Track the number of patients that arrive at an appointment with a family member present to support them.

PoTenTial mnT PaTienTs

To evaluate “the action of potential MNT patients in Bedford, IN; specifically to increase the number of successfully completed first time appointments (10 patients in Bedford, IN between January 1 and April 1).”

Metric: Record the number of patients that show up to their first scheduled appointment.

To evaluate “the awareness of patients in Bedford, IN; specifically to increase their knowledge about the services of the MNT program. (50% of patients diagnosed in Bedford between January 1 and April 1).”

Metric: Record the number of people who are aware of MNT through surveys distributed to all medical care providers in Bedford, IN.

CamPaign evaluaTion

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mediCal Care Providers

To evaluate “the acceptance of Medical Care Providers in Bedford; specifically to increase positive attitude toward MNT and the qualifications of RD’s involved (40% between January 1 and April 1).”

Metric: Track changes in acceptance by distributing before and after surveys to medical care providers in Bedford, IN.

To evaluate “the action of Medical Care Providers in Bedford, IN; specifically to increase the amount of patients referred to the MNT program (20 patients in Bedford, IN between January 1 and April 1).”

Metric: Record the number of patients referred to the MNT program through their primary care provider.

iu healTh emPloyees

To evaluate “the acceptance of IU Health Community Health Department Employees; specifically to increase their positive attitude toward the MNT program (75% between January 1 and April 1).”

Metric: Track changes in acceptance by distributing before and after surveys to IU Health employees.

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aPPendix a: iu healTh’s vision and mission sTaTemenTs

Indiana University Health’s vision:

“IU Health strives to be a preeminent leader in clinical care, education, research and service. Our excellence is measured by objective evidence and established best practices. Exemplary levels of respect and dignity are given to patients and their families, while professionalism and collegiality mark relationships between employees and physicians. IU Health continues to focus on innovation and excellence through collaboration among its partner hospitals and its affiliation with Indiana University School of Medicine.”

Indiana University Health Bloomington Health’s mission:

“Indiana University Health Bloomington Hospital’s mission is to improve the health of our patients and community through innovation and excellence in care, education, research and service”

Indiana University Health Bloomington Hospital’s values include trust, excellence, accountability, and mutual respect.

aPPendix b: samanTha sChaefer inTervieW

Conducted by Chelsea Katz via email with Samantha Schaefer, Registered Dietitian, MS, RD, CD-- South Central Region Team Lead on October 5, 2015.

1. In our meeting with Carol, she only spent a short time talking about the MNT program and the problems you are facing, so we were hoping you could expand on that a little.

The newest service lines are in Bedford and Morgan hospitals. We have established services in Bloomington and Paoli, although we are always looking for ways to increase presence in the community and our referral rates. Morgan went live in May and Bedford went live in June. Referral rates have been slow trying to get the word out to providers within the IU Health system and to outside providers. One issue was we had a hold up on the creation of the marketing materials being revised for a regional branding, and were waiting on the printing, but we have those now! The Registered Dietitian (RD) is also a new RD, so there is a learning curve with training of the processes and systems on top of establishing ourselves at new sites and learning who to contact to get things done in that facility etc. They all seem to want the service, but the Bedford location seems more focused on showing return on investment for the RD time there. No show rates can be high (even with reminder calls and mailed reminder cards). Bedford is unique in that it already has a RD in the Southern Indiana physician clinic that sees those providers patients and they have a Diabetes Center who will see all those with that diagnoses, so it is more selective on who can be marketed to and which patients go where. I have an algorithm for Bedford (attached). Bedford is only on Wednesdays and Morgan is only on Thursdays right now.

aPPendix

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2. What tactics are you currently using to get the word out about the services you provide. We have created “physician packets”, which include a letter, MNT brochure, RD bio, and other

materials showing the benefits of MNT. I am happy to give you a hard copy of one of these! We have also submitted a newsletter article to the Southern Indiana Physicians newsletter for the providers, which is put out twice a month I believe. We have sent emails to the office managers introducing ourselves and requesting meetings this fall/winter, as well as our RD making some visits and calls or networking when possible. I have created a list of common Q&As for marketing to the providers (attached). In Bloomington, we have visited and provided lunch to the clinics before, but this gets expensive! A small way to close the communication loop is to send the progress notes for communication after the patient is seen by the RD. I see this as a way to market in a way. We send handwritten notes to new providers introducing ourselves or thanking them for new referrals. It has been proposed that we do a community forum at the convention center hosted by the hospital to present about nutrition on a panel with providers that refer to the services and RDs.

3. We were told that the main issues lie in Bedford and Martinsville. Have you found that thetwo cities face similar problems? Or are there any notable differences between the uses of the MNT program in those cities?

I think they are different. It has seemed there are personality differences in leadership and staff, and Bedford seems to have taken off a little faster even though they started later and we have done very minimal marketing. Morgan seems more cautious to roll out new ideas in the community for programming outside of MNT appts as well. I have heard concerns that Morgan has mainly a Medicaid population and insurance coverage may be a concern or issue, but I am sure there are similar concerns in Bedford. Morgan is also considered the “Academic Health Center” affiliated with Indy, while Bedford is part of the IU Health system as the other sites are. They may have different rules to use.

4. Is there any specific condition that you see more often than others? What is the breakdown inthe conditions seen in the therapy centers?

See attached referral form. Our top diagnoses are weight management, pre-diabetes, hypertension, hyperlipidemia, and eating disorders. However, you can also see that we have a large variety of diagnoses that we see.

5. Do you have any previously collected data that you think we would find helpful in our efforts?Anything and everything would be fantastic!

Yes-I will send in another email!

6. How many patients are you currently seeing per year? What would you like to see it at? I only have data from Bloomington and Paoli as we are just gathering data on the new sites. We

have about 85-95 patient appts per month between these 2 sites (so close to 1,100 per year). These are patient appointments (not patients) as some people come weekly etc, so we are tracking encounters for # appointments (by initial and follow up appts). I would like to see Morgan and Bedford around 15-20 appts per month eventually at each site (total 216 per site).

7. Which doctors refer the most patients? What is their specialty?I only have data for Bloomington region and will attach on another email.

8. Do you have a list of all the primary care providers in the two cities?

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See attached SIP provider list, lists location and specialty. This does not include non-IU Health providers.

9. Why do you think patients are not referred? This is data from focus groups with some of the SIP providers in the region and most of them are

common:· Cost/Payer Issues/Insurance· Distance/Geography· Lack of Benefit· Time· Patient’s Readiness /Willingness/Engagement/Motivation· Pt Cancellations· Referring to non-RD providers (either providers do the education or some communityprogram or weight loss fad)

10. What are the qualifications for all the dietitians?Anyone can call themselves a nutritionist, but only a Registered Dietitian (RD) or Registered

Dietitian Nutritionist (RDN) has completed multiple layers of education and training. In addition to holding a bachelor’s degree, a RD or RDN must fulfill a specially designed, accredited nutrition curriculum, complete an extensive (1200 hours) supervised program of practice (UNPAID!) and pass a rigorous national registration exam. Then, complete 75 continuing education credits each 5 years and set professional development goals.

11. What insurance covers what treatments? Have you found this is a problem?Insurance coverage is always an issue. At the present time, Medical Nutrition Therapy is a

reimbursed service for Medicare clients with a diagnosis of Diabetes or Chronic Kidney Disease. Private insurance plans vary widely on their coverage. We encourage people to contact their insurance company to inquire about Medical Nutrition Therapy as a covered benefit. Some visits are covered with medical necessity, some by diagnosis, some say no. No straight answer, which is hard. Diabetes and CKD are usually guaranteed certain number of hours per year allowed.

12. And finally, does IU Health have a physician liaison? Do you have his/her contact info?Yes, my understanding is these are assigned by region possibly. I have one name Brian Moore

is for non-SIP offices (don’t have his info-would need to get it. Think Carol has it). The practice administrators for Bedford is Brigid Thomas and Morgan Dave Burnworth for the SIP practices. Have been working with the practice administrators, but not the liaisons yet.

aPPendix C: sherry hanes inTervieW

Conducted by Megan Schmidt via phone with Sherry Hanes, Registered Nurse at Hendricks Regional Health Diabetes Education Center on October 12, 2015.

Can you tell us what the differences are between insurance types and their coverage of MNT?Mostly, I know what Medicare and Medicaid will cover. Medicare will only cover 2 diagnoses -

diabetes and chronic kidney disease. Any other diagnosis for the patient would be out-of-pocket.

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Medicaid will cover diabetes education, but that is it. If the person has pregnancy Medicaid coverage, it will cover their education on gestational diabetes and any other education related to their pregnancy. Anything else will be out-of-pocket for the patient.

As far as traditional insurance, they all differ. In that situation, we have our patients call their insurance companies directly. We tell them the code that will be filed and any other information that would help with their coverage (e.g. physician-ordered consult, meeting with a Registered Dietitian, Registered Nurse, and/or Certified Diabetes Educator).

aPPendix d: amanda PrueTT inTervieW

Conducted by Taylor Craddock via phone with Amanda Pruett, Registered Nurse and Office Manager of Riley Physicians Bedford on November 9, 2015.

What is the first indicator that a patient could benefit from MNT?We usually first notice signs in their growth charts, obviously sometimes you can just tell [by

looking] too. We show these to the parent so they can have a better understanding of height vs weight, and where their child falls on the BMI chart. That will initiate a referral. We ask a series of questions when they come in, such as if they receive a variety of foods, if not that’s an indicator as well.

Why do you refer patients to MNT?Typically it’s the kids that have high BMI’s just to give them better ways and different tips on

weight management and weight loss, what types of food to eat and portion sizes. Not in terms of how many pounds you need to lose, more about eating better, e.g. these foods instead of these foods, help them but not make them feel uncomfortable. It needs to be tactful.

Why do you feel that some providers don’t refer?It depends on the family, if you have a family really interested and willing to do what it takes, it’s

easier. Usually we make the referral regardless.

Have you had patients not show up to MNT appointments?Yes, unfortunately it happens a lot.

Why do you think that is?Not having the resources to get them to the appointment. Not having the money to pay, not

caring enough. People won’t drive from Bedford to Bloomington when they don’t have the gas money or a car. This is a major problem across the board, in order to save money they buy the cheap junk [food] because they can’t afford healthier [foods]. The ones that go are interested in bettering themselves. We make the recommendation regardless.

What are the main types of insurance held by patients in Bedford?I’d say not quite 50% are on Medicaid. A lot of Medicaid patients, very few are uninsured.

If no insurance or insurance doesn’t cover, would you still refer? Yes, but sometimes it can be a waste of time. Unless they say “no, don’t” we refer. We try to

accommodate their insurance.

What messages do you think parents of potential MNT patients need?What should be their role?

Kids eat what they are provided, if their parents are able to provide healthier choices, and make healthier choices themselves their kids will follow that example. Speaking from experience as a parent myself I know sometimes it’s easier to give them what they want, but it’s good [and important] to have [the kids] see the parents making better choices. The parents have a huge impact, they’re the ones who buy and cook the food.

What are some of the direct results you have noticed in patients that have attended MNT appointments?

We don’t always have a lot that follow through. For those that have, and have stuck with what they’ve been taught there has been drastic change in the way they eat and feel. It just has to be the right family who want and are willing to make the changes.

Roughly what percent of your patients have commercial insurance as opposed to Medicaid? (answered above: I’d say not quite 50% are on Medicaid. A lot of medicaid patients, very few are uninsured.)

Hypothetically how much would it cost to hire you to speak at an open forum as an advocate for the MNT program?

I don’t feel like i have enough info/knowledge on the program to do anything like that. It’s definitely a good thing, we could refer everyone almost. It’s hard with kids though, the parents have to be on board, and if they’re not, then just forget it. Referrals for kids is definitely different than the adult world. We do refer quite a bit, but the families don’t always follow up like we hope, but the ones we have have had great results. Typically those that need it the most are those that don’t have the resources to travel and get there, the morel convenient, local, and closer the better.

aPPendix e: 2014 TaCTiC (PoTenTial mnT PaTienTs, objeCTive 1)

Invites you to

Medical Nutrition Therapy

Did you know?Small changes in diet mean big changes in your personal health

Our registered dietitians are certified through masters programs and supervised practice to help you manage your health problems through nutrition

Familial support is crucial to the success of MNT

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aPPendix f: ClienT meeTing minuTes

Date: October 16, 2015Time: 1:00-2:00 p.m. Location: 431 S. College, Bloomington, IN 47403

Name of client: Samantha C. Schaefer, MS, RD, CD with Medical Nutrition Therapy

Meeting Attendees:Sydney Kayman (Meeting chair)Chelsea Katz (Meeting note taker)

Invited Attendees: Lindsey Silva Sydney Kayman

Taylor Craddock Chelsea KatzMegan Schmidt

Purpose: To gather a sense of how to approach primary research and answer questions that have come up in meetings so far.

Discussion: 1. What RDs do when they are not travelling for MNT

When not travelling, the MNT RDs are marketing the program or working on community out-reach.2. Details of the typical MNT session

When patients come in, they always sign a consent form to be seen and give a copy of their in-surance. The initial appointment lasts for one and a half hours while the follow up is half an hour. The patient will always stay with the same dietician, and that dietician will try to tie in goals that fit to each individual’s lifestyle. At the end of the session, the patient has to repeat the goal to make sure they are on the same page. The second appointment varies by patient. 3. Not the same as diabetes center

They work WITH the diabetes center, not so much of a competition. Instead, Samantha ex-plained it is a specialized practice. 4. Important marketing and PR documents provided to providers

Samantha provided us with several PR documents that we will incorporate into our PR cam-paign plan.5. Contact information for Primary Research

After discussing the different possible primary research tactics, we concluded that the best tactic would be to interview a doctor that has referred several patients to MNT in Bedford. Samantha provided us with contact information.

Follow-up meetings: While no follow up was specifically decided, we plan to communicate via email and phone if

possible and in person if necessary.

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aPPendix g: 2014 QuarTerly daTa

IU Health BloomingtonCommunity HealthOutpatient Medical Nutrition Therapy ReferralsCY2014

1 Qtr 2014 2 Qtr 2014 3 Qtr 2014 4 Qtr 2014

97802 Initial97803 Follow-‐

Ups No Show 97802 Initial97803 Follow-‐



Ups No Show Totals

Adult -‐ Blgtn Clarizz 5 2 2 2 3 4 1 1 1 2 1 24

CAUGHLIN,JAMES PATRICK 1 1 1 1 1 5

HARTUNG,SARAH SUZANNE 1 2 1 1 2 3 10

LEE,SUSAN KAY 1 1

NIEHAUS,RYAN JAMES 1 1 2 1 5

OLIGER,MIALA RENEE 1 1

VUCESCU,RALUCA IOANA 1 1 2

Adult -‐ Blgtn Liberty Dr 1 5 1 2 3 2 9 3 5 31

ARCHER,JAMES WESLEY 1 3 1 3 2 2 12

KNABEL,ERIC ROBERT 1 1 1 3

KNUDSON,LAURA BRYCE 1 1 1 2 6 3 2 16

Adult -‐ Blgtn Rogers 1 2 6 4 5 1 5 2 4 6 3 39

LAUGHLIN,SUSAN GLENNA 2 2

LUPOV,MACKENZIE ELIZABETH 1 2 3 1 4 1 12

MCKINLEY,LEE 1 2 3

TOWELL,CHERI MONROE 1 1 1 3

WIBLE,HAYLEY ROSE 2 2 2 4 1 2 2 1 2 1 19

Adult -‐ French Lick 3 3 3 4 3 2 18

MATHIES,SHERRI KAY 1 1 2

SMITH-‐JR,DONALD GARNER 2 2 3 4 3 2 16

Adult -‐ Nashville 1 1 2

GARCIA-‐III,MARIN 1 1

SWANSON,DIANA LEE 1 1

Total 10 4 3 16 10 10 8 12 6 17 9 9 114

Adult -‐ Ellettsville 2 1 1 1 4 7 3 1 6 5 31

HARDISTY,LAUREN MARIE 3 1 1 1 3 9

LANG,VINCENT JOSEPH 2 1 1 1 1 6 2 6 2 22

Adult -‐ Gosport 1 1

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aPPendix h: bedford mnT algoriThm

Provider Identifies Patient Appropriate for Medical Nutrition Therapy Referral

Does the patient have Diabetes? (Type 1, Type 2, Gestational)

Yes No

Refer to the Bedford Diabetes Center RD, CDE by faxing referral and demographic info.

Fax: 812-‐275-‐1230 Phone number: 812-‐275-‐1233

Kim Ledden, RD, CDE

Is this a patient of Bedford Southern Indiana Physicians?

Yes No

Refer to Bedford Southern Indiana Physicians RD and schedule through SIP front desk staff.

Phone number: 812-‐278-‐8800

Lynn Brooking, RD

Refer to Outpatient Medical Nutrition Therapy RD. Fax referral with patient name, DOB, referral to RD, diagnoses, signature, date, and time and fax to

Patient Financial Navigation Pre-‐Services.

Fax: 812-‐275-‐1285 Phone: 812-‐275-‐1270

Martina Samm, RD

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aPPendix i: mnT admin rePorT aug. 2015 sCr mnT & goal

AUGUST GOAL 2015 GOAL 2014Total Patient Appointments 6 8Total Patient Contacts 5 7Initial Appointments 3 6Follow up Appointments 2 1No Shows F/U 0 1 %F/U 0.00 12.50 Initial 1 0 % Initial 16.67 0.00Total No Shows 1 1 % Total 16.67 12.50

Total Possible Charges $1,224 $1,584

IUHB 2015 IUHB 2014 Paoli 2015 Paoli 2014 Morgan 2015 Bedford SIP 2015 Bedford MNT 2015Total Patient Appointments 107 90 17 11 7 14 9Total Patient Contacts 82 75 14 10 2 11 6Initial Appointments 22 28 6 4 1 11 2Follow up Appointments 60 47 8 6 1 0 4No Shows F/U 12 6 2 0 0 0 2 %F/U 11.21 6.67 11.76 0.00 0.00 0.00 22.22 Initial 13 9 1 1 5 3 1 % Initial 12.15 10.00 5.88 9.09 71.43 21.43 11.11Total No Shows 25 15 3 1 5 3 3 % Total 23.36 16.67 17.65 9.09 71.43 21.43 33.33

Total Projected Charges $11,067 $11,472 $2,346 $1,632 $408 $2,142 $1,020Actual $11,628 $13,488 $1,836 $408 $1,020Budgeted $9,037Total Work Hours 492.75 429.25 44 52 35.5 34.5 40.5Total PTO/NWNP Hours 0 9 8 0 0 16 0Community Health Referrals 0 0 0 0 0

2015 2014TOTAL SOUTH CENTRAL REGION CHARGES 14,892$ 13,104$

Comments:

Nutrition Therapy Administrative Report -‐ August 2015

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aPPendix j: mnT admin rePorT july 2015 sCr mnT & goal


Total Projected Charges $11,934 $8,389 $1,938 $1,152 $357 $3,672 $1,122Actual $12,138 $12,078 $2,040 $357 $1,122Budgeted $14,259Total Work Hours 455.75 398.75 52 31 109.75 51.5 46Total PTO/NWNP Hours 64 116 0 9 32 0 0Community Health Referrals 0 0 0 0 0


Comments: Stacey-‐Thank you from a patient for a helpful session; Kudos for planning and organizing Flatwoods picnic.

Nutrition Therapy Administrative Report -‐ July 2015

Samantha-‐Kudos for arranging additional volunteers for the Flatwoods event; thank you card from the IUHB Career Camp participants and ED pt for support.

JULY GOAL 2015 GOAL 2014Total Patient Appointments 15 6Total Patient Contacts 11 5Initial Appointments 11 3Follow up Appointments 0 2No Shows F/U 0 1 %F/U 0.00 16.67 Initial 4 0 % Initial 26.67 0.00Total No Shows 4 1 % Total 26.67 16.67

Total Possible Charges $2,142 $1,344

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aPPendix k: mnT admin rePorT june 2015 sCr mnT & goal


Total Projected Charges $12,444 $9,773 $3,417 $1,440 $612 $2,703 $612Actual $11,934 $10,719 $3,417 $612 $612Budgeted $11,688Total Work Hours 507.25 492.25 61 52 149.25 40 33.5Total PTO/NWNP Hours 20 40 0 0 0 24 0Community Health Referrals 0 0 0 0 0


Stacey: Kudos for helping submit a Healthy Kitchen article while Teri was doing Clinicals. Comments:

Nutrition Therapy Administrative Report -‐ June 2015

JUNE GOAL 2015 GOAL 2014Total Patient Appointments 2 3Total Patient Contacts 2 3Initial Appointments 2 2Follow up Appointments 0 1No Shows F/U 0 0 %F/U 0.00 0.00 Initial 0 0 % Initial 0.00 0.00Total No Shows 0 0 % Total 0.00 0.00

Total Possible Charges $714 $576

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aPPendix l: iu healTh mnT markeTing Q&a

IU Health Medical Nutrition Therapy Marketing Q&A

1. What is Medical Nutrition Therapy (MNT)? MNT combines the science of nutrition with the art of therapy (counseling). It includes build-ing a relationship and meeting the patient where they are at with readiness to change. RDs will work at assessing a client’s health condition and nutritional status, developing and implementing an individual-ized nutrition plan using evidence based guidelines, and then monitoring the client’s progress over time.

2. How does MNT complement patient care? Medical providers are typically limited on the amount of time they can spend with each patient. With the demands of meeting quality indicators, some providers note that it is challenging to spend as much time as they would like with patients on diet and physical activity education. RDs are able to work in an interdisciplinary team and complement medical care. RDs can spend the time focusing on assess-ing, educating, counseling, and creating an individualized plan for these areas of focus, and are also able to provide that follow up monitoring and evaluation. 3. What type of people should be referred to MNT? Once the provider assesses medical necessity, the provider can then evaluate the patient’s read-iness to change and receptivity to a referral to MNT. Since food is medicine, and all of us have some form of lifestyle behavior changes we can make, many people can benefit.

4. How can the provider get the patient engaged and willing to go to a MNT appointment? Much of what MNT is about is using the Transtheoretical Model (Stages of Change). It is im-portant to meet the patient where they are at. It is helpful to find the main motivator and connect back to it. Patients may also need to discuss the pros and cons of change. Being able to “manage up” the MNT service and the RD, and sharing what to expect is very helpful. If you can get the patient to us, we are trained on how to meet them where they are at for their stage of readiness to change and help create small, realistic goals for them to follow.

5. What are your top diagnoses seen? MNT is appropriate for prevention or treatment of many chronic diseases or conditions. The main types of diagnoses seen are: Diabetes, pre-diabetes, hyperlipidemia, hypertension, obesity, CKD, eating disorders, celiac disease, food allergies, GI disorders, and prenatal nutrition.

6. Where are you located? MNT Services are located in the IU Health Morgan Hospital. Patients arrive at the main en-trance and check in at the registration desk.

7. What is your appointment availability? At this time, outpatient MNT appointments are available on Thursdays from 9:30a-5p.

8. How long are the MNT appointments? MNT initial appointments are 1.5 hrs and follow up appointments are scheduled as needed for 30 min. The RD will discuss suggested frequency for follow up at the end of each session and will han-dle the scheduling.

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9. How do I refer and schedule an appointment? A referral is required for MNT and must be faxed prior to scheduling. For your convenience we have a MNT referral form which outlines all the steps of the referral process. Please fill out the patient information, mark all pertinent diagnoses (which may help with insurance coverage), and sign, date and time the document. The referral can then be faxed to Central Scheduling at 812-353-9606. The patient or the provider can call scheduling to make the appointment or once the referral is received, scheduling will try calling the patient up to 3 times to schedule. If the patient is not able to be reached, scheduling will notify the provider. The referral will be good for 1 year.

10. Aren’t there other outpatient specialty services? Martina also sees patients in Cardiac Rehab and Oncology on Mondays by appointment. Please contact these respective departments for scheduling these outpatient services.

11. How do the RDs communicate back to the provider? Progress notes will be faxed, emailed, or sent via Cerner message center after each patient visit.

12. How do I know if my patient attended their scheduled appointment? For any patient that is scheduled and does not show up for their appointment, “no show doc-umentation” is completed in the chart and the provider will be notified by phone, email, fax, or cerner message center. The patient then will enter scheduling’s calling queue, to be called within the same week (up to 3 times if no contact) to see if they would like to reschedule their missed appointment. Unfortu-nately, patients that are referred, but never scheduled, or patients that are scheduled and cancel prior to their appointment, are not able to be tracked.

13. I have concerns about the cost of the services? All insurance plans are accepted by IU Health and billing will be done by IU Health. Benefits vary widely by insurance companies, and patients are encouraged to contact their insurance provider directly prior to their appointment to assess coverage. Some plans cover specific diagnosis (by medi-cal necessity), which is why it is helpful to have all appropriate diagnosis marked on the referral form. Insurances will use the diagnoses coded on the claim to determine the reason for the service. Based on the insurance plan they may or may not cover. Data collection from MNT 2014, show an estimated 67% reimbursement rate across all payors. MNT is a covered Medicare benefit for diabetes and chron-ic kidney disease (limited by number of hours per year). If a Medicare patient is referred for another diagnosis, the provider will be contacted by Medical Review Nurses prior to the appointment to veri-fy diagnoses. Medicare patients will then be notified prior to their appointment if the appointment is not covered and will be required to sign a form accepting the service and notifying them of expected Medicare non-coverage for MNT. For Medicaid patients, as long as the medical necessity is met for the services, Medicaid has been paying well for these services and as a general rule there is no copay or additional amount owed for Medicaid patients. As always, financial services are available for all patients and payment plans can be set up.

14. Do you have groups or classes available? Group sessions can be scheduled upon request if siblings or a family would like to come in together. Caregivers or support persons are always welcome to join an individual during their session. Adult and pediatric weight management programs are only available through Bloomington at this time

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and offered 3 sessions per year.

15. How is meeting with a RD different than patients meeting with a medical provider or health educa-tor? Anyone can be a nutritionist, but Registered Dietitians are the nutrition expert and have spe-cialized training. They have received a minimum of a Bachelors degree from an accredited university, have completed over 1200 hrs of an accredited internship, and have passed a national exam. RDs are required to complete a professional portfolio, with a 5-year plan, and earn continuation education an-nually. Many RDs specialize, have other certificates of training, or hold higher degrees. RDs are able to go beyond the basic nutrition education, use evidence based guidelines, and are trained in the medical management of nutrition and disease.

16. What type of feedback do you receive about your services? Each patient is given a patient satisfaction survey after their first visit and every quarter for follow up visits. Data collected has always shown a very high patient satisfaction with outpatient MNT services. Patients feel it is worth their time and appreciate the expertise. Since patients have to reveal insight into their personal life with behavior and habits, it can be anxiety and assumptions about what the MNT will be like or what RDs will tell them. Many have received so many messages already and know what to do. Many patients leave saying “that wasn’t bad at all” as they assume someone will give them basic education and be judgmental. They appreciate someone meeting them where they are at and listening.

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aPPendix m: mnT referral form 2013

Indiana University Health Community Health Bloomington, Indiana MEDICAL NUTRITION THERAPY H&P AND ORDERS Patient Name __________________________________________________ Date of Birth _______________________ Patient Address ____________________________________________________________________________ Phone (home) ________________________________ (cell) _________________________________________ If minor, name of Parent/Guardian ______________________________________________________________ ORDER Please choose one of the consultations below and fax completed referral to the designated number. Call Central Scheduling at 812-353-9600 or 800-978-2177 to schedule an appointment date and time. Nutrition Consult (Central Scheduling Fax #812-353-9606) Nutrition Consult Eating Disorder (Central Scheduling Fax #812-353-9606) Nutrition Consult G.O.A.L. (Get Onboard Active Living) (G.O.A.L. Fax #812-353-5787) HISTORY and PHYSICAL (please enter current lab data values) ______ Ht. ______ Total Cholesterol ______ GFR ______ Blood Pressure ______ Wt. ______ LDL Cholesterol ______ BUN ______ Glucose ______ BMI ______ HDL Cholesterol ______ Creatinine ______ HgbA1C ______ BMI% ______ Triglycerides ______ CrCl Is this patient cleared for exercise? Yes No CURRENT MEDICATIONS __________________________________________________________________________ _________________________________________________________________________________________

Dietary Surveillance & Counseling Weight Management Obesity/Weight Management Weight Gain/Excessive Weight Loss/Abnormal Underweight Failure to Thrive Cardiovascular/Lipid Management Hypercholesterolemia Hypertriglyceridemia Hyperlipidemia Syndrome X-Dysmetabolic Hypertension CAD, not otherwise specified CHF CVD Glucose Management At Risk for Diabetes/Pre-Diabetes: Impaired Fasting Glucose Impaired Glucose Tolerance Test Diabetes, Type II w/o Complications Diabetes, Type I w/o Complications Diabetes, Unspecified, Out of Control Complications Diabetes w/ Renal Complications: Type I Type II Hypoglycemia Polycystic Ovarian Syndrome Disordered Eating Anorexia Nervosa Eating Disorder, NOS Bulimia Nervosa Binge Eating D/O

Chronic Kidney Disease Chronic Kidney Disease Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 End Stage Kidney Disease, Dialysis Kidney Disease, NOS Kidney Stones Gastrointestinal Esophageal Reflux Crohn’s Disease Irritable Bowel Syndrome Celiac Sprue Inflammatory Bowel Disease Fatty Liver Prenatal HTN-Pregnant/Preeclampsia Excessive Wt. Gain w/o HTN, antepartum Underweight Pregnancy Diabetes, Gestational Allergy Allergy (food) Please Specify _______________ Other Cancer, Unspecified Site Malnutrition/Mod. PCM Anemia/Iron Malnutrition Calorie Deficiency Ostomy ____________________________________ ___________________________________________ ___________________________________________ ___________________________________________

Entered by ______________ Date _______ Time ______

Noted by ______________ Date _______ Time ______

____________________________________ o M o F __________ Patient-Last Name, First Name, Middle Initial Age __________________ __________________ ___________________ Admission Number Date Birth Date ___________________________________________________________ Physician Name ____________________ Patient Identification Medical Record Number

_____________________________________ _________ _________ Referring Provider Signature Date Time

184884 10/14/13 MEDICAL NUTRITION THERAPY H&P AND ORDERS *011067* p. 1 of 1 Physician Orders 425-011067

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aPPendix n: mnT CamPaign budgeT

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aPPendix o: Timeline and budgeT key

Documents

Campaign Design FINAL-EDITED-11.30.15