Creating Value Based Home Health Programs for Improved Outcomes

Transcription

1 Creating Value Based Home Health Programs for Improved Outcomes HHSM Executive Clinical Director Melissa Couty BSN HH National Clinical Director HHSM Progressive HH Clinical/Operations Firm Founded by Arnie Cisneros Post-Acute >30 yrs SURCH - UR Protocol - nationally for HH Providers Daily HH POC development and management HHSM UR Pioneer ACO PAC Med Adv Auth Bundled Payment for Care Improvement (BPCI) HHGM Clin Management Model Unique to HH Post Acute PPS 30 Day PAC Bundling (2021) Healthcare Reform Arrives in Terms of Value (versus Volume) Programming 1

2 Home Health Value Programming Changes Fiscal Results tied to care quality performance Increased attention to Care Intrinsics required Traditional Care Approaches now defunct Clinician i i Managed care WON T WORK Focus Independence, Acuity, Compliance Increased Reporting, Communication Lacking HH Utilization Decreased Payments Home Health Value Programming Changes Management of Nursing/Rehab Volumes Safety Based Clinical Frequencies Provider Control of Scheduling/Productivity Programs change due to in episode progress MD care management altered to Value goals Care volumes altered due to acuity identity Care delivery & value changes = STRESS Why Value Programming Works for the Home Health of Tomorrow 2

3 Why Value Programming Works for Home Health Improves Care Quality/Results for CMS beneficiaries Offers a quality HH response to Reforms and Cuts Assures Optimal Payment and Quality HH Outcomes Directly addresses Star Ratings Quality concerns Resolves CMS Reform Focus ER visits, Readmits Manages care on an IN-AGENCY basis SOC to DC Rewires Volume model for front-line clinical staff Care platform for future Value Models (PAC PPS) Utilization Review Management of Home Health for Value Outcomes (Volume to Value Shift) Utilization Review Management of Home Health Creates episode expectations and specific care plans for programming based on QA identified clinical concerns or deficits. A refined clinical profile is employed to create an individualized patient program modified in an ongoing manner through In Episode Management for response to treatment, clinical efficiency, skill management, required documentation, and rapid value outcomes. 3

4 Relation of Clinical to Fiscal Factors in Home Health Programming Model Review of HH PPS Model for Clinical & Fiscal Identity HH 60 Day Certification Period up to 60 days of care Acuity based Case Mix creates Cost based HHRG rate OASIS Admission Assessment cornerstone of HH PPS OASIS Multi System/Discipline global assessment HH POC reflective of OASIS clinical profile declines HH Clinical disciplines Evals Objective POC Program Skilled HH Episode thru CMS required HH content Episode DC or Recertify Goals met or Another 60 Days Home Health PPS Clinical vs. Fiscal Analysis HH PPS incorporates both CLINICAL &FISCAL elements Clinical Factor is the primary driver in HHRG care model Clinical component is based on patient acuity level Patient acuity established via accurate OASIS admit Clinical Acuity connects to Fiscal Identity (HHRG) Clinical acuity & Therapy volume determine CMI HHRG Higher Acuity patients = Higher Case Mix & HHRG rate Relates to value of accurate OASIS SOC data 4

5 How Volume Approach & Operational Inefficiencies relate to Value-Based Programs How Volume & In-Efficiency affect Home Health Value Volume 60 Day Cert Period approach Post Acute Care Volume Lack of timely interventions SOC, Evals, Visits Volume Lack of Global Program, clinical schedule model Volume Lack of Safety Based frequency limits acuity Inefficiency Inaccurate OASIS, Admit POC development In Efficiency Decreased content focus audit issues In Efficiency Lack of content increases volume to goals In Efficiency Lack of DC Control leaves uncovered care How Clinical ID Affects Case Mix in Home Health PPS Model 5

6 Clinical Factors affecting Home Health Case Mix HH PPS is based primarily on patient clinical identity OASIS admission document determines patient specifics OASIS has been challenge for Home Health since intro Timely admission, struggle for accuracy, INTERVIEW OASIS accuracy rates = 70% despite ongoing education Inaccurate OASIS ADL profile both nursing & rehab OASIS DC more accurate than Admit we learn patients Lack of Global programs Multi System/Discipline SOC Operational Areas in Home Health Model that Compromise Clinical Acuity Home Health Operational Areas affecting Acuity ID Intake Integrity Incomplete intake data limits timely SOC OASIS Admit Inaccurate Case Mix clinical data profile POC Development Inaccurate OASIS data, non global Scheduling Control Managed by front line staff, MV Documentation Review Unqualified Evals, Visit notes In Episode Management Assures rapid, skilled progress Rapid Outcomes Timely goal resolution vs. increased LOS Discharge for Outcomes Independent DCs, dovetail DC 6

7 Management of Home Health Operational lareas for Value Results Home Health Operational Management for Value Intake Scripting for complete referral for 24 hour SOC OASIS Collaborative SOC Accurate profile, functional walk POC Development Global POC (30 day) by decline depth Add on Disciplines 48 hour addn disciplines, connect to SOC Scheduling Control Safety Based Frequencies MV mgmt Documentation Review Unqualified Evals, routine visit notes In Episode Management Weekly clinical rounds Rx to date Discharge for Outcomes Rapid outcomes, Post DC HP Fiscal Results of Value Based Home Health Episode 7

8 Fiscal Results of Value Based HH Episode $150 Accurate and evolved OASIS SOC data (5%) $600 POC control Nursing & rehab visit totals (22%) $200 Ongoing real time schedule control, loss of MV (7%) ($??) IEMs assure skill, Patient/Cgvr status, desired goals (4.5 5 Star) Assures Value Based Purchasing bonus Fiscal results from Utilization Review versus Traditional HH Total Bottom Line HH Savings >30% versus HHRG benchmark Addresses HH reforms, ACO mgmnt, HHGM, Post Acute PPS Summary of Operational Approach to Value Based Home Health Care Operational Summary re Value Based HH Care HH Volume legacy hampers program value and outcomes Burden Over reliance on Volume Structure of HH PPS model Demos value of Clinical Acuity Management for HH success SOC & Eval accuracy, Efficient SOC DC operational mgmt HH Reforms address value in operations/payment structure Increase Clinical & Operational value, decrease volume Reforms require Utilization Control for value model install Rewire HH agency in value terms for HHGM, VBP, PAC PPS 8

9 Home Health Strategic Management HHSM 9