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877.399.6538 | [email protected] | www.kinnser.com © 2016 Kinnser Software, Inc.
RISK, QUALITY, PERFORMANCE:
Key Words for Future Success in Home Healthcare
The software that powers post-acute carekinnser.com
by Sharon Harder, President of C3 Advisors
INTRODUCING
KINNSERRISKPOINT™
To prevent hospitalizations, you have to predict them before they occur.
ON PAGE 6: Learn more about making quality outcomes your competitive advantage!
877.399.6538 | [email protected] | www.kinnser.com © 2016 Kinnser Software, Inc.
When I was growing up, we had a game at our house known as Word of the Day.
Every evening at dinnertime, our parents would come up with a word (usually something obscure!) that my brother and I would have to define and use in a sentence. Whoever came up with the best, most complete definition and sentence (that made sense) won. Like any good game, there were financial incentives for the winner. And, yes, I loathed losing to my little brother and did spend an inordinate amount of time during those years with my head in the dictionary! But, this paper isn’t really about the game. It is, however, about three important words that have significant meaning for the home health industry – Risk, Quality and Performance – and what those words mean to the future success of your agency.
It’s no secret that much of our industry’s success in the coming years will depend on our ability to obtain and effectively use data to make timely and informed decisions. Good decision-making will reduce risk, enhance care quality and improve organizational performance. It doesn’t matter if the agency is a large scale provider or small organization. In order to succeed in a patient-centric world where cost and quality are top of mind, every provider must be able to make educated, on-point judgments that will yield continual improvement of patient care and outcomes. And, just like Word of the Day, this ‘game’ will have definite winners and losers.
RiskA lot has been written in recent years about risk stratification of patients. The theory is pretty simple, really. The most effective providers will be those able to identify and appropriately classify patient risk for the express purpose of deploying the right care resources at exactly the right time to mitigate undue exposure to things like unanticipated hospitalizations or preventable health declines. Every patient served by a home health agency has some level of clinical risk. It may be low or, as we often see in our work, the risk is moderate with the potential to escalate and move to high risk if the patient isn’t stabilized
Our industry’s success in the coming years will depend on our ability to obtain and effectively use data to make timely and informed decisions.
About the authorSharon S. Harder has over three decades of executive management experience in the healthcare industry. She has served in financial and operational leadership roles in a variety of healthcare organizations ranging from a major healthcare professional association to large post-acute healthcare providers. As President of C3 Advisors, LLC, Sharon engages with clients to develop and implement the strategic vision required to improve their profitability and competitive position in the rapidly transforming healthcare market place. Her demonstrated expertise extends to regulatory compliance, financial management and business improvement solutions for achieving growth and long term success. Sharon frequently speaks on a range of industry topics, has led research projects on industry trends and authored numerous articles.
Learn more at C3Advisors.com.
877.399.6538 | [email protected] | www.kinnser.com © 2016 Kinnser Software, Inc.
and closely monitored.
The pressing question for many is how to effectively predict risk in the first place. Large health institutions have had longstanding access to data analytics and decision support tools that enable them to better predict and manage patient outcomes. This has not been the case for home health since predictive data analytics have not been available. But that is about to change with the introduction of an exciting new analytical tool from Kinnser.
Home health agencies aren’t the only providers that are worried about risk and quality based reimbursement initiatives. Hospitals are now being financially penalized for readmissions within 30 days of a patient’s discharge. Not surprisingly, this is having a trickle-down effect on the providers to whom those patients were referred in the first place which is frequently a home health agency. Because it is hitting them in the proverbial pocketbook, hospitals not only expect but demand that their home health partners focus on measuring risk, mitigating readmission exposure through efficient and effective resource deployment, and ensuring that patients referred to home health are stabilized as quickly as possible. Frankly, that expectation flies right into the face of our industry’s longstanding tradition of spacing visits out over the course of a 60-day episode rather than looking at visit frequencies and interventions in terms of what is needed to achieve maximum improvement in the shortest period of time possible.
Understanding and reducing patient risk also has a bearing on an agency’s publicly reported information. As we all know, both Star Ratings and Home Health Compare measures are predicated in part on acute care re-hospitalizations where the lower the re-hospitalization percentage is, the better the rating will be.
Star Ratings and Home Health Compare metrics influence decisions made by patients in their selection of a home health provider. They also influence decisions made by potential partners who may be inclined to consider an agency as a participant in a risk-based bundling arrangement or accountable care initiative; but only if key ratings are within acceptable ranges.
If we have a hypothetical agency with a 15% re-hospitalization rate which is pretty average; we have an
Get started with Kinnser RiskPoint
Call 877.399.6538
“Kinnser Riskpoint™
is like a compass...It points us toward the patients who are high risk and need extra case management, extra visits or
extra care to stay out of the hospital.
Kinnser RiskPoint is our guide to those patients who need the most attention.”
- SUE CIAGLIA, PT, COS-C Vice President of Clinical Operations
Custom Home Health, Inc. - Royal Oak, MI
877.399.6538 | [email protected] | www.kinnser.com © 2016 Kinnser Software, Inc.
agency that is essentially running in the middle of the pack in terms of managing risk. Assuming that this agency served 500 patients who were referred from an inpatient facility over the course of a year, its re-hospitalization rate equates to 75 patients who were readmitted within 30 days of starting a home health episode. What would happen if that agency had access to a tool that would allow the clinical team to identify patients with an increasing or high risk of re-hospitalization such that each month the agency was able to prevent just one readmission? In effect, the rate would move from 15% to 12.6%, which would be well below the average for most areas of the country. Effectively managing risk is critically important in terms of patient health and well-being. It is also critical to an agency’s financial and partnership prospects in an increasingly difficult reimbursement environment.
QualityNow here is a word that definitely isn’t the word of the day. It’s more akin to the word of the decade. Whether we think it’s a good idea or not, all healthcare providers are going to be paid based on the quality of care and outcomes produced. Medicare expects to tie 50% of its fee-for-service payments to quality by 2018. Home Health Value- Based Purchasing has only been introduced in nine states, but it is a reasonable bet that the number of states will grow, and soon. Within the next five years Value-Based Purchasing could mean payment increases or decreases of up to 8% for some agencies based on their performance related to specified quality metrics. Those metrics, and the improvement that will be necessary to reach the highest tier of payment incentive; will require an ability to effectively monitor, as care is progressing, the overall outcome risk of each patient. Successful agencies under the VBP program will not only be analyzing their historical data for clues about what could have been done better ; they will also
be continually analyzing episodes in progress for predictors of outcome risk as a prelude to taking steps to manage that risk and improve quality.
Bundling of payments across a continuum of providers is also gaining steam with the first
Comprehensive Care for Joint Replacement initiative now playing in 67 areas across the country. This represents tremendous opportunity for home health agencies that are able to come to the negotiating table with two things: 1. Data that supports their ability to participate in the rehabilitative process by turning in high quality, cost-effective results;
2. Real-time analytical tools that will help them identify opportunities for outcome improvement as episodes are progressing.
Why does that matter? Avalere Health has characterized CJR initiative as a wake-up call that could be especially unwelcome for the 60% of hospitals where spending on joint replacements is greater than regional averages. And, since 40% of total spending on the knee and hip joint replacements relates to hospital readmissions and post-discharge care, this represents opportunity for the providers who can prove their metrics and who can demonstrate that they have access to a predictive technology tool that will enable them to turn in acceptable patient outcomes.
PerformanceReducing risk, elevating quality and improving efficiency produces better organizational performance which, in turn, produces more market opportunity. It’s like the old adage about the rich getting richer. The home health providers with the best performance in terms of risk reduction, quality outcomes and financial efficiency are going to be the agencies that are able to capitalize on partnership opportunities. And, they are going to be the ones that will be able to operate effectively
Home health providers with the best outcomes
are going to be the agencies that are able to capitalize on partnership
opportunities.
877.399.6538 | [email protected] | www.kinnser.com © 2016 Kinnser Software, Inc.
ABOUT KINNSERKinnser creates the software solutions that power post-acute care. From its headquarters in Austin, Texas, Kinnser leads the industry by consistently delivering the smartest, most widely-used solutions for home health, private duty home care, therapy and hospice. With an enduring focus on success, Kinnser helps post-acute care businesses reduce expenses, increase revenue, streamline processes and improve care. For more information, visit kinnser.com or call toll free 877.399.6538.
in a reimbursement environment that is risk-based with the highest payment incentives being realized by the agencies that can turn in the best results.
Kinnser RiskPoint™ All of this brings me around to an exciting new risk analysis tool that has been developed and just introduced by Kinnser Software. Kinnser RiskPoint is an analytical tool that collects and measures raw data across an entire patient episode for the purpose of accurately predicting patient risk for significant health decline and/or hospitalization.
All OASIS M element responses, diagnoses, severity factors, vital sign trending and visit note entries are mined for key data points and analyzed to assign each patient to one of five risk categories. All of the algorithms involved in the analysis have been developed by Kinnser based on information gleaned from over three million actual patient episodes using over 2,100 data points for analysis. What this means for an agency is that each of their patient episodes is being compared to trended data points to unearth patterns that can serve as early warning signs to the care team that something looks like it’s heading in the wrong direction. What that means in practical terms is better predictive accuracy. And, it doesn’t stop with just a snapshot of risk factors at the beginning of an episode. As time goes on and an episode progresses, patient changes are continuously monitored in terms of fluctuations in overall risk. Unlike the reports that many agencies subscribe to from vendors who are monitoring a limited amount of historical OASIS data, visit disciplines and frequencies or claim activity, Kinnser RiskPoint is continuously gathering information, analyzing it against multiple data points and reporting on it.
Risk categorization ranges from “Low” to “Very High” with “Guarded”, “Elevated” and “High” levels in between. A Kinnser RiskPoint Overview screen allows the clinical manager to view all of the patients who are included in a specific risk
category and click into details about any of them. Hospitalized patients and those with rising risk are also viewable with a single click. On a single screen the user is able to see what the risk factors are, whether or not there has been a change in the last week and a progression of risk over the course of the 60-day episode with an easy to understand graphic display. The Quick Patient Chart highlights key information necessary for guided decision making including the patient’s primary clinician, diagnoses, most recent visit and episode comments. Follow-up actions can include physician notification, case conference, or coordination of care templates in K-Mail to alert clinicians and others regarding escalating risk for any patient under care.
For a clinician trying to keep track of a large number of patients, their particular risk factors and making decisions about how best to deploy clinicians where and when they are needed most, Kinnser RiskPoint will be extraordinarily useful. For a marketing representative charged with making a case for the agency’s quality and value proposition, there will be no better way to do it than through quantifiable, provable performance data available in the Kinnser RiskPoint Marketing Report. For the administrator trying to compete with larger players in the marketplace, this is a tool that can set the agency’s performance apart from the competition. Clearly, the longer an agency uses a tool like RiskPoint, the greater the advantage and the more measurable return on investment will be. It is a significant addition to the arsenal of functions available to Kinnser clients.
In closing...let’s consider another important Word of the Day – Innovation. Kinnser has again brough innovation to home health in a way that promises distinct advantages for its clients who make the decision to use Kinnser RiskPoint. I’m excited about it and hope that you’ll decide to take a look.
877.399.6538 | [email protected] | www.kinnser.com © 2016 Kinnser Software, Inc.
In the rapidly changing world of home healthcare, clinical outcomes are your biggest competitive advantage.In 2015, a whopping $26 Billion was spent on Medicare re-admissions, 76% of which MedPac has deemed as preventable. Because patients and acute providers alike expect home health agencies to improve outcomes and prevent complications from arising, Kinnser developed Kinnser RiskPoint™.
Kinnser RiskPoint extends the power of the Kinnser Agency Manager™ EHR to deliver the first of its kind––a real-time hospitalization management tool for home health. With Kinnser RiskPoint, agencies can identify, monitor, and proactively manage their patient populations who are at highest risk of hospitalization. Not only is Kinnser RiskPoint an immediate competitive advantage, but quality initiatives like Value-Based Purchasing and Star Ratings ensure that preventing readmissions will be key to every agency’s future success.
Use the past to predict the futureTo create a predictive tool that can analyze relevant data about a patient and determine how likely they are to be hospitalized, we needed data, and lots of it. Because Kinnser is the most widely used web-based EHR (meaning customers can login anywhere, anytime, on any device, with no servers or hosting required), we have access to the largest single dataset in home health. Our team of data scientists spent more than a year
INTRODUCING
KINNSERRISKPOINT™
IDENTIFYMONITORPROACTIVELY MANAGE
A 29% reduction in hospitalization
“ We saw a large reduction in hospitalization. Comparing February 1 to March 31 of 2016 to the same period last year in 2015, we reduced our hospitalization rate from 11.6% to 8.2% when we were using Kinnser RiskPoint. That’s a 29.7% reduction.
- Jonathan WohlgemuthChief Operating Officer Community Home Health, Inc. - Claremore, OK
“The key to making quality outcomes your competive advantage
877.399.6538 | [email protected] | www.kinnser.com © 2016 Kinnser Software, Inc.
INTRODUCING
KINNSERRISKPOINT™
The key to making quality outcomes your competive advantage
uncovering trends from the 3 million+ patient episodes documented in Kinnser Agency Manager to develop Kinnser RiskPoint, a rigorously tested tool that automatically assesses hospitalization risk throughout the episode and provides alerts as the patient’s risk changes. This allows clinical teams to proactively adjust and mitigate escalations that without Kinnser RiskPoint would likely end with the patient going to the hospital.
Proactive population management made easyThe Kinnser RiskPoint dashboard is the command center for clinical leaders in your agency. With “Very High” risk patients 4x more likely to be hospitalized, your clinical team can intensify efforts on those patients. And because the risk scores are continuously updated based on current information from M items, the Comprehensive Assessment, the Plan of Care, and ongoing patient vital sign information across all visit types, your team will always know when a patient’s risk level
has changed. In Kinnser RiskPoint, clinical leaders can click into patient details to see why the algorithm categorizes them as being at risk, view patient-level vital trends, and securely message care team members to coordinate care.
Marketing made easierNot only does Kinnser RiskPoint give agencies a dramatic clinical edge, it also provides a significant marketing advantage in competitive markets. By managing and marketing low hospitalization rates to referral sources, hospitals, and ACO’s, agencies that leverage the Kinnser RiskPoint Marketing Report can easily earn more business and build stronger referral relationships.
What Kinnser RiskPoint™ can do for you
“Kinnser Riskpoint™ is like a compass...it points us toward the patients who are high risk and need extra case management, extra visits or extra care to stay out of the hospital. Kinnser RiskPoint is our guide to those patients who need the most attention.”
- SUE CIAGLIA, PT, COS-C Vice President of Clinical Operations Custom Home Health, Inc. - Royal Oak, MI
• Manage and reduce your hospitalization rate
• Improve your referral relationships
• Increase the relevance of your marketing to referral sources, hospitals, and ACOs
• Empower your clinical team with risk alerts that allow them to proactively intervene
• Improve your Star Rating
• Gain a competitive advantage
Kinnser RiskPoint Marketing Report
Get started with Kinnser RiskPointCall 877.399.6538
