“Data” is often cited as the magic bullet for health care providers, especially when it comes to improving quality of care, negotiating with payers and building relationships with stakeholders throughout the care continuum.
Count Premier Home Health Care as one of the latest home care companies trying to take its data game to the next level.
New York-based Premier Home Health Care is a home care company that provides care management, assessment services, live-in care, companionship, in-home respite care and in-home rehab services to roughly 34,000 clients. In addition to New York, the provider operates in New Jersey, Massachusetts, Florida, Illinois, North Carolina and Connecticut.
Currently, the company works with a diverse payer mix, including Medicaid, Medicare, Medicare Advantage, ACOs, commercial insurers and managed care while also operating on a private-pay basis.
For a company like Premier, which has been around since 1992, innovation and data became increasingly important as the health care landscape evolved. Over the past several years, that evolution has included a rapidly aging population and a worsening caregiver shortage.
In 2012, Premier moved out of the fee-for-service space and into the value-based payment world.
While carving out a place in the new health care landscape, Premier decided to start collected data through its caregivers.
“We realized that our [caregivers] were one of our best assets,” Jennifer Gentzlinger, vice president of strategic development at Premier, told Home Health Care News. “That [caregiver] knows more about [our patients] than almost anyone else on their interdisciplinary team because they are the eyes and ears in the home. They are there almost every day.”
For example, in Premier’s New York market, the company averages anywhere between 130 to 150 hours a month of direct care in the home, according to Gentzlinger.
To collect data, Premier uses its telephone-based Electronic Visit Verification (EVV) system.
Each caregiver in the home has a set of questions that go along with a client’s specific care plan. The company’s real-time data platform then allows the collected information from the home to go back into the company’s system and over to a care manager.
“If somebody had a recent hospitalization and has a history of experiencing sepsis, we go through an education curriculum that will teach [caregivers] what they should be looking for in the home,” Gentzlinger said. “They are able to take this and actually provide timely, appropriate interventions to keep this person living safely at home.”
In general, Premier uses data in three ways: real-time information used in interventions to prevent hospitalizations, as a quality measure to close gaps in care and as a source to develop best practices from a population health standpoint.
And over time, the goals of Premier’s data collection efforts have changed.
Initially, the company focused on specific quality measures before moving to the six potentially avoidable hospitalization diagnoses determined by the New York Health Department: anemia, congestive heart failure, electrolyte imbalance, respiratory infection, sepsis and urinary tract infection.
Since the company began utilizing real-time data, Premier has seen significant improvements in their quality scores, which is important for its value-based payment arrangements.
Currently, the company has 14 value-based arrangements with different health plans.
“The data points that we measure tie back to particular indicators that plans are looking for in our contracts and/or what they are being required to track by their government payers,” Christy Johnston, vice president of governmental and managed care services at Premier, told HHCN. “The other piece is … we are collecting the data and using it internally, and while we rely on the scorecards that come from our payers, we don’t want to simply sit back and wait for that data.”
Premier’s biggest takeaway when it comes to value-based arrangements and the role that data plays is that there isn’t a one-size-fits-all solution.
“As a community provider, as somebody that is looking to maintain boots on the ground with the populations that we serve, you have to be flexible and meet the payer and population where they are,” Gentzlinger said. “You can’t say, ‘Well this is my cookie cutter [solution], this is how I do things.’”
To enter its various value-based arrangements, Premier has had to learn what each payer is up against and where each payer was falling short in terms of quality metrics. Premier also spent time figuring out who each payer was serving, a task that included studying the needs of those individuals, according to Gentzlinger.
“From our perspective, the value is what [payers] define it to be — and that’s where we have had success,” she said. “Being able to meet these people where they are and adjust our particular product to meet their needs.”