In reviewing data from our Care Intelligence and Performance Intelligence tools and processes, it was clear that an independent home health agency within one of our health plan customer’s Home Health Agency (HHA) network was experiencing lagging outcomes. The mid-size agency provided both skilled and non-skilled private duty care spanning three counties, but our Network Performance Managers noted that this particular agency lacked partnerships with strategic hospitals/health systems. Without a marked improvement in outcomes, the agency could easily be eliminated from the network without much abrasion to members and providers. With a thorough understanding of its performance relative to the overall network, the agency was highly engaged and eager to partner with Helion to receive support with best practice implementation and process optimization.
Helion worked together with the agency to complete a current state assessment and to develop and implement a performance improvement plan. This included a thorough review of the referral process as well as the development of process improvement plan for SNF and Hospital engagement and collaboration on transition to home health and review of shared patients. As a result, new processes that better-connected high-risk patients to resources (health plan case management and vendor programs community resources, etc.), reduced unnecessary returns to the ED/hospital, and evaluated, treated, and released patients back to home with home health to avoid observation stays and readmissions were implemented.
Helion also worked with the agency to evaluate and optimize the process for 7-day PCP follow-up appointments, conduct root cause analysis for all readmissions, and provide real time support on challenges.
As a result of the focused effort to execute on the action plan, the agency realized a significant improvement in outcomes over a 12 month period:
Overall Ranking (Cumulative % Score of Weighted Ranking Metrics):
Risk-Adjusted 30-Day Readmission Rates: