MHA Corner Podcast

Intro 
Welcome to the MHA Corner Podcast, where we discuss the latest news and developments in the post-acute space. In today's episode, we'll dive into our modern approach to bereavement support with nanaBEREAVEMENT, a solution that's transforming how organizations provide grief care. Joining us today is Alyssa Grythe, Manager of Bereavement Services at St. Croix Hospice, who will share how they've integrated and leveraged nanaBEREAVEMENT to enhance their bereavement support services, offering more personalized and compassionate care to families in need. 

Tom: 
Hi, good morning. I'm Tom Maxwell. I'm the Chairman of Maxwell Healthcare Associates. We have a special guest here with us today. Alyssa comes from St. Croix Hospice. She runs their bereavement program. Really excited for you to hear her story and kind of the outcomes of what's happened with the nanaBEREAVEMENT product. 

nanaBEREAVEMENT's been live for a few months at St. Croix. It's been developed and on the market for about 6 months now. But let's jump in. I think it's really exciting to, uh, hear from the customer about what we're building, why we built it, and the success of it. 
So, Alyssa, please introduce yourself. 

Alyssa: 
Hi, everyone. I'm Alyssa Grythe. I'm the Manager of Bereavement Services with St. Croix Hospice. I am super excited to be a part of this podcast and share our experience with nanaBEREAVEMENT. St. Croix Hospice has been—we actually just hit our 15-year anniversary, so we're super excited to kind of start to implement, you know, these new technologies and way to expand our services to support patients and their family members. 
So my background, I have the social work experience and all of that. And so just being able to provide additional support to patients, their loved ones, all those family members who are needing extra support—we’re super excited to be able to implement this program, to continue to carry through with that. 

Tom: 
Describe the old bereavement process for us. Just, like, how did you do it prior to implementing nanaBEREAVEMENT? 

Alyssa: 
Yeah, so previously we would send all of our mailings and brochures, newsletters, different types of resources periodically throughout the 13 months of bereavement support that we provide to family members. And so this would all go through, you know, your typical snail mail. Everything would be mailed out, printing, all of that type of stuff. 

But then we started to try to come up with a way with, you know, our societal standards are changing. We all are adapting to the new technology changes, things like that. So being able to adapt to the way everybody's lives are changing on a daily basis—we were able to then implement this new text messaging system now, where instead of sending out a these paper mailings and newsletters that people are waiting for in the mail, or maybe not even ever receiving an opening. 
 
I mean for myself, personally, I check my mailbox every couple of weeks. I'm not checking it on a daily basis. So sometimes those pieces of mail get missed or just kind of tossed aside, and so we're not reading them. So we decided to implement this, where we're still sending out these periodic text messages, now, throughout the 13 months where we will still send one at the initial—kind of condolence message, which is seven days after the date of death. 

We then send them periodically at the 2-, 4-, 7-, 11-anniversary and 13 months that they'll receive this text message now, which then includes that landing page where they can view all of these exact same resources and newsletter information that we would send in the paper copy. 

Tom: 
That's really cool. Just to define a little bit more about nanaBEREAVEMENT—so it extracts data from the EMR. Social worker, nurse, bereavement coordinator still creates a care plan. So they go get a different care plan for each patient, whether they're high risk or moderate risk or low risk. 
And then that data gets extracted into nanaBEREAVEMENT. And then nanaBEREAVEMENT then triggers those messages at specific times of the day. And instead of sending a letter—a snail mail letter, like she said—to the patient's home, it actually sends a text message out to, um—with that information in it. 
But it includes those links. And those links drive people to your website. Those links drive more resources. So instead of just getting a letter in the mail—and hopefully if there's a website on the bottom of it, you can type that into your computer—you just simply click the link, and it takes you right to the website. 

One of the things that St. Croix has done, is they spent a lot of time on their websites making sure that the bereavement resources are there. They had Dr. Andy Mayo, who's their Chief Medical Director—one of the most amazing guys I've ever met in my life—actually does a really nice video on their website kind of welcoming them to the family, talking to them about grief and different processes, the steps of grief, the symptoms that you're going to feel. So if you get a chance, check out their website. It's cool.  
The other thing is, they made it really mobile-friendly, right? So most people—and I always say this, and it's a terrible thing to say—but the only good thing that COVID brought us was everybody now uses their cell phone. 

I was in the pharmacy the other day, and the lady in front of me was an elderly lady. And, you know, they asked her for her date of birth. And I overheard it, and she was 94 years old. And then after she was waiting for her medications, I peeked over at her, and she was on Instagram looking at recipes.And so, here's a 94-year-old lady looking at recipes. She's looking at recipes on Instagram, you know she's texting. And so that's a positive of this.  
Another positive is, I think people don't delete text messages. Some people do, but most people don't delete text messages. So if you have a great experience with St. Croix Hospice, and they're texting you on an ongoing basis, like Alyssa said, and then if you're a friend or family member, or somebody says, “Hey, who treated that patient?” 
 
They may not remember St. Croix. Everybody thinks St. Croix is down in the Bahamas.  

Alyssa: 
Yep. 

Tom: 
But they—it's easy to go find hospice, and then you can say, “Hey, it was St. Croix Hospice.” And, by the way, that link's hot all the time, so you can click on it. You can go back to it multiple times.  
Talk about, um, a little bit, Alyssa—so what has been the feedback from the family members or the bereaved contacts that you've seen? 

Alyssa: 
Yeah, I mean, we have received a significant amount of feedback from these text messages. I mean, from the beginning, we had a few of our own staff members that were a little bit, kind of hesitant about transitioning to a text message.  

But yes, we—you know, we have these at the palm of our hands now. We can click and navigate all of those resources, where we get a lot of text messages in return. And this is something—we didn't fully know was something that was even possible, that we would be able to see these responses that people text back.  

You know, you get those pretty typical thank you messages or the little emojis, things like that. But we've been receiving a lot of feedback from individuals who are talking about their experience with just hospice in general. So they're really able to kind of pinpoint specific care team members who are able to kind of—they're able to thank directly. And so we can take those instant feedback and then share them with our team. 

You know, those individuals, the nurses, the chaplains, the social workers, anybody who provided services—we can share their thank yous to them, and it'll help us continue to improve. And, you know, you get those few responses here and there, where they're just kind of opting out or saying, you know, “Thank you for your services. I don't need any more additional support,” and things like that.  
But it's been really nice to see those physical responses come through to help us improve our support that we're providing them. And if they're needing an increase in their level of bereavement support, we can increase that too. So it's just been mind-blowing seeing all those responses. 

Tom: 
Yeah, it's the thing that we didn't expect. You know, we expected people to engage a little bit, but not at the level they're engaging. And if you get a demo of nanaBEREAVEMENT, if you're out there listening to this and you get a demo, you'll see some of the responses that we've received. 

It's been unbelievable. It's almost overwhelming how good they are. And then being able to take those like St. Croix has and roll those up and hand them to the caregivers and say, “You took care of Mr. Jones and his family—um, you know, congratulated us on the most amazing experience,” and being able to pass that back to the social worker, the aide, the medical director, the department's leadership, being able to say thank you back to the caregivers. So we think that's a really big deal. 
 
So far, over the last couple of months, St. Croix’s at 7,304 text messages, and they've only had 20 people opt out. Some say “Stop. I don't need bereavement anymore.” Or, you know, say “I don't want texts. I want to continue letters,” or “I want to continue phone calls.” 

To me, those numbers are just fascinating. Like, I expect it to be a lot higher on opt out, and I expect it to be, um, less engagement. You have a 30.7% engagement score. So engagement means I either responded to the text message or I went to your website. Of those 7,304 texts that we sent, 1,775 people have gone to your website and actually clicked around, and we can see where they click and all those kind of things—blows my mind. Like, it's unbelievable. 

Alyssa: 
Yeah. And what's nice—yeah, and what's nice with that is that number doesn't fully even reflect the people who are revisiting that, because then on our end, we're able to revisit those numbers. Okay, we can see that our number is actually higher on that click-through rate of people going back or either sharing that link with another family member. 

Tom: 
It's, uh—it's—it blew my mind. Like, I was completely baffled by it. Um, what about—like, I just didn't know it was going to be this popular, and I didn't know it was going to be this positive. And we're seeing that in our other customers too. It's amazing. 

And like you said, people are sharing that text message. So if I'm a bereaved contact—my sister's not, my cousin's not—all that, but that's a really heartfelt message that St. Croix sent me. And this website is phenomenal with all these resources on it and, you know, videos and all those things. If I forward that to somebody else, they get that link too, and they can click on it, and they can go get grief and care themselves.  

In the old way, if I didn't want bereavement services anymore—I didn't need them, so I didn't want you to continue to remind me, you know, grandma passed away. It's sad. She's in heaven. All those things are great. But I wanted to stop bereavement. How would I stop bereavement in the old way? 

Alyssa: 
So the old way, if people wanted to stop bereavement, they could call us or send us an email ultimately, or wait until that next phone call when one of our bereavement coordinators are checking in. They can just say, “Nope, I don't need this anymore. My support is fine.” 

But with this new way, you know, they're getting these text messages. They can reply back, “Stop,” or they can even click on those links that are in our text messages that bring them to our landing pages, where there is a form on the very bottom of every single landing page where they can opt out of specific services that we provide during our bereavement services. 

So it's been really beneficial. I've honestly even seen an influx of people just responding back to that, just, you know, asking for more support. It's crazy that just us adding in this text message, we're getting more people saying, “Hey, I need support today. Can someone call me?” We're immediately able to set them up for another phone call, rather than seeing those people opt out the old way. Yeah, it was—they would have to wait until their next call to tell us, or they could always just pick up the phone and call us or email us. But most of the time we're not really even getting someone to speak to. We're usually leaving a voicemail for some of them. 

Tom: 
Yeah, it's awesome. It's, again, another area that I never thought about. So why continue to spend money and send, you know, letters or newsletters or postcards just to a patient that doesn't want them or to a family member that doesn't want them?  

Alyssa: 
Yeah. 

Tom: 
Let's talk a little bit about the implementation process. So as you guys were implementing, you did a phenomenal job on the websites and all that. What were challenges? What did you find easy? What worked? What didn't work? What would you do different if you could do anything different? 

Alyssa: 
Yeah, I think we went into it really just looking at this like, “Oh, we're so excited. We can switch to text messages,” thinking that it was going to be an easy transition. In the long run, like, we thought hard about, you know, if we're going to go into this and we're going to put everything into it, we're going to take the longer route to make sure we're doing everything right. 

We took our time making these landing pages and, you know, implementing as many things as possible. We have our surveys on the 1-month, 4-month, and closing text message. So we're slowly able to add all of these different moving pieces.  
I think that was the biggest piece for us, was we were so excited and ready to just like launch it and start it, that we kind of had to take that step back and really be like, “Okay, do we want to launch something that we're not really happy with or excited to be promoting and sharing? 

We're going to take a little bit longer time, implement all of those moving pieces, and then be able to send this out to everybody where everyone's happy, everyone's able to receive the right support, or navigate these pages correctly.” 

Tom: 
One of the other things that we noticed with the responses, so we were getting, you know, hundreds and hundreds, thousands of responses. I mean, we're getting—It's really bizarre how many people are actually responding to these text messages with really positive sentiment. And so one of the things that we worked with, with St. Croix, is to make sure that we connected.  

If I know the bereaved contact—I know the patient that passed away—I know the patient that passed away. I know the referral source.  If I know the referral source, then I know the referring physician. I know the admission coordinator. I know the salesperson, all those. 

So taking it and tying that together and being able to deliver this to, you know, the sales team to say, “Here are valid, true facts where people are saying, ‘St. Croix Hospice did an amazing job.’” How impactful is that? And how are you guys using that today? 
 
Alyssa: 
Oh, my gosh, it's been so impactful. I mean, being able to see these responses and then be able to immediately pinpoint, “This was the referring facility. This was the care team.” Being able to really dive into that without seeing that, that was something, again, that we were even going to get out of this—we're able to now immediately share that feedback with those team members.  

And we have also implemented at some of our different office locations, like, a reward system. So we receive a bunch of paper surveys back in the mail and, depending on how those responses are, you know, the more positive responses we get, their names are being put into a drawing to win gift cards for meals for their family every month.  

So we're able to implement these different reward systems for our staff to really encourage them to work directly with these patients and family members and share the excitement of this new text messaging system, but also allowing a space for people to provide that immediate feedback to us. 

Tom: 
Yeah. And can you share a scenario where we had the opposite of that, where we had somebody that, you know, wasn't a positive scenario or positive event, and then what do we do with those? 

Alyssa: 
Yeah, so there's a couple different situations that have occurred with that. You know, there's some people that are immediately texting back, “I don't need this service. Please stop texting me.” We're able to kind of look at our EMR system and kind of navigate, “Is this individual needing additional support from a different perspective?”  

We were able to kind of navigate what was their connection to that patient and to see what kind of support that they really needed. And then we had some people who are immediately texting back and they're like, “I need immediate support.” So they're not really sharing their thanks for the care team, but they're able to tell us that, “I need the support.” 

I'm able to quickly read these responses on a daily basis and reach out immediately to whoever is the assigned bereavement coordinator, social worker, chaplain, who is the one that's providing that support to them—to be able to share with them that, “Hey, someone can connect with you.” So it'll either be myself or one of those bereavement coordinators who are reaching out to them directly to see what kind of support they're needing in addition to that.  

Or even higher-ups, where they're able to kind of look into this and see because we've had some people respond about, you know, the negative care or something like that, that's not super in a positive experience, or where they're just confused on what happened—they're able to really dive into that and say, “Hey, what's going on?” And we're kind of able to calm them down in a different light, where we can then refocus back into that bereavement support for them. 

Tom: 
As we continue to enhance the product. We're putting the sediment in there, so it'll be positive, negative, or needs a phone call. So our goal is to read all these responses using machine learning and AI, and then flag them certain ways so that we can give them to you in a list so that you can follow up on—you know, if someone needs a phone call back, we want to put those into a specific list, escalate those to the highest level.  

You know, if someone, and I know we had a scenario where someone reached out and said, “You know, I really need additional support,” and we got the social worker to call them. I mean, I'm not. I don’t want to overdo that, but we might have saved a depression event or a really sad scenario. And, I mean, that's what this is about. This is about taking care of the families that would, you know—that we're part of a—you know, the patients that we took care of. That's awesome.  
Let's talk about ROI a little bit. So, um, current cost to do what's called metered mail is about $0.64 for the stamp. And then you have some change—let's call it $0.07 to $0.08—to create the letter, the newsletter, those kind of things.  

And then in the EMR, you process this. It puts the name and phone number and all that stuff on there, and someone has to roll that up and fold it. So usually the volunteers are doing that, which, which is awesome. Or the bereavement coordinators are doing that.  
ROI was a big deal as you guys were looking at this. Like, how—and by the way, for those of you that don't know, CMS doesn't pay you anything to do bereavement. That's part of the care. It's a requirement that you have to do. And so there's no additional funding for the bereavement services. It's just part of the program—the Conditions of Participation that CMS wants. But how are you seeing the ROI of nanaBEREAVEMENT and the cost compared to snail mail?  

Alyssa: 
Yeah, so we started this, you know—we started sending out our text messages about 3—2 ½ to 3 months ago is when we started to switch to the text messages. And so in just those few different months of us sending out these text messages, we noticed a 90% to 95% decrease in cost of mailing. 

So we would be sending like over 10,000 mailings for the month of July. And then we noticed that was down to, you know, maybe only 3,000 for the month of August. So we were noticing right away off the bat that we saved that huge percentage when it came to sending those pieces of mail. 

But then in addition to it, to see that individuals are still clicking on that link to still view these resources, so it's not being neglected in that aspect. And what's been really nice is that we didn't fully communicate with all of our team, our bereaved individuals, family members about this change. And for us to see that percentage change such drastically without having that full communication, we're continuing to hope and
see that this will continue to improve for us.  

And so, again, we've only sent out about half of our mailings via the text message. So once we start to transition that, we're going to continue to see that cost savings come along with it too. 

Tom: 
It's pretty amazing to me to see how fast it's been adopted and then, you know, with the instant ROI, right? If you're not just wasting money and paying that US Postal Service for metered mail, and text messages are the way that people want to communicate now. Everybody wants to communicate. 
We all text. If you don't text, you're not—I mean, it's un-American, I guess, to say that if you're not texting, ‘cause everybody does it. I mean, it's—I get thousands and thousands of text messages and same with emails. And so emails are tough.  

When we started building nanaBEREAVEMENT, we really looked at an app, right? 
 
We wanted to have a patient engagement app or a family member engagement app. We side away from that because the app requires username, login, multi-factor credentials, all that. So we went away from the app side of it and went to pure texting, which is—we think is why we have such a high compliance rate. 

Thoughts around that? I mean, do you think that was the right move for us, or do you think that we should have done something different there? 

Alyssa: 
No, I definitely am on board with just the text messaging thing, because if it were to go the app route, that's what I feel like sets this whole program apart is: going an app route, you have to then communicate with all these family members here. You have to download this app, and not knowing if people are actually going to download it, and then having to update these apps so frequently that, you know, eventually, it's just another app that just gets kind of pushed aside. 

Where text message, it's something more immediate. We can send it to them immediately. They can see it right away. They can revisit it. Where sometimes those apps—you know, those notifications—you're just kind of having them sit there and it's kind of more of a burden on those family members to remind them to check those. And it's not something that's as easily accessible as a text message. 

Tom: 
Yeah, I agree with you. We went way down the path of writing the app and then quickly shut it down and said, “That's not the right way to do it.” I mean, it's easy to build apps now. I mean, everybody has an app or something.  

What kind of advantage do you think, you know, being an early first adopter—St. Croix Hospice historically has done that. I mean, you were the first adopter of Muse. You were the first adopter of lots of tools out there. It's really cool. And I think it speaks really highly of, you know, Heath and Dr. Mayo and Stephen Phenneger and those guys that are in leadership—Susan Freeman for sure—that are in leadership there that, you know, want to be the first. They want to—they want to test these kind of things. What kind of advantage do you think that nanaBEREAVEMENT’s given St. Croix Hospice in the markets that you guys serve? 

Alyssa: 
I think the advantage to it is that we're able to really kind of create these programs or systems to really format what we feel is best going to fit and support those individuals in need. So if, you know, we're noticing that, like, “Hey, this isn't working,” we can immediately come back to you guys and say, “Hey, like, can we try this, this, or this?” 

And we're able to kind of work together on that to kind of build something that can continue to improve over time as we move in through the future. You know, 10 years from now, how can we continue to improve these? Rather than, “Here's a program. This is what's created. These are the things that it does,” and then not really allowing that space to continue to expand on areas, right? 

Like, we didn't know we could get those text message feedback right away. There were all these things that you can continue to change. Okay, now we can add that the care team is visible on these things. So I think being a team that can kind of be those first runners to kind of run through it, there's that advantage of it, where we can kind of build it to what we feel would fit our bereaved needs best. 

Tom: 
And I was talking to your Head of Sales, and, you know, if you get—if there's 7,304 text messages that have been sent over the last couple of months, you have a 30% engagement score. If you did the math on that, let's call it 3,000, um, estimate.  

So if every month, you were getting 3,000 St. Croix Hospice lovers, right, people that really loved what you did over a year's timeframe, I mean, you're going to have, you know, tons and tons and tons—50,000 people that love St. Croix Hospice. And so you're continuing to put the marketing message out about St. Croix Hospice—and now 50,000 people. 

So pretty soon, over a couple of years, you're going to have everybody in Minnesota, everybody in Wisconsin, everybody in Iowa that's going to know who St. Croix Hospice is. And these are people that are impacted by St. Croix Hospice. So I really think that's a really cool thing that you—as people begin to talk. 

And if I'm just sending you a postcard—you look at the postcard; you throw it in the trash, right? Or you hopefully put it on the counter or the refrigerator. But now that we're engaging with these family members of these hospice patients—so when they're at church or they're at the grocery store, they're at the post office picking up their snail mail, you know, they're having conversations. 
Someone said, “Who took care of, you know, Uncle Buck in hospice?” You're going to have that right there available. So it's an “aha” moment for me that I was like, “Holy cow. You're going to have all these people that love what you're doing.”  

I also believe that this will help in your HHCAHPS scores, because we're communicating more. We're communicating with the right people. We're sending them messages. We're giving materials. We’re communicating. And when there's a problem, we know that too. If they send a problem that says, you know, “I really didn't like my care,” or something happened or, you know, didn't —those get escalated into the environment and then some—you, Alyssa’s probably going to get somebody on the phone at that branch.  

Or maybe it's Heath, Dr. Mayo, somebody that's going to call that patient up and, “What did we do wrong? What could we have done better? How do we learn from this environment? How do we learn from these situations?” And I think it's a good teaching opportunity. So without that, if you had to send you a letter, you're just still mad at me, then I send you an HCAHPS letter—which is the, you know, the government survey. And now you're mad at me, and now I get a negative. And so if I can address the issues right away, it's better. And so I'm super excited about it.  

Alyssa, thank you so much. You've been just absolutely amazing. Desiree and Andy on my team love working with you. We love working with the St. Croix Hospice team. You guys are the best of the best, in our opinion. And you've grown like crazy. I remember when you guys were 500 ADC, you know, 14 years ago, and now you're at 5,500, 5,600. 

Alyssa: 
Yep. 

Tom: 
It's been an amazing—t's been amazing run. I think about all the families that you guys have touched and, you know, all the lives that are better. And so I just want to personally, for me, say thank you for all the help and work that you've done for us. 

Alyssa: 
Yeah, absolutely. You guys have been an amazing team to, like, work alongside with for nanaBEREAVEMENT and all of the other programs that are—we're working with or continuing to expand on. And, you know, nanaBEREAVEMENT has been my first interaction with your guys’ team directly, and it's just been phenomenal to see your support and helping us, you know, continue to expand in our organization across St. Croix Hospice. 

Outro 
Thanks for listening to the MHA Corner podcast. A special thanks to St. Croix Hospice for sharing their experience and demonstrating how they're using nanaBEREAVEMENT to deliver compassionate care to grieving families. If you'd like to learn more about nanaBEREAVEMENT or Maxwell Healthcare Associates, reach out to us at sales@maxwellhca.com or visit us at maxwellhca.com.