For home health providers looking to reduce confusion, increase patient and staff satisfaction and improve quality metrics, honing in on the case management model is the best way to do so.
This is especially true in the wake of the Patient-Driven Groupings Model (PDGM), and in the lead-up to the Home Health Value-Based Purchasing (HHVBP) Model’s expansion, J’non Griffin, a principal at SimiTree, noted during a presentation at the annual Illinois HomeCare & Hospice Council (IHHC) conference on Wednesday.
“Remember that under HHVBP one of our main goals is patient outcomes,” she said. “Case managers need to be looking at, overall, how is this patient progressing in their goals?”
A shifting of mentality in regards to case management is in order, she argued. This means that providers should adopt the mindset that case management begins at the referral.
“How many [providers] have case managers that are in contact with their intake department and understand – just from the referral – what is needed for that patient?” Griffin said. “Probably not a lot.”
Starting case management at the referral stage contributes to a good hand-off between referral intake, the clinical manager and admitting clinicians, according to Griffin.
“The case manager’s responsibility is to act as the air traffic control,” she said.
Part of this case management mentality shift is also recognizing and leaning into the several factors that result in quality episode management. This includes a proper assessment of the patient, critical thinking, a comprehensive plan of care, coordination of care, patient engagement and multidisciplinary team care.
Additionally, the case manager should also reinforce agency policies and expectations, stay on top of producing timely and accurate documents and bolster patient experience. Griffin noted that patient experience plays a big role in HCAHPS scores.
“How often is somebody talking to you about your medications?” she said. “If you call into the office, how responsive are they? All of that is in your HCAHPS questions.”
It’s also important to recognize that not everyone makes a good case manager.
“[Case managers] are the front line of the organization,” Griffin said. “This is going to be the key person in your matrix that needs to lead the team.”
In terms of PDGM, case managers must consider “30/30” planning as well, she said.
“Probably the biggest area where we see Low Utilization Payment Adjustments (LUPAs) happening is in your second 30-day period, and it’s usually a lot of scheduling,” Griffin said. “It’s that you moved a visit from Tuesday to Wednesday, and [the patient] moved from day 30 to day 31.”
Ultimately, patient success can be measured by checking off the boxes of timely discharge, delivering on the plan of care, improvement or stabilization in functional status, the ability to manage medications, no complications and, again, patient satisfaction.
Meanwhile, providers can measure financial success by working toward fewer LUPAs, timely RAP NOA, timely final billing, low outstanding accounts receivable and low staff turnover rates.
“With staff turnover, new staffing can cost you thousands of dollars, so onboarding them and training them is very important,” Griffin said.
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