Home Health and Hospice Value Proposition Using Data · and new payment reform models, is...
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Home Health and Hospice Value Proposition Using Data
Transcript of Home Health and Hospice Value Proposition Using Data · and new payment reform models, is...
Home Health and Hospice Value Proposition Using Data
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Home Health and Hospice Value Proposition Using Data
Raymond BellesManaging Consultant
Learning Objectives
• Define the environmental factors that are changing behavior in the continuum of care
• Understanding the key components of an influential value proposition
• Outline key data elements building a value proposition to drive relationships across the continuum of care
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Learning Objectives
Define the environmental factors that are changing behavior in the continuum of care
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Environmental Factors
• Accountable care organizations (ACO’s)
• Alternative payment models
• Physician alignment
• Hospice proposed payment rule for 2020
• Payment driven grouping model (PDGM)
• Collaboration across the continuum of care
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Learning Objectives
• Define the environmental factors that are changing behavior in the continuum of care
• Understanding the key components of an influential value proposition
• Outline key data elements building a value proposition to drive relationships across the continuum of care
Alternative Payment Model Structure
• Risk Based Modelo Retrospective reconciliation for hospitals
o Target price
o Inclusions/exclusions
o Anchor stay +90 days post-discharge
o Collaboration dependent
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Physician Alignment
• Development challenges
• Consensus on protocols and standardization
• Skepticism in data and measurement
• Concern with clinical decision making
• Perception of profit sharing
• Lack of trust
Hospice Proposed Payment Rule 2020
• Rebasing of continuous home care (CHC), Inpatient respite care (IRC), & General inpatient care (GIP)
• An estimated annual payment update of -2.7 percent/elimination of the one-year “lag” in use of hospital wage index so that hospices are not a “year behind”
• A proposed FY2020 aggregate cap amount of $29,993• Significant changes to the patient election statement and
addendum to ensure greater transparency regarding non-covered services and safeguard patient rights
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Hospice Proposed Payment Rule 2020
• A request for information on the role of hospice and coordination of care at the end of life, (how to include hospice into other care delivery models like Medicare Advantage)
• Updates to the hospice quality reporting
Payment Driven Grouping Model (PDGM)
• 30-day payment periods
• Therapy utilization removed from payment model
• Addition of admission source
• 12 clinical groupings based on diagnostic category (from claims)
• Comorbidity adjustment (from claims)
• Case-mix weight / LUPA thresholds
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Hospital Drivers
• Oversight of Medicare spendingo Two-sided risk model with hospitals bearing the financial
responsibility
• Continuum of care qualityo “preferred provider”
o HH and SNF compare websites
o Increased use of “navigators” for enhanced patient hand-off and coordination
• Physician engagement
Collaboration
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Maybe the Biggest Environmental Factor
DATADATA
Learning Objectives
Understanding the key components of an influential value proposition
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What is a Value Proposition?
• An innovation, service, or feature intended to make a company or product attractive to customers.
What does that equal for the Health Care Continuum of Care???
What is a Value Proposition?
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Home Health and Hospice Value Proposition
Improve the
Patient
Experience
Improve
Outcomes
TRIPLE AIM
Lowering the Cost of
Care
The Landscape is Changing
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The Landscape Today
• Availability of information, increased focus on quality, and new payment reform models, is substantially changing referral relationships and patterns.
o Star Ratings (Home Health and Hospice Compare)o Quality Assurance & Performance Improvement (QAPI)o Narrowing Networkso Evaluating Payment Patterns Electronic Report (PEPPER)o Continuum of Care Spending Data (CMS Claims Data)
Target Audience & What They Care About
• Hospitals
• Physicians
• Skilled Nursing Facilities
• Community groups
• Other actual or potential partner agencies
• Patients/families
• Payers
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What is Important to the Audience?
• Timelinesso Response time
o Yes we can attitude
o Hours of operation
• Thoroughness
• Communicationo Internal/external
o Frequency
Learning Objectives
Outline key data elements building a value proposition to drive relationships across the continuum of care
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Building a Value Proposition
• Assess the organizationo Identify strengths, weakness, opportunities, & threats
(SWOT)
• Build a plano Leverage strengthso Outline action to be take on weaknesseso Build on opportunitieso Define how threats will be monitored
• Leverage the data
Identifying Key Data Elements
• Assess the organizationo Identify strengths, weakness, opportunities, & threats
(SWOT)
• Build a plano Leverage strengthso Outline action to be take on weaknesseso Build on opportunitieso Define how threats will be monitored
• Leverage the data
Improve the
Patient
Experience
Improve
Outcomes
TRIPLE AIM
Lowering the Cost of
Care
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IS YOUR ORGANIZATION DATA CENTRIC ?
Core Values Of A Data Centric Organization
• Data belongs to everyone in the organization
• Data is a n asset
• Buy – in from top down
• Transparency and information sharing is KEY
• Data quality is a number one quality
• Setting KPIs are critical to success
• Be data harvesters
• Practice an analytic culture
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Key Value Proposition Components
• Market analysis
• Quality/patient satisfaction
• Continuum of care spending
• Collaboration
Understanding Your Market
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Analyzing Your Market – County Level
Analyzing Your Market – Home Health
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Analyzing Your Market – Hospice
Analyzing Your Market – Hospital Discharges
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Identifying Hospice Physician Opportunities
Identifying HHA Physician Opportunities
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Quality/Patient Satisfaction
Episode Volume by DRG
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Average Episode Total
Average Episode Total
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Collaboration
• Internal
• External
Collaboration
• Communication – across the organizationo Lead with data
o Get buy- in from top down
o Describe your organizations place in the market
o Define why quality and continuum of care spending are equally important
o Hospitals have your data
o Everyone in the organization is a marketer
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Home Health & Hospice Value Proposition Using Data
Raymond BellesManaging [email protected]
