An Unexpected Savior: How PDGM Prep Helped Home Health Agencies Ease COVID-19’s Impact

Home health agencies spent 2019 prepping for the Patient-Driven Groupings Model (PDGM) — and it may have saved some of them from more dire outcomes tied to COVID-19.

As providers transformed to become more efficient and technologically driven, they inadvertently readied themselves for a public health emergency that no one saw coming.

“One of the things that PDGM did for us was promote continuous learning,” MaineHealth Care at Home President Donna DeBlois told Home Health Care News. “The focus for PDGM was all about changing how we manage care. … And then when COVID came along, it was a bit of a parallel; we switched to focusing on infection control and other wrinkles.”


Saco, Maine-based MaineHealth Care at Home offers home health services to eight different counties across the state and a handful of island communities.

Instead of being the “boogeyman” it was expected to be, PDGM ended up becoming an unexpected savior in some ways. A lot of the home health lessons gained from the new payment model and COVID-19 overlapped. 

Dallas-based Axxess, a home health technology company that develops cloud-based software solutions for providers, helped prepare agencies for PDGM. It has also recognized the benefits of PDGM being a precursor to COVID-19.


“We hadn’t really given much thought to that concept,” Tammy Ross, senior vice president of professional services at Axxess, told HHCN. “But once we did, we came up with a handful of points where PDGM prep would’ve helped prepare agencies for COVID. Some of those are very subtle, and some of them are pretty glaring.”

The overarching theme between the two was handling change, David Hoover, vice president of revenue cycle management for Axxess, told HHCN.

“I definitely think that some of the agencies’ preparation — and really understanding their businesses — did help them move through change,” Hoover said. “It prepared them for PDGM, and then another significant change with COVID.”

Providers were aware that there would be disruptions to their cash flow once PDGM was implemented. Anticipated payment delays and the reduction of Requests for Anticipated Payment (RAPs) on the front end forced agencies to have a better understanding of their billing and the timing surrounding it.

So once COVID disrupted billing, home health agencies across the country were more prepared to deal with it.

A keen understanding of their business and how to handle their money also helped agencies appropriately handle any grants or loans from the government during the public health emergency.

“I think it helped them manage those monies that the government issued or made available to agencies,” Hoover said. “That way, they knew what they needed, and they knew what they could do with that money. And I think that became a little bit of an advantage.”

Additionally, those agencies that found a way to predict what kind of money would be coming in during each payment period helped them forecast changes to their revenue in 2020. Providers had an idea of what may happen to their bottom lines, allowing them to skillfully manage sudden revenue swings.

“We talked with providers about being prepared for potential Low-Utilization Payment Adjustments (LUPAs) because there was going to be an increase due to PDGM,” Hoover said. “There were several issues with getting people to continue their visits during the pandemic. And I think managing the schedule, really understanding that LUPA potential, being a little bit more detailed and applying the right resources probably has helped them often during COVID.”

Staffing and touch points

PDGM — and the change from volume to value — adjusted the way providers thought about visits and staffing.

For MaineHealth Care at Home, it moved toward an interdisciplinary team model where clinical managers work much more closely with clinicians during care management and planning.

“When COVID hit, that actually ended up being extremely beneficial because people were working much more remotely — and we were discouraging them from coming to the office at all,” DeBlois said. “So this small-team model, actually, was a really nice precursor.”

Still, increased unemployment benefits, fear of COVID-19 and workers being infected or exposed to the virus themselves all contributed to an even worse staffing environment in 2020. That’s why provider efforts to handle staffing and visits more efficiently in Q4 2019 came in handy later on.

“They already started reinventing ways to get to the same quality outcomes, but maybe with less visits,” Ross said.

PDGM — and then COVID-19 — has thrust the home health sector into rethinking its staffing models, making operators more fluid and adjustable as a result.

Reducing in-person visits has also been important because it minimizes touch points between seniors and workers as the virus spread across the country.

“With PDGM, we started talking about how you could scale to need and how you didn’t need all these full-time staffers, but you could have people that want to fill in here and there,” Ross said. “Well, when the pandemic hit, that became huge. Workers were even able to cross state lines under the emergency management system to fill need. … Because we started talking that language during PDGM prep, it really prepared the workforce to be utilized [efficiently].”

Technology adoption

The entire health care system has driven the point home since March of last year: The technology revolution is here.

Home health providers are delivering far more telehealth visits than they ever have. They have more employees working remotely. They have to conduct business over the phone or a computer more often.

“We used telehealth and reduced face-to-face contact to once per week,” DeBlois said. “So that has worked out really well. And because of our early adoption with telehealth, we were suddenly approached by other parts of our health system and asked to help manage their patients with [remote care] at home.”

MaineHealth Care at Home was an innovator in telehealth. But across the sector, PDGM forced agencies to update their systems.

“When preparing for PDGM, a lot of agencies really upgraded their platforms,” Ross said. “Some of the EMR platforms just weren’t doing what needed to be done for PDGM. So I think they did invest in upgrading their platforms, which, again, put them in a much better place to control their operations during the pandemic.”

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