HOME HEALTH & HOSPICE SURVIVAL TEST

October 22 2015Carevoyant Users Conference

AGENDAPurposeSpeaker BackgroundEnvironmental Context4 Survival Test questions

Home Health Hospice

Implications/Conclusions

PURPOSEUnderstand how the healthcare delivery

landscape is changing for home health and hospice

Provide a self-assessment tool for organizations to gauge the prospects for future success in home health and hospice

Outline next steps for organizations based on results of tool

SPEAKER BACKGROUNDOver 20 years in home care35 years of experience in planning and

marketingMBA from the Sloan School of Massachusetts

Institute of TechnologyPresident, Healthcare Market Resources,

HEALTHCARE MARKET RESOURCES Leading market research firm serving post-

acuteHelps home health agencies, hospices and

SNF’s better understand their market, competitors and referral sources

Clients use our data in strategic/market planning, benchmarking, sales targeting and key account developmentReferral data on hospital, SNF’s and MD’s

CHANGING LANDSCAPEReduced margins

RebasingCase mix creep adjustmentDifferentiated reimbursementShift to “managed care”Sequestration

CHANGING LANDSCAPEPay for Value, not Volume

Demonstration projectsAccountable Care Organizations-Population

Health Management“Capitation” thru voluntary and mandatory

bundled paymentsPerformance Incentives/Penalties

CHANGING LANDSCAPENarrowing provider referral lists

HospitalsSNF’sPhysicians

More data transparency & differentiationRe-admission ratesSTAR ratings

Increased regulatory scrutinyDrive unnecessary care and costs out of

system

FOUR QUESTIONSOrganic Growth

Post-Acute Networks

Reimbursement Impact

Efficiency

QUESTION 1 HOME HEALTHCan we grow organically?

How mature is my market?How concentrated is my market?Is there an opportunity to shift post-acute site

of care mix?Can we increase revenue per patient-less

LUPA’s, higher case weight & more re-certs

QUESTION 1 HOSPICECan we grow organically?

How mature is my market?How concentrated is my market?What is median LOS for my market?What is my market’s non-cancer mix?What is my market’s site of care mix?What is utilization amongst underserved

population?Can my hospice use palliative care to capture

patients earlier in the disease process?What is managed care penetration?

QUESTION 2 HOME HEALTHWhat is my role within post-acute networks?

How big is the post-acute market?How dominant are captive agencies at their own

facilities?How will proposed bundle payments for joint

replacements affect referral patterns in my market and at specific local hospitals?

How does your organization compare to its competitors to be asked to join these network(s)?

Will hospitals monitor referrals of owned MD’s?

QUESTION 2 HOSPICEWhat is my role within post-acute networks?

How big is the post-acute market?How dominant are captive agencies at their

own facilities?Where do the hospitals in your market stand on

bundled payments, ACO’s & value-based purchasing metrics-mortality rates, re-admission rates and per beneficiary spending?

Is there inpatient & palliative care capacity to limit end of life expenditures?

QUESTION 3 HOME HEALTHWhat is impact of reimbursement changes on

my agency, market and competitors?Shift in weighting for therapy casesDual eligible demonstration projectLimits on re-cert ratesCost re-basing & sequestrationIMPACT ActValue-based purchasing for Home HealthICD-10 Coding Transition

QUESTION 3 HOSPICEWhat is impact of reimbursement changes on

hospice?Two tiered rates beginning 1/1/2016 under and over

60 days for routine home care(RHC)Added reimbursement in last 7 days for professional

visits to RHC patientsCompare LOS mix versus competitors to estimate

impact Hospices over the cap most affected(-5.4%) margins ;

current profits could be being re-directed to prior yr repayment plans.

MedPAC recommendation to move hospice to managed care

QUESTION 4 HOME HEALTHIs your agency cost efficient?

Does it benchmark performance against local competitors?

Does it optimize visit levels by HHRG by disciplineDoes it analyze why LUPA’s occurred?Does it have practices in place to optimize episode

management Frontloading chronic disease, joint replacement and

surgical aftercare patients Appropriate use of nursing in therapy cases? Evaluation of therapy need based on clinical triggers

QUESTION 4 HOSPICEIs your hospice cost efficient?

Compare visit levels per patient per week by discipline to competitors

New quality measure as visits in 2 days prior to death

Visits correlate to patient satisfaction levels, particularly near end-of-life(EOL)

Preponderance of short-stay patients

IMPLICATIONSNeed to get a passing score(3 out of 4) to

have a chance to survive long termCannot rest on laurels; bar will get higherFailing scores seriously need to consider

HARD optionsMergerSalePhase-out

Passing scores or the prospect of one means you need to making changes NOW

CONCLUSIONSValue-based purchasing is here to stay across ALL

segmentsHospitals will dominate post-acute landscapeMD’s and insurers will focus on pre-acute or

community-based referralsREFERRAL LISTS WILL SHORTENHospices and HH agencies will need to

differentiate themselves with outcomes/dataLow barriers to entry will prompt large post-acute

providers and short-term acute hospitals to add captive HH and hospice capacity

FREE OFFERStart the process by answering Question 1 or

4Need to understand the maturity of your

market by understanding utilization level of home health and/or hospice

Need to understand if appropriate visit level are bing performed by HHRG

Hand business card and indicate on the back as to which report you want

MARKET DECISIONS BASED ON DATA, NOT PERCEPTIONS

CONTACT INFORMATIONRich ChesneyPresident, Healthcare Market Resources1133 Dundee Drive, Ste. 100, Dresher, PA 19025rchesney@healthmr.com215.657.7373