Data Analytics Arms Race Continues Ahead of PDGM

With the implementation of the Patient-Driven Groupings Model (PDGM) less than four months away, agencies continue to prepare for the biggest reimbursement change the industry has seen in about 20 years.

Technology and data providers are rolling out tools to help agencies rise to the challenge. Most recently, WellSky launched a new data analytics solution for home health. The company has been working on PDGM tools for more than a year.

Overland Park, Kansas-based WellSky is a health and community care technology company backed by TPG Capital. Its new Home Health CareInsights tool uses predictive analytics to provide insights on hospitalization risk, social determinants of health, care setting suitability and LUPA risk.


“Our system is currently making about 3.5 million predictions per day,” Wes Little, vice president of analytics for WellSky, told Home Health Care News. “For each individual patient, the moment that data is saved out in the field by a clinician, it’s immediately going through our algorithm and running a new prediction on that patient in just under one second. Having that speed of insight, caregivers and the whole care team know right away when something has changed.”

CareInsights draws from more than 7 million home health patient episodes to make its predictions and recommendations. PDGM was the driving force behind the tool’s creation, Little said.

“We think home health care is at a turning point where integrated insights go from a ‘nice to have’ to a ‘must have,’” he said. “That was the reason for our organization investing as much into this predictive solution of care insights.”


Already, five organizations have implemented the solution, with thousands of clinicians using it every day. The idea is to integrate the insights into the workflow of caregivers who have their hands on the patients to inform better care and improved outcomes.

“What we’ve done is actually put every single patient into one of the 432 PDGM groupings they’ll be assigned Jan. 1,” he said. “We’ve taken CMS’s same groupings logic and helped organizations understand … not only the total number of visits that [a patient] would typically receive with a positive outcome, but also the type of visits.”

Efficiency and outcomes become especially important under PDGM, as reimbursement is more closely tied to patient characteristics. Utilization alone is less of a payment driver.

As such, a number of companies have set out to help agencies navigate the changes. In addition to WellSky, Predictive analytics firm Medalogix and post-acute data and growth solutions provider PlayMaker Health — both based in Nashville — are also in that camp.

“Data broadly is important to understanding where you stand and where you might fare under PDGM,” PlayMaker CEO John Griscavage previously told HHCN. “Then, [it can tell you] what you can do proactively to anticipate those changes and make modifications to your referral stream, relationships, market education and even clinical pathways.”

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