“[The home-based care industry] has been asking for this,” J. Scott Tapp, president and CEO of Trella, told Home Health Care News. “Instead of having multiple vendors, they wanted a single [organization] that they could turn to.”

Atlanta-based Trella Health offers health care organizations – including direct-contracting entities (DCEs), accountable care organizations (ACOs) and post-acute care providers – market intelligence that enables them to improve their outcomes.

Meanwhile, Brentwood, Tennessee-based PlayMaker Health is a post-acute data and growth solutions provider.

“[The industry needs somebody] who’d be a trusted provider to help them with market intelligence, growth and performance analytics,” Tapp continued. “This acquisition gives them just that.”

Overall, the combined companies give Trella Health a little over 50% market share of the top 200 home health and hospice organizations in the U.S.

“The blend of these two solutions is truly a game-changer for the industry, and I’m looking forward to seeing the impact it will have for post-acute care going forward,” Gregg Boyle, CEO of PlayMaker Health, said in a press release.

Trella Health’s acquisition of PlayMaker Health fits into the company’s strategy, which focuses on customer-driven innovation.

“We want our customers to help us determine where we’re going next – our next feature, our next capability,” Tapp said. “One of the things they’ve regularly asked is if we can provide an integrated customer relationship management (CRM) solution, along with our data, to help their business.”

Last year, Tapp began early talks with Boyle. The two leaders determined that they were hearing similar feedback from their respective customer bases, so opted to pull the trigger on a deal.

“While we compete in the market, we found ourselves going down a path where we were both developing capabilities — and redundant capabilities, if you will,” Tapp said. “That started the initial conversation of, ‘Wouldn’t it be great if we could bring these two capabilities together and create the ultimate platform for these customers in order to help this industry really enhance their businesses?’”

On its end, PlayMaker Health’s CRM capability, which tracks referral opportunities, and electronic medical records (EMR) integration capabilities made the company an attractive acquisition target.

“If you combine our data, with the ability to then integrate into workflows within the CRM world — having great insights, data, and enabling our customers to manage their relationships through the CRM … creates an unbelievable workflow of insights within their business,” Tapp said.

This deal is Trella Health’s first major acquisition since Cressey & Company’s growth investment in November.

The health care-focused private investment firm’s support helped to accelerate the deal, according to Tapp.

“We put a strategy in place last year that looked at all the additional capabilities our customers were asking for,” he said. “As part of that strategy, we went to market to raise strategic investment. Part of Cressey’s thesis, and ours, is to speed up our investment in new capabilities. That’s through our investment in developing those things ourselves, … but also through acquiring other companies in our space, as a platform.”

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The COVID-19 pandemic resulted in a lot of unknowns for care services providers in 2021, especially for sales teams in home-based care that are trying to navigate unprecedented hurdles. To successfully maintain revenue and referral sources, operators need to rethink plans for 2022.

Among the changes, the pandemic underscored the importance of an inside sales team, which acts as support for the team working outside of the office. Together, the inside and outside teams can efficiently work hand-in-hand to transition from a single-payer approach to an all-payer mentality for care providers.

“What I think has been surprising is how quickly the industry was able to develop inside and outside sales teams,” says Holly Miller, chief revenue officer of PlayMaker Health, a provider of market intelligence tools for the post-acute care market including home health.

Particularly as face-to-face sales declined during the pandemic due to limited contact, Miller has seen agencies focus the inside team on developing virtual contacts, while the outside team operates strategically in its face-to-face contacts.

Without the benefit of time to react to the pandemic, outside sales teams relied on inside sales groups to act as the liaison between referral partners and sales during 2020 and 2021, rather than lean on in-person approaches.

Today, as in-person meetings begin to resume, there remains a strong need for inside sales teams. They take responsibility for doing the research and maintaining communication with accounts, while predicting where new trends will take place. The team also assists the outside teams with administrative tasks to help them maintain the time they spend outside of the office with prospects.

Here are three key tips home health sales teams can employ to develop new referral sources in the year ahead.

1. Go Beyond Medicare

By looking beyond Medicare, providers can incorporate old tactics to conduct new ways of doing business, while working with existing referral partners. These referrals take on an important role because they bridge the gap between health care providers and prospects.

“You can’t just live in the Medicare pool anymore,” Miller says, “or your pool is going to drain.”

Taking referrals from various sources will allow home-based care providers more knowledge from numerous fields.

2. Go Deeper on Data

Another key path from a single-payer approach utilizing fee-for-service to multi-payer mindset is to go deeper on data. Predictive analytics supports the outcomes of the future or unknown events.

Customer relationship management (CRM) data shows sales efforts fell toward the beginning of 2020 but rose again in 2021. These findings help home health care networks to navigate more customized attention to smaller accounts. The operators are then able to closely consider their target market to utilize forecasting and strategic planning to look ahead to 2022.

3. Learn to Manage Risk

Managing risk can help providers monitor potential downfalls that would negatively impact their network. These risks can be eliminated by avoiding distractions to improve outcomes. By selecting the more customized referral sources, operators are able to provide clients with the best health care providers for their needs.

Utilizing the inside and outside sales teams helps to capitalize the resources that are available. These teams are willing to make use of products that otherwise would be overlooked.

In 2020 and 2021, sales teams were reactively solving issues, because they were unsure how long the pandemic would last. In 2022, they will be able to proactively operate through their plans they had already put in place so that they are more prepared.

“I think the indoor-outdoor sales team pairing will be the norm going into 2022 and beyond,” Miller says.

This article is sponsored by PlayMaker Health. To learn more about inside sales and forecasting for the coming year, click here to download PlayMaker’s white paper: Reading the Analytical Tea Leaves — How to Use Your Data to Forecast 2022.

The post 3 Tips for Rethinking Referral Sources in 2022 appeared first on Home Health Care News.

Home Health Care News: Let’s start at the top. What career experiences do you most draw from in your role today?

Holly Miller: Looking back, I’ve spent the majority of my career in health care technology. I grew up in my career at HealthStream, where I started in sales, moved into sales leadership and oversaw the launch of HealthStream’s post-acute division and health care technology. I learned so much in doing that, in terms of how to build an organization, how to build a sales team and how to enter a new emerging market. HealthStream is where I learned the most in my career — PlayMaker is where I gained the best experience.

I joined PlayMaker as the head of sales about four years ago, but that role quickly expanded. At first, PlayMaker’s sales team was operating on the transactional plane selling staff-based technology, but selling health care is different. We shifted our sales model to follow a consultative approach that examines the needs of the client and guides them through the buyer’s journey. That was easily the biggest shift in my career.

Then, if we look back to February of 2020, I assumed the role of Chief Revenue Officer at PlayMaker, taking responsibility for the entire revenue continuum. It has been a great learning experience and we’ve been successful in aligning the cross-functional teams to support clients through the entire journey.

From a sales and marketing perspective, what are the top two to three changes that you’ve seen in your career, in terms of how home health and marketing teams are built and structured?

Miller: Home health and hospice marketing teams have historically distanced themselves from sales responsibilities. They were and still are marketers and liaisons, but that has shifted since the start of the pandemic. You’re seeing more agencies hire people with sales orientation and focus while continuing to operate with the patient top-of-mind.

The other major change is the demographic shift in our marketing teams. Home health and hospice used to attract experienced people with long-term careers in the industry. Now, a new generation is entering this field. Many new hires are joining home health and hospice agency marketing and sales teams right out of school, with little home health and hospice experience. Again, it goes back to that concept of having more sales-oriented people.

More people who have been raised on technology are entering the industry. Everything they’ve done has been based on technology, phones, computers, tablets, et cetera. Not only are they open to having that type of technology support them in the professional world, but they expect it. A lot of agencies use it as a recruiting tool to grow their sales and marketing teams with right-fit prospects.

Let’s talk about the impact the pandemic made on home health sales and marketing efforts. How has home health CRM commitment and comfort evolved since the start of COVID?

Miller: I think a couple of things happened throughout the pandemic. From an industry perspective, we’ve always known that home health and hospice, versus post-acute, is the fastest-growing segment in the health care continuum. The pandemic accelerated that awareness and growth by helping more people realize that the safest, most compliant place to receive care if possible, is in the home. As a company that supports home health agencies, we had to shift our mindset as well. We quickly diverted from the current roadmap and put much of our resources into making our platform easier for customers to use. We made adjustments to our CRM platform to enable better tracking of virtual sales calls, and we enhanced functionality to streamline the logging process.

We did a lot of webinars with industry thought leaders and our partners to make sure that people had tips and tricks on how to navigate this virtual world. We also did a lot of training and best practices on how to utilize the system to the best of its ability to do that. What can we do to help with our main thing, our main focus?

What were the biggest adjustments PlayMaker made in 2020 to accommodate the move from in-person sales to a largely virtual sales effort?

Miller: The biggest thing we did was take a deep dive into our data. We realized that these marketers had to have data to understand where to go next. Face-to-face meetings and traditional sales tactics were not an option. They needed the data to understand what’s going on in the market and it became an integral part of their process. We also took a lot of steps to enhance the data.

PlayMaker has the most robust data set in the market with Medicare Part A, Medicare Part B and Medicare Advantage. We have operational metrics and KPIs that enable everyone involved in the purchasing process to make informed decisions. Even before the pandemic, we started to see a shift from donuts to data, where sales teams are not just making in-person calls, they’re making meaningful calls. Our referral sources’ time is precious. Making sure patients get the right care at the right place at the right time, and having data to guide these home health and hospice agency marketers has been critical.

Our biggest commitment was to make sure they had the tools and resources they needed along with the data.

What changes did PlayMaker make, in terms of its features and functionality for home health sales teams?

Miller: If you look at the growth of Medicare Advantage over the last few years, there will be a time in the near future where it will surpass traditional Medicare, and in some states, we’re already seeing that. We made sure that dataset was readily available to all of our customers when they needed it. Then we went out and proactively made sure that they could get their hands on it.

We also enhanced all of our datasets to include all of those revenue and operational metrics from a KPI standpoint, to understand the cost of care and what that looks like across the entire continuum. Then, we spent a lot of time and resources building and synchronizing our mobile and desktop platforms to make sure home health and hospice marketers can work anywhere within the applications.

We’ve always had a mobile application, but we’ve enhanced it over the last 12 months to improve workflows. Little things like being able to click on contact information or automatically log touchpoints seem insignificant, but they make a world of difference. We made reporting and dashboards readily available so managers can gain oversight of their marketers and liaisons. This way, managers can have opportunities and still have the ability to manage them and guide them in a virtual world.

What does the industry look like today from a revenue perspective?

Miller: If you look at the health care continuum, post-acute has been the fastest growing segment for a while. As I mentioned earlier, the pandemic accelerated the awareness and knowledge that the safest place to receive care is in the home. It also drove awareness in hospice and palliative services.

We have an aging population, so there’s more awareness of home health and hospice services. Reimbursement and guidelines, however, have shifted. We have Medicare Advantage benefits that are increasing for the segment of the continuum, so it will continue to grow.

What’s in store for home health sales and marketing technology next year in 2022?

Miller: This is where I get really excited. I think we’ve all been reliant on data for the last few years. When I came into PlayMaker, we had many agencies that were not using claims data at all. That is not the norm anymore. Now, people are familiar with claims data that they want, and if you look at CMS claims data, it’s all historical.

I know people want more real-time information and more meaningful data and we can look back historically to see trends and to see where we need to focus. Having that real-time data, whether it’s flowing in from the EHRs right into the platform, or we’re doing our own analysis on data and putting that in place, predictive analytics and data is where the industry is headed.

With all these various points, whether it’s our CMS data with your traditional Medicare claims, or it is the Medicare Advantage data, I believe we have the largest datasets in the industry. We have data from clearing houses, which are across the country, but we also have rep behavior data. How many times does the rep log into a system, or how many times does it take a high-performing rep to convert someone to a referral source? What does your traditional book of business look like for high-performing reps? All of these data points are going to become more meaningful and more critical. If agencies focus on expansion and growth over the next 24 months, meaningful data will be key.

Entering this year, no one knew fully what to expect. What has been the biggest surprise to you in the home-based care industry, and what impact do you think that will have on the industry for the remainder of the year?

Miller: The biggest surprise and sigh of relief was how quickly the industry adapted. It adapted to new virtual workflows, as well as to supporting their referral sources and more importantly, their patients. As I look forward, I think this concept of virtual and remote work is here to stay. We’ve put out some information on the screen-to-screen salesman. I think that face-to-face interactions are coming back, but there will always be a blended approach of face-to-face and virtual interactions with our patients and our referral sources. I think that’s here to stay.

The other thing that I think has been surprising is how quickly the industry was able to develop inside and outside sales team. The inside person focuses on the virtual contacts and the outside person operates strategically and deliberately in that face-to-face contact. I think it is going to be the norm going into 2022 and beyond.

Editor’s note: This interview has been edited for length and clarity.

PlayMaker Health is a post-acute growth platform serving hundreds of home-based care organizations. To learn how we can help your business, visit us at playmakerhealth.com.

The Voices Series is a sponsored content program featuring leading executives discussing trends, topics, and more shaping their industry in a question-and-answer format. For more information on Voices, please contact sales@agingmedia.com.

The post Voices: Holly Miller, Chief Revenue Officer, PlayMaker Health appeared first on Home Health Care News.

That’s according to recent data from PlayMaker Health, a post-acute growth platform that serves hundreds of organizations across the country.

Specifically, Q4 saw a 2.45% decline in home health admissions, nationally. The decline in home health admissions in Q4 was on par with the previous quarter, which saw a 3.38% decrease in patient volumes, nationally.

When looking at data from the same period, 60% of home health referrals were from community sources, while 40% of referrals were from institutional sources.

This isn’t a major change from Q3 2019, which saw 59.9% of home health referrals coming from community sources and 41.1% coming from institutional sources. 

After the implementation of the Patient-Driven Groupings Model (PDGM), experts predicted that providers would largely focus on referrals from institutional sources. Under PDGM’s 432 case-mix groupings, reimbursement is usually higher when caring for patients discharged from institutional settings, including hospitals or skilled nursing facilities (SNFs).

In reality, there was only a tiny increase in the percentage of institutional sources.

“If you look at Q4, it shows that people were starting to implement their plan to make sure there was an emphasis on institutional referrals,” Holly Miller, chief revenue officer at PlayMaker Health, told Home Health Care News. “I think what I’m pleased to see is people aren’t shying away from community referrals, which I think everybody was worried would happen. That wasn’t the case.”

As the home health industry begins to see more post-PDGM data, it may also start to see a further increase in institutional referrals.

“Post-PDGM data, meaning Q1 and Q2 2020, we’ll start to see those numbers increase on the institutional resources, but I don’t think it’ll be dramatic,” Miller said. “I think it will start to level out.”

The public health emergency may also impact these numbers, as providers have already reported that they are treating COVID-patients and others in the home.

Additionally, Q4 2019 data showed that patients are using Medicare Advantage (MA) at a rate of 34% of Medicare. This is a 4% increase over the prior period, which saw patients using MA at a rate of 29%.

This growth is partly due to the high number of plan options.

There was also more aggressive growth in newer markets, according to Miller. 

“This makes sense based on the number of Medicare Advantage plans coming to the market, which is causing a shift,” she said. “If you break it down by various states, several had double-digit growth for Medicare Advantage. [Even] states that we don’t typically see pop up. For example, Michigan had 11% growth and Indiana had a 10% growth. Mississippi had a 13% growth.”

One factor to keep in mind when evaluating home health care data trends in recent quarters is the mergers-and-acquisitions activity that took place during the time, Miller noted.

“Some of these numbers are the result of the tremendous amount of mergers and acquisitions that happened from 2018 to 2019,” Miller said. “For example, over that time period, I think we had a 3.6% decrease in agencies overall from 2018 to 2019, because of [M&A activity].”

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HHCN: Tell me a little bit about your background and how you came to lead PlayMaker Health.

Boyle: I’ve been involved in health care technology for about 20 years, with a number of companies, with my work heavily focused on helping health care agencies improve data-driven decision making. Just over two-and-a-half years ago, I joined PlayMaker Health because I saw post-acute care as a vertical that could benefit if given the ability to harness the power of data to accelerate decision making. Over the last two years, I’ve helped lead an acquisition that further strengthened the breadth of our data and launched two new products. At the beginning of this year, I stepped in as the CEO.

What are you seeing right now in terms of the biggest challenges in this industry?

The pandemic is top of mind for everyone. It’s all we read about every day. I believe the largest challenge isn’t the pandemic itself, it’s our industry’s ability to be prepared for what happens post-pandemic. This was the PDGM year for home health. We came into Jan. 1 with everyone focused on the implications of payment reform. Some organizations were well prepared. Others were still preparing. Then 60 days in, we encountered an entirely new set of challenges related to COVID-19.

The challenge that most organizations have right now is figuring out how they are going to sustain through this gap in services. There are new constraints and restrictions preventing agencies from allowing their nurses and their staff to see patients. Agencies are focused on balancing the need to get through what’s happening in the short-term while being prepared for when service demand gets reintroduced. How do they balance that mix of continuing to keep staff utilized, finding creative ways to use them to solve the right problems, keeping relationships with patients but then also being prepared as demand increases here in the short term?

As we come out at the other end of this situation, they will be asking themselves, “Did I take the right steps during this time to improve inefficiency I had in the business? Did I take the right steps to reinforce relationships I had with my referral networks and keep in touch with patients, families and facilities during this time?” That way, as demand for services rebounds, they are prepared.

How can home health providers set themselves up for success? You mentioned working on efficiencies or different processes. Are there any specifics that you could mention on that?

Home health, like other industries impacted by this global pandemic, can use this as an opportunity to pause, reflect and figure out where we need to make improvements. It’s interesting to see how quickly some agencies have evolved past the “How long is this going to last, and how do we get through it?” mindset and have embraced the mindset of, “How do we take advantage and better ourselves during this time so that when things come back, we’re in a better place and a stronger place to do that?”

These agencies see that this is really about data — about having the right visibility into their referral networks, into how business dynamics are changing and where the referrals are coming from. Between PDGM and COVID-19, do they really have their fingers on the pulse of changes, do they understand what’s happening and can they react as quickly as they need to?

Without the right systems and the right data to understand in real time what’s happening in the business, they’re going to be challenged. It’s not that they won’t be successful, because there will be a large amount of demand that is introduced into home health as these restrictions come back. The question becomes: Are you as prepared to be successful as you could have been?

What are you seeing in regard to how agencies are adapting and positioning themselves for when this demand surges?

It’s interesting: Limitation really does breed innovation. When you’ve got constraints, it makes you creative, and what I’ve seen in all of these organizations is that they’re finding innovative ways to use their staff to provide value to these families and these patients in ways they didn’t before.

They’re doing meals-on-wheels, they’re delivering medication, they’re just finding new ways to provide value to patients. And then they are communicating that, through the right tools, back to their referral partners to make sure those partners understand that they really are focused on the outcome of the patient.

I think they’re building a better brand right now, those who are using this time to be creative for their agencies and with their partners, than maybe they would have before.

How is PlayMaker supporting providers to maintain existing referral relationships right now?

We are a post-acute workflow and business intelligence company that focuses on helping agencies understand and improve those valuable relationships. Our solutions expose hidden insights into new opportunities, evolving risks, inefficiencies within the marketing process and changes to the quality of their networks. The goal of this is to give providers the information they need to forge and maintain strong relationships with their partners.

Using our platform, agencies get up-to-date information on what referrals are flowing into their business. They can see how referral patterns are changing, and quickly take action. With a few taps on their smartphone, they can quickly connect with the discharge planner from the facility where a referral originated and be able to talk in detail about the patient that was referred based on data right there on their phone that was seamlessly synced directly from their electronic medical record.

Once the call is done, if there is a follow-up, our application transcribes their comments into notes that can be referenced by intake back at the agency.

Then, within our platform, we aggregate the data from all of these interactions into trends and patterns that give the sales managers and executives visibility into performance indicators, showing both the health and new opportunities within the referral process.

What do you see as the most critical data that home health agencies need right now, and how has that changed over the last year?

Let’s start by saying that data itself is one of the most critical things a home health agency needs. If we keep on the topic of referral management, the way that agencies can capture the data they need is by asking, “Where is the opportunity?” and, “How effective are we at converting that opportunity into admissions?”

To gain these insights, they need complete visibility into how patients are flowing from facilities and the community into home health, and who is potentially influencing those decisions. Once they have those market insights, they then need the operational ones that provide visibility into how their agency is interacting with those opportunities and where they rank compared to their competition.

Understanding the benchmarking that comes with this competitive aspect is more critical now than ever. It’s no longer good enough to just survive. You need to thrive in this environment in order to maneuver through the future of value-based care and payment reform.

What’s on the horizon for PlayMaker? You mentioned some of the exciting things that have happened so far under your leadership. Is there anything that you’re excited about what’s coming down the pike?

There are a few interesting things on the horizon. We are uniquely positioned to provide market intelligence mixed with behavioral sales analytics, giving agencies near real-time views into how effectively they are growing their referral networks. We are focused on ensuring agencies not only understand where opportunities exist, but how to manage and mitigate where they are sub-optimized from a sales process perspective.

What is the greatest opportunity that you see for home health this year?

I just echo what I think a lot of people are now quickly realizing, which is that serving patients in their homes is absolutely the most cost-effective and safest place for patients. What we’re going through right now has only confirmed it. I think home health will be one of the shining stars that comes out after the COVID challenges. The entire world is quickly learning that many of the things we thought had to be completed in an office can be done very effectively from the home. Home health will be a big beneficiary of this shift.

Editor’s note: This interview has been edited for length and clarity.

PlayMaker Health is a post-acute growth platform serving hundreds of home-based care organizations. To learn how we can help your business, visit us at playmakerhealth.com.

The Voices Series is a sponsored content program featuring leading executives discussing trends, topics, and more shaping their industry in a question-and-answer format. For more information on Voices, please contact sales@agingmedia.com.

The post Voices: Gregg Boyle, Chief Executive Officer, PlayMaker Health appeared first on Home Health Care News.

When it comes to the latter, any drastic shifts in referrals and admissions could throw a huge wrench into the planning that went into Patient-Driven Groupings Model (PDGM) preparations. Under PDGM’s 432 case-mix groupings, reimbursement is typically higher when caring for patients discharged from institutional settings, including hospitals or skilled nursing facilities (SNFs), both COVID-19 hot spots.

“You certainly were trying to obtain those institutional referrals over community-based ones, mainly because they paid more,” J’non Griffin, owner and president of Home Health Solutions LLC, told Home Health Care News. “You could see the patient more and still be profitable.”

Carbon Hill, Alabama-based Home Health Solutions is a consulting company that works with post-acute care companies.

In theory, home health providers may soon see increases in institutional referrals due to coronavirus. So far, that hasn’t really played out, but some home health stakeholders describe early April as “the calm before the storm.”

In the present, institutional-sourced admissions have largely fallen, in part because most elective procedures, such as hip and knee replacements, have been postponed.

“People are just taking what they can get,” Griffin said.

For now, it’s difficult to tell whether the COVID-19 crisis will alter referral patterns on a long-term basis.

When looking at Q3 2019 data, 59.9% of home health referrals were from community sources, while 41.1% of referrals were from institutional sources, according to PlayMaker Health, a post-acute growth platform that serves hundreds of organizations.

Though home health saw more referrals from community sources for Q3 2019, the percentage of institutional sources had grown due to the implementation of PDGM, Holly Miller, chief revenue officer of PlayMaker, told HHCN.

“In Q3, what you are seeing is people being proactive in preparing for PDGM and starting to build out those alliances with [referral partners] who operate within institutional settings,” Miller said.

Over the past few weeks, home health providers have begun positioning themselves as the solution to decreasing the ever-growing burden on U.S. hospitals. Over-capacity issues remain a major concern.

Providers that have already formed these alliances ahead of PDGM’s launch may be first in line when it comes to receiving referrals from these institutions during the COVID-19 crisis, according to Miller.

“These agencies are really working closely with the institutional facilities to alleviate the burden by having patients who are less critical discharged to home health to make room for COVID-19 patients,” she said.

It’s tempting to assume that COVID-19 will automatically drive an increase in institutional referrals down the road, but this doesn’t tell the whole story, according to Griffin.

“We are seeing institutional referrals,” she said. “Providers are not getting a lot of community referrals when it comes to COVD-19, most patients that are COVID-19 positive are coming from the hospital. That said, there are a lot of community referrals that agencies are getting because the patient can’t go to the doctor’s office or outpatient therapy, because they may be immunocompromised.”

One question the COVID-19 pandemic raises: Would an uptick in institutional referrals change expectations for PDGM, a payment model that is supposed to be budget neutral?

That also may not necessarily be the case, according to Griffin.

“The uptick in community referral would still have a diluting effect,” she said. “Even if we get a surge of institutional referrals, I think it’s all going to even out from what I’ve seen.”

One thing that will certainly remain the same as before the pandemic is providers that want to attract referrals from institutional sources must have a strategy in place to accomplish as much.

“If [providers] want to go after those institutional referrals, they’ve got to have a plan in place,” Griffin said. “Just like they did before this.”

The post Industry Insiders: Too Early to Tell How Coronavirus Will Affect Admission Patterns, PDGM Reimbursement appeared first on Home Health Care News.

Those three regulatory hurdles — and other changes — likely set up an even more chaotic year in 2020.

Home health industry insiders and top executives widely expect PDGM to steal the show next year. But they also anticipate technology advances, value-based care initiatives and M&A to play major roles.

Below are predictions from 13 home health CEOs and industry insiders. Home Health Care News will highlight home care predictions in a follow-up piece published later in December.

* * *

I don’t think we’re in for big surprises on what will shape home health in 2020. I believe the implementation of PDGM combined with the revisions made to CMS’s RAP payment policy will cause significant disruption among many home health providers — especially in the second and third quarters. For providers based in RCD states, I expect that to further exacerbate challenges.

Challenging circumstances always give rise to accelerated innovation and change. The specific way in which forward-thinking providers deliver care to optimize patient outcomes will likely improve and become more patient-specific than they have been in the past — and patients will benefit. On a market-by-market basis, I think we will see the more dominant providers taking more market share from their smaller and less sophisticated competitors.

I believe regional and national providers will be better equipped to weather the storms that 2020 will bring, especially in geographic areas projected to be subject to greater rates cuts related to PDGM.

— Luke James, president of Encompass Health – Home Health & Hospice

* * *

The transition to PDGM is the factor that will shape home health in 2020. From a clinical care and documentation standpoint to a back-office process standpoint, adapting to these changes will require adjustments to the day-to-day operational work of our teams. These changes — and other changes across the broader health care system — will continue to drive the formation of more effective partnerships between home health providers and both acute and post-acute networks.

While there will be changes and challenges in implementing and adapting to PDGM, we continue to see home health being elevated as part of the overall care continuum. As excellent providers throughout the industry continue to deliver improved clinical outcomes in the lowest-cost setting, we anticipate increased demand for our services — and that payers will see increased value.

We also anticipate PDGM — coupled with the impact of the RAP reduction and eventual elimination — will drive more consolidation.

— John Gochnour, COO of The Pennant Group

* * *

In 2019, the home health industry experienced a lot of uncertainty. While demand for services overall increased significantly, there were also major payment reform changes, a focus on integrated clinical care and renewed support from private equity investment.

Now, all eyes are on 2020, as these trends continue to impact the industry. Specifically, there are the legislative changes, including the highly anticipated final version of PDGM that goes into effect Jan. 1.

Americans are rapidly aging and experiencing more complex health issues and co-morbidities. Patients deserve home care that factors in all aspects of their health, so it will be more important than ever for the home health industry to focus on consolidating care. One example is behavioral health, and I predict we’ll see continued expansion in this space.

At Elara Caring, our Behavioral Health Business is continuing to grow – we’re currently serving patients in Connecticut and Texas, and we have plans to expand this program to all our service areas over the next several years.

— Elara Caring CEO Scott Powers

* * *

Obviously, the biggest factors that will shape home health in 2020 are the moldability and adaptability of organizations to the changes PDGM and RCD bring. It’s going to be an interesting few months going into 2020, but I believe every organization, regardless of size, has the ability to steer their organization in any direction — if they align their clinical, operational and financial goals.

I think 2020 will be a catapult year for the industry in relation to continued growth — specifically leadership growth. The industry has historically siloed clinical, operational, sales and financial, but these departments will learn to team up and not work against each other. For example, I think clinical will lean on finance to better understand lean management, while sales will lean on clinical to determine a “worthy” referral.

I’m excited for the challenges that PDGM and RCD will bring. I know that sounds insane, but I have always been an advocate for the underdog. We, as an industry, have studied, prepared, collaborated and made required changes, so I am hopeful that we will come out on top and see the fruits of our labor.

— Summer Napier, CEO of Healing Hands Healthcare

* * *

Foundational to the care delivery model, PDGM changes will most likely clear the playing field for agencies that were able to embrace and adjust.

Further consolidation amongst hospitals, rehabs and physician groups may present short-term challenges for referral partnerships for independent agencies. Due to more complicated home health business operations, billing practices and reduced revenue, unified organizations may start outsourcing their home health services, thus presenting new opportunities for super-effective independent operators.

A new reimbursement model may force home health services to shift from a hand-holding and chronic-care-management approach toward short-term intervention, with care plan goals shifting from treatment to patient education.

I predict strategic home health providers will look into diversifying their service lines and payer portfolio (at least this is what LifeCare is planning to do). But looking forward to the next year, I am worried about a number of things. As a smaller agency, we are worried about the cash flow. How long will it take CMS to start processing payments under the new regulations? Will we be able to meet the new stringent turnaround times for internal processing? How will patients and health care providers react to shorter episodes of care with fewer visits? How will cuts in services affect actual patient outcomes?

Winston Churchill once said: “A pessimist sees the difficulty in every opportunity; an optimist sees opportunity in every difficulty.” For this upcoming year, a Churchill perspective is key.

— Jane Shekman, CEO of LifeCare

* * *

I believe home health is on a path to reductions in length of stay, as health systems and managed care accelerate a push for a more efficient and effective home health experience. With PDGM moving the industry to a 30-day episode, there will be a push for greater effectiveness of care.

Competition for nursing labor will continue, with agencies needing to be more creative in how they attract and retain the staff they need. M&A will accelerate in the later half of 2020, but the acquisitions will be even more focused on platforms or high-quality assets with sustainable business models.

Managed care’s innovative use of home-based platforms will expand, and more pilots and value-based programs will be tried. The creep toward more effective use of in-home telemonitoring and other technology will continue, both within and outside of the core home health platform.

— AccentCare CEO Steve Rodgers

* * *

The need for excellence in home health care will only grow, and 2020 will be a year that defines how clinical growth can and will occur. With the advent of new technologies, I am excited to see how these will be embraced to enhance the home-based clinical experience and expand possibilities once only dreamed about.

The new model for payment, PDGM, begins with “patient-driven” for a reason. In 2020, we’ll see home health providers moving towards a more holistic management strategy versus an episodic treatment approach. As a nurse, I feel this is the best way to provide care. Anytime there is change to the status quo, it forces us to think differently and to innovate.

— Anna-Gene O’Neal, division president for Brookdale Health Care Services

* * *

Obviously the rollout of PDGM will be the biggest factor, but what will the aftermath look like? That’s the important question as it pertains to M&A, consolidation and course-correction. The providers that navigate PDGM by being proactive, rather than reactive, will be the ones that thrive in the new model.

For next year, I’m most excited about the expanded role of data and business intelligence in helping providers maintain and differentiate in their markets.

— PlayMaker Health CEO John Griscavage

* * *

What will be the biggest factors that shape the home health and home care industries in 2020? PDGM and workforce shortages.

In 2020, home health will have increased focus on care planning and service utilization. Meanwhile, home care will focus on improving staff retention through career advancement opportunities.

— William A. Dombi, president of the National Association for Home Care & Hospice (NAHC)

* * *

In 2020, the home health sector is expected to undergo the most drastic series of reimbursement and regulatory changes since the Balanced Budget Act of 1997, and many industry leaders fear that the result may be similar.

While CMS delivered a bit of a reprieve on the PDGM front, it stuck to its guns regarding the phaseout of the RAP. We believe the combination of PDGM and phaseout of RAPs will wreak havoc on providers’ revenue cycle, as billing and coding changes will take a toll on collections, resulting in increasing DSO and working capital needs while hampering cash flow generation.

In the U.S., the average home health agency generates about $1.5 million revenue. Based on analysis performed by Homecare Homebase, which processes about 40% of the industry’s visits data, operators are expected to see their cash collections cycle lengthen by 23 to 25 days, resulting in $90,000 to $100,000 cash flow shortages for the average mom-and-pop provider.

We’ve been closely following the home health and hospice industry for the last 15 years, and one of the things we observed is that there is usually a spike in M&A activity about 12 to 24 months after major regulatory or reimbursement changes. Given the robust home health and hospice M&A market that we have seen over the last three years (and with valuations at unprecedented levels), we expect consolidation to continue … perhaps even at a more accelerated pace, though multiples are likely to compress somewhat.

We foresee operators diversifying their business models and service offerings as they look to evolve into more comprehensive and integrated, end-to-end providers to serve customers along the full continuum of care. Provider and payer collaboration is on the rise, and we expect to see increased importance being placed on hospital referral relationships. Acute care health systems will look to more actively manage their post-acute networks and seek to establish preferred relationships or joint ventures with best-of-breed providers with a focus on quality outcomes, increased patient satisfaction and tangible cost savings.

— Eugene Goldenberg, managing director at Edgemont Capital Partners

* * *

Next year, it’s obvious that PDGM will dominate the headlines. But in my opinion, the lasting legacy of payment reform will be home health providers tapping into their clinical, operational and financial information like never before. We’ll see the home health field begin to stratify based on how well they convert their data into actionable analytics. As the best performers optimize their reimbursements from smarter coding and internal efficiencies, they’ll also begin to systemize care plans that deliver the best outcomes. That means they’ll be able to leverage their clinical staff in a smarter, more impactful way.

With value-based contracting and a unified payment model just over the horizon, home health providers that align their people, processes and technology will win. And analytics will drive it all.

— Craig Mandeville, CEO and founder of Forcura

* * *

The biggest factor shaping home health in 2020 will continue to be cost. Americans spent $3.65 trillion on health care in 2018 — and that number is expected to rise by more than 5% per year going forward.

While companies like Amazon and Google are looking for ways to disrupt the health care model, the real cost savings are going to come from helping people manage their chronic conditions successfully and avoiding expensive hospitalizations — and that happens in the home and community. So, finding cost-effective ways to help people stay active, eat well, and manage their medications in their day-to-day lives while also keeping them well-connected with their community physicians has never been more important.

These factors are also driving the increasingly sophisticated — and often collaborative — home-based care management approaches being developed by insurers, physician groups and home-based care providers like VNSNY. We recently contracted with a large insurer to manage the care of their high-risk members at home for a 60-day period following hospital discharge (to make sure those members’ recoveries stay on track).

Larger home care organizations, along with the insurers and medical centers they’re contracted with, are getting better and better at capturing granular data about their patient populations and then analyzing that data to understand exactly who should get what care when, in order to optimize patient outcomes. The new PDGM methodology, with its more detailed categorization of patient conditions, is going to require this growing capability.

— VNSNY Chief Administrative Officer Michael Bernstein

* * *

We all know that with challenges come opportunities — and also threats. Home health has never seen a paradigm shift in payment and clinical reconstruction in nearly two decades like we are about to see with PDGM starting in January. And my state of North Carolina and few others are to assume RCD beginning in a few short months. State associations have been leading the way along with the nationals in agency preparations as best as we can.

Other continued predictions I see are further Medicare Advantage footprinting, more hospice scrutiny, especially in audits by the MAC’s and federal oversight.

— Tim Rogers; president and CEO of the Association for Home & Hospice Care of NC and the SC Home Care & Hospice Association

The post Home Health Executive Forecast: 2020 Trends, Challenges and Opportunities appeared first on Home Health Care News.

Because home health payments will reward quality of care based on specific patient characteristics, having the right referral conversations can make or break a provider’s business model.

Data is a major resource that will help providers identify the right partners so they can set themselves up for success. This white paper will discuss how providers can use data to navigate the new payment landscape and survive and thrive under PDGM.

In this white paper you will learn:

— Why data is a critical component of PDGM
— 6 strategies for success under the new payment model
— How to target the most fruitful referral partners using market data
— … and more

Sponsored by

The post [White Paper] Having the Right Referral Conversations Under PDGM appeared first on Home Health Care News.

Because home health payments will reward quality of care based on specific patient characteristics, having the right referral conversations can make or break a provider’s business model.

Data is a major resource that will help providers identify the right partners so they can set themselves up for success. This white paper will discuss how providers can use data to navigate the new payment landscape and survive and thrive under PDGM.

In this white paper you will learn: 

— Why data is a critical component of PDGM 
— 6 strategies for success under the new payment model 
— How to target the most fruitful referral partners using market data 
— … and more

Sponsored by

The post [White Paper] Having the Right Referral Conversations Under PDGM appeared first on Home Health Care News.

Technology and data providers are rolling out tools to help agencies rise to the challenge. Most recently, WellSky launched a new data analytics solution for home health. The company has been working on PDGM tools for more than a year.

Overland Park, Kansas-based WellSky is a health and community care technology company backed by TPG Capital. Its new Home Health CareInsights tool uses predictive analytics to provide insights on hospitalization risk, social determinants of health, care setting suitability and LUPA risk.

“Our system is currently making about 3.5 million predictions per day,” Wes Little, vice president of analytics for WellSky, told Home Health Care News. “For each individual patient, the moment that data is saved out in the field by a clinician, it’s immediately going through our algorithm and running a new prediction on that patient in just under one second. Having that speed of insight, caregivers and the whole care team know right away when something has changed.”

CareInsights draws from more than 7 million home health patient episodes to make its predictions and recommendations. PDGM was the driving force behind the tool’s creation, Little said.

“We think home health care is at a turning point where integrated insights go from a ‘nice to have’ to a ‘must have,’” he said. “That was the reason for our organization investing as much into this predictive solution of care insights.”

Already, five organizations have implemented the solution, with thousands of clinicians using it every day. The idea is to integrate the insights into the workflow of caregivers who have their hands on the patients to inform better care and improved outcomes.

“What we’ve done is actually put every single patient into one of the 432 PDGM groupings they’ll be assigned Jan. 1,” he said. “We’ve taken CMS’s same groupings logic and helped organizations understand … not only the total number of visits that [a patient] would typically receive with a positive outcome, but also the type of visits.”

Efficiency and outcomes become especially important under PDGM, as reimbursement is more closely tied to patient characteristics. Utilization alone is less of a payment driver.

As such, a number of companies have set out to help agencies navigate the changes. In addition to WellSky, Predictive analytics firm Medalogix and post-acute data and growth solutions provider PlayMaker Health — both based in Nashville — are also in that camp.

“Data broadly is important to understanding where you stand and where you might fare under PDGM,” PlayMaker CEO John Griscavage previously told HHCN. “Then, [it can tell you] what you can do proactively to anticipate those changes and make modifications to your referral stream, relationships, market education and even clinical pathways.”

The post Data Analytics Arms Race Continues Ahead of PDGM appeared first on Home Health Care News.