Similar to all Medicare-certified home health providers, CHI Health at Home has spent the past several months developing and executing on its Patient-Driven Groupings Model (PDGM) Strategy.
The Milford, Ohio-based integrated care provider has at least one unique advantage over its peers, however. CHI Health at Home is part of CommonSpirit, the $29 billion health system formed in early 2019 following the realignment of Catholic Health Initiatives and Dignity Health as a single organization.
One of the largest nonprofit health systems in the country, CommonSpirit’s footprint currently spans nearly two dozen states, spread across 137 hospitals and over 700 individual care sites. That scale means CHI Health at Home takes care of millions of patients over the course of the year, the bulk of whom come from CommonSpirit’s institutional settings.
“We serve a large population of patients across a diverse geography,” Dan Dietz, CEO of CHI Health at Home, told Home Health Care News.
As a main home-based care arm of CommonSpirit, CHI Health at Home offers a mix of home health, hospice, home infusion and home respiratory services. In a couple markets, CHI Health at Home also offers medical transportation services.
Overall, CHI Health at Home operates across roughly 75 sites of care. Its average daily home health and hospice census is about 14,000 patients.
Dietz, a long-time home health industry veteran, first joined CHI Health at Home when the Prospective Payment System (PPS) was put in place. To lead CHI Health at Home through today’s major reimbursement overhaul, he has helped come up with a six-point strategy.
“I started right at the beginning of PPS,” Dietz said. “People warned me that there was this big change coming — and it was a big change. PDGM is going to have some similar impacts on the industry.”
One of the priorities for CHI Health at Home in the new PDGM landscape is strengthening its already impressive list of hospital and health system partnerships, according to Dietz.
On a fundamental level, PDGM is a new patient classification model with 432 case-mix buckets based on admission source, timing, co-morbidities, functional impairment and clinical groupings. The “admission source” part of PDGM links reimbursement to whether patients are coming from the community or from institutional referral sources, generally with higher reimbursement rates for the latter.
Institutional referral sources include hospitals or skilled nursing facilities (SNFs), for example.
“As you’re probably aware, there’s a look at where the patient is being discharged from or being admitted from into home health care,” Dietz said. “Nationally, I think it’s about 25% of patients are coming from facility or institutional settings.”
Within CHI Health at Home, that figure is about 75%.
While some of those institutional patients come from CommonSpirit, many come from elsewhere. In total, CHI Health at Home has partnerships with 12 other health systems outside of CommonSpirit, some relationships nearly as old as CHI Health at Home itself.
“It’s primarily so much higher because our approach to growing in our markets and supporting our communities has been around relationships with health systems, whether that’s a CommonSpirit health system or another in the market,” Dietz said.
Apart from the referral source advantage under PDGM, the strong health system presence also means CHI Health at Home has already been taking care of acutely ill, very sick individuals, the CEO noted. PDGM is a model designed to more closely tie reimbursement to patient needs, so that gives CHI Health at Home an edge as well.
Due to PDGM’s immense complexity, Dietz has also made accurate coding and OASIS completion a priority for his organization. That has included investments in clinician training and an outsourced coding vendor, he said.
“We spent a lot of time with clinicians and clinical managers across our footprint to ensure folks were appropriately answering all the OASIS questions and looking at how PDGM would change them,” Dietz said. “It’s about making sure we’re appropriately coding patients and addressing all the questions that come through OASIS to the best of our ability. A significant amount of training has gone into that clinical team.”
A third priority related to the clinical team: making sure they’re following evidence-based, clinical practices.
“We’ve developed a lot of different programs to support that,” Dietz said. “For instance, we’ve developed a career ladder for RNs. And we now have a population-health nurse level within our organization, a position that we often utilized to serve our most at-risk populations.”
A ‘better together’ culture of care
Health system partnerships, coding and clinical practices make up the first half of CHI Health at Home’s PDGM strategy. Physician education, data and organizational buy-in make up the remaining priorities.
Generally speaking, PDGM isn’t just a big change for home health providers. A whole new set of rules also make it a huge shift for the physicians who have been referring patients to home health.
Perhaps the best illustration of the change from PPS to PDGM for physicians falls under “generalized muscle weakness,” once a common reason to send patients to home health services. Now, generalized muscle weakness is no longer an acceptable diagnosis.
Historically, the U.S. Centers for Medicare & Medicaid Services (CMS) hasn’t done a great job of educating the physician community when there’s a big Medicare change that doesn’t directly involve them. As a result, Dietz said, home health providers need to turn into teachers — or risk intake setbacks.
“We’ve made sure we were providing a high level of education back to our partners in our different communities,” he said.
When it comes to data, CHI Health at Home has worked diligently with its EMR partner, Homecare Homebase. Specifically, the two have teamed up and are in constant communication to model PDGM, figuring out what it means for CHI Health at Home on a market-to-market basis.
CHI Health at Home expects PDGM to be largely neutral — or even slightly positive. It’s especially likely to have a positive financial impact in markets where CHI Health at Home’s institutional referrals are particularly high, Dietz said.
In terms of shifting therapy utilization patterns based on those projections, CHI Health at Home is largely standing pat.
“We’re not going to avoid taking care of patients that have therapy needs,” Dietz said. “We have competitors in almost every market that, in the past, have been almost exclusively therapy. But that would not be how you describe our mix.”
CHI Health at Home’s final PDGM priority: implementing a “better together” culture of care. For Dietz, that means constantly learning while gleaning new insights from his organization’s entire footprint and health system partners.
“We rely on identifying experts within our own organization to help us develop best practices,” Dietz said. “And as we go into new markets or work with new hospitals, we always find new best practices to take back to our entire footprint, whether that has to do with PDGM or other things. This is something we really work hard on and nurture.”