July 5, 2023 • 24 mins
Ready to unlock the secrets behind data trends in home health and hospice? This insightful episode, featuring Kara Justis from Trella Health, guarantees to reshape your understanding of data's evolving role in healthcare.
We explore an intriguing paradox as we discuss the 5.2% decline in home health admissions juxtaposed with a rise in Medicare Advantage enrollments. This episode is more than just a casual discussion; it explores how data steers quality and growth in the healthcare sector. Together with Kara, we discuss leveraging data to pinpoint opportunities, ramp up referral volumes, and escalate admissions. We also delve into articulating value in a saturated market, where data scores often mirror one another.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:08):
Hi there, i'm Jennifer Kennedy, the head for
quality at CHAP, and welcome tothis month's CHAPcast.
Today I'm talking with CaraJustice, vp of Strategic
Consulting from Trello Health,and we're going to talk about
data trends in home health andthe hospice space today.
Hi Cara, how's it going?
Speaker 2 (00:28):
Good, how are you?
Thanks for having me.
Speaker 1 (00:31):
Oh, we're so glad you're here.
I love talking about data.
Data is awesome, but before wejump into it, could you talk to
us a little bit about TrelloHealth and your position there?
Speaker 2 (00:43):
Sure, i'd love to.
So my position at Trello Healthis VP of Strategic Consulting,
so I lead our consultingpractice.
I've been with Trello for abouta year and in the post-acute
space for about 20 years priorto that, so I'm showing my age a
little bit there.
I've been a customer or usingTrello on the sidelines for many
, many years, so I was superexcited to join the organization
(01:03):
a year ago, and my role atTrello is really focused on
helping our customers optimizeour solutions.
So we offer an integratedplatform that consists of the
most robust market intelligencethat's out there, a CRM product
that's an intelligence CRM.
We actually incorporate ourmarket intelligence into our CRM
(01:24):
product and then we have theability to integrate that CRM
with EHRs with about 30 EHRs, ibelieve we're up to at this
point.
So it's a really robustplatform and, as I said, my
team's role is to help ourcustomers get the most out of
that platform and reallyoptimize their use, use it to
inform growth strategy, budgetdecisions, things like that.
So really exciting.
(01:45):
I have a great team of peoplethat I work with and a lot of
really great people at Trellothat make it all happen.
Speaker 1 (01:50):
Well, i'm glad that Trella has you on board because
it sounds like you have a reallygreat swath of expertise to
bring to them.
And then you know, in turn,you're sharing that with the
providers who use your datareport, of which I looked at it
and I was so impressed with thatdata report that you put out.
It was really, reallyinformative.
(02:10):
And I wish I you know, when Iwas two feet back in a hospice
organization that's my spacecarer I wish I would have had
access to data like this becauseit's extremely helpful when
you're looking at.
Well, let's just face it, datamakes the organization go, no
(02:31):
matter whether you're in homehealth or hospice or any area of
the healthcare continuum, youneed data.
You know I love the Demingquote Without data, you're just
another person with an opinion,right?
So, yeah, i mean that reportwas really great And I'm hoping
you and I can have a greatconversation today to talk about
some of the highlights in thatreport.
(02:51):
So you tell me where do youwant to start?
Speaker 2 (02:54):
Well, thanks, jennifer for that.
We're really proud of thatreport and we're going to
continue to enhance it over time.
Look later this year for someadditional enhancements coming
to that report.
I actually brought a few statsobviously not all of them or
we'd be here for quite a whilebut I brought a few key stats
from that report to share withyour audience today And
obviously anyone is welcome toreach out with any questions
(03:16):
related to it And I'm sure we'llshare the link and things like
that.
It's a free download, by theway.
Anybody can go out and accessit, so we'd love to have folks
grab it and ask questions asthey have them.
Speaker 1 (03:27):
Well, it was easy to grab, so I'll attest to that.
All you have to do is put someinfo in about yourself and puff.
you get your report.
So what do you want to startwith?
Home health hospice you choose.
Speaker 2 (03:39):
Why don't we start with home health?
if that's okay, I thought I'dtalk about just volume trends
and home health In general.
And then the big thing everyonealways wants to know is how is
Medicare Advantage impactinghome health?
because that's been a challengefor us for a number of years.
So I can start with the trendsin general around home health
volume.
So in the most recent volumereport that we put out, we are
(04:02):
still seeing a decline year overyear in home health admissions.
So when we look at 2022 Q3 dataand we compare that to 2021 Q3
data So that's a quarterly view,a year over year view We saw a
5.2% decline in home healthadmissions.
That's not a new trend.
(04:22):
We've seen home healthadmissions decline year over
year for many quarters in a row.
Right now, And I think it'sprobably no surprise to most of
your listeners, most of us inthe space, that that's largely
related to the increasingenrollment in Medicare Advantage
.
When I talk about this decline,this is specifically looking at
fee for service admissions andhome health, not Medicare
(04:45):
Advantage.
Obviously, that number comesdown as we see Medicare
Advantage enrollment go up InMedicare Advantage.
We are now actually at that 50%mark.
So we've all been kind ofanxiously awaiting to see us
cross over that line.
And if you look at the numberof Medicare enrollees that are
enrolled in both Part A and PartB and then also enrolled in
(05:09):
Medicare Advantage, we havecrossed over the 50% penetration
mark.
So for home health agenciesthat's a little scary.
It's a little scary to knowthat that number keeps climbing
because that impacts our abilityto continue to source those fee
for service patients.
Speaker 1 (05:24):
No doubt.
So health agencies share really, when they're looking towards
our future.
Should they be contracting withMA plans updates?
That's where my head is goingwhen I'm thinking about where
that data drives them.
Speaker 2 (05:39):
For sure, and it's become more than a should.
It's almost a have to now.
And the great thing about homehealth is that a lot of home
health organizations arestarting to work together to,
you know, work to negotiatebetter rates for home health
with MA payers.
That's been a challenge for along time, but home health is
(05:59):
going to have to get really goodat working with MA payers for
sure.
Now the upside is, even thoughthere's a decline in those
admissions, we're still talkingabout 765, little over 765,000
fee for service admissions inthe quarter I referenced, which
was Q3 2022.
So well, absolutely positively,we have to get good at working
(06:22):
with Medicare Advantage payersin the home health space.
We also have to recognize thereis fee for service volume there
to go after And we have to getreally good at competing to win
So that pool of patients havebeneficiaries it's getting
smaller, which means our abilityto find competitive advantages
in our market and outperform thecompetition and steal share is
(06:47):
the going to be the secret togetting the opportunity to care
for those fee for servicepatients.
So it's really twofold,jennifer, i would say is
leverage your quality metrics toget those good MA contracts,
but know your competitiveadvantage in your market to
continue to steal share in thefee for service space as well.
Speaker 1 (07:05):
You know I, when I looked at your report I saw the
map.
You know you had your your homehealth map.
I thought that was reallyinteresting to see that sort of
mapped out where yourconcentration was in your fee
for service provider.
So you know, those who arelistening out there, please pull
the report and look at that map, because it was really, really
helpful to see.
(07:26):
Oh my gosh, i didn't think thedistribution would look like
that.
Speaker 2 (07:30):
That's a great point.
I'm glad you said that Andwe've had a lot of that feedback
because unfortunately, a lot oforganizations just assume that
the Medicare enrollment rate isthe same everywhere And it's not
.
There are some states wherethat number is much, much lower
And, unfortunately, some stateswhere that enrollment number is
higher.
So you really do need to knowwhat it looks like in your
market And we do have thosenumbers in the report.
Speaker 1 (07:52):
Yeah, so helpful.
So, um, In addition to you knowhome health, strategically
looking where they need to go inthat pipeline moving forward,
i'm sure hospice is.
You know, when we look at yourdata, hospice needs to be
(08:13):
thinking along the same lines aswell.
So what could you highlightsome of your data points in your
report about the hospice base?
Speaker 2 (08:20):
Sure, I'd be happy to .
So hospice volume when we lookyear over year at hospice volume
, we're actually seeing a littlebit of an increase there, so
that's positive news.
Hospice volumes up about 1.2%quarter four of 2022 over
quarter four of 2021.
So that year over year numberis up a little bit.
So, like I said, that's greatnews for the hospice space.
(08:42):
Another exciting thing on thehospice front is that we now
have more publicly reportedquality metrics than ever before
.
So a lot of folks are reallyexcited about their HCI, or
hospice care index, number.
We do have those metrics in thedata that we present in our
product and they were in thereport.
But the most interesting thingI think about that HCI metric is
(09:03):
when you look at it in theaggregate.
When you look at it across thecountry, 80% 80.7% in fact of
agencies have an HCI score ofeight or higher.
So that's on scale, as you know, of 10, 1 to 10.
So 80% are eight, nine or 10.
So suddenly what was a reallyexciting metric for those of us
in hospice, what we felt wasgoing to be this opportunity to
(09:25):
really differentiate ourselves,has become not so exciting
because so many agencies areeight or above.
So what we're learning as wespend a lot of time in that data
is that it's really importantthat agencies know how to
differentiate themselves byindividual HCI metric.
(09:46):
So it's not going to be enoughto just talk about the total
number.
Agencies are going to have toreally understand what each of
those metrics are and how theycompare to the county and state
average or state and nationalaverage to really differentiate
themselves in the market.
So that's the good and the badof HCI, jennifer is, we were
really excited It would allow usall to differentiate ourselves
(10:07):
And unfortunately it made us alllook pretty similar.
But if we just have a couplelevels go ahead.
Speaker 1 (10:13):
I was just going to say it's kind of the same
principle of the hospice itemset.
It's topped Everyone's sittingat a good approximately a high
composite score with the HIS.
So actually was in the HCI datathis week as well.
(10:35):
Looking at some of those thingsAnd I'm going to be honest with
you, Kara, as a long timehospice nurse, I did not like
that whole measure when it cameto fruition because I really
felt there's just a lot ofcompliance built into that
measure.
And for me, looking at quality,I didn't really see at first
(10:59):
the quality proposition withinthe indicators in that measure.
But you know what, the morethat I look at it I say to
myself oh boy, if you look at,like the VBID measures for
hospice, with carving into MAplan, that whole demo, those are
similar kinds of measures thatpayers are building into their
(11:25):
measure set.
So it almost feels like apathway to value-based
purchasing.
Speaker 2 (11:33):
Now that I sort of equate it and look at it that
way, Absolutely, i completelyagree, and I agree It's not
always, i don't think, a realreflection of the big picture of
the quality of a program.
Unfortunately, it's what we'regiven right, or maybe not what
(11:55):
we're given.
It's where the path we'reforced down.
But yeah, I completely agreewith your assessment.
Speaker 1 (12:05):
Yeah, it's just a whole interesting thing.
Yeah, and again, i agree withyou with the whole sort of
topping out of that HCIcomposite score no-transcript,
then drill down.
You open up the data sets, youlook at the individual indicator
scores.
Yeah, there's really room forimprovement.
(12:28):
And, like I said, i was in thedata this weekend.
I'm like, ooh, this one hospiceI was looking at, boy, they
have a really high.
You know, their burdensometransition and discharge aren't
looking so good.
So, you know, if I were, youknow again two feet back in a
hospice.
And that was our point.
We need to work on these items,you know, because it does
(12:51):
impact quality.
Even if you don't think itinitially impacts quality, it
really does The overall bigpicture of quality within an
organization.
Speaker 2 (13:01):
I agree.
And to your point earlier, datais so powerful.
Our consumers and our referralsources are demanding more and
more data.
They're demanding quantitativeevidence of quality, right?
So our ability to then getthose quality metrics up and
then leverage that in ourmessaging with our referral
sources is more important nowthan ever before.
(13:24):
I mean, you know, having donethis for a few years, as I
mentioned, it used to be easier.
Frankly, it used to be easierto explain quality.
Now people want to know.
Tell me what that means, giveme some numbers to back it up.
So it's tough And thoseunfortunately aren't numbers
that are easily moved in a lotof cases.
So you know, oftentimes we'redigging through data with
(13:46):
customers also to help themexplain why their number is not
the best in the market.
And everybody assumes, if mynumber is not the highest, when
top of the scale means good,that I don't have a story to
tell.
And what we find often is thatagencies are taking care of a
more clinically complex patient,for example.
So there's scores in some casesare going to be a little bit
lower, and so it's just thecomplexities that come with
(14:09):
trying to message in this datadriven environment are just
incredibly difficult.
Speaker 1 (14:17):
Yeah, and you know what, to your point.
I just had a thought while youwere talking about sort of top,
top scores in, you know, whetherit's home, health or hospice, i
think organizations can't siton their laurels.
Oh great, i have a 10 and myHCI score.
or I've got a, you know, a 99and my HIS composite score,
(14:37):
whatever that might be.
You know, oh great, we're doinggreat.
Well, i mean, there's alwaysroom for improvement.
There's always and you have toput it into context, as you
mentioned too is that these,these measures are topped.
you know, so it's going to bethe nature of everyone's going
(14:58):
to look like that, right?
So you can't rest on yourlaurels or your good data scores
, you know, or else you're nevergoing to be pushed to move
forward and move your colony,and it'll forward.
Speaker 2 (15:12):
That's right.
That's right.
And I'll add to that you know,even when you do have great
scores right, and maybe bycomparison, everybody in your
market looks very similar, ifyou can articulate what that
means to a referral source andhow it brings them some value,
it's really not going to helpyou grow.
So when we're thinking about,you know, using this kind of
(15:34):
data to help you grow yourreferral volume and grow your
admission volume, you just haveto be able to articulate that
and make it resonate with thatperson that you're interacting
with.
So it's just a much morechallenging atmosphere than
we've worked in before.
Speaker 1 (15:53):
So let's say, Kara, i have your report in hand and
I'm looking at it and I'm eithera home health provider or a
hospice provider.
How am I going to use this datahere to help me with my
organization, growing it, movingit forward, etc.
Speaker 2 (16:10):
That's a great question, jennifer.
So the first thing that I wouldsay is you need to understand
how these trends apply to you.
So a lot of what you're lookingat in the report are national
trends.
There's some drill down then tothe state level.
You need to get down to thatlevel and then sometimes down
even to the county level tounderstand what does it look
like in your market, right?
(16:31):
Just because hospice is growingas an industry, for example,
doesn't mean that utilization isimproved in your area.
So that's the first piece istranslating all of these trends
into something that's meaningfulin your market and then using
that to drive your approach.
So, understanding what theuniverse of opportunity looks
like is where I would startknowing how many patients are
(16:53):
accessing the benefit of homehealth or hospice today, knowing
that our biggest opportunity ifwe want to grow referrals is to
compete and win the right tocare for some of those patients,
and then knowing where thosepatients are being cared for.
Now that you're not going to getout of the report right Now
we're talking about getting downto a granular level.
that involves some more veryindividual market specific data,
(17:18):
right, and sometimes a littlebit of art.
just knowing your market wealth.
You've been in it for a longtime, but that's where I would
start is look at the trends,understand how they apply in
your market and then just figureout where are those patients,
what's that universe ofopportunity and where are those
patients that you need to earnthe right to serve and what is
(17:40):
the advantage you bring to thetable to that conversation that
will earn you that right.
I mean, that sounds like I'moversimplifying it, but it works
.
every time You can get morecomplicated, jennifer.
Obviously there's a lot morethat we can get into.
We can talk about adherencerates.
So there's great data out there.
There's great data in ourproduct, for example, around
(18:01):
adherence, looking at patientsthat are referred to home health
and the difference in outcomesbetween those who actually
adhere to those instructions anddon't.
For example, we know thatpatients that are instructed to
get home health, when they justcharge from the hospital and
adhere to those instructions,have an admit rate generally of
about 13% right now.
Those that don't adhere have anadmit rate of 15.7.
(18:24):
So those are the kind ofmetrics, right, big difference.
So, and I think all of us in theindustry look at that and go
well, that's no surprise.
You mean people who get homehealth when they should stay out
of the hospital more.
Of course they do, of coursethey do, of course they do.
But those are the things thatwe need to get really good at
taking that data back to ourreferral sources and having
(18:48):
conversations about how thatimpacts them.
So again, that's not specificto the report, but that's
another way in which the datathat's available to
organizations out there can helpthem build stronger
relationships with theirreferral sources and help them
grow their referral and admitvolume.
Show a discharge planner thatif we're involved, if you're a
(19:10):
home health provider, and theyinvolve you early in the process
and we get that patient toagree to services, that's going
to help keep them from showingback up in the ER the next day.
Those are the kinds of thingsthat I think, the kinds of
conversations that this dataneeds to drive, and the report's
the first piece of that.
Speaker 1 (19:30):
Right, you know, and as CMS sort of looks at that
continuum of measures withintheir little Medicare world, i
really hope that moves a littlemore quickly.
You know, sharing measures likereadmission rates and things of
that nature.
I think that helps push peopleor providers rather, to use data
(19:56):
in a more uniform way, becauseyou know, in that case, with the
re-emission thing, everybody'srowing in the same direction,
right?
And that's really what measuresshould really be doing, not
only to help outcomes for thepatient and their family, but
also we want the measures to beconsistent enough to help the
(20:21):
outcomes of organizations andthe continuum at large, right?
Is that fair to say?
Speaker 2 (20:26):
It's absolutely fair and I love what you said about.
Not only are the outcomes gonnasupport a better experience for
patient and families.
At the end of the day, all ofus working towards better
outcomes, all of us using thisdata to figure out where there's
opportunity for improvement,benefits the most important
person and the most importantgroup of people in all of us,
which is the patient and thefamily, right, i mean?
(20:48):
we're all striving to do thebest job that we can in this
industry so that the people whoneed and deserve these services
get the best possible experience.
So, as painful as it issometimes to be measured in
these ways and to be reportedpublicly on in these ways, it
makes us all better and it helpsus ultimately deliver a better
service.
Speaker 1 (21:09):
I agree and I think the data actually, when it's
explained right and at the righthelp literacy level for your
lay public, is, you know it's abetter way to push partnership
between patients, families andclinicians at large.
So I'm all for transparency,for sure.
Speaker 2 (21:31):
I agree.
We actually have some customersthat have started using more
data in their initialconversations with patients and
families, particularly inhospice.
It's so interesting that youknow we're having a conversation
with a hospice patient andtheir family about whether or
not to consider hospice servicesAnd when they're saying things
like we just want to know thatsomebody's going to be here for
(21:54):
that admission nurse or thatintake coordinator role, to say
you know what?
we actually have data thatshows that we're here when you
need us.
It's interesting to see how thedata is even being pulled into
that dialogue And it's driven byconsumers, who are more
educated than ever before abouttheir choices And they want to
work with organizations that canprove that they provide quality
(22:16):
of care.
So it's just such aninteresting dynamic to see data
at the center of all of theseconversations where, you know,
five, 10 years ago it justdidn't exist.
Speaker 1 (22:26):
Yeah, and I think you know you can't be a provider in
the health care space withoutbeing data driven today.
I mean, you're not going tosurvive if you're not for sure I
agree.
Well, your tool is superhelpful And thank you so much
for coming on to the CHAPCAS totalk to us a little bit about
(22:48):
the Trello report.
Any closing thoughts for us,Kara?
Speaker 2 (22:53):
No, i'll just say thank you back to you.
Thank you for having me, thankyou for letting Trello be a part
of this, and thank you all forthe work that you do as well.
You know, you guys are afantastic organization that does
so much to enable organizationsto be better in so many ways,
so we're really excited to workalongside you in this industry
(23:14):
and continue to help folks bebetter and better at what they
do And, like I said, ultimatelygetting more and more people to
services that are so desperatelyneeded.
So thank you, guys also.
Speaker 1 (23:23):
All right.
Well, the CHAP team does.
Thank you all out there andpodcast land for taking time out
of your day to listen to ourpodcast.
And thank you, kara, again forcoming on and talking to us
about this important tool thatorganizations can leverage to
(23:45):
not only move their growthforward but absolutely move
their quality forward.
And I'm going to throw inanother deming quote because I
have to.
In God we trust, but all othersmust bring data.
So thanks, kara, i learned alot today.
I hope you all out therelistening did too And from
everyone at CHAP, stay safe andwell, and thanks for all you do.
Hi there, i'm Jennifer Kennedy, the head for
quality at CHAP, and welcome tothis month's CHAPcast.
Today I'm talking with CaraJustice, vp of Strategic
Consulting from Trello Health,and we're going to talk about
data trends in home health andthe hospice space today.
Hi Cara, how's it going?
Speaker 2 (00:28):
Good, how are you?
Thanks for having me.
Speaker 1 (00:31):
Oh, we're so glad you're here.
I love talking about data.
Data is awesome, but before wejump into it, could you talk to
us a little bit about TrelloHealth and your position there?
Speaker 2 (00:43):
Sure, i'd love to.
So my position at Trello Healthis VP of Strategic Consulting,
so I lead our consultingpractice.
I've been with Trello for abouta year and in the post-acute
space for about 20 years priorto that, so I'm showing my age a
little bit there.
I've been a customer or usingTrello on the sidelines for many
, many years, so I was superexcited to join the organization
(01:03):
a year ago, and my role atTrello is really focused on
helping our customers optimizeour solutions.
So we offer an integratedplatform that consists of the
most robust market intelligencethat's out there, a CRM product
that's an intelligence CRM.
We actually incorporate ourmarket intelligence into our CRM
(01:24):
product and then we have theability to integrate that CRM
with EHRs with about 30 EHRs, ibelieve we're up to at this
point.
So it's a really robustplatform and, as I said, my
team's role is to help ourcustomers get the most out of
that platform and reallyoptimize their use, use it to
inform growth strategy, budgetdecisions, things like that.
So really exciting.
(01:45):
I have a great team of peoplethat I work with and a lot of
really great people at Trellothat make it all happen.
Speaker 1 (01:50):
Well, i'm glad that Trella has you on board because
it sounds like you have a reallygreat swath of expertise to
bring to them.
And then you know, in turn,you're sharing that with the
providers who use your datareport, of which I looked at it
and I was so impressed with thatdata report that you put out.
It was really, reallyinformative.
(02:10):
And I wish I you know, when Iwas two feet back in a hospice
organization that's my spacecarer I wish I would have had
access to data like this becauseit's extremely helpful when
you're looking at.
Well, let's just face it, datamakes the organization go, no
(02:31):
matter whether you're in homehealth or hospice or any area of
the healthcare continuum, youneed data.
You know I love the Demingquote Without data, you're just
another person with an opinion,right?
So, yeah, i mean that reportwas really great And I'm hoping
you and I can have a greatconversation today to talk about
some of the highlights in thatreport.
(02:51):
So you tell me where do youwant to start?
Speaker 2 (02:54):
Well, thanks, jennifer for that.
We're really proud of thatreport and we're going to
continue to enhance it over time.
Look later this year for someadditional enhancements coming
to that report.
I actually brought a few statsobviously not all of them or
we'd be here for quite a whilebut I brought a few key stats
from that report to share withyour audience today And
obviously anyone is welcome toreach out with any questions
(03:16):
related to it And I'm sure we'llshare the link and things like
that.
It's a free download, by theway.
Anybody can go out and accessit, so we'd love to have folks
grab it and ask questions asthey have them.
Speaker 1 (03:27):
Well, it was easy to grab, so I'll attest to that.
All you have to do is put someinfo in about yourself and puff.
you get your report.
So what do you want to startwith?
Home health hospice you choose.
Speaker 2 (03:39):
Why don't we start with home health?
if that's okay, I thought I'dtalk about just volume trends
and home health In general.
And then the big thing everyonealways wants to know is how is
Medicare Advantage impactinghome health?
because that's been a challengefor us for a number of years.
So I can start with the trendsin general around home health
volume.
So in the most recent volumereport that we put out, we are
(04:02):
still seeing a decline year overyear in home health admissions.
So when we look at 2022 Q3 dataand we compare that to 2021 Q3
data So that's a quarterly view,a year over year view We saw a
5.2% decline in home healthadmissions.
That's not a new trend.
(04:22):
We've seen home healthadmissions decline year over
year for many quarters in a row.
Right now, And I think it'sprobably no surprise to most of
your listeners, most of us inthe space, that that's largely
related to the increasingenrollment in Medicare Advantage
.
When I talk about this decline,this is specifically looking at
fee for service admissions andhome health, not Medicare
(04:45):
Advantage.
Obviously, that number comesdown as we see Medicare
Advantage enrollment go up InMedicare Advantage.
We are now actually at that 50%mark.
So we've all been kind ofanxiously awaiting to see us
cross over that line.
And if you look at the numberof Medicare enrollees that are
enrolled in both Part A and PartB and then also enrolled in
(05:09):
Medicare Advantage, we havecrossed over the 50% penetration
mark.
So for home health agenciesthat's a little scary.
It's a little scary to knowthat that number keeps climbing
because that impacts our abilityto continue to source those fee
for service patients.
Speaker 1 (05:24):
No doubt.
So health agencies share really, when they're looking towards
our future.
Should they be contracting withMA plans updates?
That's where my head is goingwhen I'm thinking about where
that data drives them.
Speaker 2 (05:39):
For sure, and it's become more than a should.
It's almost a have to now.
And the great thing about homehealth is that a lot of home
health organizations arestarting to work together to,
you know, work to negotiatebetter rates for home health
with MA payers.
That's been a challenge for along time, but home health is
(05:59):
going to have to get really goodat working with MA payers for
sure.
Now the upside is, even thoughthere's a decline in those
admissions, we're still talkingabout 765, little over 765,000
fee for service admissions inthe quarter I referenced, which
was Q3 2022.
So well, absolutely positively,we have to get good at working
(06:22):
with Medicare Advantage payersin the home health space.
We also have to recognize thereis fee for service volume there
to go after And we have to getreally good at competing to win
So that pool of patients havebeneficiaries it's getting
smaller, which means our abilityto find competitive advantages
in our market and outperform thecompetition and steal share is
(06:47):
the going to be the secret togetting the opportunity to care
for those fee for servicepatients.
So it's really twofold,jennifer, i would say is
leverage your quality metrics toget those good MA contracts,
but know your competitiveadvantage in your market to
continue to steal share in thefee for service space as well.
Speaker 1 (07:05):
You know I, when I looked at your report I saw the
map.
You know you had your your homehealth map.
I thought that was reallyinteresting to see that sort of
mapped out where yourconcentration was in your fee
for service provider.
So you know, those who arelistening out there, please pull
the report and look at that map, because it was really, really
helpful to see.
(07:26):
Oh my gosh, i didn't think thedistribution would look like
that.
Speaker 2 (07:30):
That's a great point.
I'm glad you said that Andwe've had a lot of that feedback
because unfortunately, a lot oforganizations just assume that
the Medicare enrollment rate isthe same everywhere And it's not
.
There are some states wherethat number is much, much lower
And, unfortunately, some stateswhere that enrollment number is
higher.
So you really do need to knowwhat it looks like in your
market And we do have thosenumbers in the report.
Speaker 1 (07:52):
Yeah, so helpful.
So, um, In addition to you knowhome health, strategically
looking where they need to go inthat pipeline moving forward,
i'm sure hospice is.
You know, when we look at yourdata, hospice needs to be
(08:13):
thinking along the same lines aswell.
So what could you highlightsome of your data points in your
report about the hospice base?
Speaker 2 (08:20):
Sure, I'd be happy to .
So hospice volume when we lookyear over year at hospice volume
, we're actually seeing a littlebit of an increase there, so
that's positive news.
Hospice volumes up about 1.2%quarter four of 2022 over
quarter four of 2021.
So that year over year numberis up a little bit.
So, like I said, that's greatnews for the hospice space.
(08:42):
Another exciting thing on thehospice front is that we now
have more publicly reportedquality metrics than ever before
.
So a lot of folks are reallyexcited about their HCI, or
hospice care index, number.
We do have those metrics in thedata that we present in our
product and they were in thereport.
But the most interesting thingI think about that HCI metric is
(09:03):
when you look at it in theaggregate.
When you look at it across thecountry, 80% 80.7% in fact of
agencies have an HCI score ofeight or higher.
So that's on scale, as you know, of 10, 1 to 10.
So 80% are eight, nine or 10.
So suddenly what was a reallyexciting metric for those of us
in hospice, what we felt wasgoing to be this opportunity to
(09:25):
really differentiate ourselves,has become not so exciting
because so many agencies areeight or above.
So what we're learning as wespend a lot of time in that data
is that it's really importantthat agencies know how to
differentiate themselves byindividual HCI metric.
(09:46):
So it's not going to be enoughto just talk about the total
number.
Agencies are going to have toreally understand what each of
those metrics are and how theycompare to the county and state
average or state and nationalaverage to really differentiate
themselves in the market.
So that's the good and the badof HCI, jennifer is, we were
really excited It would allow usall to differentiate ourselves
(10:07):
And unfortunately it made us alllook pretty similar.
But if we just have a couplelevels go ahead.
Speaker 1 (10:13):
I was just going to say it's kind of the same
principle of the hospice itemset.
It's topped Everyone's sittingat a good approximately a high
composite score with the HIS.
So actually was in the HCI datathis week as well.
(10:35):
Looking at some of those thingsAnd I'm going to be honest with
you, Kara, as a long timehospice nurse, I did not like
that whole measure when it cameto fruition because I really
felt there's just a lot ofcompliance built into that
measure.
And for me, looking at quality,I didn't really see at first
(10:59):
the quality proposition withinthe indicators in that measure.
But you know what, the morethat I look at it I say to
myself oh boy, if you look at,like the VBID measures for
hospice, with carving into MAplan, that whole demo, those are
similar kinds of measures thatpayers are building into their
(11:25):
measure set.
So it almost feels like apathway to value-based
purchasing.
Speaker 2 (11:33):
Now that I sort of equate it and look at it that
way, Absolutely, i completelyagree, and I agree It's not
always, i don't think, a realreflection of the big picture of
the quality of a program.
Unfortunately, it's what we'regiven right, or maybe not what
(11:55):
we're given.
It's where the path we'reforced down.
But yeah, I completely agreewith your assessment.
Speaker 1 (12:05):
Yeah, it's just a whole interesting thing.
Yeah, and again, i agree withyou with the whole sort of
topping out of that HCIcomposite score no-transcript,
then drill down.
You open up the data sets, youlook at the individual indicator
scores.
Yeah, there's really room forimprovement.
(12:28):
And, like I said, i was in thedata this weekend.
I'm like, ooh, this one hospiceI was looking at, boy, they
have a really high.
You know, their burdensometransition and discharge aren't
looking so good.
So, you know, if I were, youknow again two feet back in a
hospice.
And that was our point.
We need to work on these items,you know, because it does
(12:51):
impact quality.
Even if you don't think itinitially impacts quality, it
really does The overall bigpicture of quality within an
organization.
Speaker 2 (13:01):
I agree.
And to your point earlier, datais so powerful.
Our consumers and our referralsources are demanding more and
more data.
They're demanding quantitativeevidence of quality, right?
So our ability to then getthose quality metrics up and
then leverage that in ourmessaging with our referral
sources is more important nowthan ever before.
(13:24):
I mean, you know, having donethis for a few years, as I
mentioned, it used to be easier.
Frankly, it used to be easierto explain quality.
Now people want to know.
Tell me what that means, giveme some numbers to back it up.
So it's tough And thoseunfortunately aren't numbers
that are easily moved in a lotof cases.
So you know, oftentimes we'redigging through data with
(13:46):
customers also to help themexplain why their number is not
the best in the market.
And everybody assumes, if mynumber is not the highest, when
top of the scale means good,that I don't have a story to
tell.
And what we find often is thatagencies are taking care of a
more clinically complex patient,for example.
So there's scores in some casesare going to be a little bit
lower, and so it's just thecomplexities that come with
(14:09):
trying to message in this datadriven environment are just
incredibly difficult.
Speaker 1 (14:17):
Yeah, and you know what, to your point.
I just had a thought while youwere talking about sort of top,
top scores in, you know, whetherit's home, health or hospice, i
think organizations can't siton their laurels.
Oh great, i have a 10 and myHCI score.
or I've got a, you know, a 99and my HIS composite score,
(14:37):
whatever that might be.
You know, oh great, we're doinggreat.
Well, i mean, there's alwaysroom for improvement.
There's always and you have toput it into context, as you
mentioned too is that these,these measures are topped.
you know, so it's going to bethe nature of everyone's going
(14:58):
to look like that, right?
So you can't rest on yourlaurels or your good data scores
, you know, or else you're nevergoing to be pushed to move
forward and move your colony,and it'll forward.
Speaker 2 (15:12):
That's right.
That's right.
And I'll add to that you know,even when you do have great
scores right, and maybe bycomparison, everybody in your
market looks very similar, ifyou can articulate what that
means to a referral source andhow it brings them some value,
it's really not going to helpyou grow.
So when we're thinking about,you know, using this kind of
(15:34):
data to help you grow yourreferral volume and grow your
admission volume, you just haveto be able to articulate that
and make it resonate with thatperson that you're interacting
with.
So it's just a much morechallenging atmosphere than
we've worked in before.
Speaker 1 (15:53):
So let's say, Kara, i have your report in hand and
I'm looking at it and I'm eithera home health provider or a
hospice provider.
How am I going to use this datahere to help me with my
organization, growing it, movingit forward, etc.
Speaker 2 (16:10):
That's a great question, jennifer.
So the first thing that I wouldsay is you need to understand
how these trends apply to you.
So a lot of what you're lookingat in the report are national
trends.
There's some drill down then tothe state level.
You need to get down to thatlevel and then sometimes down
even to the county level tounderstand what does it look
like in your market, right?
(16:31):
Just because hospice is growingas an industry, for example,
doesn't mean that utilization isimproved in your area.
So that's the first piece istranslating all of these trends
into something that's meaningfulin your market and then using
that to drive your approach.
So, understanding what theuniverse of opportunity looks
like is where I would startknowing how many patients are
(16:53):
accessing the benefit of homehealth or hospice today, knowing
that our biggest opportunity ifwe want to grow referrals is to
compete and win the right tocare for some of those patients,
and then knowing where thosepatients are being cared for.
Now that you're not going to getout of the report right Now
we're talking about getting downto a granular level.
that involves some more veryindividual market specific data,
(17:18):
right, and sometimes a littlebit of art.
just knowing your market wealth.
You've been in it for a longtime, but that's where I would
start is look at the trends,understand how they apply in
your market and then just figureout where are those patients,
what's that universe ofopportunity and where are those
patients that you need to earnthe right to serve and what is
(17:40):
the advantage you bring to thetable to that conversation that
will earn you that right.
I mean, that sounds like I'moversimplifying it, but it works
.
every time You can get morecomplicated, jennifer.
Obviously there's a lot morethat we can get into.
We can talk about adherencerates.
So there's great data out there.
There's great data in ourproduct, for example, around
(18:01):
adherence, looking at patientsthat are referred to home health
and the difference in outcomesbetween those who actually
adhere to those instructions anddon't.
For example, we know thatpatients that are instructed to
get home health, when they justcharge from the hospital and
adhere to those instructions,have an admit rate generally of
about 13% right now.
Those that don't adhere have anadmit rate of 15.7.
(18:24):
So those are the kind ofmetrics, right, big difference.
So, and I think all of us in theindustry look at that and go
well, that's no surprise.
You mean people who get homehealth when they should stay out
of the hospital more.
Of course they do, of coursethey do, of course they do.
But those are the things thatwe need to get really good at
taking that data back to ourreferral sources and having
(18:48):
conversations about how thatimpacts them.
So again, that's not specificto the report, but that's
another way in which the datathat's available to
organizations out there can helpthem build stronger
relationships with theirreferral sources and help them
grow their referral and admitvolume.
Show a discharge planner thatif we're involved, if you're a
(19:10):
home health provider, and theyinvolve you early in the process
and we get that patient toagree to services, that's going
to help keep them from showingback up in the ER the next day.
Those are the kinds of thingsthat I think, the kinds of
conversations that this dataneeds to drive, and the report's
the first piece of that.
Speaker 1 (19:30):
Right, you know, and as CMS sort of looks at that
continuum of measures withintheir little Medicare world, i
really hope that moves a littlemore quickly.
You know, sharing measures likereadmission rates and things of
that nature.
I think that helps push peopleor providers rather, to use data
(19:56):
in a more uniform way, becauseyou know, in that case, with the
re-emission thing, everybody'srowing in the same direction,
right?
And that's really what measuresshould really be doing, not
only to help outcomes for thepatient and their family, but
also we want the measures to beconsistent enough to help the
(20:21):
outcomes of organizations andthe continuum at large, right?
Is that fair to say?
Speaker 2 (20:26):
It's absolutely fair and I love what you said about.
Not only are the outcomes gonnasupport a better experience for
patient and families.
At the end of the day, all ofus working towards better
outcomes, all of us using thisdata to figure out where there's
opportunity for improvement,benefits the most important
person and the most importantgroup of people in all of us,
which is the patient and thefamily, right, i mean?
(20:48):
we're all striving to do thebest job that we can in this
industry so that the people whoneed and deserve these services
get the best possible experience.
So, as painful as it issometimes to be measured in
these ways and to be reportedpublicly on in these ways, it
makes us all better and it helpsus ultimately deliver a better
service.
Speaker 1 (21:09):
I agree and I think the data actually, when it's
explained right and at the righthelp literacy level for your
lay public, is, you know it's abetter way to push partnership
between patients, families andclinicians at large.
So I'm all for transparency,for sure.
Speaker 2 (21:31):
I agree.
We actually have some customersthat have started using more
data in their initialconversations with patients and
families, particularly inhospice.
It's so interesting that youknow we're having a conversation
with a hospice patient andtheir family about whether or
not to consider hospice servicesAnd when they're saying things
like we just want to know thatsomebody's going to be here for
(21:54):
that admission nurse or thatintake coordinator role, to say
you know what?
we actually have data thatshows that we're here when you
need us.
It's interesting to see how thedata is even being pulled into
that dialogue And it's driven byconsumers, who are more
educated than ever before abouttheir choices And they want to
work with organizations that canprove that they provide quality
(22:16):
of care.
So it's just such aninteresting dynamic to see data
at the center of all of theseconversations where, you know,
five, 10 years ago it justdidn't exist.
Speaker 1 (22:26):
Yeah, and I think you know you can't be a provider in
the health care space withoutbeing data driven today.
I mean, you're not going tosurvive if you're not for sure I
agree.
Well, your tool is superhelpful And thank you so much
for coming on to the CHAPCAS totalk to us a little bit about
(22:48):
the Trello report.
Any closing thoughts for us,Kara?
Speaker 2 (22:53):
No, i'll just say thank you back to you.
Thank you for having me, thankyou for letting Trello be a part
of this, and thank you all forthe work that you do as well.
You know, you guys are afantastic organization that does
so much to enable organizationsto be better in so many ways,
so we're really excited to workalongside you in this industry
(23:14):
and continue to help folks bebetter and better at what they
do And, like I said, ultimatelygetting more and more people to
services that are so desperatelyneeded.
So thank you, guys also.
Speaker 1 (23:23):
All right.
Well, the CHAP team does.
Thank you all out there andpodcast land for taking time out
of your day to listen to ourpodcast.
And thank you, kara, again forcoming on and talking to us
about this important tool thatorganizations can leverage to
(23:45):
not only move their growthforward but absolutely move
their quality forward.
And I'm going to throw inanother deming quote because I
have to.
In God we trust, but all othersmust bring data.
So thanks, kara, i learned alot today.
I hope you all out therelistening did too And from
everyone at CHAP, stay safe andwell, and thanks for all you do.
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