Unlock the Keys to Value-Based Care and Alternative Payments

 Bundles / Financing 
 Technology 

Agency
Home Healthcare Hospice and Community Services, Keene, New Hampshire.

Agency Description:
Home Healthcare, Hospice and Community Services (HCS) is a visiting nurse and hospice serving southwestern New Hampshire. HCS has provided comfort, care, and support to people at home since the first visiting nurses started in the Peterborough area in 1907.
More than 100 years later, Home Healthcare, HCS is a unique organization serving the region's communities with comprehensive nursing and therapy services that help speed recovery after a hospitalization and provide independence at home for those who are chronically ill. From visits to newborns to comfort at the end of life through our hospice program, Home Healthcare, HCS is there for all members of your family.

HCS is a local, nonprofit organization. Many services are funded by Medicare, Medicaid, private insurance plans, and grants. No one is denied the care necessary for their health and safety solely on the basis of ability to pay.

Home Healthcare, HCS is Medicare certified and licensed by the state of New Hampshire as a home care provider. HCS does not exclude, deny benefits to or otherwise discriminate against any person on the ground of race, color, national origin or on the basis of disability or age in admission to, participation in or receipt of the services and benefits of any of its programs and activities or employment therein.

Population Impacted:
Medicare-eligible beneficiaries utilizing their home health benefit.

Strategic Partners:
Home Health Strategic Management, Inc., Arnie Cisneros Strategic Health Programs.

Project Description:
New care and programming models outlined in the Affordable Care Act have arrived, and home health providers face changes that alter many of our historical community care delivery practices. Value-based purchasing, comprehensive care for joint replacements (CCJR), readmission efforts and alternative payments challenge the status quo for post-acute providers. Value-based care delivery is achieved and can be accounted for through standardizations and protocols for documentation, visits , and internal processes for measuring and monitoring progress toward a clinical goals. Clinical and fiscal breakdowns of home health programs identify areas of opportunity for rewiring in terms of value rather than volume.

The agency retained oversight and management of care delivery, thus allowing the determinations of visit frequency, care planning, and discharge planning to remain in the hands of individual clinicians.

By using a service utilization model and interpretation of OASIS data to determine the type, frequency, and intensity of services, the clinician is able to more readily focus on the delivery of care. Management oversight of clinicians requires intense management of the care plan and results in improved communication and documentation that address the elements required by regulation and achievement of patient goals efficiently.

Results:
Seventy-three percent increase in case mix weight and a 73 percent increase in reimbursement retained for nine months. Improved recruitment and retention of clinical staff. The episode length of stay decreased from 56 days to 33 days. Rehospitalization rates within 30 days decreased from 15.5 percent to 7.2 percent.

Outcome Measures:
Using Strategic Health Programs, the overall improvement in all process and outcome measures is statistically significant. The CMS Star Rating is holding at five stars as measured monthly in SHP data scrubber. Home Healthcare, Hospice and Community Services was measured at three Stars by CMS at the onset of implementation of the program. Improvement in the Star Rating data and outcome measurements in the publicly reported outcomes are expected to reflect this improvement, but it takes a year to see the change. 

Barriers to Implementation:
Inconsistency regarding OASIS assessment data interpretation creates inconsistency in outcome measurement and reporting. Leaving this valuable and critical interpretation to the clinician collecting the data promotes inconsistency in care delivery and care planning. This, in turn, contributes to patients receiving care they may not need or not enough care being delivered. In addition, increased utilization of rehab visits to achieve outcomes required more physical therapists and occupational therapists produced an increased stressor on scheduling and resource management of therapy caseload and visit volume.