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.
Click here to DOWNLOAD Trella Health's Post-Acute Care Industry Trend Report
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Connect with us - LinkedIn, Twitter, YouTube, Facebook
Make Lives Better
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.
Click here to DOWNLOAD Trella Health's Post-Acute Care Industry Trend Report
Visit our website
Connect with us - LinkedIn, Twitter, YouTube, Facebook
Make Lives Better
Hi there, i'm Jennifer Kennedy, the head for quality at CHAP, and welcome to this month's CHAPcast. Today I'm talking with Cara Justice, vp of Strategic Consulting from Trello Health, and we're going to talk about data trends in home health and the hospice space today. Hi Cara, how's it going?
Speaker 2:Good, how are you? Thanks for having me.
Speaker 1:Oh, we're so glad you're here. I love talking about data. Data is awesome, but before we jump into it, could you talk to us a little bit about Trello Health and your position there?
Speaker 2:Sure, i'd love to.
Speaker 2:So my position at Trello Health is VP of Strategic Consulting, so I lead our consulting practice.
Speaker 2:I've been with Trello for about a year and in the post-acute space for about 20 years prior to that, so I'm showing my age a little bit there. I've been a customer or using Trello on the sidelines for many, many years, so I was super excited to join the organization a year ago, and my role at Trello is really focused on helping our customers optimize our solutions. So we offer an integrated platform that consists of the most robust market intelligence that's out there, a CRM product that's an intelligence CRM. We actually incorporate our market intelligence into our CRM product and then we have the ability to integrate that CRM with EHRs with about 30 EHRs, i believe we're up to at this point. So it's a really robust platform and, as I said, my team's role is to help our customers get the most out of that platform and really optimize their use, use it to inform growth strategy, budget decisions, things like that. So really exciting. I have a great team of people that I work with and a lot of really great people at Trello that make it all happen.
Speaker 1:Well, i'm glad that Trella has you on board because it sounds like you have a really great swath of expertise to bring to them. And then you know, in turn, you're sharing that with the providers who use your data report, of which I looked at it and I was so impressed with that data report that you put out. It was really, really informative. And I wish I you know, when I was two feet back in a hospice organization that's my space carer I wish I would have had access to data like this because it's extremely helpful when you're looking at. Well, let's just face it, data makes the organization go, no matter whether you're in home health or hospice or any area of the healthcare continuum, you need data. You know I love the Deming quote Without data, you're just another person with an opinion, right? So, yeah, i mean that report was really great And I'm hoping you and I can have a great conversation today to talk about some of the highlights in that report. So you tell me where do you want to start?
Speaker 2:Well, thanks, jennifer for that. We're really proud of that report and we're going to continue to enhance it over time. Look later this year for some additional enhancements coming to that report. I actually brought a few stats obviously not all of them or we'd be here for quite a while but I brought a few key stats from that report to share with your audience today And obviously anyone is welcome to reach out with any questions related to it And I'm sure we'll share the link and things like that. It's a free download, by the way. Anybody can go out and access it, so we'd love to have folks grab it and ask questions as they have them.
Speaker 1:Well, it was easy to grab, so I'll attest to that. All you have to do is put some info in about yourself and puff. you get your report. So what do you want to start with? Home health hospice you choose.
Speaker 2:Why don't we start with home health? if that's okay, I thought I'd talk about just volume trends and home health In general. And then the big thing everyone always wants to know is how is Medicare Advantage impacting home health? because that's been a challenge for us for a number of years. So I can start with the trends in general around home health volume.
Speaker 2:So in the most recent volume report that we put out, we are still seeing a decline year over year in home health admissions. So when we look at 2022 Q3 data and 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 health admissions. That's not a new trend. We've seen home health admissions decline year over year for many quarters in a row. Right now, And I think it's probably no surprise to most of your listeners, most of us in the space, that that's largely related to the increasing enrollment in Medicare Advantage.
Speaker 2:When I talk about this decline, this is specifically looking at fee for service admissions and home health, not Medicare Advantage. Obviously, that number comes down as we see Medicare Advantage enrollment go up In Medicare Advantage. We are now actually at that 50% mark. So we've all been kind of anxiously awaiting to see us cross over that line. And if you look at the number of Medicare enrollees that are enrolled in both Part A and Part B and then also enrolled in Medicare Advantage, we have crossed over the 50% penetration mark. So for home health agencies that's a little scary. It's a little scary to know that that number keeps climbing because that impacts our ability to continue to source those fee for service patients.
Speaker 1:No doubt. So health agencies share really, when they're looking towards our future. Should they be contracting with MA plans updates? That's where my head is going when I'm thinking about where that data drives them.
Speaker 2:For sure, and it's become more than a should. It's almost a have to now. And the great thing about home health is that a lot of home health organizations are starting to work together to, you know, work to negotiate better rates for home health with MA payers. That's been a challenge for a long time, but home health is going to have to get really good at working with MA payers for sure. Now the upside is, even though there's a decline in those admissions, we're still talking about 765, little over 765,000 fee for service admissions in the quarter I referenced, which was Q3 2022.
Speaker 2:So well, absolutely positively, we have to get good at working with Medicare Advantage payers in the home health space. We also have to recognize there is fee for service volume there to go after And we have to get really good at competing to win So that pool of patients have beneficiaries it's getting smaller, which means our ability to find competitive advantages in our market and outperform the competition and steal share is the going to be the secret to getting the opportunity to care for those fee for service patients. So it's really twofold, jennifer, i would say is leverage your quality metrics to get those good MA contracts, but know your competitive advantage in your market to continue to steal share in the fee for service space as well.
Speaker 1:You know I, when I looked at your report I saw the map. You know you had your your home health map. I thought that was really interesting to see that sort of mapped out where your concentration was in your fee for service provider. So you know, those who are listening out there, please pull the report and look at that map, because it was really, really helpful to see. Oh my gosh, i didn't think the distribution would look like that.
Speaker 2:That's a great point. I'm glad you said that And we've had a lot of that feedback because unfortunately, a lot of organizations just assume that the Medicare enrollment rate is the same everywhere And it's not. There are some states where that number is much, much lower And, unfortunately, some states where that enrollment number is higher. So you really do need to know what it looks like in your market And we do have those numbers in the report.
Speaker 1:Yeah, so helpful. So, um, In addition to you know home health, strategically looking where they need to go in that pipeline moving forward, i'm sure hospice is. You know, when we look at your data, hospice needs to be thinking along the same lines as well. So what could you highlight some of your data points in your report about the hospice base?
Speaker 2:Sure, I'd be happy to. So hospice volume when we look year over year at hospice volume, we're actually seeing a little bit 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 number is up a little bit. So, like I said, that's great news for the hospice space.
Speaker 2:Another exciting thing on the hospice front is that we now have more publicly reported quality metrics than ever before. So a lot of folks are really excited about their HCI, or hospice care index, number. We do have those metrics in the data that we present in our product and they were in the report. But the most interesting thing I think about that HCI metric is when you look at it in the aggregate. When you look at it across the country, 80% 80.7% in fact of agencies have an HCI score of eight or higher. So that's on scale, as you know, of 10, 1 to 10. So 80% are eight, nine or 10.
Speaker 2:So suddenly what was a really exciting metric for those of us in hospice, what we felt was going to be this opportunity to really differentiate ourselves, has become not so exciting because so many agencies are eight or above. So what we're learning as we spend a lot of time in that data is that it's really important that agencies know how to differentiate themselves by individual HCI metric. So it's not going to be enough to just talk about the total number. Agencies are going to have to really understand what each of those metrics are and how they compare to the county and state average or state and national average to really differentiate themselves in the market. So that's the good and the bad of HCI, jennifer is, we were really excited It would allow us all to differentiate ourselves And unfortunately it made us all look pretty similar. But if we just have a couple levels go ahead.
Speaker 1:I was just going to say it's kind of the same principle of the hospice item set. It's topped Everyone's sitting at a good approximately a high composite score with the HIS. So actually was in the HCI data this week as well. Looking at some of those things And I'm going to be honest with you, Kara, as a long time hospice nurse, I did not like that whole measure when it came to fruition because I really felt there's just a lot of compliance built into that measure. And for me, looking at quality, I didn't really see at first the quality proposition within the indicators in that measure. But you know what, the more that I look at it I say to myself oh boy, if you look at, like the VBID measures for hospice, with carving into MA plan, that whole demo, those are similar kinds of measures that payers are building into their measure set. So it almost feels like a pathway to value-based purchasing.
Speaker 2:Now that I sort of equate it and look at it that way, Absolutely, i completely agree, and I agree It's not always, i don't think, a real reflection of the big picture of the quality of a program. Unfortunately, it's what we're given right, or maybe not what we're given. It's where the path we're forced down. But yeah, I completely agree with your assessment.
Speaker 1:Yeah, it's just a whole interesting thing. Yeah, and again, i agree with you with the whole sort of topping out of that HCI composite score no-transcript, then drill down. You open up the data sets, you look at the individual indicator scores. Yeah, there's really room for improvement. And, like I said, i was in the data this weekend. I'm like, ooh, this one hospice I was looking at, boy, they have a really high. You know, their burdensome transition and discharge aren't looking so good. So, you know, if I were, you know again two feet back in a hospice. And that was our point. We need to work on these items, you know, because it does impact quality. Even if you don't think it initially impacts quality, it really does The overall big picture of quality within an organization.
Speaker 2:I agree. And to your point earlier, data is so powerful. Our consumers and our referral sources are demanding more and more data. They're demanding quantitative evidence of quality, right? So our ability to then get those quality metrics up and then leverage that in our messaging with our referral sources is more important now than ever before. I mean, you know, having done this for a few years, as I mentioned, it used to be easier. Frankly, it used to be easier to explain quality. Now people want to know. Tell me what that means, give me some numbers to back it up. So it's tough And those unfortunately aren't numbers that are easily moved in a lot of cases.
Speaker 2:So you know, oftentimes we're digging through data with customers also to help them explain why their number is not the best in the market. And everybody assumes, if my number 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 that agencies are taking care of a more clinically complex patient, for example. So there's scores in some cases are going to be a little bit lower, and so it's just the complexities that come with trying to message in this data driven environment are just incredibly difficult.
Speaker 1:Yeah, and you know what, to your point. I just had a thought while you were talking about sort of top, top scores in, you know, whether it's home, health or hospice, i think organizations can't sit on their laurels. Oh great, i have a 10 and my HCI score. or I've got a, you know, a 99 and my HIS composite score, whatever that might be. You know, oh great, we're doing great. Well, i mean, there's always room for improvement. There's always and you have to put it into context, as you mentioned too is that these, these measures are topped. you know, so it's going to be the nature of everyone's going to look like that, right? So you can't rest on your laurels or your good data scores, you know, or else you're never going to be pushed to move forward and move your colony, and it'll forward.
Speaker 2:That's right. That's right. And I'll add to that you know, even when you do have great scores right, and maybe by comparison, everybody in your market looks very similar, if you can articulate what that means to a referral source and how it brings them some value, it's really not going to help you grow. So when we're thinking about, you know, using this kind of data to help you grow your referral volume and grow your admission volume, you just have to be able to articulate that and make it resonate with that person that you're interacting with. So it's just a much more challenging atmosphere than we've worked in before.
Speaker 1:So let's say, Kara, i have your report in hand and I'm looking at it and I'm either a home health provider or a hospice provider. How am I going to use this data here to help me with my organization, growing it, moving it forward, etc.
Speaker 2:That's a great question, jennifer. So the first thing that I would say is you need to understand how these trends apply to you. So a lot of what you're looking at in the report are national trends. There's some drill down then to the state level. You need to get down to that level and then sometimes down even to the county level to understand what does it look like in your market, right? Just because hospice is growing as an industry, for example, doesn't mean that utilization is improved in your area. So that's the first piece is translating all of these trends into something that's meaningful in your market and then using that to drive your approach. So, understanding what the universe of opportunity looks like is where I would start knowing how many patients are accessing the benefit of home health or hospice today, knowing that our biggest opportunity if we want to grow referrals is to compete and win the right to care for some of those patients, and then knowing where those patients are being cared for.
Speaker 2:Now that you're not going to get out of the report right Now we're talking about getting down to a granular level. that involves some more very individual market specific data, right, and sometimes a little bit of art. just knowing your market wealth. You've been in it for a long time, but that's where I would start is look at the trends, understand how they apply in your market and then just figure out where are those patients, what's that universe of opportunity and where are those patients that you need to earn the right to serve and what is the advantage you bring to the table to that conversation that will earn you that right. I mean, that sounds like I'm oversimplifying it, but it works. every time You can get more complicated, jennifer.
Speaker 2:Obviously there's a lot more that we can get into. We can talk about adherence rates. So there's great data out there. There's great data in our product, for example, around adherence, looking at patients that are referred to home health and the difference in outcomes between those who actually adhere to those instructions and don't. For example, we know that patients that are instructed to get home health, when they just charge from the hospital and adhere to those instructions, have an admit rate generally of about 13% right now. Those that don't adhere have an admit rate of 15.7. So those are the kind of metrics, right, big difference.
Speaker 2:So, and I think all of us in the industry look at that and go well, that's no surprise. You mean people who get home health when they should stay out of the hospital more. Of course they do, of course they do, of course they do. But those are the things that we need to get really good at taking that data back to our referral sources and having conversations about how that impacts them. So again, that's not specific to the report, but that's another way in which the data that's available to organizations out there can help them build stronger relationships with their referral sources and help them grow their referral and admit volume. Show a discharge planner that if we're involved, if you're a home health provider, and they involve you early in the process and we get that patient to agree to services, that's going to help keep them from showing back up in the ER the next day. Those are the kinds of things that I think, the kinds of conversations that this data needs to drive, and the report's the first piece of that.
Speaker 1:Right, you know, and as CMS sort of looks at that continuum of measures within their little Medicare world, i really hope that moves a little more quickly. You know, sharing measures like readmission rates and things of that nature. I think that helps push people or providers rather, to use data in a more uniform way, because you know, in that case, with the re-emission thing, everybody's rowing in the same direction, right? And that's really what measures should really be doing, not only to help outcomes for the patient and their family, but also we want the measures to be consistent enough to help the outcomes of organizations and the continuum at large, right? Is that fair to say?
Speaker 2:It's absolutely fair and I love what you said about. Not only are the outcomes gonna support a better experience for patient and families. At the end of the day, all of us working towards better outcomes, all of us using this data to figure out where there's opportunity for improvement, benefits the most important person and the most important group of people in all of us, which is the patient and the family, right, i mean? we're all striving to do the best job that we can in this industry so that the people who need and deserve these services get the best possible experience. So, as painful as it is sometimes to be measured in these ways and to be reported publicly on in these ways, it makes us all better and it helps us ultimately deliver a better service.
Speaker 1:I agree and I think the data actually, when it's explained right and at the right help literacy level for your lay public, is, you know it's a better way to push partnership between patients, families and clinicians at large. So I'm all for transparency, for sure.
Speaker 2:I agree. We actually have some customers that have started using more data in their initial conversations with patients and families, particularly in hospice. It's so interesting that you know we're having a conversation with a hospice patient and their family about whether or not to consider hospice services And when they're saying things like we just want to know that somebody's going to be here for that admission nurse or that intake coordinator role, to say you know what? we actually have data that shows that we're here when you need us. It's interesting to see how the data is even being pulled into that dialogue And it's driven by consumers, who are more educated than ever before about their choices And they want to work with organizations that can prove that they provide quality of care. So it's just such an interesting dynamic to see data at the center of all of these conversations where, you know, five, 10 years ago it just didn't exist.
Speaker 1:Yeah, and I think you know you can't be a provider in the health care space without being data driven today. I mean, you're not going to survive if you're not for sure I agree. Well, your tool is super helpful And thank you so much for coming on to the CHAPCAS to talk to us a little bit about the Trello report. Any closing thoughts for us, Kara?
Speaker 2:No, i'll just say thank you back to you. Thank you for having me, thank you for letting Trello be a part of this, and thank you all for the work that you do as well. You know, you guys are a fantastic organization that does so much to enable organizations to be better in so many ways, so we're really excited to work alongside you in this industry and continue to help folks be better and better at what they do And, like I said, ultimately getting more and more people to services that are so desperately needed. So thank you, guys also.
Speaker 1:All right. Well, the CHAP team does. Thank you all out there and podcast land for taking time out of your day to listen to our podcast. And thank you, kara, again for coming on and talking to us about this important tool that organizations can leverage to not only move their growth forward but absolutely move their quality forward. And I'm going to throw in another deming quote because I have to. In God we trust, but all others must bring data. So thanks, kara, i learned a lot today. I hope you all out there listening did too And from everyone at CHAP, stay safe and well, and thanks for all you do.