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Almost all home health providers want to get into value-based care. Many don’t know where to start.
Performance-based benchmarks like patient satisfaction, timeliness of care and staff efficiency are all metrics they should begin to track diligently. That will come in handy when negotiating value-based care deals in the future.
“Quality metrics are extremely important, of course, but at the same time, they are a single piece to the overall health care puzzle,” Amy Kaszak, EVP of strategic initiatives at Curana Health, told Home Health Care News.
Curana Health is a Texas-based post-acute care organization with multiple business segments that include a provider-led medical group — Curana Health Medical Group — Medicare Advantage health plans from AllyAlign Health and a Medicare Accountable Care Organization called the Curana Health ACO.
Many home health providers recognize they are not in the position to take on full risk just yet, banking on their clinical outcomes to be the main selling point in a value-based negotiation with a payer.
Kaszak has a unique perspective given Curana’s place as both a value-based payer and provider.
She believes providers can – and should – sell themselves through performance-based benchmarks that are becoming more important to payers.
“You can only control what you can measure or what you can directly contribute to, and I think a great place to start is around patient experience and patient satisfaction measures,” Kaszak said. “Those measures are very important to value-based organizations. The answers to the surveys are going to directly impact ACOs’ quality score, very similar to the Medicare Advantage side with the CAHPS surveys.”
CAHPS surveys, or Consumer Assessment of Healthcare Providers & Systems, are designed to reliably assess the experiences of a large sample of patients.
Those surveys, and others like them, hold a lot of weight and are something providers should prioritize when trying to improve quality measures.
“Patient satisfaction speaks for itself,” Lisa McClammy, a senior clinical education consultant with MAC Legacy, told HHCN. “We want our patients happy, we want them to feel empowered and want them to feel like they’re valued. It’s always been such an important aspect of what these providers do, but I think with the rise of value-based purchasing, these points become so much more important.”
MAC Legacy is a Denton, Texas-based home health and hospice coding and consulting company.
McClammy said that performance measures like patient satisfaction and timeliness of care can be tied together, because they both should answer the question, “Does the agency value the patient and what kind of care is being provided?”
“Timely initiation of care is a great one because it puts the emphasis on, ‘Does the agency value the care that is being provided enough to make sure they are intaking that patient in a timely fashion?’” McClammy said. “You’re getting that patient for a reason, so you want to get any intervention started as soon as possible. Agencies that put a priority on that tend to shine above those that don’t.”
First impressions also go a long way.
“You can’t teach culture, but you can teach your clinicians how to empower a patient through their care program and then eventually develop a culture based on how you provide that care,” McClammy said.
New quality measures
A motivator for home health agencies to get into value-based care is Medicare fee-for-service rate cuts.
The more strategic home health agencies have started to enter risk-share agreements with health systems, ACOs, MCOs in order to prove their value, Jon Higginbotham, VP of business development at Homecare Homebase (HCHB), told HHCN.
“It makes a lot of sense because, even if I have a capitated amount of money or if they want specific rehospitalization metrics in order for me as an agency to get my maximum reimbursement, it’s still going to be better than what a lot of the MA payers and commercial payers are paying per visit,” he said. “If you’re not measuring your metrics, specific to what is important when it comes to payers and Medicare, then you’re at a really big disadvantage.”
The Dallas-based HCHB is a home health and hospice software company.
A newer metric that the company was able to build a unique dashboard for is non-visit discharges.
Essentially, a non-visit discharge happens when a patient or family will call their provider to tell them their loved one is fine, doing better and doesn’t need home-based care services anymore.
“But the problem with that is CMS guidelines say that you still have to fill out a discharge OASIS for that patient to capture certain information,” Higginbotham said. “And you have to use the last in-person visit as the guideline for outcomes. I’ve always had this gut inclination that there has to be a correlation between outcomes and non-visit discharges.”
After building the dashboard, HCHB found there was more than a correlation.
“It’s significant,” Higginbotham said. “We’re talking about a 10-point percentage swing on almost all of the value-based purchasing measures. TNC mobility, TNC dyspnea, all of that. I would say all of the OASIS-driven measures are significantly impacted by non-visit discharges, so if I want a quick boost to my outcomes, I need to do everything in my power not to have non-visit discharges. A lot of it starts with communication at the very beginning of admission because it really is all about education at the end of the day.”
Reducing hospitalizations and lowering emergency room visits are worthwhile measures to focus on.
But OASIS and discharge planning education doesn’t take a lot of time to fix and can be “such a significant boost to a provider’s outcomes,” Higginbotham said.
On the other hand, another key metric providers should be paying attention to is missed visits.
One of the industry’s biggest blindspots from an operational standpoint, Higginbotham believes, is automated communication between provider and client.
“I think something that’s been lacking for a very long time is automated patient/family communication,” he said. “That could prevent missed visits — missed visits cause worse outcomes and so there’s this synergistic effect. We developed a notification system that sends out an automatic message reminding people when they have an appointment. We’ve seen this trend inform the patient to where they’re more apt to understand that they need care, and number two, that it saves time in the day for the clinician.”