There has never been a more important time for the home care industry. In terms of preference and in cost-effectiveness, home health care represents the greatest hope for meeting the needs of the estimated 10,000 baby boomers turning 65 every day for the next 15 years. This trend will put a tremendous strain on our nation’s limited resources for care, forcing the home health industry to become even more efficient and effective at keeping patients healthy and out of the hospital. This demographic shift is necessitating a move toward capitated and value-based reimbursement models, which provide significant incentives and penalties to encourage agencies to focus on the status improvement results of their patients. Fortunately, home health care agencies of all sizes will have a powerful tool at their disposal to help them accomplish these outcome goals—applied analytics. While many agencies are already taking advantage of intelligence software to visualize and understand the financial and operational health of their businesses, the highest potential of analytics in home care will be only truly achieved if they move out of the boardroom and into the care setting. Utilized by clinicians at the point of c are, these powerful analytic tools will increasingly help guide coding, optimize care planning and simplify patient monitoring. By bringing easy-to-understand, data-driven insights directly into the process, agencies can help to standardize care and provide better clarity into the specific needs and risks of individual patients. Analytics will be effective tools in helping the home health agency of the future keep patients out of the hospital, avoid costly governmental audits and create a foundation for sustainable and profitable growth. Together, these three changes help enable the home care industry to thrive in an era of increased needs and reduced resources.
Keep Patients Out of the Hospital
Imagine that, as a clinician is completing an assessment using an electronic health care record (EHR) system, that system was also automatically comparing the patient’s profile to millions of other patients to determine the risk of that individual being rehospitalized, represented in a “Rehospitalization Risk Score” from 1 to 100. With this number, your EHR software could also recommend the optimal plan to reduce the individual risk index for that person, giving you the numerical impacts that each additional call, visit or therapy session would have. Agencies will also gain additional clarity on this risk score from their nurses’ notes, which could be analyzed using natural language processing tools to find key words or descriptions that may point to a patient’s condition worsening. Armed with a live dashboard of this risk information across their patient population, directors and administrators would be able to monitor the risk changes in each patient and pinpoint their care resources directly to the ones who need them most. The agencies that take advantage of predictive analytics to proactively prevent falls, infections and other negative events that lead to readmissions will have a significant competitive advantage in the patient referrals marketplace.
Prevent Costly Audits
Imagine if you could significantly lower your risk of being audited by Medicare without having to hire additional QA staff. Powerful big-data algorithms are already being used by state and federal governments to help spot instances of agency fraud and abuse, but these tools will increasingly be placed directly in the hands of agencies to help them avoid filing questionable claims that might lead to audits and ADRs. Using “machine learning” techniques to quickly comb through past data of which claims have been flagged by Medicare and comparing it to a claim that is about to be filed, an analytically powered system could help an agency know if the claim has any elements that might make it more likely to be audited as well. This system could warn a clinician, QA staff member or director of nursing of potential risks prior to submission, and then prescriptively guide what changes need to be made in the assessment or plan of care in order to reduce this risk.
Be More Profitable
Think of the resulting benefits if your agency could automate and optimize some of the tasks that most directly affect your revenue, cash flow and profits. In an increasingly competitive marketplace for referrals, agencies will be able to utilize analytically informed marketing tools to directly target those doctors and hospitals most likely to give them patients; it will also assist in creating promotional materials customized to that specific referrer’s patient population. Once an agency has a patient, analytics will also help improve the coding process, where even small changes in a patient’s assessment or code order to more accurately reflect acuity can result in significant increases in per-episode payments. By automatically comparing a clinician’s M0 item assessment of a patient with that individual’s previous history, medications and plan of care, an agency that utilizes assessment analytics can ensure that it correctly codes for the amount of care to suit the needs of each patient without having to rely on expensive outside coding services or additional staff. Agencies will also be empowered to shorten cash-flow cycles, with analytics systems monitoring the status of each claim and quickly identifying potential bottlenecks in an agency’s processes or alerting administrators when there is a high likelihood of a costly delay occurring. With a larger census, a higher average per-patient profit margin and a shorter cash cycle, home care agencies will be well poised to meet the growing needs of the patient population.
Partner for Growth
The power of analytics is currently allowing companies in other industries to dramatically increase understanding of customers and improve the quality of service provided. As our nation continues to increase dependence on home health care providers to help the elderly and disabled recover from significant medical issues and stay out of the hospital, thoughtful and progressive home care agencies will be compelled to take advantage of these same technological tools. Agencies that utilize applied analytic insights in the process of caring for their patients and running their agencies are poised to have a significant advantage over their competitors in care outcomes and profitability, positioning them for financial success and growth.
