AT & T vs. Home Health Providers


Published: 7/20/2017

Just as we discussed in our previous post, intimate knowledge of the marketplace and consumer needs has become critical to those needing to stop the erosion of their market share.

 Volume-based Home Health providers have been highly successful under a twenty-year business model that institutionalized maximum payments through high service utilization, increased coding reimbursement, and extended lengths of stay/service engagements with their patients.

 Just like cable television, this business model is quickly becoming unsustainable. CMS, Medicare Advantage plans, and Commercial insurers are pushing back on health care costs. As a higher portion of those costs is being passed along to consumers, they, too, are pushing back.

 Where streaming video has fueled customer revolt of cable television, hospitals now have options other than Volume Based providers, and the “National Brands”. To the “National Brands”: those who embrace change and become value leaders will soon outpace any volume provider despite the name.

 Efficiency, predictability, and cost of care will be what gains the loyalty of hospital partners, especially as Value Based Home Health Care Providers tailor services that better fit their growing expectations for low prices and high convenience.

 Transitioning from Volume to Value

The legacy process of the past twenty years made a profit, more in some years, and much less in recent years. Efficiency in process, service delivery, and embracing data driven total census management is where the profits now begin.

 We watch agencies with 250 censuses and smaller throw away $4,000 to $6,000 per day in over utilization without any outcomes to show for it. Ramp those numbers up to account for multiple offices, branches etc. and they are staggering. 

 Utilizing OperaCare’s PreSURe process coupled with our Live QA will accomplish the following:

  • Reduce the Cost of OASIS events by 50%
  • Perform 4-5 OASIS events per day per with no afterhours computer work.
  • Increase reimbursement and reduce ADR risks; Increasing revenue integrity
  • Implement Acuity based staffing
  • Embrace Data driven census management
  • Automate QAPI exceeding new COP requirements